Provider Purchasing and Contracting for Health Services_The Case

Contracting for nonclinical services
Apart from clinical services, contracting mechanisms also apply to nonclinical services.
Nonclinical services include security, catering, laundry, cleaning, maintenance, and printing.
Although most public health facilities do not contract out the above services, a few of them
do. The limited contracting in these services can be explained by the fact that most public
institutions have departments tasked to perform these duties. For instance, most of the public
facilities have laundry, catering, cleaning, and printing facilities as well as personnel to carry
out these services. For the most part, these employees are contracted on a short-term basis
and are referred to as Classified Daily Employees (CDEs). Hospitals also hire personnel with
specialized skills to supply the above services. This scenario also characterizes the faithbased
organizations. Nonetheless, the government contracts with the private sector for
construction of infrastructure. Such contracts are handled through the Zambia National
Tender Board.
On the other hand, contracting for nonclinical services is common in private for-profit
facilities. Generally, the private for-profit providers noted that it is imperative to subcontract
nonclinical services such as laundry and catering to enable them concentrate on providing
their core services—health care provision. There is very little evidence of serious negotiation
between the contractors and contractees of these services. Usually, flat market rates apply,
but discounts are also considered depending on the nature of the contract. Contract renewal is
dependent on the quality of services provided. Contracts are subject to termination if one
party is dissatisfied with the service.
Over 90 percent of surveyed institutions that contract for nonclinical services observed that
the quality and timely delivery of the services is the indicator of performance and the basis
for renewal.
7. Findings from Case Studies
This section provides empirical characterizations of contracting models in Zambia based on
the field work undertaken. The case studies covered six districts that were selected to depict
the rural-urban dichotomy of the country. The study surveyed six District Health
Management Teams—the Choma, Mazabuka, Lusaka, Ndola, Kitwe Mufulira, and Chingola
DHMTs—in order to characterize contracting in Zambia at the service delivery level. While
the private for-profit sector is limited in Choma and Mazabuka, the other districts have a
relatively large presence of private for-profit health care providers. Mazabuka and Choma
have first-level mission hospitals. It was envisaged that the characteristics and perceptions of
the changes in contracting arrangements in the sampled districts and hospitals would provide
a proximate view of the situation in Zambia.
Contracting and budgetary process
Since the dissolution of the Central Board of Health, the Ministry of Health acts through the
Provincial Health Offices as the principal in the contractual arrangements between the fundholding
agents and the sources of the funds. The Ministry of Health has always acted as a
source of funding. During its existence, the Central Board of Health operated as a financial
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