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

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Afghanistan Box 1. National health policy priorities 2005–2009 Delivery of health services 1. *Implement the basic package of health services 2. *Implement the essential package of hospital services 3. *Establish prevention and promotion programmes 4. Promote greater community participation 5. Improve coordination of health services 6. Strengthen the coverage of quality support programmes Reducing morbidity and mortality 7. *Improve the quality of maternal and reproductive health care 8. *Improve the quality of child health initiatives 9. *Strengthen the delivery of cost effective integrated communicable disease control programmes 10. Reduce prevalence of malnutrition, increasing access to iodized salt and micronutrients, and increase exclusive breastfeeding Institutional development 11. *Promote institutional and management development 12. *Strengthen human resources development, especially of female staff 13. *Strengthen health planning, monitoring and evaluation 14. Develop health financing and national health accounts 15. Strengthen provincial level management and coordination 16. Continue to implement priority restructuring and reform 17. Establish quality assurance 18. Develop and enforce public and private sector regulations and laws *Top priority Source: National health policy 2005–2009 and national health strategy 2005–2006, Ministry of Health Afghanistan, April 2005 OBJECTIVES AND METHODOLOGY This study aims to document the experience of outsourcing publicly financed health services to private organizations or the nongovernmental organization sector in Afghanistan. The specific objectives of the study are to: present an overview of the context in which contracting out is functioning in the health sector; highlight actual experiences including factors that influence contracting in health; share the findings about the contracting of Basic Package of Health Services (BPHS) as a specific public health programme that has taken up contractual arrangements as its principal implementation strategy; and summarize lessons learnt to date regarding the contractual arrangements in post-conflict Afghanistan. An extensive review was undertaken of the reports developed by the Ministry of Public Health and international development agencies involved in health. Donor mission reports on the role of contracting out of health services were reviewed, in addition to published and unpublished literature on contracting out of health services. Detailed discussions were held 40
Afghanistan with the staff of the Ministry of Public Health and those directly involved in contracting, especially international advisers to the Ministry of Public Health. The checklist provided by the WHO Regional Office for the Eastern Mediterranean for assessing the overall capacity for contracting out of health services was used as a guide for data collection. FINDINGS Wider governmental context for contracting As a result of war, no legislation was passed during the past 25 years and the existing laws were largely irrelevant to the current situation in the health sector. The legal framework was thus obsolete. Such a situation provides a new opportunity for updating legislation to support contracting out of health services in Afghanistan. With an elected government in place the environment is conducive to developing legislation to support health sector reforms. The policy of the government on contracting out of health services was developed and is being implemented within the framework of the 2004 Constitution of Afghanistan and the Public Investment Programme (2004). The Constitution is supportive of the private sector and its further development in the country. In recent years the government worked to prepare legislation to support the role of nongovernmental organizations in the country, which is to be submitted to the country’s president for endorsement. This legislation has been subject to heated discussion in the cabinet, especially one of the articles which prohibits the nongovernmental organizations from participating in construction and other profit-making bidding processes. Although the proposed bill prohibits the nongovernmental organizations from participating in any kind of bidding, it has yet not been approved by the president, and discussions continue in the media as there are diverse views on the experience of working with nongovernmental organizations. Of specific concern is the issue of nongovernmental organizations, which by nature are nonprofit entities, being involved in profit-making ventures. Contracting policy The Ministry of Public Health is closely following the legislative process, since its experience of working and coordinating with nongovernmental organizations has been successful in the past. The Ministry of Public Health has also gained considerable experience in monitoring and evaluation and regulation of nongovernmental organizations. The Ministry believes that nongovernmental organizations can play effective roles in the development of Afghanistan through delivery of essential health services, while the Ministry itself can focus on effectively regulating the organizations and on further strengthening its monitoring and evaluation capacity. A key priority in the Public Investment Programme (2004) is expansion of delivery, coverage and quality of both basic health services and hospital services. The public investment programme calls for strengthening and accelerating implementation throughout government, since it acknowledges that ‘implementation will make or break Afghanistan’s 41
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 37 and 38: Afghanistan AFGHANISTAN 37
Page 39: Current health services delivery Af
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
Page 85 and 86: Egypt deposit the fees of opening n
Page 87 and 88: Islamic Republic of Iran ISLAMIC RE
Page 89 and 90: 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
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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
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Tunisia Table 8 shows an increase i
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Tunisia to the private sector. The
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CONCLUSIONS Tunisia Three closely i
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