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. The purchasing context in these countries is quite different: large national health insurance schemes cover most of the population in some countries, while ministries of health at the national and sub-national levels dominate the purchasing landscape in others. Across these different geographies, the project works to strengthen schemes that are critical to improve the delivery of PHC and address the needs of the poor. The project also improves alignment across different purchasing arrangements within the health system. The SP4PHC learning agenda generates and diffuses knowledge to influence policy and practice at the country, regional, and global levels.
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.
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.
ThinkWell conducted a rapid scoping exercise in each project country to inform the development of context-specific project strategies. While the strategies we implement 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, 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.
In Burkina Faso, we are enhancing strategic purchasing in the context of ongoing results-based financing (RBF) and user fee reimbursement initiatives. We also support the eventual harmonization of these schemes under a newly formed public purchasing entity.
In Indonesia, we are supporting the purchasing agency for the national health insurance scheme, Jaminan Kesehatan Nasional, to expand the program to include private midwives, who deliver a large share of FP and MNCH services already. We also explore purchasing reforms that can shift the balance of spending towards PHC and extend health service coverage to under-served areas.
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 national government schemes, such as the free maternity care program.
In the Philippines, we are supporting PhilHealth, the agency that manages the national health insurance scheme, to both increase the range of providers from whom it purchases FP and MNCH services to include private providers as well as effectively purchase an expanded PHC package from newly formed service delivery networks.
In Uganda, we are supporting the Ministry of Health to develop and implement a more coherent approach to purchasing that draws from the experience of ongoing RBF and voucher projects and leverages the full range of public and private health facilities in the country.
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 are also conducting global reviews that combine the project countries’ experiences with broader global experience to draw insights and offer policy recommendations. Finally, we collaborate with other existing health financing and strategic purchasing initiatives on knowledge sharing and learning.
Contact us to learn more: SP4PHC@thinkwell.global