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

Divya Parmar, Inke Mathauer, Danielle Bloom, Fahdi Dkhimi, Aaron Asibi Abuosi, Dorothee Chen, Adanna Chukwuma, Vergil de Claro, Radu Comsa, Albert Francis Domingo, Olena Doroshenko, Estelle Gong, Alona Goroshko, Edward Nketiah-Amponsah, Hratchia Lylozian, Miriam Nkangu, Obinna Onwujekwe, Obioma Obikeze, Anooj Pattnaik, Juan Carlos RivillasJanet Tapkigen, Ileana Vîlcu, Huihui Wang, Pura Angela Wee Co

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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.

Original languageEnglish
Pages (from-to)213-223
Number of pages11
Issue number2
Publication statusPublished - Mar 2024
Publication typeA1 Journal article-refereed


  • COVID-19
  • health financing
  • health purchasing
  • middle-income countries

Publication forum classification

  • Publication forum level 2

ASJC Scopus subject areas

  • General Medicine


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