[Trends in Health Financing: The Move from Passive to Strategic Purchasing in Middle- and Low-Income Countries].

Strategic purchasing is not new, rather it first started in Western Europe in the 1960s, as an approach to improving health system responsiveness, as well as for them more effective matching of supply and demand. In the 1960s some Western European facilities were affected by empty beds, others by overcrowding. Doctors were not showing up for work, due to the establishment of dual practice. There were consumer queues, and complaints that providers were inhumane. There was a shift purchasers in High Income Countries like Organization and Economic Cooperation for Development (OECD) countries, from paying for inputs to outputs and now outcomes. These challenges are yet to be overcome by non-OECD countries. In this article, we discuss the shift towards strategic purchasing in Middle Income Countries (MICs) and Lower Middle Income Countries (MLICs). There are successful models in both categories of emerging markets. The article begins with an overview of health funding, then focuses on the allocation of funds and strategic purchasing.

Donor and Domestic Financing of Primary Health Care in Low Income Countries.

Abstract-This paper evaluates resource commitments to primary health care (PHC) by donors and selected governments between 1990-2011. Donor commitments to financing PHC are assessed by reclassifying OECD/CRS data on health assistance into spending on 'PHC Service Delivery' versus spending on 'Health System Strengthening'. Domestic spending on PHC is assessed using a case study approach and National Health Accounts for two major recipients of donor assistance, Ethiopia and Nigeria. Results are generally consistent with three simple hypotheses that guide the inquiry. First, though donor funding for health among LICs has mushroomed over the last decade, it remains a miniscule share of per capita spending targets prescribed by international forums to attain universal access to basic/essential PHC services. Relative to levels of domestic public spending in LICs, however, donor funding has considerably more significance as a potential lever to improve PHC efficiency. Second, as reflected in on-going debate in the literature, donor spending on broader 'health system strengthening' has not kept up with mushrooming financing of disease control programs. Third, at country level, where the 'rubber meets the road', allocative efficiency of donor and domestic spending on health is highly conditional on contextual factors, especially political will to improve financing and delivery of PHC services, and the process of managing and implementing public spending on PHC.