The Strategic Health Purchasing Progress Tracking Framework: A Practical Approach to Describing, Assessing, and Improving Strategic Purchasing for Universal Health Coverage

Abstract

ABSTRACT Strategic purchasing of high-priority services is a critical part of effective spending to advance UHC goals. Available conceptual frameworks for strategic purchasing have facilitated high-level advocacy and policy dialogue, and they have framed research and analytical work to describe and understand countries’ purchasing arrangements. What has been missing is a framework and approach that combines the conceptual framing of strategic purchasing with practical guidance to describe and assess purchasing in sufficient detail to inform policy. This paper presents a practical framework and approach to tracking progress in purchasing: the Strategic Health Purchasing Progress Tracking Framework. Co-created by a group of health financing researchers and academics through the Strategic Purchasing Africa Resource Center (SPARC), it builds on existing frameworks and focuses on the core purchasing functions of benefits specification, contracting arrangements, provider payment, and performance monitoring. It incorporates factors that can either strengthen or weaken the power of purchasers to directly influence resource allocation and provider behavior. The paper also proposes a set of evidence-based benchmarks that country stakeholders can use to assess where their health system is on the continuum from passive to strategic purchasing and to identify steps to make purchasing more strategic. Application of the framework has shown the value of mapping purchasing functions across all health financing arrangements to identify where strategic purchasing progress is more advanced and where it may be lacking. It has helped countries identify challenges—such as fragmentation and duplication of purchasing functions across health financing arrangements—and prioritize policy actions.