Can Strategic Purchasing of Health Services Be Better Coordinated? Experiences of Five Countries in Sub-Saharan Africa

Strategic purchasing (SP) for health is an important policy lever to influence health service provision and accelerate progress toward universal health coverage (UHC). The effectiveness of SP in reaching UHC goals is limited if there is poor coordination and fragmentation between schemes. We drew cross-cutting lessons on the coordination of SP based on case studies of five African countries - Cameroon, Kenya, Nigeria, Senegal, and Sierra Leone. This report is based on analysis of policy documents and reports on SP reform processes in these countries, and in-depth interviews with key stakeholders. While SP is being considered in the government’s roadmap for UHC, countries are at different stages of implementing these reforms, which include designing legal and institutional frameworks, integrating services, improving information systems, standardizing provider selection, improving payment mechanisms, and aligning benefits package design. Our cross-cutting analysis identified three ways in which countries are attempting to coordinate and harmonize SP processes: (a) stakeholder coordination in the design and implementation of benefits packages; (b) coordination of accreditation and standardized provider selection processes; and (c) designing incentives and contractual arrangements to improve provider performance