Contracting

This study assesses the internal contracting, an approach where contractors work within the ministry of health but do not hire or fire health workers, as a means for improving the management of district health services and strengthening service delivery. [adapted from author]

Contracting in private sector is promoted in developing countries facing human resources shortages as a challenge to reduce maternal mortality. This study explored provision, practice, performance, barriers to execution and views about contracting in specialists for emergency obstetric care in rural India. [from abstract]

The Cambodian experience of contracting out for health workers discussed in this document suggests how a move away from the traditional government-provided health services model to government-financed and monitored contracts for health services can be an effective approach to expand coverage especially for the low-income groups. [adapted from author]

Focusing on the demand-side (governments and donors) of contracting out with the private sector, the primer describes the concept of contracting out, discusses its rationale and process, and summarizes three cases of contracting out programs. [from summary]

This primer aims to provide clear lessons and recommendations to help service delivery organizations
and program managers establish, implement, and strengthen contracting arrangements. The primer draws on Marie
Stopes International’s experience of delivering government-contracted services in Bangladesh, India, and South
Africa. [from summary]

The paper describes performance-based incentive contracting schemes that have been implemented to improve results for a range of interventions from time-limited immunizations to chronic conditions that require significant lifestyle changes, such as diabetes. It argues that performance incentives are a viable and potentially more powerful solution than typical inputoriented approaches to dealing with underutilization, poor quality, and low efficiency. [from publisher]

The paper reviews various purchasing models and the advantages each offers for purchasing from the private sector. It then identifies the key challenges to successful implementation of these models, and discusses improvements needed in the contracting mechanism itself. It determines that the purchasing mechanism can create new incentives for providers, payers, and consumers on a national scale, but it may require that changes be made in the health sector as a whole for new programs to be successful. [from publisher]

The objective of this study was to identify and characterize contracting models that have existed in the Zambian health sector and their consequences on access to health care. The study was aimed at assessing the extent to which the identified contracting models have been successful in achieving their intended goals and at determining their potential to be scaled up to the entire health sector, including the private sector. [from summary]

This book presents the principal findings of a study on contractual arrangements between faith-based hospitals and public health authorities in four sub-Saharan African countries.

The purpose of this study is to review the research literature on the effectiveness of contracting-out of primary health care services and its impact on both program and health systems performance in low- and middle-income countries. [from abstract]

There is increasing interest in contracting with the private sector for the delivery of health primary health care services in developing countries. This paper describes the experience with contracting under two large projects in Bangladesh and explores some of the practical issues. [adapted from author]

This paper describes and analyses the perceptions and opinions of managers and workers about the benefits and challenges of the contracting model for health services to private providers that has been in place for almost 10 years in Mexico. [adapted from abstract]

Contracts can be used to govern the relationship between the public and the private sectors where the private sector delivers services on behalf of the state. On occasion, this allows the state to offer services such as basic medical provision where public sector provision does not reach. Researchers examine the case of primary care in South Africa where such contracts are being utilised. [from author]

This toolkit provides practical advice to anyone involved in, or who is interested in becoming involved in, performance-based contracting of health services with nonstate providers in the context of developing countries. It addresses many of the issues that may be encountered and provides input from experienced contracting professionals, many of whom contributed to the development of this toolkit. [adapted from introduction]

Contracting out public services is a way for governments to complement their own delivery of services. It is particularly effective for high risk or hard-to-reach populations that can be more effectively served by private groups. It can also contribute to more efficient delivery of primary health care. [from introduction]

Contracting NGOs to manage the primary health care system was found to be an effective means to increase service coverage and achieve a more pro-poor distribution of services in rural areas of Cambodia. The Ministry of Health (MOH) proposed contracting NGOs to manage the public health care system at the district level using a results-based contract to monitor progress.

The Argentine Maternal-Child Health Insurance Program uses an interesting approach of combining output-based contracting with an output-based funding mechanism. Particularly innovative is the combination of enrollment numbers and performance indicators as a way to address the trade off between quantity and quality.

In 1999, Cambodia contracted out management of government health services to NGOs in five districts that had been randomly made eligible for contracting. The contracts specified targets for maternal and child health service improvement. The program increased the availability of 24-hour service, reduced provider absence, and increased supervisory visits. There is some evidence it improved health. The program involved increased public health funding, but led to roughly offsetting reductions in private expenditure as residents in treated districts switched from unlicensed drug sellers and traditional healers to government clinics.

This paper reviews some experiences of social agencies contracting with the private sector to provide health care services. It focuses on the capacity of this mechanism to improve access to services by the poor. The term private sector is used to cover both for-profit and not-for-profit providers of health services. The paper draws on these experiences to suggest some lessons and basic guidelines for contracting. [author’s description]

This case study provides details of a partnership that emerged in Georgia following the initiation of health sector reforms in 1995. It mainly focuses on describing the details of how and why the public purchaser contracted a non-governmental provider to deliver a set of health services in Georgia. The case study is discussed with proper attention to the context within which this arrangement developed. The nature of the services provided was paediatric cardio-surgery, which can hardly be considered a basic essential health service.

This primer introduces key aspects of contracting and summarizes key lessons from countries’ experiences in contracting-out. In doing so, it is intended to serve the practical needs of contracting practicioners in developing countries that are considering contracting as a way to deliver RH/FP services. Intended users include country-level decision makers, contract operation managers, and mission officers and advisers from donor agencies. [publisher’s description]

Contracting with non-state entities, including non-governmental organisations, has been proposed as a means for improving health care delivery, and the global experience with such contracts is reviewed here. The ten investigated examples indicate that contracting for the delivery of primary care can be very effective and that improvements can be rapid. [from author]