About SP4PHC

The Strategic Purchasing for Primary Health Care (SP4PHC) project aims to improve how governments purchase primary health care (PHC) services, with a focus on family planning (FP) and maternal, newborn, and child health (MNCH). The project is supported by the Bill & Melinda Gates Foundation and is implemented by ThinkWell in collaboration with government institutions and local research partners in five countries: Burkina Faso, Indonesia, Kenya, the Philippines and Uganda. Across these countries, the project works to strengthen schemes that are critical to improve the delivery of PHC and address the needs of the poor, while also improving alignment across different purchasing arrangements within the health system.

Download the SP4PHC overview presentation and handout.

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.

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.

Read more about the country strategies in the “countries” tab above.

SP4PHC Learning Agenda

A key part of the SP4PHC project is generating knowledge about effective approaches to prioritize government spending for PHC and improve the delivery of FP and MNCH services through strategic purchasing. Through discussion and collaboration with a range of stakeholders, we developed a 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, 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.

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Country Strategies

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 PHC services is critical to improve population health and achieve more value for the money spent. There is 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. As they explore integration options, they need to ensure that the benefit package, the mix of providers, and the 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 could remain unmet. Our country strategies are focused on making purchasing more strategic with the aim of improving delivery of FP and MNCH services.

SP4PHC in Asia

In Indonesia, we are supporting BPJS-K, the implementing agency for the national health insurance scheme, JKN, and the Ministry of Health to improve engagement with private providers, including private midwives, who deliver a large share of FP and MNCH services. We are also exploring policy changes that can shift the balance of spending towards PHC and incentivize improved quality of care.

In the Philippines, we are supporting PhilHealth and the Department of Health to implement the Universal Health Care Law, which includes providing technical support on policy development and directly working with two pilot Universal Health Care integration sites. We are also collaborating with PhilHealth and the Commission on Population and Development to encourage private provid­ers to offer quality FP services.

SP4PHC in Africa

In Kenya, we are strengthening how county governments, which are the main purchasers of PHC services, allocate resources to health facilities and manage their performance, especially in the context of the free maternity care program, the Universal Health Coverage pilot, and the Transforming Health Systems for Universal Care program supported by the Global Financing Facility.

In Uganda, we are supporting the Ministry of Health to develop and implement a more coherent approach to purchasing that draws from the lessons of ongoing results-based financing and voucher programs and leads to harmonization of disparate schemes. We are also facilitating multi-stakeholder dialogue on leveraging the full range of public and private health facilities from the national to municipal levels.

In Burkina Faso, we are working with the Ministry of Health to enhance strategic purchasing of FP and MNCH services in the context of ongoing user fee reimbursement (gratuité) and results-based financing initiatives. We are also supporting the eventual harmonization of these schemes under a newly formed public purchasing entity.

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