Contracting for Delivering Health
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World Bank, Washington, DC
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Substantial improvement in the delivery
of health services will be necessary to achieve the
health-related Millennium Development Goals (MDGs). A review
of developing country experience with contracting for health
service delivery was undertaken to examine its
effectiveness, determine the extent to which the posited
difficulties actually occur in practice, and make
recommendations regarding future efforts in contracting. The
focus of the review was instances in developing countries of
governments contracting with non-state providers (NSPs) to
deliver primary health care services including nutrition
(but excluding hospital care or ancillary services such as
drug procurement and distribution). Based on the success
thus far, health services' contracting should be
significantly expanded in developing countries as a way of
helping achieve the MDGs, and increasing accountability.
While the evidence for contracting is reasonably good,
future efforts should still include rigorous evaluations to
obtain more robust estimates of the effects under various
conditions and address unresolved issues, such as the
effectiveness of performance bonuses, and means for
improving contract management.
Palabras clave
ANTENATAL CARE, CHILD DEATHS, DECISION MAKING, DELIVERY OF HEALTH SERVICES, DISTRICT HEALTH MANAGEMENT, DISTRICT HEALTH MANAGEMENT TEAM, DISTRICTS, DRUGS, HEALTH, HEALTH CARE SERVICES, HEALTH FACILITY, HEALTH MANAGEMENT, HEALTH SERVICE, HEALTH SERVICES, HEALTH SYSTEMS, HEALTH WORKERS, HOSPITAL CARE, IMMUNIZATION, IMMUNIZATION COVERAGE, INCOME COUNTRIES, INFANTS, LOW INCOME, NONGOVERNMENTAL ORGANIZATIONS, NUTRITION, PRENATAL CARE, PRIMARY HEALTH CARE, PRIMARY HEALTH CARE SERVICES, PRIVATE SECTOR, PUBLIC HEALTH, PUBLIC SECTOR, RURAL AREAS, WORKERS