The role of contractual arrangements in improving health sector ...
The role of contractual arrangements in improving health sector ...
The role of contractual arrangements in improving health sector ...
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Pakistan<br />
Annex 1<br />
GUIDELINES FOR DISCUSSION<br />
Question Discussion po<strong>in</strong>ts Source<br />
1. What is the rationale for<br />
M<strong>in</strong>istries <strong>of</strong> Health to enter<br />
<strong>in</strong>to <strong>health</strong> services contracts<br />
with nongovernmental<br />
organizations or the private<br />
<strong>sector</strong>?<br />
2. What is the <strong>in</strong>terest <strong>of</strong> the<br />
nongovernmental<br />
organizations/private <strong>sector</strong> <strong>in</strong><br />
receiv<strong>in</strong>g public <strong>sector</strong><br />
f<strong>in</strong>anc<strong>in</strong>g?<br />
3. Is the political environment<br />
enabl<strong>in</strong>g/disabl<strong>in</strong>g for the<br />
execution <strong>of</strong> <strong>contractual</strong><br />
<strong>arrangements</strong> <strong>in</strong> <strong>health</strong> <strong>sector</strong>?<br />
Does the political environment<br />
<strong>in</strong>fluence the negotiation and<br />
execution <strong>of</strong> contracts?<br />
Does the bureaucratic set-up<br />
support contract<strong>in</strong>g out <strong>of</strong><br />
services to the private <strong>sector</strong>?<br />
Is the legal framework robust<br />
enough to facilitate<br />
contract<strong>in</strong>g between the<br />
public and private <strong>sector</strong>s:<br />
Extend basic services to underserved areas<br />
Inability <strong>of</strong> to provide specific service by the public<br />
<strong>sector</strong><br />
Efficiency and effectiveness <strong>in</strong> delivery <strong>of</strong> services<br />
Why?<br />
Ownership<br />
Incentives<br />
Flexibility <strong>in</strong> decision mak<strong>in</strong>g<br />
Use <strong>of</strong> market mechanisms<br />
Weaken<strong>in</strong>g <strong>of</strong> wested <strong>in</strong>terest <strong>in</strong>fluence<br />
Functional specialization rather hierarchical tall<br />
organizational structures<br />
Role <strong>of</strong> state enabl<strong>in</strong>g rather service delivery<br />
Transparency<br />
Decentralization<br />
Distanc<strong>in</strong>g from political process<br />
Increased competition result<strong>in</strong>g <strong>in</strong> quality<br />
Challenge to established power <strong>of</strong> organized labour<br />
Dangers<br />
Equity<br />
Increased staff turnover<br />
Fulfil social mission/Enhance size and scope <strong>of</strong><br />
activities<br />
Other sources not available/accessible<br />
F<strong>in</strong>ancial susta<strong>in</strong>ability<br />
Recognition from government<br />
Enabl<strong>in</strong>g<br />
Political commitment<br />
Disabl<strong>in</strong>g<br />
Influence<br />
Explicit procedures; Comprehensiveness and<br />
transparency<br />
Process<strong>in</strong>g time<br />
Standard contract<strong>in</strong>g tool<br />
Responsibility <strong>of</strong> decision mak<strong>in</strong>g<br />
Statutes/ord<strong>in</strong>ance<br />
Frameworks developed by autonomous organizations<br />
Legal mechanisms/status <strong>of</strong> nongovernmental<br />
organizations<br />
Jo<strong>in</strong>t community contract<strong>in</strong>g<br />
Accreditation<br />
National standards<br />
223<br />
Federal<br />
Secretary<br />
DG<br />
Programme Managers<br />
DFA<br />
Law and Justice<br />
Senior Jo<strong>in</strong>t Secretary<br />
Chief Plann<strong>in</strong>g Health<br />
Registration Authorities<br />
Prov<strong>in</strong>cial<br />
DGs<br />
Plann<strong>in</strong>g Officers<br />
Organizations<br />
NRSP<br />
PRSP<br />
IPH<br />
Punjab Health Foundation<br />
Others<br />
Selected nongovernmental<br />
organizations<br />
Private hospitals?<br />
Federal and prov<strong>in</strong>cial<br />
Planners and managers/<br />
Experts <strong>in</strong> the field<br />
Federal and prov<strong>in</strong>cial<br />
Planners and managers/<br />
Experts <strong>in</strong> the field<br />
EDOs<br />
Federal and prov<strong>in</strong>cial<br />
Planers and managers/<br />
Experts <strong>in</strong> the field<br />
Federal and prov<strong>in</strong>cial<br />
Planners and managers/<br />
Experts <strong>in</strong> the field<br />
Federal Law and Justice Dept.<br />
Prov<strong>in</strong>cial Regulation Dept.<br />
Are there efficient Availability <strong>of</strong> guidel<strong>in</strong>es for arbitration <strong>of</strong> disputes Federal and prov<strong>in</strong>cial
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