Table 3.

Strengths and weaknesses in the SHP function of goods and services to purchase

State budgetary allocation for health	State Social Health Insurance Scheme
Strengths include existence of - Explicit minimum service package which was revised in 2018 - Essential medicines list and generics-only policy - Referral guidelines - Service delivery and quality standards Weaknesses include lack of - Implementation of gate-keeping - Transparency to clients about entitlements and obligations - Adherence to generics-only policy by health facilities	Strengths include existence of - Explicit minimum service package which was revised in 2018 - Essential medicines list - Mechanisms for systematic periodic review of MSP using evidence of disease burden - Referral guidelines and gate-keeping policies - Standard treatment guidelines and standards for the quality of care delivered Weaknesses include lack of - Incentives or disincentives to clients for compliance or non-compliance with the gate-keeping policy - Incentives or disincentives to service providers for compliance or non-compliance with the referral guideline
Opportunities	Opportunities
Work with the SHIS to align on an evidence-informed and participatory process for review of the service package Leverage already existing communication channels to inform beneficiaries of their entitlements and obligations	Align evidence-informed and participatory process for review of the service package with the MOH process
Threats	Threats
Direct access to higher level care and no adherence to generics-only policy can lead to unproductive cost escalation	Direct access to higher level care can lead to cost escalation resulting in financial unsustainability