Applying the Strategic Health Purchasing Progress Tracking Framework: Lessons from Nine African Countries

Area of Science:

• Health Policy and Systems Research
• Health Economics
• Public Health

Background:

• The Strategic Purchasing Africa Resource Center (SPARC) developed a framework to assess and strengthen strategic purchasing in African health systems.
• Strategic purchasing is key to improving health system performance and achieving universal health coverage.

Purpose of the Study:

• To summarize overarching lessons from applying SPARC's strategic purchasing framework in nine African countries.
• To identify progress, challenges, and key factors influencing strategic purchasing in diverse health financing systems.

Main Methods:

• A functional and practical framework was applied across nine African countries.
• Data collection involved document reviews and key informant interviews (September 2019 - March 2021).
• A Microsoft Excel-based matrix documented governance, purchasing functions, external factors, and results.

Main Results:

• All nine countries exhibit fragmented health financing systems with distinct purchasing arrangements.
• Progress was noted in benefit package specification and selective contracting with providers.
• Limited progress was observed in provider payment mechanisms and performance monitoring.

Conclusions:

• Overall progress in strategic purchasing has been constrained in most countries.
• Persistent out-of-pocket payments and system fragmentation hinder purchasing power and health system improvements.
• Enhancing provider payment and performance monitoring is essential for effective resource allocation and quality improvement.