“Strategic purchasing for nutrition and the approach proposed in these resources provide policymakers and implementers with tools to focus resources and health provider attention on nutrition actions while taking a holistic view of primary health care financing and payment,” said Cheryl Cashin, a managing director at R4D. “It is a practical way to prioritize nutrition and make it visible in health financing arrangements to increase accountability for coverage and quality of nutrition services.” 

The overview document, developed by the WHO, examines strategic purchasing of nutrition services within PHC. It introduces key terms and payment methods for countries to use in preparing to transform their health financial systems to scale up nutrition services. It does so by introducing nutritional perspectives to strategic health purchasing core areas: what to buy, from whom to buy and how to buy.   

What to buy covers how nutrition services should be prioritized and provides further understanding of nutrition service characteristics with examples and tools to assist decision-makers in deciding what to buy. From whom to buy describes providers and how decision-makers should select providers relevant to their nutrition services through contractual means and accreditation. How to buy introduces the various payment methods and describes recent research on nutrition services and payment schemes.

The document on the diagnostic assessment approach, developed by R4D, aims to strengthen the understanding of how nutrition services can be incentivized within purchasing arrangements for PHC to improve the quality, coverage and efficiency. It proposes a diagnostic approach for the systematic assessment of how nutrition services are purchased within existing health purchasing arrangements. The approach can be used by country teams to document and assess the place of nutrition in broader PHC purchasing arrangements, within a tested, established PHC purchasing framework. It provides four steps and 28 guiding questions to help governments and other stakeholders become more strategic in purchasing nutrition services within PHC.  

“Integrating essential nutrition actions within routine PHC services is important for comprehensive care, and this can only be achieved through sustainable financing,” said Mary D’Alimonte, a program director at R4D. “This tool is a huge step forward in identifying practical solutions countries can take to make financing for essential nutrition actions within PHC more strategic and sustainable. By following these steps, countries can dive deeper into understanding pathways toward more strategic use of funds in ways that avoid fragmentation and siloed programming.”

These publications were developed to ensure that nutrition services are not left behind — by increasing knowledge and building further understanding of strategic purchasing for nutrition services.

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About Results for Development
Results for Development (R4D) is a leading non-profit global development partner. We collaborate with change agents — government officials, civil society leaders and social innovators — supporting them as they navigate complex change processes to achieve large-scale, equitable outcomes in health, education and nutrition. We work with country leaders to diagnose challenges, co-create, innovate and implement solutions built on evidence and diverse stakeholder input, and engage in learning to adapt, iterate and improve. We also strengthen global, regional and country ecosystems to support country leaders with expertise, evidence, and innovations. R4D helps country leaders solve their immediate challenges today, while also strengthening systems and institutions to address tomorrow’s challenges. And we share what we learn so others around the world can achieve results for development too. www.R4D.org   

Photo © USAID/Morgana Wingard

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The primary goal of the workshop was to discuss nutrition financing situations in Malawi and to agree on what a sustainable financing framework for nutrition should include. This work also complements the ongoing USAID Advancing Nutrition support to the Scaling Up Nutrition Movement to galvanize more and higher quality financing for nutrition in Malawi.

The workshop comprised four sessions including sessions on The National Multi-Sector Nutrition Strategic Plan and a review of its cost by Priority Areas and Nutrition Financing Trends in Malawi. The workshop also probed into district level annual and budget planning processes and ways to secure budget lines for multisectoral nutrition activities across various sectors including health, agriculture and education and discussed ways to advocate for increased nutrition funding within the district council development budgets.

We had participants from four districts in Malawi and from key nutrition stakeholders including the academia, development partners and civil society organizations.

The post Sustainable Financing for Nutrition in Malawi: Post Workshop Report appeared first on Results for Development.

As countries undertake health financing reforms to advance toward universal health coverage (UHC), the desired outcome or objectives of the reform, are often conflated with the instruments for achieving them. This has led to a proliferation of UHC pilots and schemes, as well as initiatives focused on specific interventions or diseases, that may be misaligned, or even work against, the objectives the reforms seek to achieve.

Over the course of four sessions high-level experts from national governments, academic institutions, NGOs and multilateral organizations discussed what it means to design “ends-driven” health financing reforms, and shared specific examples of challenges and progress.

Joe Kutzin, former coordinator for health financing at the World Health Organization, kicked off the series with the following questions: “How do we get the question right? If the question is: How do I subsidize the poor and get everyone else to contribute? Then I pretty much only have one policy option. But if it’s instead how to improve effective service use and with financial protection for people outside of the formal sector, then there are many policy options. So, it’s really about getting that question right, and also taking the entire system and population as the unit of analysis.”

Recordings of the sessions can be found below.

• Session 1: What is ends-driven reform? Practical examples from the field

In session one, experts shared concepts and country experience from Argentina, Ghana, Malaysia, Mexico, and Uganda that illustrated the practical importance of separating ends (the objectives a reform seeks to achieve) and means (the instruments for achieving health systems reforms).

