Protecting efficient, comprehensive and integrated primary health care: principles and guidelines for inter-governmental contracting/service agreements

Protecting efficient, comprehensive and integrated primary health care: principles and guidelines for inter-governmental contracting/service agreements

Contracting for devolved primary health care delivery in South Africa

The devolution of primary health care delivery to local government means that intergovernmental relations are emerging as a critical issue in the transformation of South Africa’s health system. The role of contracts or service agreements in helping to define the nature of these inter-governmental relationships is important and complex.This document, produced by the Health Systems Trust, considers the nature of inter-governmental relationships, the type of contract most likely to be appropriate in helping to define and control them, as well as some of the potential pitfalls of an 'overly zealous' approach to contracting for a service such as primary health care (PHC).

More specifically, this paper introduces the advantages and disadvantages of contractual relationships within the public health sector, examines different types of contracts, describes the nature of inter-governmental relationships in South Africa and features of the PHC Approach and District Health System model integral to the South African health system, and discusses how these factors will influence and potentially be influenced by the use of contracts. It also emphasises the importance of integrated district and provincial health planning as the basis for contracts.In addition, this paper discusses the issues raised and draws conclusions of interest to those involved in the process of establishing contracts.

The paper makes the following recommendations for a successful inter-governmental contractual relationship for the provision of PHC:

  • work from a national / provincial strategic and policy framework, and from a comprehensive and integrated area-based PHC plan
  • adopt a relational approach to contracting that encourages partnership, and emphasises trust, mutual support and a shared vision
  • adopt contract specifications that are broad and flexible, and which stress constructive monitoring and evaluation procedures
  • start slowly and build capacity.

 

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