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

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Islamic Republic of Iran affiliated with banks, municipalities, and other organizations further complicate the system, and perhaps make it less efficient. Table 1 shows the number and types of hospitals in terms of the sectors to which they belong. Table 1. Number and types of hospitals Type of Hospital No University 484 Private 123 Charity 238 Social Security Organization 50 Others 33 Total 928 Source: Ministry of Health and Medical Education, 2001 It is worth noting that most private hospitals are well-equipped with modern technology and are located in major cities, particularly in Teheran. Whereas conflict of interests, inefficiency, inequity, poor management and public dissatisfaction characterize the costly, urban-oriented curative services (public and private sector), primary health care services run satisfactorily. The main reasons for the notable success of the primary health care system of Islamic Republic of Iran are believed to be the firm commitment of the government to health and the relatively proactive public health approach adopted since the development of the primary health care network. Allocating a relatively modest share of government budget (around 7%) and GDP (around 1.7%) to public health, and using low cost, culturally appropriate and acceptable public health strategies, the Islamic Republic of Iran has succeeded in reaching almost universal levels of immunization, breastfeeding and use of iodized salt, in providing safe drinking-water to almost all communities and extending relatively inexpensive (if not entirely free) but efficient public health services to the remotest corners of the country. In addition to training low-cost community-based primary health workers, the country has also managed to expand opportunities for classical medical education opportunities at both general practice and specialized levels and has developed its pharmaceutical industry to a level that can meet the basic needs of the country (Mehriar et al, 2004). Figure 1 shows the structure of Islamic Republic Iran’s health care system (public sector) in which the lowest levels of the system (health houses, and rural/urban health centres) mainly deliver primary health care preventive services under supervision of the public sector. The private sector has not been involved or participated in delivery of services in these areas. Only during recent years, after the waves of privatization which were legalized through the third major socio-economic development plan, have universities of medical sciences begun to contract primary health care services or part of them to the private sector (see Annex 2). At district level, however, the private sector does participate actively, even dominantly, in hospital-based service delivery. 92
Delivery Facility Health House Source: Abolhasani, 2001 Islamic Republic of Iran Ministry of Health and Medical Education School of … Director of District University Teaching Health Network Hospital District Health Centre District General Hospital Rural Health Centre Urban Health Centre Health House Health House Medical University of the Province Health Post Figure 1. Organigram of the public health care system of the Islamic Republic of Iran 93 Health Post Health Post
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Morocco Draft The role of contractu
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CONTENTS FOREWORD..................
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The role of contractual arrangement
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Islamic Republic of Iran care (incr
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Afghanistan AFGHANISTAN 37
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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
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
Page 91: Islamic Republic of Iran OVERVIEW O
Page 95 and 96: Islamic Republic of Iran PBSC invol
Page 97 and 98: Islamic Republic of Iran authoritie
Page 99 and 100: Islamic Republic of Iran From an ad
Page 101 and 102: Islamic Republic of Iran 6. Shieber
Page 103 and 104: Medical Sciences University Islamic
Page 105 and 106: Jordan JORDAN
Page 107 and 108: INTRODUCTION Jordan This study docu
Page 109 and 110: Jordan hospital beds in Jordan. In
Page 111 and 112: Jordan health education programmes.
Page 113 and 114: Jordan Benefits by health subsystem
Page 115 and 116: Jordan Table 2. Summary of health e
Page 117 and 118: Jordan ASSESSMENT OF OVERALL CAPACI
Page 119 and 120: Jordan attract foreign investment,
Page 121 and 122: Jordan businesses efficiently. The
Page 123 and 124: Expected risks and incentives Minis
Page 125 and 126: Jordan Table 4. Profile of contract
Page 127 and 128: Fee-for-service contracts Royal Med
Page 129 and 130: Jordan King Abdullah Hospital (KAH)
Page 131 and 132: Strengths Jordan • Provides acces
Page 133 and 134: Jordan • The minimum charge scale
Page 135 and 136: Jordan The main reasons behind the
Page 137 and 138: Jordan • Interviews with the Mini
Page 139 and 140: Jordan • This type of contracting
Page 141 and 142: 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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