Provider Purchasing and Contracting for Health Services_The Case

Contents
1. Introduction............................................................................................................................1
Socioeconomic profile ...........................................................................................................1
Statement of the research problem.........................................................................................2
Objectives ..............................................................................................................................4
Study methodology ................................................................................................................4
Ethical issues..........................................................................................................................4
Data collection methods.........................................................................................................4
Sample....................................................................................................................................5
Limitations of the study .........................................................................................................5
2. Literature Review...................................................................................................................6
3. Evolution of the Zambian Health System..............................................................................8
Health reforms in Zambia, 1964–2005 ..................................................................................8
Health care financing reforms..............................................................................................16
Limitations of the 1992–2005 reforms ................................................................................17
Dissolution of the Central Board of Health .........................................................................18
4. Structure of the Zambian Health System.............................................................................20
Composition and distribution of health care facilities .........................................................22
5. Profile of the Private Sector in Zambia................................................................................25
Private for-profit providers ..................................................................................................25
Composition and distribution...............................................................................................25
Strengths and constraints .....................................................................................................26
Stakeholder perceptions.......................................................................................................27
Faith-based organizations ....................................................................................................27
Relationship with the government .......................................................................................30
6. Contracting Models in Zambia ............................................................................................31
Contracting in the public sector: Purchaser-provider design...............................................31
Contracting-in: Purchaser-provider design..........................................................................34
Contracting-in process .........................................................................................................35
Contracting among public providers....................................................................................37
Monitoring and evaluation...................................................................................................38
Human resources..................................................................................................................39
Pharmaceutical supply chain investment.............................................................................39
Contracting arrangements after 2005...................................................................................41
Contracting with private for-profit and private not-for-profit organizations.......................41
Contracting with private not-for-profits: Mission hospitals ................................................42
Contracting with private for-profit providers ......................................................................43
Disease/condition-specific contracting: Public-private .......................................................44
Contracting among private hospitals and private companies or corporations .....................44
Contracting among private health care providers ................................................................44
Public sector contracting with nongovernmental organizations ..........................................45
Contracting for nonclinical services ....................................................................................46
7. Findings from Case Studies .................................................................................................46
Contracting and budgetary process......................................................................................46
Potential model for private sector contracting.....................................................................53
Performance assessments.....................................................................................................53
8. Partnerships between the Public Sector and Private For-Profit Providers...........................54
Partnerships specific to malaria, TB, and HIV/AIDS programs..........................................54
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