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Table 2 Applying Siddiqi et al. [19] governance framework principles to purchasing in FMCHP

From: Scaling-up strategic purchasing: analysis of health system governance imperatives for strategic purchasing in a free maternal and child healthcare programme in Enugu State, Nigeria

Principle Domains
Strategic vision
 Strategic vision means that actors should have strategic direction with clear priorities, roles and performance targets; and a shared long-term goal and strategic plan Organisational autonomy of purchasing agency and providers.
Selective contracting with providers
Participation and consensus orientation
 People should have voice in decision-making for health, either directly or through their legitimate intermediate institutions that represent their interest Participation in implementation of evidence of tax payment.
Engagement of Local Health Authority Secretaries in reimbursement process.
Rule of Law
 Legal frameworks pertaining to health and standards, guidelines, policies, and regulations should be fair and consistently enforced. Enforcement of reimbursement standards
 Processes, institutions and information needed to monitor health matters are directly accessible to relevant health system actors when and where they are needed. Transparency of benefit package design and reimbursement of providers.
 Institutions and processes should try to serve all stakeholders to ensure that policies and programs are responsive to health and non-health needs of its users Policy modification through implementation, resource gaps and implications.
Equity and inclusiveness
 All men and women should have opportunities to improve or maintain their health and well-being Equity in access to free care
Effectiveness and efficiency
 Processes and institutions should produce results that meet population needs and influence health systems outcomes without waste of resources Organisational capacity of Steering and Implementation Committees of FMCHP
 Public officials and service providers are answerable to the public and institutional stakeholders for processes and outcomes. Citizen-driven accountability in purchasing
Intelligence and information
 Timely generation, collection, analysis and dissemination of accurate information to provide evidence for informed decisions that influence behaviour of different health system actors. Availability of information technology-driven provider payment system.
Generation and use of data for wider system monitoring and decision-making.
 Policies and institutional mechanisms should promote and enforce high ethical standards in healthcare and safeguard interests and rights of patients. Rationing of free services and ethical standards of care.