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

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Lebanon Table 4. Contractual arrangements of Ministry of Public Health Area of contract Contracted party(ies) Hospital services Private hospitals (103) Public hospitals (20) Primary care services Essential drugs for chronic diseases PCC (45 centres in 2003) Type(s) of provider Mix (for profit/non-/NGO) YMCA International NGO Start of contracting arrangement Length of contract Ongoing Annual, renewable Public Ongoing Annual, renewable Public/NGO Ongoing–national plan initiated 1996 1991 Annual, renewable Immunization UNICEF UN Agency 1991 Annual, renewable Basic social services NGO’s NGOs Ongoing Annual, renewable National health programmes Public health expertise WHO UN Agency 1991 Annual, renewable Health professionals Maternal care Makassed Health System Various health professionals Ongoing Annual, renewable NGO/non-profit 2003 Annual, renewable Services covered Geographical coverage Hospitalization All regions Hospitalization All regions 5 years Primary care services All regions Procurement and distribution of essential drugs for chonic diseases to PCCs Procurement and distribution of vaccines to PCCs All regions All regions Basic health and social services All regions Administration of several national programmes Furbishing primary health consultations Provide normal delivery in addition to primary care services NA NA Akkar
Lebanon performance or mechanisms for monitoring such performance. Nevertheless, the Ministry of Public Health sees these contracts as serving the public good and as serving multisectorality in health protection and encouraging inclusion of various civil society partners. • Procurement of drugs for chronic diseases. The Ministry of Public Health contracts out to the local branch of a large international nongovernmental organization, the Young Men’s Christian Association (YMCA), for procurement of essential drugs for chronic diseases. The YMCA purchases essential generic drugs for conditions such as diabetes, hypertension, and heart disease from international markets at bulk rates which are much lower compared with rates for similar drugs in the Lebanese market. The YMCA stores and distributes these drugs using a network of around 400 health care outlets (health centres and dispensaries). There are attempts to interlink these using a computerized system. Around 150 000 people are served through this network a year, at a cost of about US$ 15–20 a year. This offers substantial savings compared with costs of the private market. The total cost for the programme is about US$ 2.5 million a year. The YMCA is not allowed to turn anyone away for financial reasons. The contract covers a small part of the overhead for the YMCA and dispensing outlets. Chances for abuse in this system are low. Of note, YMCA procurement of essential drugs started during the civil war with the aid of foreign donors who filled an important gap after the breakdown of the government-supported primary care and drug delivery infrastructure. After the end of the civil war, foreign donations of drugs stopped, so the Ministry of Public Health decided to continue to sponsor this programme because of its efficiency and its ability to promote equitable access to essential drugs. This sponsorship will continue for the foreseeable future. • Securing immunization material. The Ministry of Public Health has a contract with UNICEF to procure vaccines. UNICEF purchases immunization kits on behalf of the Ministry of Public Health in the international market and then gives them to the Ministry of Public Health which distributes them to its PCC network. This programme has proved to be very efficient and a source of considerable savings, as UNICEF is able to secure immunization material at much lower discounted rates than the Ministry of Public Health would be able to (UNICEF purchases vaccines on behalf of many other low- and middle-income countries). UNICEF perceives this programme as providing opportunities to promote preventive services. • Upgrading maternal care. The Project in Wadi Khaled is being implemented through a contract with Makassed Health System in an underserved area in north Lebanon which is part of the Akkar district. This area has low maternal health indicators, including high use of traditional birth attendants. The aim of the project is to encourage better antenatal care and offer facilities for normal delivery while ensuring that more complicated cases are referred to other hospitals using well established referral networks. A currently-operational primary care centre, with well-trained staff, opened in May 2003. In additional to the usual set-up designed for primary care services, this centre also offers specially-designed facilities for normal delivery. The centre is manned around the clock. For complex or high risk deliveries or when problems arise unexpectedly during normal delivery, the centre has established protocols and procedures for evacuation patients to hospitals. Doctors are expected to deliver the usual primary care services other than antenatal care, including safe motherhood and
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Morocco Draft The role of contractu
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CONTENTS FOREWORD..................
