More low- and middle-income countries seek to shift to strategic purchasing, creating a demand for practical tools to assess current purchasing situations and identify options for future development. To contribute to such processes, a collectivity group on Strategic Purchasing and Universal Health Coverage was launched jointly by the WHO, Institute of Tropical Medicine Antwerp, and the Communities of Practice "Performance-Based Financing" and "Financial Access to Health Services" who developed an assessment guide for strategic purchasing. Four country assessments were conducted to explore how weaknesses in purchasing set-ups affect UHC intermediate and final objectives as well as other effects on the health system. The assessments were complemented with literature review, interviews and discussions with key stakeholders, and quantitative data collection. They were conducted between March - July 2018 in Burkina Faso, Colombia, Karnataka - India, and the Philippines.