Purchasing primary health care (PHC) services is often a complex challenge for country governments. What to purchase, whom to purchase from – and importantly, how to pay are three questions countries face as they work towards UHC.
At this year's UHC Financing Forum with the theme of health equity, an annual conference hosted by the World Bank and USAID, JLN country practitioners from Kenya, Malaysia, Mongolia and Vietnam introduced tools developed by implementers, for implementers, with the goal of getting these three questions right for primary health care systems, a vital avenue to attaining universal health coverage (UHC).
Dr. Kamaliah Noh of the Cyberjaya University College of Medical Sciences in Malaysia opened the session with the remark that all recent evidence points to primary health care as the fastest road to achieving UHC. Yet primary care continues to suffer from low political priority, insufficient financing and inefficiencies.
JLN countries, however, increasingly recognize the importance of providing quality and cost-effective primary care services to achieve equity in citizens’ access to quality health services. These countries had, therefore, convened through the Primary Health Care and Provider Payment Mechanisms initiatives to jointly learn and identify effective practices for purchasing PHC services.
What Health Services to Purchase
Dr. Phuong Nguyen Khanh, head of the health economics department in Vietnam’s Health Strategy and Policy Institute, led the discussion on how countries can decide what health services to include in their health benefits packages.
Because all countries have limited resources with which to create and implement a new or revised benefits package, health benefit packages must be designed within the financial, technical, and economic capabilities of the country’s health system.
To better answer the question of what services to purchase, the JLN Health Benefits Policy collaborative developed the Health Benefits Policy Framework, an open-source tool that countries can apply to their health benefits reform efforts. In 2017, Ghana, Indonesia, Kenya, Malaysia, Mali and Vietnam applied the framework to their country’s health system reforms and are in the process of publishing an assessment of their own work.
While the health benefits policy framework is not an answer for every problem encountered during the design and implementation of a benefits package, it can help practitioners approach the design in a structured way.
Whom to Purchase Health Services From
Another major question that countries face includes deciding which providers to purchase health services from. Dr. Ahmed Omar, a health policy specialist with the Kenyan Ministry of Health, encouraged countries to consider engaging the private sector, as they often can go where the government is unable to.
When JLN countries began exchanging their experiences in working alongside the private sector for the delivery of PHC services, they realized how little guidance existed. Through the Private Sector Engagement collaborative, JLN countries co-produced a practical guide, Engaging the Private Sector in Primary Health Care to Achieve Universal Health Coverage, to help guide countries through the process.
How to Pay for Health Care Services
Lastly, one of the most debated topics among practitioners is the question of how to pay providers for the health care services offered through a primary care package. Ms. Tsolmongerel Tsilaajav, an independent health economist and former director of policy and planning at Mongolia's Ministry of Health, has been involved in JLN conversations about provider payment mechanisms for nearly six years and shared what the group has learned.
Government agencies need to pay providers while ensuring effective coverage and quality of provided health services and maintaining financial sustainability. All payment mechanisms involve trade-offs, making it difficult for to select appropriate methods.
Through the Provider Payment Mechanisms initiative, JLN countries first developed a guide around the costing of health services, followed by a manual for better tracking of how the health system manages its financial resources, Using Data Analytics to Monitor Health Provider Payment Mechanisms. These toolkits in tandem can help countries design or bolster their provider payment systems to reach their larger health systems goals.
While many questions remain around paying providers, fellow practitioners might benefit from consulting a recent series of case studies conducted in 15 low- and middle-income countries on innovative financing and payment models for primary health care systems.
A Practitioner-to-Practitioner Marketplace
Following the introduction to the PHC tools available to countries as global public goods, the attending practitioners and other stakeholders met in small groups at an interactive marketplace session, where they had the opportunity to explore the tools further with the JLN members – how to adapt JLN tools to their own country’s context and how they could contribute to equity in the health system.
Dr. Omar put it best by framing how country-driven tools can support equity: “UHC is an equitable goal, but the path to UHC may not always be equitable. The JLN is helping us get there as equitably as possible.”