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The role of contractual arrangement
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Islamic Republic of Iran care (incr
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Afghanistan AFGHANISTAN 37
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Current health services delivery Af
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Afghanistan with the staff of the M
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Afghanistan 3) Greater emphasis cou
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Afghanistan Table 2. Implementation
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Provider Strengths Afghanistan •
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Bahrain BAHRAIN
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Bahrain services to be contracted-o
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Bahrain claiming under them respect
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Financing Bahrain There is a clear
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Bahrain receipt of the invoice. The
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Bahrain RESULTS AND DISCUSSION: CAS
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Bahrain The competitive bidding pro
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Bahrain 11. SMC Cleaning Services C
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INTRODUCTION Egypt The health secto
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Egypt are governed by their own set
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Egypt One of the key objectives of
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Egypt Is the legal framework robust
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Egypt The opportunity for the HSRP
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Egypt The Research Unit includes Fa
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Egypt How was the nongovernmental o
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Egypt How did the approved list of
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Egypt districts, where private and
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Egypt Annex 1 Contract copy between
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Egypt deposit the fees of opening n
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Islamic Republic of Iran ISLAMIC RE
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INTRODUCTION Islamic Republic of Ir
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Islamic Republic of Iran OVERVIEW O
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Delivery Facility Health House Sour
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Islamic Republic of Iran PBSC invol
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Islamic Republic of Iran authoritie
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Islamic Republic of Iran From an ad
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Islamic Republic of Iran 6. Shieber
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Medical Sciences University Islamic
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Jordan JORDAN
Page 107 and 108: INTRODUCTION Jordan This study docu
Page 109 and 110: Jordan hospital beds in Jordan. In
Page 111 and 112: Jordan health education programmes.
Page 113 and 114: Jordan Benefits by health subsystem
Page 115 and 116: Jordan Table 2. Summary of health e
Page 117 and 118: Jordan ASSESSMENT OF OVERALL CAPACI
Page 119 and 120: Jordan attract foreign investment,
Page 121 and 122: Jordan businesses efficiently. The
Page 123 and 124: Expected risks and incentives Minis
Page 125 and 126: Jordan Table 4. Profile of contract
Page 127 and 128: Fee-for-service contracts Royal Med
Page 129 and 130: Jordan King Abdullah Hospital (KAH)
Page 131 and 132: Strengths Jordan • Provides acces
Page 133 and 134: Jordan • The minimum charge scale
Page 135 and 136: Jordan The main reasons behind the
Page 137 and 138: Jordan • Interviews with the Mini
Page 139 and 140: Jordan • This type of contracting
Page 141 and 142: Jordan CONCLUSIONS AND RECOMMENDATI
Page 143 and 144: Jordan 3. Prospective payment mecha
Page 145 and 146: Jordan Annex 1 CONTRACT/AGREEMENT A
Page 147 and 148: Lebanon LEBANON
Page 149 and 150: Lebanon at their disposal for regul
Page 151 and 152: Research methods and data sources L
Page 153 and 154: Lebanon and local municipalities. E
Page 155 and 156: Lebanon Table 1. Contractual arrang
Page 157: Lebanon Table 3. Costs of contractu
Page 161 and 162: Lebanon Overall, the contracts allo
Page 163 and 164: Lebanon belong to the Ministry of S
Page 165 and 166: Lebanon Perhaps the more obvious di
Page 167 and 168: Lebanon quality of care in the cont
Page 169 and 170: Lebanon Correcting this imbalance b
Page 171 and 172: Lebanon could be a first step towar
Page 173 and 174: Lebanon Table 5. Scorecard of contr
Page 175 and 176: Lebanon support for wide reform and
Page 177 and 178: Lebanon Sabri B et al. Health secto
Page 179 and 180: INTRODUCTION Morocco During the pas
Page 181 and 182: Morocco A contractual arrangement i
Page 183 and 184: Morocco services, as the administra
Page 185 and 186: Morocco The programme budget is lik
Page 187 and 188: Morocco According to his Act, each
Page 189 and 190: Morocco The number of patients curr
Page 191 and 192: Morocco facilities and the technica
Page 193 and 194: Morocco Evaluation of the subcontra
Page 195 and 196: Morocco Annex 2 EVALUATION OF THE E
Page 197 and 198: Chefchaouen Reassignment of agents,
Page 199 and 200: Ain Seb. Hay Moh. S. B. Zenata El F
Page 201 and 202: Pakistan PAKISTAN
Page 203 and 204: Pakistan To improve the health stat
Page 205 and 206: Pakistan the government grants a co
Page 207 and 208: Pakistan The relevant documents wer
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Pakistan Table 1. Examples of contr
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Pakistan Each contract generally sp
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Pakistan services. The specialized
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Pakistan Case study: contractual ar
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Pakistan used in the project to col
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Pakistan GFATM support, and a Natio
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RECOMMENDATIONS Pakistan 1. Conduct
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Pakistan Annex 1 GUIDELINES FOR DIS
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Pakistan Question Discussion points
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INTRODUCTION Tunisia The health ins
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Tunisia hospital facilities may be
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Tunisia the regulations of the mutu
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Tunisia pocket household expenditur
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Tunisia The Tunisian health strateg
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Table 2. Distribution of agreements
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Tunisia Coverage of MRI procedures
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under the agreements, 1995-2004 Tun
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Tunisia Table 5. Beneficiaries (BEN
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Tunisia The National Pension and So
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Tunisia Table 8 shows an increase i
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Tunisia to the private sector. The
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CONCLUSIONS Tunisia Three closely i
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