Performance Based Contracting For Health Services In Developing Countries

Despite the existence of effective interventions, there are many developing countries which are not on track to achieve the Millennium Development Goals (MDGs) for health. In many countries the delivery of health services is inadequate and one way of improving the situation is to contract with non-state providers. Contracting is a mechanism for a financing entity to procure a defined set of services from a non-state provider. Performance-based contracting is a type of contracting with: (a) a clear set of objectives and indicators; (b) systematic efforts to collect data to judge contractor performance; and (c) some consequences for the contractor, either rewards or sanctions, based on performance. Effective contracting for health services can be facilitated by using a systematic approach, described in this toolkit, that addresses key issues, including how to: 1. have a constructive dialogue with all stakeholders; 2. define the health services in terms of what services are to be delivered, where, the quantity of beneficiaries to be served, equity, and quality of care; 3. design the monitoring and evaluation to judge the performance of contractors; 4. select the contractors in a fair and transparent way; 5. arrange for effective contract management; 6. draft the contract and bidding documents; and 7. carry out the bidding process and successfully manage the contracts. The toolkit also includes a review of 14 evaluated examples of contracting in developing countries which concludes that the current weight of evidence indicates that contracting improves the coverage and quality of services rapidly. The six cases with controlled, before and after evaluations demonstrated large impact with themedian double difference (follow-up minus baseline in the experimental group minus follow-up minus baseline in the control) ranging from 9 to 26 percentage points.

Whatever the theoretical attractiveness of certain policy options, the fact that public employees are people who make independent decisions about their careers and lifestyles can set bounds on how well government agencies can deliver promised services, such as universal health care, including in rural areas. Hammer and Jack examine the design and limitations of incentives for health care providers to serve in rural areas in developing countries. Governments face two problems: it is costly to compensate well-trained urban physicians enough to relocate to rural areas, and it is difficult to ensure quality care when monitoring performance is costly or impossible.

Based on careful analysis of burden of disease and the costs ofinterventions, this second edition of 'Disease Control Priorities in Developing Countries, 2nd edition' highlights achievable priorities; measures progresstoward providing efficient, equitable care; promotes cost-effectiveinterventions to targeted populations; and encourages integrated effortsto optimize health. Nearly 500 experts - scientists, epidemiologists, health economists,academicians, and public health practitioners - from around the worldcontributed to the data sources and methodologies, and identifiedchallenges and priorities, resulting in this integrated, comprehensivereference volume on the state of health in developing countries.

Health systems in most low-income countries are under-resourced and underused, failing to meet the needs of those who need health care the most. But what if health service providers-or even patients-were rewarded partially on the basis of their performance? Based on a review of experiences to date, the authors of this volume argue that performance incentives have great potential to improve health care for the world's poor. They are one way to use funding dedicated to individual diseases or interventions to strengthen core health system functions. In Part I, Eichler and Levine provide clear guidance about how to design, implement, and evaluate such programs, whether they target health care providers, patients, or both. Part II comprises a set of case studies that examine the use of such incentives to address a range of health conditions and challenges in diverse countries. Performance Incentives for Global Health: Potential and Pitfalls will help policymakers and program managers in developing countries and in the donor community improve health care systems through the strategic use of performance incentives. Book jacket.

To achieve the health-related Millennium Development Goals, it will be necessary to improve the delivery of health services, particularly to poor people. One proposed approach to improving both coverage and quality of care is to contract with NGOs or other non-state entities to deliver health services. This paper reviews experiences with contracting in which some coherent form of evaluation was carried out, using at least before and after, or controlled evaluation designs. Ten examples of contracting with NGOs were found and from these studies, it appears that in developing countries, contracting with non-state providers to deliver primary health or nutrition services can be very effective and that improvements can be rapid. These results were found in a variety of services and settings. Six of the ten studies compared contractor performance to government provision of the same services and all six found that the contractors achieved better results. There are a number of concerns about contracting that have been raised, including scale, cost, sustainability and contract management. Scaling up appears not to be a problem. Four of the examples studied involved populations of many millions of beneficiaries. On the issue of cost, four of the studies found that NGOs performed better even when provided the same resources as the public sector. Of the nine studies with three or more years of elapsed experience, seven have been continued and expanded. Contract management was seen as a significant issue in at least three of the examples reviewed, however, it did not prevent contractors in those instances from being successful. Based on the success thus far, health services contracting appears to improve service delivery and may help achieve the MDGs. The approach should be carefully expanded in developing countries using large scale pilots initially. Future efforts at contracting should include rigorous evaluations.

A new book published by the World Bank's Private Sector Advisory Services outlines an innovative approach to delivering development assistance for public basic services such as potable water, safe sanitation, modern energy, and primary education and healthcare. Called output-based aid, the approach delegates service delivery to the non-profit or for profit private sector under contracts that tie payments to the outputs or results actually delivered to target beneficiaries. The book gathers cases of innovative, output-based approaches from across the infrastructure and social sectors, and also provides a checklist for designing and implementing output-based schemes. (From the World Bank website)

Road asset management is one of the top priorities of the Central Asia Regional Economic Cooperation (CAREC) Transport and Trade Facilitation Strategy 2020. The implementation of performance-based road maintenance contracts (PBCs)—an essential element of road asset management—promotes effective and efficient maintenance of road networks. Well-designed PBCs keep roads in predefined good condition at relatively low cost. This guide aims to help policy makers in CAREC member countries understand and implement PBCs. After a brief history of the development of PBCs, it discusses the various types of PBCs and their relative advantages and disadvantages. It highlights PBC implementation in selected developed, developing, and transitional countries, including CAREC member countries, to illustrate best practices.

Scientific and Technical Report No. 24 Performance-Based Contracts (PBC) for Improving Utilities Efficiency: Experiences and Perspectives is a compendium of articles written by members of the PBC taskforce. It focuses on new approaches without delegated management to private operator i.e. service contracts, consulting contracts, Alliance approach, public-public partnership. It also mentions new design and generation of more traditional PPPs, (MC, lease, concession), where a larger proportion of performance-based design is being applied. List of Contents: Performance Based Contracts – Setting the scene; PBC and Results Based Financing: the inverse approach; PBC and Energy Efficiency; Internal Performance Contracts: A Case of the National Water and Sewerage Corporation in Uganda; Performance-Based Service Contracts in Navi Mumbai; Financial Comparison of PBCs and Conventional Approach; Tegucigalpa PBC Case Study; Performance Based Contracts – Key Design Issues; NRW Reduction Optimization Framework; How to improve water services performance? Performance Based Contracts (PBC) and Regulatory issues; Peer-to-Peer Partnerships Operational for sustainable water services; Performance Based Contracts in Malawi: Teamwork Works; Performance based affermage contracts; Performance based Contracts, The Aroona Integrated Alliance Experience; Experience from Eastern Europe; NRW Performance Contract – Kingdom of Bahrain; The way forward and perspectives/trends