Contracting out to improve the use of clinical health services and health outcomes in low- and middle-income countries

Odendaal, Willem; Ward, Kim; Uneke, Jesse; Uro-Chukwu, Henry Chukwuemeka; Chitama, Dereck; Balakrishna, Yusentha; Kredo, Tamara

doi:10.1002/14651858.cd008133.pub2

Cited by 32 publications

(43 citation statements)

References 62 publications

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“…However, evidence on positive health outcome and equity effects from aid coordination mechanisms (sector‐wide approaches (SWAPs), joint assessments, and budget support—as “financing plus” interventions that combine financing and governance changes) is limited Health outcome and equity effects arising from a range of other “financing plus” interventions (performance‐based financing (PBF), purchasing reforms, contracting in/out, reforms to the mix of public and private providers operating in the health sector, and others, most of which combine financing and governance reform) are mixed …”

Section: State Of the Evidencementioning

confidence: 99%

Health system strengthening—Reflections on its meaning, assessment, and our state of knowledge

Witter

Palmer

Balabanova

et al. 2019

Health Planning & Management

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Summary Comprehensive reviews of health system strengthening (HSS) interventions are rare, partly because of lack of clarity on definitions of the term but also the potentially huge scale of the evidence. We reflect on the process of undertaking such an evidence review recently, drawing out suggestions on definitions of HSS and approaches to assessment, as well as summarising some key conclusions from the current evidence base. The key elements of a clear definition include, in our view, consideration of scope (with effects cutting across building blocks in practice, even if not in intervention design, and also tackling more than one disease), scale (having national reach and cutting across levels of the system), sustainability (effects being sustained over time and addressing systemic blockages), and effects (impacting on health outcomes, equity, financial risk protection, and responsiveness). We also argue that agreeing a framework for design and evaluation of HSS is urgent. Most HSS interventions have theories of change relating to specific system blocks, but more work is needed on capturing their spillover effects and their contribution to meeting overarching health system process goals. We make some initial suggestions about such goals, to reflect the features that characterise a “strong health system.” We highlight that current findings on “what works” are just indicative, given the limitations and biases in what has been studied and how, and argue that there is need to rethink evaluation methods for HSS beyond finite interventions and narrow outcomes. Clearer concepts, frameworks, and methods can support more coherent HSS investment.

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Section: State Of the Evidencementioning

confidence: 99%

Health system strengthening—Reflections on its meaning, assessment, and our state of knowledge

Witter

Palmer

Balabanova

et al. 2019

Health Planning & Management

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“…23 Odendaal et al reviewed relevant public health outsourcing literature in Cambodia and Guatemala, concluded that outsourcing solutions might not be better or worse than services provided by the government, but elaborately designed outsourcing contracts may change this result. 24 The mainstream view of outsourcing EPHS in China is that outsourcing can improve efficiency and service quality. However, this view has not been empirical.…”

Section: Introductionmentioning

confidence: 99%

Is it worth outsourcing essential public health services in China?—Evidence from Beilin District of Xi'an

Yuan

Hou

2020

Health Planning & Management

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Background: Essential public health services (EPHS) is general welfare public health interventions led by the Chinese government and provided by the primary medical institutions to all residents. In Beilin District, Xi'an, EPHS producers can be divided into outsourced institutions and public institutions. Objective: Can outsourcing EPHS reduce costs and improve efficiency and quality? There is still no definite answer to this question. This paper compares the performance of outsourced institutions and public institutions in terms of efficiency and quality, explains the reasons for this phenomenon. Methods: This paper uses a theoretical and two-stage DEA model Based on a "triple subject" research framework. Results: The results show that the difference between public institutions and outsourced institutions is mainly reflected in service quality. When the quality is not measured, outsourced institutions' production efficiency is higher than that of public institutions. When there are quality measurements, the production efficiency of outsourced institutions is lower than that of public institutions. Conclusions: Outsourced institutions perform worse than public institutions. The reason is that a bilateral monopolistic market structure has formed between local governments and outsourced institutions. This situation makes it difficult for the government to replace poor quality outsourced institutions under the constraints of a limited budget.

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“…A recent Cochrane review found that while there was evidence that contracting reduces out-of-pocket spending on curative care, there was little or no difference in the use of preventive health services (e.g. antenatal care, immunization, contraception), and health outcomes (infant mortality, diarrhea) [ 10 ]. Another review also found that there is weak evidence that contracting increased access and utilization of health services [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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

Rao

Paina

Ingabire

et al. 2018

Int J Equity Health

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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.

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Contracting out to improve the use of clinical health services and health outcomes in low- and middle-income countries

Abstract: Contracting out to improve the use of clinical health services and health outcomes in low-and middle-income countries.

Cited by 32 publications

References 62 publications

Health system strengthening—Reflections on its meaning, assessment, and our state of knowledge

Health system strengthening—Reflections on its meaning, assessment, and our state of knowledge

Is it worth outsourcing essential public health services in China?—Evidence from Beilin District of Xi'an

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

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