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such as Thailand, the Philippines, and Vietnam, where population coverage increased after the
implementation of strategic purchasing plans (Honda, 2014). From these experiences, strategic
purchasing can be seen to be a powerful lever in progressing towards UHC.

Strategic purchasing is invaluable as a financing process in moving towards UHC to transform
budgets into purchases while prioritising population health needs through evidence-informed
service selection. Even in health systems that have nominally achieved UHC, strategic
purchasing’s focus can enable access to specific services that have not
been provided in a timely or high-quality manner thereby moving health
systems towards an enhanced realisation of UHC. In health systems that are still
developing or relying on OOP expenditures, strategic purchasing can enhance financial
protections through reductions of OOP payments, more equitable
distribution of resources, enhanced transparency, and accountability of
providers and purchasers of care (WHO, 2017b). In expanding the scope of services
that are covered by the public sector, patients are more likely to be able to access previously
costly services without having the burden of paying a significant proportion of the cost which may
incur financial hardships. Additionally, service expansion may ease demand for service provision in
the public sector, sharing it with the private. The framework of strategic purchasing also allows
countries to make changes at a pace that is suitable for its socio-economic development, without
the need for significant shifts in healthcare coverage and budgetary changes in a short span of
time. The flexibility allowed by strategic purchasing ensures that gains made to service coverage
are less likely to be reversed due to economic and financial setbacks.

2.1.2 THE SYSTEMS APPROACH: POLICY THEMES TO
MOVE TOWARDS STRATEGIC PURCHASING

The understanding of strategic purchasing as a practicable process is an invaluable approach
to purchasing and the WHO has collaborated with member states to outline a framework for
crafting and implementing strategic purchasing (WHO, 2017b). This framework is based on five
key policy themes of overarching health systems functions, core aspects of purchasing, and
cross-cutting aspects. When considered in tandem, the framework guides policymakers and
health system organisers to holistically plan a strategic purchasing proposal that strives to
progress towards UHC. The five key policy themes are governance, information
management systems, benefit package design, mixed provider payment
systems, and managing alignment, dynamics, and sequencing.

Governance
The first theme from this framework is governance, an overarching health system function
that pertains to all other themes. Governance refers to the exercise of authority and the
allocation of roles, responsibilities, and interactions between providers, purchasers,
beneficiaries, and society within a health system. To implement strategic purchasing for UHC,
it is necessary that purchasers and providers both be accountable to serving system-wide and
population health goals, as defined by policymakers and health systems planners. Purchasers
defined in the governance structures need to be granted purchasing power through legal
provisions in order to prompt positive shifts across the larger health system. Governance
structures must also ensure that programmes and plans put in place are operating as
intended.

Information management systems

Information management systems is a key policy element for the success and growth
of health systems when strategic purchasing is implemented. The cornerstone of strategic
purchasing is in information availability for performance aspects and population health needs
and the linkage of such information to the funding of payments for providers. Information
management systems should be structured on IT systems, however many health systems
continue to rely on more outdated methods of data collection and storage that limit the ability

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