Provider Purchasing and Contracting for Health Services_The Case

ased organization; HMBs = Hospital Management Boards; HMIS = Health Management
Information System; MoH = Ministry of Health.
The contracting mechanisms outlined in the table above were designed to ensure efficient
delivery of health services through the creation of an internal market. The key tenets of the
contracting mechanisms are:
• Creation of an internal market structure through public-to-public sector contracting
• Contracting-out of defined services based on predetermined criteria of services using
the Basic Health Care Package for primary, secondary, and tertiary services
• Contracting-out through franchising primary health care services to the private sector
in the urban areas and areas that are not served by the public or faith-based
organizations in the rural sector to supplement health care service
• Contracting-out to the private sector for clinical and nonclinical services
The structure for contracting in the Zambian health system is illustrated in figure 4 below.
Figure 4: Structure of contracting in the public health system
Ministry of Health
Contracts with CBoH
Financing
CBoH Contracts with DHB,
2nd and 3rd-Level Facilities
DHB-Fund Holder
Subcontracts vertical and
horizontal
2nd- and 3rd-Level
Hospitals Contracts
with CBoH and DHB
Contracts nonclinical:
Public-Private
sector
Contracts: clinical
support services
(e.g., diagnosis laboratory)
Contracts: Private
sector clinical
Quality Assurance
Monitoring and
Evaluation
Accountability and
Reporting
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