• Contracting out of health care provision

Contracting out of health care provision

This article, published in the Lancet, examines the effectiveness of contracting out health care delivery to non-state entities including NGOs, universities, and for-profit companies in developing countries. It discusses the potential benefits and anticipated difficulties of contracting, and examines the extent to which these have occurred during implementation. Using data from ten developing countries the paper finds that contracting for delivery of primary care and nutrition services can be very effective and that improvements can be achieved rapidly. Contractors provided greater quality care and achieved better coverage than the government even in poor and remote areas.

The paper concludes that under real world conditions and at a large scale, contracting has achieved impressive and rapid results. The authors recommend that future efforts at contracting should continue to include rigorous evaluations to better determine its effectiveness, obtain robust estimates of the effect size, and test it under various conditions. Such operational research should also address remaining issues such as the effects of contracting on equity, the usefulness of performance-based bonuses, its cost-effectiveness compared with grants to NGOs, and different approaches to establishing the price of contracts. [adapted from author]

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