Adjustments in purchasing arrangements to support the COVID-19 health sector response: evidence from eight middle-income countries.

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.

Generating Political Priority for Primary Health Care Reform in Romania.

This paper examines how political priority was generated for comprehensive reforms to address inequitable access to high-quality primary health care (PHC) in Romania. We apply John Kingdon's model of political agenda setting to explore how the convergence of problems, solutions, and political developments culminated in the adoption of a government program that included critical PHC reforms and approval of a results-based funding instrument for implementation. We draw on a review of the gray and peer-reviewed literature and stakeholder consultations, and use content analysis to identify themes organized in line with the dimensions of Kingdon's model. We conclude this paper with three lessons that may be relevant for generating political priority for PHC reforms in other contexts. First, national PHC reforms are likely to be prioritized when there is political alignment of health reforms with the broader political agenda. Second, the availability of technically sound and feasible policy proposals makes it possible to seize the political opportunity when the window opens. Third, partners' coordinated technical and financial support for neglected issues can serve to raise their priority on the political agenda.