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

Pakistan
Case study: contractual arrangements for provision of PHC services
Introduction
In March 2003, a contract was signed between the Punjab Rural Support Programme
(PRSP) and the District Government of Rahim Yar Khan for the efficient delivery of an
agreed health services package at local basic health units (BHU). According to the agreement,
104 BHUs of district Rahim Yar Khan are managed through public–private partnership with
the support of the beneficiary local communities. The duration of the contract is five years.
The agreement between two parties was reviewed by the health, finance, local government
and law departments of Government of the Punjab.
The 104 BHUs of district Rahim Yar Khan were taken over and assigned into clusters in
July 2003. Each cluster of three BHUs has a Medical Officer In-charge. The Medical Officer
was given a new contract with the PRSP with an enhanced compensatory package, along with
agreement that the original contract with the government is protected. The Medical Officer is
required to reside at the “Focal BHU” and is not allowed to have a private practice. The
Medical Officer spends two days a week at each of the three BHUs in the cluster. The
availability and efficient management of medicines complements the presence of a doctor.
Since July 2003, the monthly outpatient attendance at BHUs has increased significantly.
Many collateral services are now being developed to supplement the growing outpatient
service. School health programmes, immunizations and preventive interventions are some of
the services that add value to the initiative. With the introduction of female doctors into the
service, many new vistas are expected to open. Prominent among these will be population
planning services, mother and child health services and gynaecological services.
Purchaser and provider
The District Government of Rahim Yar Khan is a public sector organization under
devolved arrangements. The elected District Assembly, led by a District Nazim, is the key
decision-making body in the district. The financing source is the direct government funds,
without any donor inputs.
The PRSP was incorporated in 1997 as a non-profit-making organization. It is currently
operating in 20 districts of Punjab through 8 regional offices located at Lahore, Gujranwala,
Sialkot, Faisalabad, Sargodha, Sahiwal, Multan and Muzzafargarh. The PRSP is a replication
of the rural support programmes approach, proven successful in Pakistan through two decades
of community organization, capacity building and empowerment. The process is designed
around organization of poor village communities through rediscovery of community
consciousness, common aspirations and ambitions before providing skill development,
financial and technical support. The purpose of such a support system is to initiate and sustain
a process of diversified growth of economic, human and natural resources specifically for the
poor. The main features of the PRSP package are:
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