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...
| Main Authors: | , |
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| Format: | Working Paper |
| Language: | English en_US |
| Published: |
World Bank, Washington, DC
2013
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| Subjects: | |
| 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 |
| Summary: | 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. |
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