Provider Purchasing and Contracting for Health Services_The Case

Zambia’s health delivery system takes a unique approach in terms of inter-linkages required
to help provide the best health services to its population. So far, what is clear is that if fund
holders are given autonomy and sufficient funding, there are no serious restrictions on the
modes of contracting as long as particular desired services are provided. This kind of
mechanism, once improved upon, will be able to cater to all classes of people.
Clearly, the modes of contracting on offer within the government, whereby the Ministry of
Health subcontracts with its affiliates to provide health services, show the extent to which
contracting-in is easy to establish and effect, thereby improving efficiency and allocation of
resources. Because the Ministry of Health is the main contracting body, it has made it easy to
coordinate services and monitor performance. In this arrangement, it is evident that a
defaulting public contractee is given chance to improve or, where certain capacities are
lacking, interventions have been undertaken to help enhance service delivery. This
arrangement does not call for contract termination or penalizing the contractee once default is
established, but correctional activities are instead advocated and, where lacking, capacity is
built. Services are reviewed and improvements suggested.
The case of CHAZ has also presented a very pertinent example of how the public sector can
work closely with the private not-for-profit sector to enhance health service delivery. As
outlined above, CHAZ’s affiliates are contracted on an institutional basis or through CHAZ
itself. This kind of contracting is unique. The government deploys health personnel to CHAZ
affiliates and pays for the services they provide, instead of CHAZ doing so. This model has
worked well because, where the government has no representation in terms of infrastructure,
CHAZ affiliates have, and where CHAZ affiliates lack certain manpower, the government
provides up to 75 percent of the operations grant. This model has also helped outsourcing of
resources where CHAZ affiliates are not restricted to source funds from their churches.
Similarly, the case of CHAZ has also demonstrated that an umbrella structure and a buffer
between the government and missions is preferable to hierarchical arrangements—allowing
for a contractual relationship but independence as well.
As it has been already recognized, the contracting-out of clinical services to private forprofits
is not common in Zambia. There is a limited amount of contracting-out in laboratory
services. Informally, doctors have made referrals to and from public or government/private so
their clients can access some specialized services. A few examples have worked well where
private for-profit providers have contracted with each other to provide a particular service.
The example of Ronald Ross and Malcom Watson Hospitals is a classic case. However, the
original arrangement where these were both government-run facilities forms the backbone
upon which this unique contracting model has worked. This, however, can be replicated
within the private for-profit facilities. In addition, the role of private players in health
provision is critical. It is therefore important that policymakers adjust and accommodate more
roles to be being played by the private for-profit organizations.
Partnerships between the government and the private sector in the delivery of public health
programs ranging from HIV/AIDs, TB immunizations, and malaria prevention have fared
well. Combined with contracting arrangements with mission hospitals, these cases could be
used as a launching pad to integrating the private for-profit providers into the health system.
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