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Gastaldi S, Accorgi D. Choosing between outsourcing contracts and in-house cleaning services: Dusting off the shadows on hospital environmental hygiene. Am J Infect Control 2024; 52:377-379. [PMID: 38141968 DOI: 10.1016/j.ajic.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/25/2023]
Affiliation(s)
- Silvana Gastaldi
- National Association of Nurses for Prevention of Hospital Infections (ANIPIO), Italy.
| | - Daniela Accorgi
- IPC Nurse, Department of Nursing and Obstetrics, Azienda USL Toscana Centro, Florence, Italy
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Samad D, Hamid B, Sayed GD, Liu Y, Zeng W, Rowe AK, Loevinsohn B. The effectiveness of pay-for-performance contracts with non-governmental organizations in Afghanistan - results of a controlled interrupted time series analysis. BMC Health Serv Res 2023; 23:122. [PMID: 36750963 PMCID: PMC9902816 DOI: 10.1186/s12913-023-09099-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 01/24/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND In many contexts, including fragile settings like Afghanistan, the coverage of basic health services is low. To address these challenges there has been considerable interest in working with NGOs and examining the effect of financial incentives on service providers. The Government of Afghanistan has used contracting with NGOs for more than 15 years and in 2019 introduced pay-for-performance (P4P) into the contracts. This study examines the impact of P4P on health service delivery in Afghanistan. METHODS We conducted an interrupted time series (ITS) analysis with a non-randomized comparison group that employed segmented regression models and used independently verified health management information system (HMIS) data from 2015 to 2021. We compared 31 provinces with P4P contracts to 3 provinces where the Ministry of Public Health (MOPH) continued to deliver services without P4P. We used data from annual health facility surveys to assess the quality of care. FINDINGS Independent verification of the HMIS data found that consistency and accuracy was greater than 90% in the contracted provinces. The introduction of P4P increased the 10 P4P-compensated service delivery outcomes by a median of 22.1 percentage points (range 10.2 to 43.8) for the two-arm analysis and 19.9 percentage points (range: - 8.3 to 56.1) for the one-arm analysis. There was a small decrease in quality of care initially, but it was short-lived. We found few other unintended consequences. INTERPRETATION P4P contracts with NGOs led to a substantial improvement in service delivery at lower cost despite a very difficult security situation. The promising results from this large-scale experience warrant more extensive application of P4P contracts in other fragile settings or wherever coverage remains low.
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Affiliation(s)
- Diwa Samad
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland. .,Ministry of Public Health of Afghanistan, Kabul, Afghanistan.
| | - Bashir Hamid
- grid.452482.d0000 0001 1551 6921The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland ,grid.490670.cMinistry of Public Health of Afghanistan, Kabul, Afghanistan
| | | | - Yueming Liu
- grid.16753.360000 0001 2299 3507Feinberg School of Medicine, Northwestern University- United States, Chicago, USA
| | - Wu Zeng
- grid.213910.80000 0001 1955 1644Department of Global Health, Georgetown University- United States, Washington, DC USA
| | - Alexander K. Rowe
- grid.452482.d0000 0001 1551 6921The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Benjamin Loevinsohn
- grid.452434.00000 0004 0623 3227Gavi, The Vaccine Alliance, Geneva, Switzerland
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3
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Kuwawenaruwa A, Makawia S, Binyaruka P, Manzi F. Assessment of Strategic Healthcare Purchasing Arrangements and Functions Towards Universal Coverage in Tanzania. Int J Health Policy Manag 2022; 11:3079-3089. [PMID: 35964163 PMCID: PMC10105173 DOI: 10.34172/ijhpm.2022.6234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/13/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Strategic health purchasing in low- and middle-income countries has received substantial attention as countries aim to achieve universal health coverage (UHC), by ensuring equitable access to quality health services without the risk of financial hardship. There is little evidence published from Tanzania on purchasing arrangements and what is required for strategic purchasing. This study analyses three purchasing arrangements in Tanzania and gives recommendations to strengthen strategic purchasing in Tanzania. METHODS We used the multi-case qualitative study drawing on the National Health Insurance Fund (NHIF), Social Health Insurance Benefit (SHIB), and improved Community Health Fund (iCHF) to explore the three purchasing arrangements with a purchaser-provider split. Data were drawn from document reviews and results were validated with nine key informant (KI) interviews with a range of actors involved in strategic purchasing. A deductive and inductive approach was used to develop the themes and framework analysis to summarize the data. RESULTS The findings show that benefit selection for all three schemes was based on the standard treatment guidelines issued by the Ministry of Health. Selection-contracting of the private healthcare providers are based on the location of the provider, the range of services available as stipulated in the scheme guideline, and the willingness of the provider to be contracted. NHF uses fee-for-service to reimburse providers. While SHIB and iCHF use capitation. NHIF has an electronic system to monitor registration, verification, claims processing, and referrals. While SHIB monitoring is done through routine supportive supervision and for the iCHF provider performance is monitored through utilization rates. CONCLUSION Enforcing compliance with the contractual agreement between providers-purchasers is crucial for the provision of quality services in an efficient manner. Investment in a routine monitoring system, such as the use of the district health information system which allows effective tracking of healthcare service delivery, and broader population healthcare outcomes.
