Adjustments in purchasing arrangements to support the COVID-19 health sector response: evidence from eight middle-income countries
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Date
2024
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Health Policy and Planning
Abstract
The COVID-19 pandemic has triggered several changes in countries’ health purchasing arrangements to accompany the adjustments in service
delivery in order to meet the urgent and additional demands for COVID-19-related services. However, evidence on how these adjustments
have played out in low- and middle-income countries is scarce. This paper provides a synthesis of a multi-country study of the adjustments in
purchasing arrangements for the COVID-19 health sector response in eight middle-income countries (Armenia, Cameroon, Ghana, Kenya, Nigeria,
Philippines, Romania and Ukraine). We use secondary data assembled by country teams, as well as applied thematic analysis to examine
the adjustments made to funding arrangements, benefits packages, provider payments, contracting, information management systems and
governance arrangements as well as related implementation challenges. Our findings show that all countries in the study adjusted their health
purchasing arrangements to varying degrees. While the majority of countries expanded their benefit packages and several adjusted payment
methods to provide selected COVID-19 services, only half could provide these services free of charge. Many countries also streamlined their
processes for contracting and accrediting health providers, thereby reducing administrative hurdles. In conclusion, it was important for the
countries to adjust their health purchasing arrangements so that they could adequately respond to the COVID-19 pandemic, but in some countries
financing challenges resulted in issues with equity and access. However, it is uncertain whether these adjustments can and will be sustained
over time, even where they have potential to contribute to making purchasing more strategic to improve efficiency, quality and equitable access
in the long run.
Description
Research Article
Keywords
COVID-19, health financing, health purchasing, middle-income countries