Purchasing in a Pandemic

Purchasing for health, which includes what, how, and from whom services are purchased, was one of the policy levers available to countries as part of their health systems' response to the COVID-19 pandemic. Ideally, the purchasing function should align with the broader health financing functions. Empirical evidence indicates that purchasing arrangements transformed during the pandemic across the world. A systematic examination of these changes can inform ongoing efforts to leverage purchasing to strengthen health system performance. The Collectivity Project is a global community of practitioners, decision makers, and re-searchers contributing to collaborative health system projects. The thematic group convened experts from eight countries to systematically assess the changes in purchasing arrangements as part of the COVID-19 health response and their implications for health system objectives. This report examines adjustments made in purchasing arrangements that occurred during the Armenia and Romanian response to the COVID-19 pandemic. The research adopted mixed methods and a deductive approach. Data were obtained from a scoping literature review, key informant interviews, and an exploratory analysis of quantitative health system indicators. The study was informed by a framework for understanding purchasing changes that adapted existing frameworks to explore the implications of purchasing adjustments on critical outcomes. The research describes critical changes in purchasing, provider and user responses to these changes, and health system outcomes that accompanied the COVID-19 response in Armenia and Romania. For example, it was essential to have a governance environment that defined shared objectives and facilitated coordination across stakeholders. During this time benefits expanded, and contracts changed, including payment mechanisms to offset the decline in essential service use and incentivize care delivery for COVID-19. Furthermore, the pandemic saw the accelerated adoption of innovation, particularly telemedicine, within service delivery. The lessons from purchasing during the pandemic have implications for improving coverage, quality, and adaptability to a crisis, including beyond the contexts studied