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

The role of contractual arrangements in improving health sector performance
The study objectives were to: 1) assess the capacity of the ministries of health to
outsource health services; 2) review a specific health intervention that has taken up
contractual arrangements as its implementation strategy; and 3) identify key factors that
influence outsourcing. The country studies were presented by the country investigators in
a regional meeting in April 2005. What follows in part one is a summary analysis of the
findings of all the country studies, along with a set of recommendations on the role of
contracting in improving health system performance developed jointly by the participants
of the regional meeting. Part two contains selected country studies.
This is the first organized effort to review outsourcing of health services among
countries of the Eastern Mediterranean Region. All ten country studies have contributed
to acquiring a better understanding of the subject in the Region. All studies have
reviewed features of the contracting process in their respective countries. However, on its
own each study is different in the manner in which it depicts the overall policy of the
country, its experience with contracting, and the extent and quality of the documentation
of the experience. While each country study has aimed to collect the best evidence, it is
recognized that there are gaps in information on the subject which need to be filled in
future efforts.
The summary analysis attempts to pull together and synthesize the findings of the
country studies, and identify the strengths and limitations of this multi-country study on
contracting. It is hoped that this effort will serve as the basis for future and more in depth
studies on contracting out of health services so as to assist countries in formulating more
rational and evidence-based policies and strategies on the subject.
References
1. Liu X et al. Contracting for primary health services: Evidence on its effects and a
framework for evaluation. 2004 Available at: HTUhttp://www.who.int/reproductive-
health/tcc/meeting_documents/hotchkiss_et_al.pdfUTH
2. Harding A, Preker AS. Private participation in health services. Human
development Network, Health, Nutrition and Nutrition Series. Washington DC, The
World Bank, 2003.
3. England R. Contracting and performance management in the health sector: A guide
for low and middle income countries. London, the Health System Resource Centre,
Department for International Development, 2000. Available at:
HTUhttp://www.eldis.org/static/DOC10297.htmUTH
4. Fifty-sixth World Health Assembly. (2003) The role of contractual arrangements in
improving health sector performance in countries. Agenda item 14.13; WHA 56.25,
Document A/56.
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