The past 2 decades have seen an unprecedented increase in the financial commitment to health by governments of LMICs. However, more money for health does not necessarily translate to better health outcomes, if not spent efficiently.
Strategic health purchasing (SHP) is the efficient use of limited resources to deliver maximum health outcomes for everyone. It involves the use of information to make purchasing decisions, including what to buy (HBP), who to buy from (provider selection) and how to pay (provider payment mechanisms). These choices are political and mired with tension, especially because they could make the difference between life and death for those affected by any given condition. This situation has been further compounded by COVID-19, which has limited the already constrained fiscal space for health, making it critical to ensure that limited resources are used better to focus on priority services.
In 2019 SPARC was launched with the mandate to #SPARCtheChange as an Africa-based resource hub, strengthening SHP capacity by connecting regional experts, supporting them with global knowledge and practical resources on strategic purchasing, and assisting countries to develop home-grown solutions for country-specific contexts. SPARC is as much about its technical mandate (SHP) as it is about the use of the coaching approach – the use of soft skills by regional experts who have complementary technical skills to support countries SHP reforms and interventions.
SPARC’s satellite session sought to raise awareness and increase the appreciation of SHP by policymakers and gauge SPARC’s progress in supporting countries to advance towards strategic purchasing.
Below are the key messages derived from the fireside chat, moderated by Dr. Nkechi Olalere, Executive Director, SPARC with panelists:
- Nat Otoo – Senior Fellow R4D, Pioneer Executive Director of SPARC and former CEO Ghana National Health Insurance Agnecy
- Dr. Parfait Uwaliraye – Head, Planning, M&E and Information Systems, Ministry of Health, Rwanda
- Dr. Pierre Yameogo – Technical Secretary, Ministry of Health, Burkina Faso
- Dr. Nneka Orji – Technical Assistant, Minister of State for Health, Nigeria.
- Aligning policy to politics: Policy needs to be aligned with politics for successful health system strengthening. Policymakers in Africa face a wide range of tough choices as they make purchasing decisions (what to buy, who to buy and what to pay) and therefore, utilizing political goodwill can support the allocation of scarce health resources. Political power should be leveraged effectively to ensure transparent, accountable governance to improve purchasing institutions.
- Simplify communication for the ultimate beneficiary (the ordinary citizen) and prevent it from being monopolized at the technical level. Communication is a key enabler of strategic purchasing reforms.
- Strengthen stakeholders’ capacity to implement policies, set up transparent processes, generate evidence to monitor performance, and then overall, achieve a more robust and sustainable health system that guarantees customer satisfaction and make sure that every decision taken to reform policy is implemented at the right time.
- Champion visionary leadership that puts people first and at the center of health reforms. E.g. the political will and visionary leadership in Rwanda puts people first, prioritizing health and spearheading different SHP reforms.
- Align stakeholders behind a shared vision of strategic purchasing. For effective implementation of SHP interventions, the right people need to be at the table, working towards a shared vision and pulling together in the same direction.
- Align the legal policy framework with that vision of strategic purchasing. In Kenya, the government focused on health in its Big Four agenda. Such political commitments can unlock the potential for Ministries of Health to advance improvements to health service delivery and make gains on key indicators.
- Prioritization of specific health services. Fiscal space is limited for all countries but prioritizing services for the most vulnerable and in areas that can have maximum impact, is an efficient way of spending limited resources. A good example is Burkina Faso, where the President focused on free health services for women and children and has also implemented free family planning services.
- Invest in homegrown solutions. Engaging regional technical resources in shaping strategic purchasing discussions is efficient instead of the old strategy of ‘fly in and fly out’ technical assistance. African countries should embrace regional technical assistance by engaging experts who have relatable local experiences and an understanding of the region’s political economy. SPARC is already making this investment with the FORCE Community – a cadre of experts who have technical skills and knowledge, as well as complementary non-technical competencies and soft skills to coach, mentor and facilitate country-led processes. The FORCE individual members share experiences with the large group on what they are doing in their current roles to strengthen knowledge sharing within the Community
- Strategic health purchasing is a journey. Countries have to be flexible and adapt as they receive additional evidence when implementing strategic purchasing reforms. As new ideas are introduced, they need to be evaluated, improved, and then iterated for continuous improvement. Strategic purchasing is not a destination – it is a journey.
- Stewardship for strategic purchasing must be deliberate. Governance is at the heart of implementing strategic health purchasing policies. Effective governance requires a clear vision, effective participation (the right people around the table), accountability and transparency.
- Implement an evidence-based approach. Use data to make the case for strategic purchasing and evidence to inform country-driven ideas and solutions. Ensure that generated data is reliable, timely and accurate.
- Tap into the private sector. Countries should engage the private sector to further increase access to services and supplement financing deficiencies.
- Create awareness for strategic purchasing by engaging decision-makers.
How can we make progress? We don’t have all the answers, and it will all be contextual. But inertia is also not helpful. Start where you are and start conversations in your countries. But do not lose sight of the objective to increase access to good quality health services while reducing financial barriers. Remember, strategic purchasing is a toolbox that can help advance universal health coverage agenda (UHC).
LET US BE THE LIGHT IN THE TUNNEL BECAUSE VISION REQUIRES NO LESS
(Line from SPARC’s Spoken Word Presentation)