This research brief provides an overview of how health service purchasing functions in the South African integrated public system (i.e. government budgeted financing of health care provision using government sector health care providers). It examines the provincial Department of Health (PDoH) as purchaser and how PDoH interacts with three key groups: health service providers, the national government and citizens. It compares actual purchasing practices with ideal strategic purchasing actions to identify design and implementation gaps and the factors that influence effective purchasing. Finally, it draws policy implications for what needs be done to produce the desired actions by groups involved in purchasing.

The RESYST Consortium, in collaboration with the Asia Pacific Observatory on Health Systems and Policies, has critically examined how health care purchasing functions in ten low and middle-income countries to identify factors that influence the ability of health care purchasers and other key actors to take strategic actions.