Provider Purchasing and Contracting for Health Services_The Case

In the first phase, the study mainly dwelt on qualitative analysis. This approach helped in
obtaining desired data because it allowed for triangulation in the collection process. The
second phase consisted in collecting quantitative data from various providers. The following
types of data were collected:
Primary data collection: Expert and stakeholder interviews were the main source of
information about contracting models that exist, especially in the private sector. Interviews
provided insights that qualified and refined our understanding and interpretations of
contracting arrangements.
Secondary data collection (desk review/analysis): The researchers reviewed relevant reports
and secondary literature that could inform the study and evaluation of the contracting
arrangements that exist in Zambia. Most of the documents and literature were collected from
within the Health Economics Research and Training Unit of the Department of Economics at
University of Zambia and the Zambian Ministry of Health, among others.
Sample
The study captured all the segments of health care providers in Zambia. These included
managers of private health facilities (hospitals and laboratories), government officials, and
managers of insurance companies. In the public sector, information was collected from the
Ministry of Health’s Head Office, and providers comprising District Health Management
Teams, and a few public hospitals from second level referral hospitals and and level three
facilities that provide highly specialized medical care and student teaching.
Limitations of the study
In an effort to characterize the contracting models that have existed in Zambia and assess the
impact of the reforms on service delivery and related aspects such as financing, quality of
care, access, and utilization, a detailed questionnaire was given to selected providers.
Although care was taken to collect information that could be required to assess performance
under a standard contracting arrangement, most providers did not have the requested
information in the required format. Thus, respondents did not answer a number of questions.
This limited the extent to which firm generalizations could be made.
Second, the study was conducted in seven districts of Zambia. Although care was taken to
ensure that they reflect the national picture (the rural-urban dichotomy), their national
representativeness could be debated. Nonetheless, the selected districts together have a
mixture of industrial providers, private for-profit providers, mission hospitals, and public
health care providers. Thus, they still provide a good snapshot of what could be found in
Zambia.
Third, the study benefited from the input of one member of the team who was part of the
team of managers that designed and implemented the policy reforms in the Zambian health
sector, including contracting. Recognizing this experience, efforts were made to limit his
potential influence over the analysis and interpretation. Further, the selection of interviewees
in the public sector was based on the position held and not individuals. It was observed that
some interviewees had personal rather than professional inclination toward some policy
changes because of their past experience. These personal inclinations could have biased some
responses in some instances; the team had to triangulate the survey findings with other
5