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Currently there is a climate of high expectations within the international community with regard to producing demonstrable results of aid effectiveness in the health sector both at global and developing country level. Yet, measuring the results from aid effectiveness presents methodological challenges. Existing evaluation frameworks are not sufficiently geared toward whether and how practices have changed. This paper presents a framework for measuring results from implementing the aid effectiveness principles at three levels: implementation process, system strengthening, and outcomes/impact. We developed it in the context of the monitoring of the results from the aid effectiveness agenda in the health sector in Mali. Despite some changes in behavior resulting in increased aid effectiveness and improved results at system and impact level, these principles have not been fully implemented so far. Expectations in terms of health outcomes should thus be realistic.

BackgroundBrazil has experienced difficulties in attracting health professionals (especially doctors and nurses) to practice at the primary health care (PHC) level and in rural and remote areas. This study presents two case studies, each a current initiative in contracting for primary health services in Brazil: one for the state of Bahia and the other for the city of Rio de Janeiro. The two models differ considerably in context, needs, modalities, and outcomes. This article does not attempt to evaluate the initiatives but to identify their strengths and weaknesses.MethodsAnalysis was based on indicators produced by the Brazilian health care information systems, a review of literature and other documentation, and key informant interviews.ResultsIn the case of Bahia, the state and municipalities decided to create a State Foundation, a new institutional public entity acting under private law that centralizes the hiring of health professionals in order to offer stable positions with career plans and mobility within the state. Results have been mixed as a lower than expected municipal involvement resulted in relatively high administrative costs and consequent default on municipal financial contributions. In the case of Rio de Janeiro, the municipality opted to contract not-for-profit Social Organizations as it made a push to expand access to primary health care in the city. The approach has been successful in expanding coverage, but evidence on cost and performance is weak.ConclusionsBoth cases highlight that improvements in cost and performance data will be critical for meaningful comparative evaluation of delivery arrangements in primary care. Despite the different institutional and implementation arrangements of each model, which make comparison difficult, the analysis provides important lessons for contracting out health professionals for PHC within Brazil and elsewhere.Electronic supplementary materialThe online version of this article (doi:10.1186/s12960-016-0101-3) contains supplementary material, which is available to authorized users.

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