• Session 2: Building universality into fragmented health financing systems

In session two, experts shared experiences from Burkina Faso, India and Tanzania targeting public spending on those most in need while strengthening foundations for universality in fragmented health financing systems.

• Session 3: Using systems-level approaches to sustainably address specific objectives

In session three, experts focused on the theme of integration — how to achieve greater efficiency through cross-program integration, including across donor programs, how to achieve greater integration across sectors and how to achieve greater integration across different levels of government.  Country examples included Rwanda and Kenya.

• Session 4: How to produce ends-driven research at a system level

In session 4, experts from Benin, Burkina Faso, India and Mexico discussed how to pursue ends-driven research at the systems level. The session discussed the challenges and opportunities for ends-driven research and proposed research questions to be taken forward.

The sessions were organized by Results for Development, the WHO, ThinkWell, Wellcome Trust and the Strategic Purchasing Africa Resource Center. They featured 18 speakers from Argentina, Benin, Burkina Faso, Ghana, India, Kenya, Malaysia, Mexico, Rwanda, Switzerland, Tanzania, Uganda and the United States.

Speakers included: Susan Sparkes, WHO; Joe Kutzin, WHO; Nirmala Ravishankar, Thinkwell; Octavio Gómez-Dantés (National Institute of Public Health, Mexico); Martin Sabignoso (Independent consultant, Argentina); Michael Reich (Harvard T.H. Chan School of Public Health); Joel Arthur Kiendrébéogo (RESADE, Burkina Faso), Kéfilath Bello, (CERRHUD, Benin); Wangari Ng’ang’a (Senior Program Officer, Bill & Melinda Gates Foundation; Board Member, R4D); Gemini Mtei (Abt Associates, Tanzania); S Pierre Yameogo (MOH, Burkina Faso); Parfait Uwaliraye (MOH, Rwanda); Aliyi Walimbwa (MOH, Uganda); Grace Achungura (WHO, India); Praneetha Vissapragada (University of Michigan); Scott Greer (University of Michigan); Nat Otoo (R4D); Rozita Halina Hussein  (Ministry of Health, Malaysia); Hélène Barroy (WHO, Switzerland); Agnes Munyua, (R4D/SPARC); Cheryl Cashin (R4D/SPARC); Edwine Barasa (KEMRI/Wellcome Trust).

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About Results for Development
Results for Development (R4D) is a leading non-profit global development partner. We collaborate with change agents — government officials, civil society leaders and social innovators — supporting them as they navigate complex change processes to achieve large-scale, equitable outcomes in health, education and nutrition. We work with country leaders to diagnose challenges, co-create, innovate and implement solutions built on evidence and diverse stakeholder input, and engage in learning to adapt, iterate and improve. We also strengthen global, regional and country ecosystems to support country leaders with expertise, evidence, and innovations. R4D helps country leaders solve their immediate challenges today, while also strengthening systems and institutions to address tomorrow’s challenges. And we share what we learn so others around the world can achieve results for development too. www.R4D.org

The post Recordings: How to achieve UHC goals with health financing reforms — top experts share insights appeared first on Results for Development.

This report examines the overall landscape of Ethiopia’s health care purchasing arrangements and identifies barriers to and opportunities for building a foundation for strategic health purchasing. It also recommends strategic actions that, when implemented together, can support Ethiopia’s move toward UHC.

Additional Resources

• Policy Brief: Advancing Strategic Health Purchasing in Ethiopia

The post Strategic Health Purchasing in Ethiopia: An Assessment and Strategic Actions to Improve Purchasing appeared first on Results for Development.

In June 2022, Results for Development (R4D) and the Strategic Purchasing Africa Resource Centre (SPARC) partnered with the WHO Health Financing Team and the WHO Regional Office for Africa, to host a three-day virtual workshop convening a diverse set of stakeholders, primarily from seven countries that conducted a CPEA assessment: Côte d’Ivoire, Comoros, Kenya, Ghana, United Republic of Tanzania, Nigeria and Uganda.

The workshop’s primary objective was to enable collaboration and learning across countries in the WHO African Region that have conducted a CPEA and to facilitate real and sustainable policy progress
to address and resolve inefficiencies.

This summary report synthesizes the findings and messages related to CPEA implementation, including both the cross-programmatic inefficiencies identified as well as mechanisms to address them. Key themes and learnings include:

• Undue fragmentation across health programs constrained each country’s progress towards Universal Health Coverage (UHC)
• CPEA can be institutionalized as a lever and integrated with other health system reforms to improve efficiency across health programs
• Both technical expertise and political commitment are required to address inefficiencies identified by CPEA
• Coordination, both vertically and horizontally, is critical and can have a multiplier effect throughout the system
• Having a single national plan that’s unified and well connected brings coherence and accountability across the system to address cross programmatic inefficiencies

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