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Introduction: Strategic purchasing has emerged as a key global health financing tool becoming deeply embedded into the global health policy lexicon. It has been touted as a key mechanism to deliver progress on universal health coverage (UHC). Strategic purchasing is seen as a way to increase efficiency, provide value for money, and improve equity in benefit entitlements and responsiveness to pro-poor policies and needs. Nevertheless, despite its popularity, strategic purchasing remains conceptually ambiguous, encompassing several potentially disparate elements. Klasa and colleagues recently developed a streamlined strategic purchasing framework with clearly identified key elements: (1) addressing population health needs, (2) empowering citizens, (3) strengthening government stewardship and capacity (4), developing effective purchaser and provider organizations, and (5) incorporating cost-effective contracting.1 Klasa showed that strategic purchasing is difficult to implement, even in high-income countries. Aim: We shed critical light on how strategic purchasing is understood as a health reform tool, and examine likely implementation challenges in low- and middle-income countries (LMICs), with examples from Senegal. Methods: A literature survey identified existing conceptual frameworks associated with strategic purchasing in LMIC settings, for comparison to the findings of Klasa and colleagues. Semi-structured interviews (N=15) and 2 focus group discussions with African health practitioners and managers enabled (i) their understanding of strategic purchasing as a health reform tool, and (ii) implementation challenges in their context. Results: Strategic purchasing remains a fuzzy concept. African health practitioners do not have a clear understanding of the concept and how it differs from other approaches such as performance-based financing. Ambiguity is fuelled by some donors. Many implementation challenges have been identified in alignment with Klasa and colleagues' framework, which suggest weak connections to UHC. In Senegal, various mechanisms could concur to the objective of strategic purchasing, but this function is not institutionalised yet, resulting in lack of coherence and efficiency. Conclusion: This study sharpens current debates on health financing and shows that many challenges need to be addressed if strategic purchasing is to advance UHC. References: 1. Klasa K., Greer S., van Ginneken E. Strategic Purchasing in Practice: Comparing Ten European Countries. Health Policy 2018; 122(5), 457-472.

"The Handbook of Global Health Policy provides a definitive source of the key areas in the field. It examines the ethical and practical dimensions of new and current policy models and their effect on the future development of global health and policy. Maps out key debates and policy structures involved in all areas of global health policy Isolates and examines new policy initiatives in global health policy Provides an examination of these initiatives that captures both the ethical/critical as well as practical/empirical dimensions involved with global health policy, global health policy formation and its implications Confronts the theoretical and practical questions of 'who gets what and why' and 'how, when and where?' Captures the views of a wide array of scholars and practitioners, including from low- and middle-income countries, to ensure an inclusive view of current policy debates "--

AbstractWhen international agencies make claims of an "existential threat" to humanity and advocate for urgent action from countries, it should be a safe assumption that they are consistent with their own data. However, a review of the data and evidentiary citations underlying the claims of the World Health Organization (WHO), the World Bank, and the Group of Twenty (G20) reveals a troubling picture in which the stated urgency and burden of infectious disease outbreaks, namely those of pandemic threat, is grossly misrepresented. These discrepancies in key documents and subsequent recitations in pandemic preparedness proposals have significant policy and financial implications. Disproportionate pandemic preparedness based on these false premises risks a significant opportunity cost through unnecessary diversion of financial and political resources away from global health priorities of higher burden. As WHO Member States plan to transform the way international health emergencies are managed at the World Health Assembly in May 2024, there is a crucial need to pause, rethink, and ensure future policy reflects evidence of need.

