Health care provider payment reforms in African states of the Commonwealth-a scoping review

Costase Ndayishimiye^*Christoph SowadaKatarzyna Dubas-Jakóbczyk

• Jagiellonian University Medical College, Kraków, Poland

This scoping review explores provider payment reform for strategic purchasing in 21 African Commonwealth countries using a scoping review method. It examines factors influencing these reforms through a health policy framework: context, content, process, and actors. Studies were retrieved from scientific databases and supplemented with gray literature. Thirty-five full-text publications were included (29 empirical studies, four technical reports/policy briefs, and two reviews). The evidence spans eight countries, with six focusing on performance-based financing (PBF). Reforms often added new payment methods to existing ones (62.85%, n=22/35), replaced existing methods (typically fee-for-service (FFS) with capitation in primary care (28.57%, n=10/35)), or adopted mixed methods (37.14%, n=13/35), with blending FFS and capitation being the most common. Various factors influenced different reform dimensions. Political inattention and inadequate policy, legal, and regulatory frameworks hindered the reform context. Reform content depended on clear core elements such as performance indicators, guidelines, tariffs, financial rewards, and provider autonomy. Factors such as a lack of reform piloting, chronic underfunding, fragmented funding flows, and inadequate monitoring and evaluation mechanisms hindered the reform process. The actor dimension was impacted by a lack of a holistic approach to stakeholders and limited stakeholder capacity to implement reforms. Current evidence for implementing provider payment reforms remains limited—concentrated in a few countries and often focused on specific reform types or evaluations from a single perspective. Future studies could focus on more comprehensive reform evaluations, incorporating multistakeholder perspectives and links with other elements of strategic purchasing.