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2023 International Health Economics Congress

In July 2023, ThinkWell cohosted several sessions at the International Health Economics (IHEA) Congress in Cape Town, South Africa. This included a pre-congress session titled “Can Direct Financing for Public Facilities Improve the Availability of Health Products?” (which will be publicly accessible virtually) and an organized session titled “Balancing Flexibility and Accountability: Institutionalizing Arrangements for Channeling Funds to Health Facilities Delivering PHC Services,” featuring papers from our Uganda and Kenya teams. SP4PHC country teams also had eight abstracts accepted, including one on the Gratuité policy in Burkina Faso and another on the effect of district health expenditure towards Indonesia’s maternal mortality rate.

Uganda reproductive maternal and child health improvement project (URMCHIP)

The Uganda Ministry of Health, in collaboration with ThinkWell and the World Bank Development Economics (DEC) team, conducted a study to assess the effect of the URMCHIP RBF project on health service utilization. The study, the results of which were published in April 2024, quantifies the effect of the RBF project on 10 incentivized reproductive maternal, newborn, and child health (RMNCH) indicators.

Counterpoint webinar on direct facility financing

We held our third Counterpoint webinar in June 2023 on direct financing for health facilities. This hour-long discussion featured Sheila O’Dougherty, a health financing and management expert who retired from her position as Vice President at Abt Associates in 2020, and Edwine Barasa, the Director of the Nairobi Program of the KEMRI Wellcome Trust Research Program in Kenya; the webinar was moderated by ThinkWell Senior Fellow, Nirmala Ravishankar. The webinar covered everything from definitions to the evolution of the idea and its relevance to the UHC agenda.

SP4PHC at HSR 2022

In November 2022, several members of the SP4PHC team participated in person and remotely in the Seventh Global Symposium on Health Systems Research (HSR2022). The symposium provided a forum for experts to discuss strategies and practices that will help combat global health challenges, a marketplace to showcase the latest relevant research, and a platform to connect with fellow practitioners and researchers face-to-face for the first time since the pandemic. Click here to read background on the research presented.

Latest learning products

Our teams across the five countries continuously contribute to global learning on strategic purchasing. Please find the latest SP4PHC learning products, including reports, briefs, and blogs below.

For a full list of published products related to the coronavirus, visit our COVID-19 page.

Results-based financing and local health system performance: Lessons from Uganda

The MOH commissioned ThinkWell to undertake a study to document how the program worked. Specifically, ThinkWell looked at the effect on 1) revenue, 2) how the funds were used, and 3) service delivery and facility performance. This was a mixed-methods study that started in January 2019 and used a combination of quantitative and qualitative data, focusing on LGs and health facilities during the first phase of RBF implementation. Of the 28 districts and 318 facilities, 10 districts and 46 facilities were sampled. This brief, published in February 2024, summarizes key findings.

The Impact of COVID-19 on Health Financing in Low- and Middle-Income Countries: The case of Uganda

This study, published in September 2022, examines Uganda’s COVID-19 response and how alterations to the health financing system helped make the system more resilient. Understanding the interaction between the pandemic and Uganda’s health financing system contributes to global evidence on how to strengthen health systems to better respond and be resilient to the effects of the pandemic.

Strengthening Local Health Systems and Health Financing Towards Universal Health Care

The Philippines embarked on a bold and ambitious journey to achieve the goal of universal health care (UHC), with its landmark legislation that aims to revitalize health care through a whole-of-systems, whole-of-government, whole-of-society, people-centered approach. This coffee table book, published in December 2023, presents the activities and experiences of our two partner provinces, Antique and Guimaras, that have been implementing the UHC law in their local contexts. It highlights the successes and challenges, the innovations and good practices of the people who have been involved in this transformative process, with a focus on the power of collaboration and partnership, vision and action, and commitment and compassion.

Financial Integration of Local Health Systems as Envisioned in the UHC Law

One of the key features of the Philippines Universal Health Care (UHC) Law is the restructuring and integration of the financing of province- or city-wide local health systems that will govern health care provider networks comprised of primary to tertiary facilities. In the three years since the law’s enactment, the Department of Health and PhilHealth have released policies to guide the implementation of financial integration. This brief, published in June 2023, explores how the financial integration of local health systems, as mandated in the UHC Law, can improve health financing in the country and provide recommendations for its successful implementation. Our analysis shows that the financial integration of local health systems has the potential to improve the quality of care, but only if several processes are fine-tuned. To achieve this, stakeholders must continue collaborating to model, test, gather evidence, and forge a consensus around continuous improvement, allowing the sector to introduce and institutionalize evidence-based health financing reforms.

Stakeholder perceptions and experiences from the implementation of the Gratuité user fee exemption policy in Burkina Faso: A qualitative study

Many stakeholders in Burkina Faso have a positive perception of the country’s Gratuité policy, which removed user fees for maternal, newborn, and child health services. Government leadership, multi-stakeholder involvement, robust internal capacity, and external monitoring have strengthened implementation; however, collateral shortage of financial and human resources, misuse of services, delays in reimbursement, political instability and health system shocks limit it achieving universal health coverage. The SP4PHC team in Burkina Faso published an article in June 2023 in Health Research Policy and Systems highlighting the perceptions and experiences of implementing the Gratuité policy.

Facility Autonomy In the Age of Devolution: County-Level Arrangements for Managing Health Facility Revenue in Kenya

In Kenya, government-owned health facilities could retain and use the revenue they collected from user fees, health insurance reimbursements, and government transfers prior to devolution in 2013. After devolution, their ability to retain and use own-source revenue became dependent on how county governments interpreted the 2012 Public Finance Management Act. Most counties started requiring facilities to transfer all own-source revenue to the county treasury. Some have since put in place arrangements to grant financial autonomy to health facilities. The SP4PHC Kenya team reviewed facility financing arrangements in Kenya’s 47 counties. This brief, published in May 2023, summarizes the findings and offers reflections on potential implications for service readiness.

Exploration of district-level innovations to address maternal and neonatal mortality in Indonesia

The Indonesian maternal and neonatal mortality rates remain some of the highest in Southeast Asia. This study aims to assess and compare district-level innovations that address maternal and neonatal mortality. This was a qualitative study conducted via FGDs in eight selected districts in November 2021. Data obtained were analyzed using the WHO health system building blocks framework.

SP4PHC’s September 2023 Newsletter

Supporting the Philippines’ journey towards UHC: Reflections from the SP4PHC project

Pura Angela Wee Co, Country Director, ThinkWell Philippines

September marks a turning point for ThinkWell in the Philippines as we wrap up our work on the Strategic Purchasing for Primary Health Care (SP4PHC) project supported by the Bill & Melinda Gates Foundation. And while we in the Philippines continue our work on other fronts, I want to take this opportunity to reflect on what we have achieved under this seminal project and what we have learned along the way.

To receive updates like this about the work our country teams are leading as part of the SP4PHC project, please sign up for the SP4PHC newsletter by clicking here.

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.