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

Authors

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

Abstract

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.

Keywords

Main Subjects


  1. Figueras J, Robinson R, Jakubowski E, eds. Purchasing to Improve Health System Performance. Maidenhead:  Open University Press; 2005.
  2. Sanderson J, Lonsdale C, Mannion R. What’s needed to develop strategic purchasing in health care?  Policy lessons from a realist review. Int J Health Policy Manag.  2019;8(1):4-17. doi:10.15171/ijhpm.2018.93
  3. World Health Organization (WHO) Strategic purchasing for UHC:  Unlocking the potential.  Global meeting summary and key messages.  Geneva: WHO; 2017.
  4. https://www.r4d.org/projects/toward-health-strengthening-strategic-purchasing-expertise-africa/. Accessed March 29, 2019.
  5. RESYST.  Strategic Purchasing Factsheet.  https://resyst.lshtm.ac.uk/sites/resyst/files/content/attachments/2018-08-22/Strategic%20purchasing%20factsheet.pdf. Accessed March 29, 2019. Published 2014.
  6. RESYST. What is strategic purchasing for health? https://resyst.lshtm.ac.uk/sites/resyst/files/content/attachments/2018-08-22/What%20is%20strategic%20purchasing%20for%20health.pdf. Accessed March 29, 2019. Published 2014.
  7. RESYST. Strategic Purchasing for Universal Health Coverage: A Critical Assessment.  Social Health Insurance Fund, Vietnam. https://resyst.lshtm.ac.uk/sites/resyst/files/content/attachments/2018-08-22/Vietnam%20purchasing%20brief.pdf. Accessed March 29, 2019. Published 2014.
  8. Munge K, Mulupi S, Barasa E, Chuma J. A critical analysis of purchasing arrangements in Kenya: The case of the National Hospital Insurance Fund.  Int J Health Policy Manag.  2018;7(3):244-254.  doi:10.15171/IJHPM.2017.81
  9. Patcharanarumol W, Panichkriankrai W, Sommanuttaweechai A, Hanson K, Wanwong Y, Tangcharoensathien V. Strategic purchasing and health system efficiency: A comparison of two financing schemes in Thailand.  PLoS One. 2018;13(4):e0195179. doi:10.1371/journal.pone.0195179
  10. Trisnantoro L, Hendrartine J, Susilowati T, Miranti PAD, Aristianti V. A critical analysis of selected healthcare purchasing mechanisms in Indonesia.  In: Honda A, McIntyre D, Hanson K, Tangcharoensathien V, eds. Strategic Purchasing in China, Indonesia and the Philippines.  Asia Pacific Observatory on Health Policies and Systems; 2016.
  11. Grindle MS, Hilderbrand ME. Building sustainable capacity in the public sector:  What can be done?  Public Adm Dev. 1995;15:441-463.