Service delivery packages and models

Good health care services deliver effective, safe, good quality personal and population-based health care to individuals in need, when and where needed, with a minimum waste of resources. No universal models for services delivery exist, but in the (early) recovery phase, governments of post-conflict states often decide on a basic package of cost-effective interventions. This package is (theoretically) based on a picture of population health needs, and addresses demand-for-care barriers (i.e. cultural, social, financial or gender issues) to the equitable expansion and access to services. Packages need to be feasible in terms of available resources such as money, staff, medicines and supplies, which are often limited in fragile states.

In conflict and some post-conflict settings, health services are primarily provided through NGOs and the private sector. Contracting out the delivery of a basic package of health services to NGOs during the post-conflict recovery period in Afghanistan has led to a rapid expansion of health service delivery in this country. Such experimental models are more common in post-conflict settings. The private-for-profit sector, which often provides the bulk of health services, has also been considered for inclusion in service delivery models, but especially in fragile states their quality and regulation is poor.

Other popular initiatives include community-based management and participation in health services, which attempt to promote community ownership and sustainability. Although still in its infancy, an initiative to improve quality and performance which is gaining momentum is performance- (or results-) based financing. These reward mechanisms can be applied at the level of service implementers such as NGOs, as well as at health facility or individual level. Supervision is key to the success of any of these initiatives.