Financing and purchasing mechanisms of primary health care in Southeast Asia region: Findings from a scoping review.

Background: Despite commitment to Primary Health Care (PHC), financing has been a persistent challenge in Southeast Asia, with limited discussions. To address this knowledge gap, this study explores three key financing mechanisms: revenue mobilization, pooling, and purchasing across the region. Methods: A scoping review, with searches in PubMed, Scopus, Embase, and Google Scholar, was conducted. Screening was done via Covidence, with data extracted and analyzed in Excel using a framework analysis. Results: Of 2521 sources, 171 were included. Limited information specific to PHC was found. Revenue mobilization mainly includes out-of-pocket payment, government funding, social insurance contributions, and a mix of government and external funding. Pooling for PHC financing was seen in Thailand, while other countries showed multiple levels of pooling under general health financing. The prevalent purchasing method for public facilities is line-item budgeting, with salaries as the primary payment method for healthcare providers. Some countries employ performance-linked methods and capitation for provider payments. Significant challenges include inadequate budget allocations, financial flow fragmentation, and poor coordination and low capacity for financial management. Conclusion: Financing for PHC is found to be insufficient and inefficient, mainly using traditional mechanisms. Cross-country learning and collaboration can support the development of strategic PHC financing mechanisms.