Provider Purchasing and Contracting for Health Services_The Case

Executive Summary
Objective and rationale of the study
The objective of this study was to identify and characterize contracting models that have
existed in the Zambian health sector and their consequences on access to health care. The
study was aimed at assessing the extent to which the identified contracting models have been
successful in achieving their intended goals and at determining their potential to be scaled up
to the entire health sector, including the private sector.
Methods
The study used both qualitative and quantitative approaches. The data were collected from
both primary and secondary sources. A selected number of providers and policymakers were
interviewed using a semi-structured questionnaire. Secondary data were collected using a
structured questionnaire.
Findings of the study
The study reveals that contracting-in and contracting-out are prevalent in Zambia.
Contracting-in is seen where the government is providing health service to the people on a
wide scale. Different levels of the referral system within the public health sector contract with
each other through the concept known as “purchase of beds.” Contracting-out is evidenced by
the relationship existing between government and the faith-based organizations and not-forprofit
nongovernmental organizations where the latter are providing health services to the
people on behalf of the government.
Despite the conducive policy environment for contracting private for-profit health service
providers, the study has established that direct contracting-out to the private for-profit health
institutions has been very limited. This is evidenced by the fact that there are no contracts or
exchange of financial resources between the government and private for-profit health
institutions for health services. Moreover, the study observed that contracting-out to the
private sector is constrained by limited budgets, attitudes of fund holders toward the private
sector, lack of a comprehensive policy for harnessing the private sector, lack of a platform
where policymakers in the Ministry of Health and the private sector interact, as well as the
reluctance of the private sector to engage in a deeper interaction with the government.
Although contracting-out is limited, partnerships between the private for-profit institutions
and the government have thrived in public health programs as well as vertical programs. For
example, in some isolated instances, the government does mandate private for-profit health
providers to carry out some services falling within public health programs such as the
distribution of anti-retrovirals to people living with HIV and AIDS, child immunization, and
malaria control programs.
Further, the study shows that with the abolishment of the Central Board of Health, the
provider-purchaser split has now been merged into the Ministry of Health structures. Despite
these changes, however, the contracting process remains the same, and evidence on the
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