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

The role of contractual arrangements in improving health sector performance
3. CONCLUSIONS AND RECOMMENDATIONS OF THE REGIONAL MEETING
ON THE ROLE OF CONTRACTUAL ARRANGEMENTS, CAIRO, APRIL 2005
The following conclusions and recommendations to countries are based on the analysis and
principal findings of the country studies and on the proceedings of the three day regional
consultative meeting of researchers, policymakers and representatives of academic and
international agencies, held in April 2005, in which the country studies were presented and the
subject of contracting out debated at length.
Contracting is being recognized as an increasingly important tool for implementing health
polices and programmes in the Region.
Contracting depends on the overall governance features of the country, such as the legal
frameworks, rule of law and enforcement mechanisms in place. To be effective,
contracting requires ministries of health to have capacity to design, award and manage
contracts.
Enhanced capacity of the private sector to implement contracts and of ministries of health to
monitor is equally important.
Contracting is a means and not and end in itself, and should be used primarily to promote public
health objectives.
Continued research is needed for evaluating the impact of contracting on health outcomes in the
Region.
Recommendations
1. Review the political, legal and administrative structure of ministries of health and
ensure the presence of well functioning information systems that allow effective
monitoring and supervision of the contracted out services.
2. Define public health goals in national health policies and use contractual arrangements
primarily to help achieve these goals. A guiding principle is that delivery of health
services may be contracted out, but not the authority and responsibility, or other aspects
related to governance and oversight of the health system.
3. Ensure that contracting with the private sector seeks only to harness its role in
achievement of public policy goals and is not considered as privatization of health care.
4. Review legislation and play a proactive part in development of legislation for
contracting of services in the country.
5. Consider use of contracting in national programmes to promote equity of health services
through targeting the poor and vulnerable populations.
6. To improve quality of health services and to ensure that clinical guidelines are followed,
include in the contractual arrangement clearly defined indicators that assess quality of
health care.