Global Health in International Relations: Editors' Introduction / SARA E. DAVIES and STEFAN ELBE and ALISON HOWELL and COLIN McINNES 825. - Health for health's sake, winning for God's sake: US Global Health Diplomacy and smart power in Iraq and Afghanistan / COLIN McINNES and SIMON RUSHTON 835. - Healthy populations, political stability, and regime type: Southeast Asia as a case study / SARA E. DAVIES 859. - Norm diffusion and health system strengthening: The persistent relevance of national leadership in global health governance / GARRETT WALLACE BROWN 877. - The rise of companies from emerging markets in global health governance: Opportunities and challenges / ANNE ROEMER-MAHLER 897. - The pharmaceuticalisation of security: Molecular biomedicine, antiviral stockpiles, and global health security / STEFAN ELBE 919. - Questioning health security: Insecurity and domination in world politics / JOÃO NUNES 939. - The Global Politics of Medicine: Beyond global health, against securitisation theory / ALISON HOWELL 961

PurposeThe use of pay for performance (P4P) as an instrument to incentivise quality improvements in health care is at a crossroads in high-income countries but has remained a commonly used tool in low- and middle-income countries. The authors aimed to take stock of the evidence on effectiveness and design from across income settings to reveal insights for the future design of performance payment across income contexts.Design/methodology/approachThe authors identified Cochrane literature reviews of the use of P4P in health care in any income setting, tracked the development in the quantity and quality of evidence over time, and compared the incentive design features used across high-income countries compared to low- and middle-income countries.FindingsThe quantity and quality of the evidence base have grown over time but can still be improved. Scheme design varies across income settings, and although some design choices may reflect differences in context, the authors find that incentive designers in both income settings can learn from practices used in the other setting.Originality/valueThe research and literature on P4P in high-, low- and middle-income countries largely operate in silos. By taking stock of the evidence on P4P from across income settings, the authors are able to draw out key insights between these settings, which remain underexplored in the literature.

Frontmatter -- CONTENTS -- ACKNOWLEDGEMENTS -- NOTES ON THE CONTRIBUTORS -- INTRODUCTION: HEALTH INEQUALITY AND GLOBAL REDISTRIBUTIVE JUSTICE -- Part 1 A Right to Equal Health? -- Chapter 1 IS THERE A HUMAN RIGHT TO HEALTH? -- Chapter 2 WHAT'S WRONG WITH GLOBAL HEALTH INEQUALITIES? -- Chapter 3 ECOLOGICAL SUBJECTS, 'ETHICAL PLACEMAKING' AND GLOBAL HEALTH EQUITY -- Chapter 4 HEALTH INEQUALITIES, CAPABILITIES AND GLOBAL JUSTICE -- Part 2 Who is Responsible for Remedying Global Health Inequality? -- Chapter 5 RE-EXAMINING THE ETHICAL FOUNDATIONS: BEHIND THE DISTRIBUTION OF GLOBAL HEALTH -- Chapter 6 GLOBAL HEALTH AND RESPONSIBILITY -- Chapter 7 OUTLINING THE GLOBAL DUTIES OF JUSTICE OWED TO WOMEN LIVING WITH HIV/AIDS IN SUB-SAHARAN AFRICA -- Part 3 Measuring Health and Health Outcomes -- Chapter 8 MEASURING GLOBAL HEALTH -- Chapter 9 EXPLORING A SUFFICIENCY VIEW OF HEALTH EQUITY -- Chapter 10 RATING EFFORTS TO EXTEND ACCESS ON ESSENTIAL MEDICINES: INCREASING GLOBAL HEALTH IMPACT -- Part 4 Borders and Health -- Chapter 11 JUSTICE AND HEALTH INEQUALITIES IN HUMANITARIAN CRISES: STRUCTURED HEALTH VULNERABILITIES AND NATURAL DISASTERS -- Chapter 12 'ILLEGAL' MIGRANTS AND ACCESS TO PUBLIC HEALTH: A HUMAN RIGHTS APPROACH -- Chapter 13 MEDICAL MIGRATION BETWEEN THE HUMAN RIGHT TO HEALTH AND FREEDOM OF MOVEMENT -- Chapter 14 HEALTHCARE MIGRATION, VULNERABILITY AND INDIVIDUAL AUTONOMY: THE CASE OF MALAWI -- BIBLIOGRAPHY -- INDEX