Contracting for the Delivery of Community Health Services : A Review of Global Experience

To achieve the health-related Millennium Development Goals, it will be necessary to improve the delivery of health services, particularly to poor people. One proposed approach to improving both coverage and quality of care is to contract with NGOs or other non-state entities to deliver health services. This paper reviews experiences with contracting in which some coherent form of evaluation was carried out, using at least before and after, or controlled evaluation designs. Ten examples of contracting with NGOs were found and from these studies, it appears that in developing countries, contracting with non-state providers to deliver primary health or nutrition services can be very effective and that improvements can be rapid. These results were found in a variety of services and settings. Six of the ten studies compared contractor performance to government provision of the same services and all six found that the contractors achieved better results. There are a number of concerns about contracting that have been raised, including scale, cost, sustainability and contract management. Scaling up appears not to be a problem. Four of the examples studied involved populations of many millions of beneficiaries. On the issue of cost, four of the studies found that NGOs performed better even when provided the same resources as the public sector. Of the nine studies with three or more years of elapsed experience, seven have been continued and expanded. Contract management was seen as a significant issue in at least three of the examples reviewed, however, it did not prevent contractors in those instances from being successful. Based on the success thus far, health services contracting appears to improve service delivery and may help achieve the MDGs. The approach should be carefully expanded in developing countries using large scale pilots initially. Future efforts at contracting should include rigorous evaluations.

Bibliographic Details

Main Authors:	Loevinsohn, Benjamin, Harding, April
Format:	Working Paper biblioteca
Language:	English en_US
Published:	World Bank, Washington, DC 2004-09
Subjects:	ACCOUNTABILITY, ADVOCACY, ALLOCATIVE EFFICIENCY, ANTENATAL CARE, BASIC HEALTH, BASIC HEALTH SERVICES, CHILD HEALTH, COMMUNITY DEVELOPMENT, COMMUNITY HEALTH, COMMUNITY HEALTH SERVICES, CONTRACTED SERVICES, DEATHS, DECISIONMAKING, ECONOMICS, ECONOMIES OF SCALE, EMERGENCIES, FAMILY PLANNING, FINANCIAL MANAGEMENT, GOVERNMENT POLICIES, HEALTH CARE, HEALTH CARE CENTERS, HEALTH CARE FINANCING, HEALTH CARE SERVICES, HEALTH CARE SYSTEMS, HEALTH EXPENDITURES, HEALTH INFORMATION, HEALTH INFORMATION SYSTEMS, HEALTH INSURANCE, HEALTH POLICY, HEALTH SECTOR, HEALTH SERVICE DELIVERY, HEALTH SERVICES, HEALTH STATUS, HEALTH SYSTEM, HEALTH SYSTEMS, HEALTH WORKERS, HOSPITAL AUTONOMY, HOSPITAL CARE, HOSPITAL MANAGEMENT, HOSPITAL SERVICES, HOSPITALS, HUMAN DEVELOPMENT, HUMAN RESOURCES, IMMUNIZATION, IMMUNIZATION COVERAGE, IMMUNIZATION RATES, INCOME, INPATIENT CARE, INTERVENTION, JOURNALS, LESSONS LEARNED, LOW-INCOME COUNTRIES, MALNUTRITION, MANAGEMENT CONTRACT, MANAGEMENT CONTRACTS, MANAGERS, MEDICAL EQUIPMENT, NONGOVERNMENTAL ORGANIZATIONS, NONPROFIT ORGANIZATIONS, NUTRITION, PHYSICIANS, PRIMARY CARE, PRIMARY HEALTH CARE, PRIMARY HEALTH CARE SERVICES, PRIVATE SECTOR, PROMOTING HEALTH, PUBLIC HEALTH, PUBLIC SECTOR, QUALITY OF CARE, RADIO, REFORMS, REPRODUCTIVE HEALTH, SANCTIONS, SERVICE DELIVERY, SERVICES DELIVERY, SEX WORKERS, SUPERVISION, TUBERCULOSIS, VACCINATION, WEIGHT, WORKERS,
Online Access:	http://documents.worldbank.org/curated/en/2004/09/5620866/contracting-delivery-community-health-services-review-global-experience http://hdl.handle.net/10986/13621
Tags:	Add Tag No Tags, Be the first to tag this record!