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Session 3-B: Purchasing needed health services

Determining how service providers and goods will be paid

Claude Meyer
P4H Network Coordinator
WHO Headquarters - Geneva

What is the P4H Network?

P4H in 2016

- West Africa and Madagascar: recently, formation of
numerous national purchasers (Cte dIvoire, Benin,
Burkina Faso) usually called universal health insurance
schemes but not only based on contributions
- Colombia: two schemes - one national health insurance
and one national health assistance
- East Africa and part of Southern Africa: historically the
Government (Uganda, Tanzania, Zambia) but recent
trends towards health insurance
- Many small scale purchasers remaining (CBHI, non
integrated PBF units, etc.)

Provision structure
- West Africa and Madagascar: more private providers in
urban settings, only public in remote areas. Estimated
share at 50% - 50% but data are scarce and not reliable
about the private sector.
- Colombia: predominantly private at all levels, unusually
high share of private pharmacies in THE
- East Africa and part of Southern Africa: similar to West
Africa with a higher share of faith-based providers in rural

Provider Payment Methods

- West Africa and Madagascar: fee for service still
widespread but all recently established UHI schemes are
in contracting processes and willing to introduce mostly
case payment.
- Colombia: the two funds were blind purchasers until
recently + constitutional challenge (tutelas)
- East Africa and part of Southern Africa: similar to West
Africa with some faith based providers learning quickly
how to game case payments
- Interesting innovations related to PBF expansion: making
data public and contributing to accountability (next slide)

Costing and tariffs

- West Africa and Madagascar: no evidence based costing
in many cases, or without normative guidelines when
analytical costing is carried out. Tariffs used for public
providers applied to private as well (balance billing OOP).
- Colombia: work in progress, powerful lobbies against
- East Africa and part of Southern Africa: similar to West
Africa, only few examples of price regulation.
- Data and capacity are available, reasons for limited
progress are non technical

The way forward

- Documenting the benefits of strategic purchasing
(knowledge management)
- Producing and circulating more data related to outputs
and payments in difficult contexts (remote areas, with
lobbies against change, etc.)
- Involving communities and the public (governance of
strategic purchasing)
- Introducing public private partnerships (complex
contractual arrangements for the design, delivery,
maintenance and management of health infrastructure)
for ancillary services and revenue generation?