The role of contractual arrangements in improving health sector ...

Lebanon
commonly missing. In such a situation, exposing equity-sensitive deficiencies of knowledge,
attitudes, practices by contracting partners, and areas where data needs to be collected, become
important in itself and this has been the approach taken here.
Many of the major determinants of health lie outside the health sector. Choices and
contents of contractual arrangements are directly affected by the positions of regulating bodies
(i.e. government) on the relevance of broad determinants to health and health sector
performance. Such determinants are rarely reflected, however, in discussions of contractual
arrangements. Analyzing contractual arrangements in light of sociopolitical determinants
requires understanding of the performance of the Lebanese economy and social and political
organization. While such a broad analysis may be beyond our focus, they constitute the context
within which contractual arrangements must be understood. As such, an attempt must be made to
bring these perspectives in discussions of contractual arrangements. The Report attempts to do so
in a modest way.
If “health sector” is interpreted broadly to mean “health system”, then contractual
arrangements must be evaluated in a much broader context. This would necessitate evaluation of
how contractual arrangements relate not only to health care delivery but also to performance of
other, broader, components of the health system, such as nutrition and basic social services.
Because this endeavour is potentially complex and very wide in scope, limited reference is made
to health system issues beyond care delivery.
While there are opportunities to improve the use of contractual arrangements as a tool,
recommendations for so doing cannot be separated from the broader issues of health sector
reform in Lebanon. A detailed consideration of health sector reform in Lebanon is beyond the
focus of this report. However, an attempt is made to contextualize recommendations for
improving use of contractual arrangements in relation to previously made recommendations for
health sector reform in Lebanon.
Considering the sheer number and breadth of contractual arrangements in Lebanon, there
are multiple ways of classifying and summarizing these arrangements. This can be done
according to which agency is involved (e.g. MOPH or NSSF), contracted party (e.g. hospitals,
primary care centres, or other parties), types of service provided (e.g. hospitalization versus
outpatient services), or other criteria. In this Report, an attempt was made to provide insights into
contractual arrangements from different angles to enhance understanding of the complexity of
the issues. A mixed approach is taken in which contracts are briefly mentioned according to the
different governmental agencies involved, while case studies investigate specific aspects of
service delivery.
Finally, an attempt is made to proceed beyond identification of problems into recognizing
aspects of good performance and opportunities for improving performance.
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