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

Pakistan
used in the project to collect and regularly report the data on disease occurrence and service
provision. Designated officials of the district government have the right to inspect the
facilities, and the PRSP is obliged to respond to the written observations made. The agreement
also requires an independent third party assessment of the BHU performance at the
completion of first project year. The continuation of interventions for the next four years is
subject to improved BHU performance during the first project year.
As per agreement, the day-to-day operational difficulties are addressed by mutual
agreement between the District Coordination Officer (district government) and an authorized
representative of the PRSP. The resolution of disputes between the parties is addressed by
referring the matter to a sole arbitrator, mutually acceptable to both parties. In case of failure
to resolve the dispute or inability to continue, both parties have the right to terminate the
agreement through agreed arrangements.
The agreement says that the BHU budget, other than the salaries of the permanent
support and auxiliary staff, is transferred by the District Government to the PRSP. The annual
budget includes the salary of doctors and other contract employees, medicines, maintenance
and repair of building and equipment, utilities, store and office supplies.
The agreement covers the provider’s risk of increased budget requirements for
medicines and supplies by provisions for readjustment of budget allocations by public sector
officials in light of requests or proposals by PRSP. The agreement forbids PRSP to charge a
fee for the performance of the relevant management functions. However, PRSP has the right
to claim reimbursement for actual costs incurred on management functions from the district
government.
Service package
The preventive and curative health services, which the BHUs are already designated to
provide, are intended to address the local health needs. The increased outpatient attendance
reflects the relevance of services to the local health care needs. Many collateral services are
now being developed to supplement the growing outpatient service. The addition of school
health services (i.e. doctor’s regular visit to schools and schoolchildren’s monthly visit to
BHU) and planned provision of female doctor services (for reproductive health as well as
maternal and child health) are valuable additions to the set of core curative and preventive
health care services at BHUs.
The services are for the rural population of the entire district. The priority target group
is poor women and children, for whom alternate sources of health care are inaccessible. The
nature of the services being offered is relatively more relevant to the health needs of the poor
population.
Monitoring and evaluation
The agreement broadly states the agreed approach to public sector monitoring and
evaluation of project performance. However, the public sector has not yet developed a set of
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