The WHO Barcelona Office for Health Systems Financing has published this policy paper as part of a series. It is a study on health purchasing governance in 10 countries in eastern Europe and central Asia (Armenia, Azerbaijan, Estonia, Georgia, Kyrgyzstan, Latvia, Lithuania, Republic of Moldova, Ukraine and Uzbekistan)
Effective governance arrangements are a critical enabler of strategic purchasing by facilitating strong coordination of all key actors, setting clear rules for decision-making, having proper regulations in place and seeking to ensure strategies are implemented.
This study reviews experiences over the past 20–30 years across a group of countries in the eastern European and central Asian subregion that have undertaken health financing reforms involving the establishment of a single national purchasing agency and the introduction of strategic purchasing. The study, through both a literature review and interviews with relevant experts, looks for empirical evidence on the relevance and effectiveness of recommended good governance principles and practices in these countries in this regard. Study findings support and expand previous literature by indicating that effective governance for health purchasers requires:
- consistency and stability;
- coherent decision-making structures that align accountability and authority;
- a clear legal framework and enforced rules;
- supervision structures and monitoring; and
- transparency and information disclosure.
The participation of stakeholders in governance did not always support purchasing effectiveness in the study countries but assuring a balanced representation, essential skills, and the avoidance of conflicts of interest on the governance body is important. Stakeholder consultation and seeking consensus was seen as vital as an input to decision-making, but only when there are institutions and processes for balancing this input and focusing it on the common good.