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

Morocco
The type of contractual arrangement depends on the nature of the relationship (purchase,
leasing, delegation, cooperation) and the subject (support services, care, etc.). The nature of
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the contractual relationship allows for three types of contractual arrangementTP PT: purchase or
leasing; delegation of responsibility; and cooperation.
Methodology
To implement this work, several data collection methods were used.
Document review. Internal documents were compiled on the experience of the Ministry of
Health in dealing with contractual arrangement. These mainly comprised legal regulations
and instruction guides and information related to the case studies, such as statistical data
and contract documents.
Interview with key personnel. Six persons were interviewed from the Department of
Regulations and Conflicts, Department of Planning and Financial Resources and the
Department of Hospitals and Ambulatory Care.
A survey mailed to public hospitals. The survey sought to document the experience of hospitals
in subcontracting. It covered all 74 state hospitals under autonomous management
(SEGMA) gathered in 46 provincial hospital centres. A questionnaire was elaborated for
this purpose and tested in a hospital prior to its use (Annex 1). A summary of survey
results are attached as Annex 2.
Focus group discussions. These were held with strategic actors of the Ministry of Health and
with private operators having experience in contracting with the Ministry of Health.
2.4 Limits and constraints of the study
The short time allocated for implementing the study constituted the main constraint to
the study. Given the originality of the research topic and the diversity of the resources
information to be consulted, it was difficult to implement the study within three months.
The definition of contractual arrangement provided in the reference statements is
narrow. The contractual arrangement is a kind of strategic alliance that leads to the creation of
value. In the business world, such value refers either to a profit or to a privileged position in
the market. In the field of health, the added value must necessarily have a social and ethical
aspect. Therefore it must be protected by one of the actors concerned in the contractual
arrangement. This should be the State, given that the State is in charge of protecting the
general public interest. Therefore the contractual arrangement in the field of health must be
submitted to law; this means necessarily that its definition must include the public
organization as initiator.
Building on the proposed structure to identify the actors involved in the governance of
health systems (State, private sector and civil society), the following definition is put forward:
1 Classification by Perrot J, Carrin G, Sergent F. (1997) L’approche contractuelle: de nouveaux partenariats pour
la santé dans les pays en développement. WHO/ICO/MESD.24
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