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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.
The role of contractual arrangements in improving health sector performance 7. Enhance capacities at national level to better implement and understand contracting. Managerial: contract design, information systems, accreditation of contractors Technical: knowledge of the areas under consideration Monitoring: developing indicators, measuring performance, protocols, standards Financial: cost–benefit analysis, health accounts Consumer satisfaction Governance capacity Relevant and adapted legal, economic and financial frameworks Human resource capacities Human resource negotiation capacities 35
Page 1 and 2: Morocco Draft The role of contractu
Page 3 and 4: CONTENTS FOREWORD..................
Page 5 and 6: The role of contractual arrangement
Page 23 and 24: Islamic Republic of Iran care (incr
Page 33: The role of contractual arrangement
Page 37 and 38: Afghanistan AFGHANISTAN 37
Page 39 and 40: Current health services delivery Af
Page 41 and 42: Afghanistan with the staff of the M
Page 43 and 44: Afghanistan 3) Greater emphasis cou
Page 45 and 46: Afghanistan Table 2. Implementation
Page 47 and 48: Provider Strengths Afghanistan •
Page 49 and 50: Bahrain BAHRAIN
Page 51 and 52: Bahrain services to be contracted-o
Page 53 and 54: Bahrain claiming under them respect
Page 55 and 56: Financing Bahrain There is a clear
Page 57 and 58: Bahrain receipt of the invoice. The
Page 59 and 60: Bahrain RESULTS AND DISCUSSION: CAS
Page 61 and 62: Bahrain The competitive bidding pro
Page 63 and 64: Bahrain 11. SMC Cleaning Services C
Page 65 and 66: INTRODUCTION Egypt The health secto
Page 67 and 68: Egypt are governed by their own set
Page 69 and 70: Egypt One of the key objectives of
Page 71 and 72: Egypt Is the legal framework robust
Page 73 and 74: Egypt The opportunity for the HSRP
Page 75 and 76: Egypt The Research Unit includes Fa
Page 77 and 78: Egypt How was the nongovernmental o
Page 79 and 80: Egypt How did the approved list of
Page 81 and 82: Egypt districts, where private and
Page 83 and 84: 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
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Lebanon Table 3. Costs of contractu
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Lebanon performance or mechanisms f
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Lebanon Overall, the contracts allo
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Lebanon belong to the Ministry of S
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Lebanon Perhaps the more obvious di
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Lebanon quality of care in the cont
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Lebanon Correcting this imbalance b
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Lebanon could be a first step towar
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Lebanon Table 5. Scorecard of contr
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Lebanon support for wide reform and
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Lebanon Sabri B et al. Health secto
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INTRODUCTION Morocco During the pas
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Morocco A contractual arrangement i
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Morocco services, as the administra
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Morocco The programme budget is lik
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Morocco According to his Act, each
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Morocco The number of patients curr
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Morocco facilities and the technica
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Morocco Evaluation of the subcontra
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Morocco Annex 2 EVALUATION OF THE E
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Chefchaouen Reassignment of agents,
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Ain Seb. Hay Moh. S. B. Zenata El F
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Pakistan PAKISTAN
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Pakistan To improve the health stat
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Pakistan the government grants a co
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Pakistan The relevant documents wer
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Pakistan Table 1. Examples of contr
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Pakistan Each contract generally sp
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Pakistan services. The specialized
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Pakistan Case study: contractual ar
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Pakistan used in the project to col
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Pakistan GFATM support, and a Natio
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RECOMMENDATIONS Pakistan 1. Conduct
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Pakistan Annex 1 GUIDELINES FOR DIS
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Pakistan Question Discussion points
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INTRODUCTION Tunisia The health ins
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Tunisia hospital facilities may be
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Tunisia the regulations of the mutu
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Tunisia pocket household expenditur
Page 235 and 236:
Tunisia The Tunisian health strateg
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Table 2. Distribution of agreements
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Tunisia Coverage of MRI procedures
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under the agreements, 1995-2004 Tun
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Tunisia Table 5. Beneficiaries (BEN
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Tunisia The National Pension and So
Page 247 and 248:
Tunisia Table 8 shows an increase i
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Tunisia to the private sector. The
Page 251:
CONCLUSIONS Tunisia Three closely i
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