Strategic purchasing is part of the policy discourse on universal health coverage (UHC) and is included in strategic plans and health financing strategies as a cornerstone of UHC policies across sub-Saharan Africa. But large-scale implementation of the full range of strategic purchasing approaches is rare in Africa, and this may lead some to conclude that health systems in Africa may not benefit from increased focus on and investments in strategic purchasing. As policymakers who have led efforts in our countries to meet UHC commitments, we would like to dispel this notion. We have seen how important even incremental steps to purchase priority services more strategically can be to make progress toward UHC goals. The language around strategic purchasing can be highly technical and sometimes abstract, and it is often associated with specific schemes or solutions. We have seen that policy makers in Africa and globally can set in motion more sustainable progress if they shift the way they think about strategic purchasing to be more practical and incremental. Rather than focusing on specific schemes or big-bang reforms, a more practical approach—one that breaks down the components of strategic purchasing reforms and considers them incrementally—can broaden the discourse and better identify where tangible improvements are needed and most feasible. No country in Africa has all purchasing functions working in perfect harmony. However, many have made incremental improvements in strengthening their purchasing systems, and their experience can be useful for other countries. In this paper, we provide a policymaker’s perspective to strategic purchasing, as a set of functions that can help achieve health system goals: specifying the benefits people are entitled to, contracting with and paying providers, and monitoring and improving provider performance to advance UHC. This paper shares some examples of how our countries, Burkina Faso and Rwanda, are advancing UHC goals through strategic purchasing approaches. We call on other countries on the continent to join in advancing a learning agenda on what is working in strategic purchasing, where, how and why.
Dr. Pierre Yameogo, Ministry of Health, Burkina Faso, Dr. Parfait Uwaliraye, Ministry of Health, Rwanda, Dr. Regis Hitimana, Rwanda Social Security Board, Rwanda