Resource Type: Publication
Authors: Cheryl Cashin, Sharon Nakhimovsky, Kelley Laird, Tihomir Strizrep, Altea Cico, Sharmini Radakrishnan, Ali Lauer, Catherine Connor, Sheila O’Dougherty, James White, and Katie Hammer
Published: September 2018

Resource Description: Making progress toward universal health coverage (UHC) can seem costly to governments, whose resources and stewardship are needed to make change equitable (WHO 2010). Expanding coverage to previously excluded populations—often poorer segments with heavier disease burdens—requires governments to address barriers to access, including financial barriers. In addition, new technologies, some of which may not be cost-effective, attract patients and providers alike (Saini et al. 2017). Governments seeking to advance UHC have three options: (1) increase government revenue for health; (2) cut costs by limiting coverage (e.g., remove services from a benefit package, increase cost sharing, or underfund inputs); or (3) increase efficiency in the use of funds (Cashin et al. 2017). A combination of the three options is almost always necessary (Cashin et al. 2017).

This report presents the strategic health purchasing (SHP) progress framework, sharing the critical functions and policy levers governments can use to improve the efficiency of health spending, the equity within the health system and the quality of health care goods and services delivered. This report presents the SHP Progress Framework and examples of its application in both High-income country and Low-income country settings, including Germany, Canada, and Tanzania. It looks across the examples to identify the characteristics of mature and maturing systems. The report ends with a discussion of ways LMIC policymakers and practitioners can apply the framework and lessons from these examples to inform their reform agendas.