July 2021 Reflections

As I reflect on the first half of the year and various country discussions that SPARC has been involved in, I find that some of the key priorities that countries are facing due to COVID-19 are centred around three areas – how to generate additional funding for healthcare within very limited fiscal constraints (exploring innovative sources of finance), while increasing efficiencies in the system (including strategic purchasing of health services), and working to improve the resilience of the health system.

As a provider of technical assistance, SPARC is supporting countries as they consider options in addressing these difficult questions, meeting countries where they are and supporting them to make the best purchasing decisions they can, given the fiscal constraints. Part of that work involves bringing important, interesting and oftentimes difficult discussions to the fore and providing a platform for sharing cross-country lessons, learning as much from what has worked, as from what has not and therefore reducing the learning curve for countries. That is part of the reason for our webinar series – sharing the evidence from work we have done but also understanding how these lessons are helping countries take the critical challenges they face today.

Last month, in continuation of our ‘ChangingtheConversation’ series, we held a webinar to discuss performance-based financing (PBF) with the aim of equipping policymakers with balanced, evidence-based information on the different pathways to progress, if they are considering better leveraging existing PBF schemes or introducing PBF.

Our invited panelists, policymakers from three African countries (Nigeria, Cameroon and Uganda) that have implemented PBF with varying degrees of success, discussed the PBF schemes in the countries, whether the schemes led to the strengthening of purchasing functions in the broader health systems of their countries and how this scheme can be leveraged for broader progress on strategic health purchasing.

We also used the opportunity of the webinar to disseminate findings from the evidence synthesis carried out by SPARC and KEMRI Wellcome Trust on PBF. This systematic review of evidence gathered from country experience with PBF implementation across Africa consolidated evidence on whether and how PBF can enhance strategic health purchasing arrangements, and its effects on the health system goals of equitable access, efficiency and quality in African countries.

We drew out a lot of lessons that can support countries to harness the inherent benefits of PBF schemes and others that can be drawn from PBF programs, that are of value to health system-wide strategic purchasing efforts including the following:

  1. Multiple benefit packages through different schemes can create confusion for providers and beneficiaries alike. Keep benefit packages simple and streamlined.
  2. In much the same way, multiple contracts should be streamlined, the language should be clear and precise about the responsibilities of each side, the terms of payment, and the process of implementation and enforcement.
  3. Payment incentives should align with service delivery objectives and be streamlined and harmonized across different payment systems, especially if multiple funding sources are paying providers differently.
  4. Although the need for rigorous and intense monitoring and verification may seem justified considering the outcomes that need to be achieved, it is important to balance this with what can be accomplished in terms of improved accountability and provider performance.
  5. Providers need enough autonomy and management capacity to internalize and respond to the incentives created by strategic purchasing policies and approaches and to meet the needs of the populations they serve.

If you have not read the topic brief, please click here to access the document. There are lots of gems in there.

Are there some emerging themes from these discussions that are impacting your work as a provider of technical assistance? Or a donor? Drop a line and let us know!

As the year starts racing to the end and the pandemic continues to be a feature of our lives, please continue to stay safe and healthy!

July 2021 Reflections

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