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Strategic Purchasing for Primary Health Care

Summary

Strategic Purchasing for Primary Health Care (SP4PHC) is a multi-country project that aims to improve how governments spend resources for the delivery of primary health care (PHC) services, with a focus on family planning (FP) and maternal, neonatal and child health (MNCH). In five project countries — the Philippines, Indonesia, Kenya, Uganda and Burkina Faso – ThinkWell is exploring how purchasing reforms can be leveraged to shape the behavior of healthcare providers to ultimately maximize access, quality, and equity. The SP4PHC learning agenda aims to generate and diffuse knowledge to influence policy and practice at the country, regional, and global levels. The $20 million project, which is funded by the Bill and Melinda Gates Foundation, commenced in mid-2017 and is currently scheduled to wrap up at the end of 2021.

The Challenges

As low- and middle-income countries (LMICs) undertake health financing reforms to achieve universal health coverage (UHC), they are increasingly exploring ways to make purchasing – the allocation of pooled funds to providers of health services — more strategic, based on information about provider behavior and population health needs. Through the introduction or expansion of government health insurance and other government financing schemes like user fee reimbursement programs and results-based financing initiatives, country governments are testing ways to link payment to performance.

Steering these reforms such that they enhance the delivery of primary health care is critical for improving population health and enhance value for money. There is also an urgent need to explore how specific high-priority health services like FP and MNCH are positioned within these schemes. Many of these services have historically been funded through vertical programs, but countries are now moving towards integrating them into broader purchasing mechanisms. In that process, they need to ensure that the benefit package, the provider mix, and methods for paying providers are designed such that they improve delivery of FP and MNCH services in terms of access, quality and equity. Without this, there is a danger that health gains made in the past decades could be lost, and that the needs of vulnerable and under-served population sub-groups like the poor and adolescent girls remain unmet.

Country Programs

ThinkWell conducted a rapid scoping exercise in each of the countries to inform the development of context-specific project strategies. In both the Philippines and Indonesia, the project is focused on improving how PHC, FP and MNCH services are purchased – with an eye towards both access and quality of care — in the context of large national health insurance schemes that cover most of the population. In the three African countries, the purchasing landscape is still heavily dominated by ministries of health at the national and sub-national levels. Our work here is focused on strengthening ongoing strategic purchasing reforms such as user fee reimbursement and results-based financing schemes to ensure that they improve delivery of FP and MNCH services, in terms of both access and quality. Our teams are also facilitating policy dialogue around how these countries can improve coherence across the disparate purchasing mechanisms that are in use in their health systems.

While the strategies we are implementing in each of the countries are tailored to the local context, our approach to country work 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 project activities. 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, all 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.

Please see here our strategies in each country: Kenya, Indonesia, the Philippines, Uganda and Burkina Faso.

The Learning Agenda

Generating knowledge about effective approaches to prioritize government spending for PHC and improve the delivery of FP and MNCH services through strategic purchasing is a key part of the project. Through discussion and collaboration with a range of stakeholders, the project team has developed an ambitious learning agenda that is framed around five key themes: prioritizing PHC; purchaser and provider engagement; access and equity; quality; and efficiency. Within each thematic area, the project is undertaking country-specific learning activities in partnership with local research institutions to document current practices and study the results from policy reform initiatives. We are also launching global reviews that combine the experience of the project countries with broader global experience to draw insights and offer policy recommendations.

In case of questions about the project, please write us at SP4PHC@thinkwell.global.

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