To begin to answer the question about what drives progress, SPARC and its 11 technical partners from across Africa developed a theory of change. This theory of change proposes that a strong strategic purchasing system carries out a set of core functions — benefits specification, contracting arrangements, provider payment, and performance monitoring. These functions are supported by clear institutional arrangements that allocate the responsibility for carrying out the functions, and governance structures to provide oversight, accountability and reporting lines, and to ensure effective stakeholder participation (Figure 1). The theory of change also acknowledges that strategic purchasing is not only a technical exercise but can also be highly political, so policy advocacy, awareness, and practical evidence can be helpful to get strategic purchasing on the policy agenda and to navigate the politics…more