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

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e) Consensus-building workshop Pakistan The researcher prepared a draft study report based on document review, focus group discussion and interviews. The draft report was discussed with the representatives of key stakeholders, and in light of discussions the final draft of the study report was produced. FINDINGS [7–14] Overall findings Range of contractual arrangements In health services, the contractual arrangement is being recognized as a potential way to optimize the use of available resources. The contractual arrangements between a public sector purchaser and a private sector provider at various levels of hierarchy vary widely in the type of contract and the set of services to be provided. The contracts are made at federal, provincial and district levels. The public sector purchasers include mainly the Ministry of Health, the provincial Departments of Health and Social Welfare, and the district governments. The private providers include mainly the international and national nongovernmental organizations, institutions as well as private firms. The contract types include mainly contracting out, cost sharing agreements, grants and loans. The set of activities covered in contractual arrangements include mainly the primary health care services, research and development services, technical and management services. Table 1 lists several examples of the ongoing contractual arrangements in Pakistan. Rationale and interest The government sector rationale for contractual arrangements generally varies with the size and nature of health problem, current coverage and capacity of public and private sector health services, perceived need for service development and innovation, and consumer perceptions and expectations. The size and nature of health problem refers to issues of disease prevalence, diseaserelated stigma, high-risk population(s), and special social and technical requirements. The coverage and capacity of services refers to the issues of limited geographical and social access, inadequate health infrastructure and resources, lack of competition leading to low efficiency, inadequate outreach services, poor staff motivation and support. The innovation refers to the issues of limited flexibility in operations, limited ability to respond to new situations/challenges, delayed decisions, and lack of market mechanisms. The consumer perspective refers to the issues of low perceived quality of care, social acceptability, and ability and willingness to pay for a set of services. The private sector rationale for contractual arrangements generally includes enhanced size and scope of current activities, recognition and financial support, and humanitarian concerns. 208
Pakistan Table 1. Examples of contractual arrangements in the health sector in Pakistan Contract type Payment mode Purchaser Provider Focus area Contracting out Service contract Contracting-in Social franchising Concession (Build-operate -transfer) Block payment National AIDS control programme Block payment Ministry of Population Welfare Block payment DoH Punjab (Rahim Yar Khan) Cost per case Ministry of Population Welfare Block payment National Programme for primary health care and Family Planning, lady health workers Programme Block payment Participatory Development Programme 1994–2001 Block payment National Trust for Population Welfare Block payment (Grant plus loan) Political environment Punjab Health Foundation Indemnification Malaria Control Programme Block payment Department of Health AJK/FANA Block payment Department of Health NWFP Block payment Department of Health Sindh 209 Private partners Management services, Third party evaluation Population Council Management and technical assistance services Punjab Rural Support Programme Family Planning Association of Pakistan Management of PHC services Provision of family planning services UNICEF Delivery of certain set of services for programme (e.g. partial evaluation) Community-based organizations/ nongovernmental organizations Nongovernmental organizations Nongovernmental organizations and private practitioners Institute of Public Health Marie Adelaide Leprosy Centre AIMS (nongovernmental organization) Sindh Graduates Association Service delivery Service delivery Service strengthening and delivery Technical services Tuberculosis service delivery Rural health care management and service delivery Management of basic health units Block payment Ministry of Health Greenstar Reproductive health services Pre-payment Department of Health Punjab Munshi Trust (nongovernmental organization) Hospital services There is increasing recognition and interest in developing public–private partnerships for better coverage and quality of health services. There is evidence of political commitment at the highest level, as shown by various statements by the Prime Minister and the Federal Minister of Health in which they have encouraged and projected public–private partnership as a major step in right direction. The introduction of transparent arrangements for collective
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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
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INTRODUCTION Jordan This study docu
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Jordan hospital beds in Jordan. In
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Jordan health education programmes.
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Jordan Benefits by health subsystem
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Jordan Table 2. Summary of health e
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Jordan ASSESSMENT OF OVERALL CAPACI
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Jordan attract foreign investment,
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Jordan businesses efficiently. The
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Expected risks and incentives Minis
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Jordan Table 4. Profile of contract
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Fee-for-service contracts Royal Med
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Jordan King Abdullah Hospital (KAH)
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Strengths Jordan • Provides acces
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Jordan • The minimum charge scale
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Jordan The main reasons behind the
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Jordan • Interviews with the Mini
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Jordan • This type of contracting
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Jordan CONCLUSIONS AND RECOMMENDATI
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Jordan 3. Prospective payment mecha
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Jordan Annex 1 CONTRACT/AGREEMENT A
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Lebanon LEBANON
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Lebanon at their disposal for regul
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Research methods and data sources L
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Lebanon and local municipalities. E
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Lebanon Table 1. Contractual arrang
Page 157 and 158: Lebanon Table 3. Costs of contractu
Page 159 and 160: Lebanon performance or mechanisms f
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
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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
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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
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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: Pakistan The relevant documents wer
Page 211 and 212: Pakistan Each contract generally sp
Page 213 and 214: Pakistan services. The specialized
Page 215 and 216: Pakistan Case study: contractual ar
Page 217 and 218: Pakistan used in the project to col
Page 219 and 220: Pakistan GFATM support, and a Natio
Page 221 and 222: RECOMMENDATIONS Pakistan 1. Conduct
Page 223 and 224: Pakistan Annex 1 GUIDELINES FOR DIS
Page 225 and 226: Pakistan Question Discussion points
Page 227 and 228: INTRODUCTION Tunisia The health ins
Page 229 and 230: Tunisia hospital facilities may be
Page 231 and 232: Tunisia the regulations of the mutu
Page 233 and 234: Tunisia pocket household expenditur
Page 235 and 236: Tunisia The Tunisian health strateg
Page 237 and 238: Table 2. Distribution of agreements
Page 239 and 240: Tunisia Coverage of MRI procedures
Page 241 and 242: under the agreements, 1995-2004 Tun
Page 243 and 244: Tunisia Table 5. Beneficiaries (BEN
Page 245 and 246: Tunisia The National Pension and So
Page 247 and 248: Tunisia Table 8 shows an increase i
Page 249 and 250: Tunisia to the private sector. The
Page 251: CONCLUSIONS Tunisia Three closely i
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