Health Policy and Planning, Vol 13, 32-40, Copyright © 1998 by Oxford University Press
A Mills
Many low and middle income countries have inherited publicly funded and
provided health services, often operating at relatively low levels of
technical efficiency. Changing ideas about the management of the public
sector, in particular stemming from new public management theory, are
spreading to these countries, whether directly or via the recommendations
of multilateral and bilateral aid agencies. Pronouncements of agencies such
as the World Bank imply that competitive contracting with the private
sector is likely to improve the efficiency of services provision. However,
very little evidence is available on whether this is likely to be the case,
and in what circumstances delivery of services through contracts with the
private sector is likely to be preferable to direct provision by the public
sector.This paper draws on evidence from five country case-studies of
contractual arrangements, in Bombay, Papua New Guinea, South Africa,
Thailand and Zimbabwe, done through collaborative research between the
LSHTM Health Economics and Financing Programme and local researchers in
each country. A common evaluative framework was applied in each country to
selected, existing contractual arrangements. Services provided under
contract and evaluated included catering, cleaning, security, diagnostic
services and whole hospitals. Information is presented on the design of
contracts, the process of agreeing contracts including the extent of
competition, and the monitoring of contract performance. A variety of
evidence, including information on the relative cost and quality of
contracted out versus directly provided services in the case of South
Africa, Thailand, and Bombay, is used to explore whether or not contracting
out to the private sector represented a preferable means of service
provision. This analysis, together with information on the capacity of the
agency letting the contract, and on the wider environment including the
level of development of the private sector, is used to identify which
aspects of the contracting process and the context in which it takes place
are important in influencing whether or not contracting with the private
sector is a desirable means of service provision.
ARTICLES
To contract or not contract? Issues for low and middle income countries
Health Policy Unit, London School of Hygiene and Tropical Medicine, London, UK
CiteULike 
Connotea 
Del.icio.us What's this?
Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.