Project overview

The Strategic Purchasing for Primary Health Care (SP4PHC) project is working to increase access to high-quality primary health care services, particularly for poor and vulnerable populations, by supporting national and subnational governments to establish how best to engage and pay health care providers. Our country teams in Burkina Faso, Indonesia, Kenya, Pakistan, and Uganda are working with public sector purchasers to make more deliberate decisions about what services to cover, which providers to contract, and the payment methods and rates to use. SP4PHC is supported by a grant from the Bill & Melinda Gates Foundation and has been implemented by ThinkWell since 2017 alongside local learning partners in the project countries and formerly the Philippines.

For more information, view the SP4PHC one-pager.

What is strategic purchasing?

Countries pursuing universal health coverage (UHC) are implementing health financing reforms to increase funding for health and ensure the optimal and equitable use of those funds at once. Strategic purchasing is linked to the second of these aims. “Purchasing” refers to how institutions controlling pooled funds—such as ministries of health, local governments, and health insurance agencies—allocate them to health care providers. Making purchasing more strategic means linking these allocation decisions to 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).

Where are the SP4PHC country programs?

Since 2017, our locally led, country-based teams have provided technical assistance to advance reforms designed to make purchasing more strategic in their country contexts. The focus of our work includes several aspects:

  • Working with national and sub-national governments to increase the availability of free primary health services, particularly for family planning and maternal and child health, through both public and private service providers, with and without health insurance schemes.
  • Supporting the implementation of large-scale health financing reforms (e.g., user fee removal and results-based approaches).
  • Assisting subnational governments to develop and implement national health financing policies.

You can see key examples of our achievements in five or our six project countries by hovering over the countries, including the Philippines, in the map below; our exciting new program of work in Pakistan started in September 2023, and their accomplishments will be added soon. Please click on the countries for more information about our work in each location or click on the unique country pages in the blue menu at the top of this page.

SP4PHC learning agenda

Philippines mother with happy baby

The project’s emphasis on learning is driven by the belief that rigorous analytics and documentation have the potential to improve the quality of the technical assistance the country teams offer; strengthen the evidence base for policy development, implementation, and evolution at the country level; and inform knowledge exchange at the regional and global levels.

To this end, the SP4PHC project is cultivating a “learning ecosystem” to both generate and share knowledge. Building on our work over the past five years, and in discussion with other stakeholders, we have framed our learning agenda around the interaction between purchasing and the following themes: advancing UHC, public financial management, scaling up innovation, and engagement with private providers. We are also seeking to understand how purchasing reforms may affect people (patients and providers) differently according to their gender. Within each thematic area, we conduct country-specific learning activities in partnership with local research institutions (including KEMRI WTRP in Kenya, RESADE in Burkina Faso, AKU in Pakistan, Makerere University in Uganda, and CHEPS in Indonesia) and other technical organizations. 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.

For more information on our learning products, click here. We also encourage you to click through the six SP4PHC countries at the top of this page for country-specific information and sign up for our newsletter below.

Contact us

We want to hear from you! Please reach out to us at to share your comments, suggestions, and ideas.

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.