Improving the quality of chronic care through purchasing arrangements in resource-constrained settings: insights from an international Delphi survey

Background
There are substantial issues with the quality of care (QoC) received by persons living with chronic conditions, particularly in low- and middle-income countries (LMICs). One possible channel to improve QoC is through financing, specifically purchasing arrangements for health services. This has been actively explored in high-income country settings, generating a growing body of scientific knowledge.

Objective
To understand the potential and the constraints of using purchasing arrangements as a way to improve QoC for chronic conditions in resource-constrained settings.

Methods
A Delphi survey was conducted with 49 international participants with content expertise in chronic care management, health financing, or both, and context expertise in resource-constrained settings including in Small Island Developing States or Fragile and Conflict-Affected States, to assess the possible contribution of purchasing arrangements to QoC for chronic conditions with respect to specific types of care providers (e.g. patients and relatives, community health workers, public health centres), decentralized coordination bodies and purchasing agencies in such settings.

Results
There was a high level of consensus among the Delphi panel in favour of considering purchasing arrangements as one of the levers to improve QoC for people living with chronic conditions. Specific directions for action were identified along with their caveats.

Conclusions
The challenge of improving the quality of chronic care in resource-constrained settings is extensive and requires immediate attention. Leveraging purchasing arrangements is one promising channel to strengthen quality chronic care in such settings.