Contracting non-state providers for universal health coverage: learnings from Africa, Asia, and Eastern Europe

Abstract

BackgroundFormal engagement with non-state providers (NSP) is an important strategy in many low-and-middle-income countries for extending coverage of publicly financed health services. The series of country studies reviewed in this paper - from Afghanistan, Bangladesh, Bosnia & Herzegovina, Ghana, South Africa, Tanzania and Uganda – provide a unique opportunity to understand the dynamics of NSP engagement in different contexts.MethodsA standard template was developed and used to summarize the main findings from the country studies. The summaries were then organized according to emergent themes and a narrative built around these themes.ResultsGovernments contracted NSPs for a variety of reasons – limited public sector capacity, inability of public sector services to reach certain populations or geographic areas, and the widespread presence of NSPs in the health sector. Underlying these reasons was a recognition that purchasing services from NSPs was necessary to increase coverage of health services. Yet, institutional NSPs faced many service delivery challenges. Like the public sector, institutional NSPs faced challenges in recruiting and retaining health workers, and ensuring service quality. Properly managing relationships between all actors involved was critical to contracting success and the role of NSPs as strategic partners in achieving national health goals. Further, the relationship between the central and lower administrative levels in contract management, as well as government stewardship capacity for monitoring contractual performance were vital for NSP performance.ConclusionFor countries with a sizeable NSP sector, making full use of the available human and other resources by contracting NSPs and appropriately managing them, offers an important way for expanding coverage of publicly financed health services and moving towards universal health coverage.

Successes, Challenges and Opportunities Towards Universal Health Coverage for Maternal and Child Health in South East Asian Countries: A Systematic Review

“…Contracting nongovernment health providers is an important step in reducing maternal mortality in India. The nding is in line with data obtained from LMIC by Rao et al 75 .…”

Equity in HIV/AIDS services requires optimization of mainstreaming sectors in Ethiopia

“…Financial constraints were aggravated by the phasing out of NGOs’ contracts. The government contracted with NGOs to expand the limited public sector capacity by reaching certain geographic areas or populations [ 73 ]. In contrast, non-contracting with NGOs escalated the service coverage disparity between rich and poor because of financial deficiency and the inability to maintain services initiated by NGOs which was mentioned by the key informants in the current study.…”

Factors affecting private sector engagement in achieving universal health coverage: a scoping review

“…The reason for this threat is the tendency of 70% of people to use health services provided by the private sector which causes the public facilities to be less utilized and finally deviated from national strategic goals [ 71 ]. Governmental challenges in the engagement of the private sector in achieving UHC are other problems that greatly affect the national health system [ 36 , 53 , 63 , 64 , 66 ]. Facing governmental challenges and trying to manage and solve them can contribute to a safe setting and bring trust among the stakeholders of private sector engagement in achieving UHC [ 37 , 66 ].…”