The Strategic Purchasing for Primary Health Care (SP4PHC) project aims to improve how governments purchase primary health care services with a focus on family planning and maternal, newborn and child health. SP4PHC is supported by a grant from the Bill & Melinda Gates Foundation and implemented by ThinkWell. The five SP4PHC countries – Burkina Faso, Indonesia, Kenya, the Philippines, and Uganda – like many countries around the world, are trying to figure out how best to engage and pay healthcare providers in order to improve access to high quality primary health care services while containing costs. Our country-based teams are working with public purchasers – national health ministries, sub-national health departments, and health insurers – to make more deliberate decisions about what services to cover, which providers to contract, and the payment methods and rates to use, with the goal of improving health outcomes. For more information, view the SP4PHC overview presentation and one pager.

What is Strategic Purchasing?

As countries implement strategies to achieve universal health coverage, they are undertaking health financing reforms to mobilize more financing for health and ensure that available funds for health are used optimally and equitably. Strategic purchasing is linked to the second objective. Purchasing refers to how institutions controlling pooled funds – like ministries of health and health insurance agencies – allocate them to healthcare providers. Making purchasing strategic involves basing purchasing decisions on information about provider behavior and population health needs in order to improve health system performance in terms of equitable access, quality of care, and financial protection. Read more in our Introduction to Strategic Purchasing one pager (also available in French).

SP4PHC Country Programs

The strategies we are implementing to improve purchasing are tailored to the local context in each country, but our approach is built on some shared principles. First, we have country-based teams in each of the five geographies and they are at the forefront of implementing the country strategies. Second, we work with the public purchaser and other relevant government institutions in each of the countries to facilitate policy dialogue on strategic purchasing reforms. Third, our work is grounded in analytics, which we use to diagnose existing challenges, design potential solutions, and test the suitability of those designs through pilot studies. Explore our country pages to learn more.

SP4PHC Learning Agenda

A priority of SP4PHC is to learn how primary health care is impacted by broader purchasing reforms, how purchasers can improve access to priority health services and influence quality of care, and how strategic purchasing can enable countries to achieve more with their health dollars. Through discussion and collaboration with a range of stakeholders, we developed a learning agenda that is framed around five key themes: prioritizing primary health care, purchaser and provider engagement, access and equity, quality, and efficiency. Within each thematic area, we conduct country-specific learning activities in partnership with local research institutions to document current practices and study the results from policy reform initiatives. We also conduct global reviews that combine the project countries’ experiences with broader global experience to draw insights and offer policy recommendations. We share our emerging insights in a quarterly newsletter with the hope that you can use our experience to inform your work. Please sign up for our newsletter below.

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Our Latest Learning Products

Overview of Health Financing Flows in Uganda

This report documents the nature and magnitude of financial flows to Uganda’s health sector and the purchase of primary health care services.

April 2021


Examining the level and inequality in health insurance coverage in 36 sub-Saharan African countries

This journal article authored by Edwin Barasa and members of the ThinkWell team found that after assessing health insurance coverage in 36 low/middle income countries (LMICs) in sub-Saharan Africa, coverage is low and pro-rich.

April 2021


Reproductive Health Voucher Schemes in Uganda: How They Worked and Lessons for the Future

This report documents the experiences and lessons learned from the recent Uganda Reproductive Health Voucher Project and the Uganda Voucher Plus Activity to inform future demand-side purchasing reforms.

February 2021


UHC Law Brief 4 - Ensuring Equitable Population Coverage: Immediate Eligibility to PhilHealth Benefits

Brief that describes how PhilHealth population coverage improved over time and how the Universal Health Care Law aims to sustain and extend these gains.

March 2021


Analysis of Demand and Costs of Family Planning, October-December 2020 (Analyse des demandes et des coûts de planification familiale, octobre à décembre 2020)

Second factsheet in a series of quarterly updates to summarize key findings of the national roll-out of free FP services, showing method mix, geographical distribution, and costs.

March 2021


Linda Mama Progress in Makueni County

Brief that provides an overview of the Linda Mama program performance in Makueni County

August 2021


SP4PHC aims to improve how governments purchase primary health care services, with a focus on family planning and maternal, newborn, and child health. SP4PHC is supported by a grant from the Bill & Melinda Gates Foundation.

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