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Parmar D, Mathauer I, Bloom D, Dkhimi F, Abuosi AA, Chen D, Chukwuma A, de Claro V, Comsa R, Domingo AF, Doroshenko O, Gong E, Goroshko A, Nketiah-Amponsah E, Lylozian H, Nkangu M, Onwujekwe O, Obikeze O, Pattnaik A, Rivillas JC, Tapkigen J, Vîlcu I, Wang H, Wee Co PA. Adjustments in purchasing arrangements to support the COVID-19 health sector response: evidence from eight middle-income countries. Health Policy Plan 2024; 39:213-223. [PMID: 38261999 PMCID: PMC10883665 DOI: 10.1093/heapol/czad121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024] Open
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.
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Affiliation(s)
- Divya Parmar
- Department for Population Health, School for Life Course and Population Sciences, King’s College London, Guy’s Campus, London SE1 1UL, UK
| | - Inke Mathauer
- Department of Health Systems Governance and Financing, World Health Organization, Avenue Appia, Geneva 1211, Switzerland
| | - Danielle Bloom
- Health, Nutrition, and Population Global Practice, World Bank Group, Washington D.C. 20433, USA
| | - Fahdi Dkhimi
- Department of Health Systems Governance and Financing, World Health Organization, Avenue Appia, Geneva 1211, Switzerland
| | - Aaron Asibi Abuosi
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra P.O. Box LG 78, Ghana
| | - Dorothee Chen
- Health, Nutrition, and Population Global Practice, Europe and Central Asia Region, World Bank Group, 1818 H Street, N.W., Washington D.C. 20433, USA
| | - Adanna Chukwuma
- Health, Nutrition, and Population Global Practice, Europe and Central Asia Region, World Bank Group, 1818 H Street, N.W., Washington D.C. 20433, USA
| | - Vergil de Claro
- RTI International Philippines, 16F Strata 2000, Ortigas Center, Pasig City 1600, Philippines
| | - Radu Comsa
- Health, Nutrition, and Population Global Practice, Europe and Central Asia Region, World Bank Group, 1818 H Street, N.W., Washington D.C. 20433, USA
| | | | - Olena Doroshenko
- Health, Nutrition, and Population Global Practice, Europe and Central Asia Region, World Bank Group, 1818 H Street, N.W., Washington D.C. 20433, USA
| | - Estelle Gong
- Health, Nutrition, and Population Global Practice, Europe and Central Asia Region, World Bank Group, 1818 H Street, N.W., Washington D.C. 20433, USA
| | - Alona Goroshko
- Health, Nutrition, and Population Global Practice, Europe and Central Asia Region, World Bank Group, 1818 H Street, N.W., Washington D.C. 20433, USA
| | - Edward Nketiah-Amponsah
- Department of Economics, University of Ghana, University of Ghana Kumasi City Campus, Legon Accra P. O. Box LG57, Ghana
| | - Hratchia Lylozian
- Health, Nutrition, and Population Global Practice, Europe and Central Asia Region, World Bank Group, 1818 H Street, N.W., Washington D.C. 20433, USA
| | - Miriam Nkangu
- Health Promotion Alliance Cameroon, Youandé, Cameroon
| | - Obinna Onwujekwe
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu 400001, Nigeria
| | - Obioma Obikeze
- Department of Community Medicine, Federal Medical Centre, No. 1 Hospital Road, Ovom, Yenagoa, Bayelsa 560231, Nigeria
| | | | - Juan Carlos Rivillas
- Health, Nutrition, and Population Global Practice, Europe and Central Asia Region, World Bank Group, 1818 H Street, N.W., Washington D.C. 20433, USA
| | - Janet Tapkigen
- International Doctoral Programme in Epidemiology and Public Health, Tampere University, Kalevantie 4, Tampere 33100, Finland
| | - Ileana Vîlcu
- ThinkWell, Regus, Nations Business Centre, 6th floor Rue du Pré-de-la-Bichette 1, Geneva 1202, Switzerland
| | - Huihui Wang
- Health, Nutrition, and Population Global Practice, Europe and Central Asia Region, World Bank Group, 1818 H Street, N.W., Washington D.C. 20433, USA
| | - Pura Angela Wee Co
- ThinkWell, Regus Plaza Bldg., United Nations Avenue, Manila 1000, Philippines
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