Strategic purchasing for health care is a key mechanism for improving the effectiveness, equity, and efficiency of health systems by directing resources toward priority outcomes. Unlike passive purchasing, it channels funding toward high-impact interventions to support universal health coverage (UHC). Governance plays a critical role in ensuring transparent decision-making aligned with national health priorities.

This literature review draws on the Strategic Purchasing Africa Resource Center’s (SPARC) strategic purchasing progress-tracking framework to analyze governance practices in Africa, focusing on Burkina Faso, Kenya, Nigeria, Morocco, and Tunisia. It examines key governance dimensions, including decision-making, autonomy, health information systems, stakeholder engagement, and transparency in resource allocation.

Common challenges across these countries include fragmented decision-making processes, unclear institutional roles, weak regulatory oversight, and inadequate health information infrastructure, which limits data-driven decision-making. Transparency in resource allocation—essential for building trust and ensuring efficiency—remains limited in most cases.

To strengthen strategic purchasing, governments must address governance challenges, enhance regulatory frameworks, invest in robust health information systems, and promote greater transparency. These measures will improve resource allocation and foster stakeholder confidence in health financing mechanisms.