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Governance of strategic purchasing in decentralized settings. Please share your experience!

Dear colleagues,

Thank you very much for your participation in our webinar last week! Martin shared great insights on how Argentina has used PBF to create joint accountability between the federal and provincial levels for using funding and achieving health sector priorities. At the same time the implementation arrangements allowed sufficient flexibility so provinces could use funding according to their needs. Juan-Carlos highlighted the need for well-functioning health information systems and capacity building to ensure smooth implementation.

The discussion focused on two key points:

Integration of the program into the general health financing architecture

How can this strategic purchasing approach be extended to the larger health financing system at sub-national level? How can it be aligned with vertical programs, with health insurance programs? Would it lead to a change of role of MoH/PoH towards being a regulator rather than a purchaser? How current governance arrangements facilitate or impede generalization of the strategic purchasing approach?

Implementation of the program at provincial level

How long did capacity building take? Were private sector providers included in the program? How was the cost of services/ the service package determined? How much autonomy do provinces have in the use of funding? How did provinces use this autonomy?

In the spirit of the Collectivity platform, we want to encourage collaborative learning. Our group brings together a broad range of experiences and country perspectives. We propose to develop a short blog post which reflects the discussions of the webinar but also includes other country experiences which we can share on the platform. This will allow us to disseminate our work and reflections to a wider audience through the Collectivity platform but also through the WHO and R4D dissemination channels together with the invitation for the next webinar.

If you want to contribute to the blog, please share your experiences and/ or reflections! Do you have experience from other countries which implemented similar programs? How did those programs address implementation issues and how did they link to other funding channels such as vertical programs or health insurance? Which governance arrangements were put in place to manage the program and clarify how federal and sub-national levels should work together? You can share your contribution by replying to this post on the platform or through getting directly in touch with Danielle or myself. Of course, the names of all contributors will be acknowledged.

We are looking forward to learning from you!

Aurélie and Danielle