Strategic Purchasing: The Neglected Health Financing Function for Pursuing Universal Health Coverage in Low- and Middle-Income Countries; Comment on “What’s Needed to Develop Strategic Purchasing in Healthcare? Policy Lessons from a Realist Review”

Document Type : Commentary


1 Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK

2 KEMRI-Wellcome Programme, Nairobi, Kenya

3 Department of Economics, Sophia University, Tokyo, Japan

4 International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand


Sanderson et al’s realist review of strategic purchasing identifies insights from two strands of theory: the economics of organisation and inter-organisational relationships. Our findings from a programme of research conducted by the RESYST (Resilient and Responsive Health Systems) consortium in seven countries echo these results, and add to them the crucial area of organisational capacity to implement complex reforms. We identify key areas for policy development. These are the need for: (1) a policy design with clearly delineated responsibilities; (2) a task network of organisations to engage in the broad set of functions needed; (3) more effective means of engaging with populations; (4) a range of technical and management capacities; and (5) an awareness of the multiple agency relationships that are created by the broader financing environment and the provider incentives generated by multiple financing flows.


Main Subjects

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  3. World Health Organization (WHO) Strategic purchasing for UHC:  Unlocking the potential.  Global meeting summary and key messages.  Geneva: WHO; 2017.
  4. Accessed March 29, 2019.
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Volume 8, Issue 8
August 2019
Pages 501-504
  • Receive Date: 29 March 2019
  • Revise Date: 15 May 2019
  • Accept Date: 18 May 2019
  • First Publish Date: 01 August 2019