Health system outcomes of Provider Payment Reforms in Sub-Saharan Africa: A Scoping Review

Several Sub-Sahara African countries have embarked on health system reforms aimed at improving efficiency, equity, service quality, and financial protection. A principal focus of these reforms has been the strengthening of health financing systems to accelerate progress toward Universal Health Coverage (UHC). Health financing comprises three fundamental functions - revenue generation, pooling of resources, and purchasing of health services. Among these, health purchasing is particularly pivotal, as it determines how financial resources are allocated to healthcare providers to deliver services for specific groups.(3,6). Central to this function is the path to strategic health purchasing, Strategic purchasing involves using data and performance evidence to decide which health services should be funded, which providers should deliver them, and how providers should be paid-including the design of payment mechanisms that align incentives with efficiency, quality, and equity goals. Many countries across SSA have implemented or are piloting strategic health purchasing reforms, supported by substantial donor funding to pilot and scale these initiatives. These reforms typically involve changes to provider payment methods (PPMs) designed to improve provider accountability and enhance the value derived from limited health resources. Despite these efforts, the health system outcomes related to equity, efficiency, service quality, and financial protection of these reforms are still not sufficiently documented. Understanding the extent to which provider payment reforms have impacted health system will be important in deciding not only the current but also the future health financing strategies in SSA. Thus, this scoping review aims to assess the evidence on the health system outcomes of provider payment reforms in Sub-Saharan Africa, mapping the types of reforms implemented, and the outcomes seen across different settings.