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Kas-Osoka C, Moss J, Alexander L, Davis J, Parham I, Barre I, Cunningham-Erves J. African Americans views of COVID-19 contact tracing and testing. Am J Infect Control 2022; 50:577-580. [PMID: 35263614 PMCID: PMC8898856 DOI: 10.1016/j.ajic.2022.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/19/2022] [Accepted: 02/19/2022] [Indexed: 11/08/2022]
Abstract
Increasing COVID-testing and contact tracing is necessary to control the COVID-19 pandemic considering suboptimal vaccine rates. We conducted semi-structured interviews to explore views towards contact tracing and testing among 62 African Americans. Based on our findings, participants identified COVID-19 testing and contact tracing as beneficial, yet medical and governmental mistrust, stigma associated with SARS-CoV-2, lack of access, poor communication, and costs as major barriers. This study also highlights intervention targets to improve COVID-testing and contact tracing.
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Affiliation(s)
- Chioma Kas-Osoka
- Meharry Medical College, School of Medicine, Department of Internal Medicine, Nashville, TN
| | - Jamal Moss
- Meharry Medical College, School of Medicine, Nashville, TN
| | - Leah Alexander
- Meharry Medical College, School of Graduate Studies and Research, Division of Public Health Practice, Nashville, TN
| | - Jamaine Davis
- Meharry Medical College, School of Medical, Department of Biochemistry and Cancer Biology, Nashville, TN
| | - Imari Parham
- Meharry Medical College, School of Medicine, Nashville, TN
| | - Iman Barre
- Meharry Medical College, School of Medicine, Nashville, TN
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Snell-Rood C, Jaramillo E, Gunderson L, Hagadone S, Fettes D, Aarons G, Willging C. Enacting competition, capacity, and collaboration: performing neoliberalism in the U.S. in the era of evidence-based interventions. Crit Public Health 2022; 32:283-294. [PMID: 35602887 PMCID: PMC9119579 DOI: 10.1080/09581596.2020.1834075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Funders increasingly encourage social and health service organizations to strengthen their impact on public health through the implementation of evidence-based interventions (EBIs). Local governments in the U.S. often utilize market-based contracting to facilitate EBI delivery via formal relationships with non-governmental community-based organizations (CBOs). We sought to understand how the discourses embedded within contracting to compete and perform influence how CBOs represent and accomplish their work. We draw on qualitative interviews conducted with government administrators (N=16) overseeing contracts for one child welfare EBI, SafeCare® and the leaders (N=25) of organizations contracted to implement this program. Participants endorsed competition, capacity, and collaboration as ideals within marketized contracting. Yet they expressed doubt about marketplace meritocracy and described the costs incurred in building the necessary organizational infrastructure to deliver EBIs and compete for contracts. We discuss the implications of marketized EBI contracting for CBOs and the limitations it poses for evidence-based public health, especially in socially marginalized communities.
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Affiliation(s)
- Claire Snell-Rood
- University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA 94720 USA
| | - Elise Jaramillo
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106 USA
| | - Lara Gunderson
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106 USA
| | | | - Danielle Fettes
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (8012), La Jolla, CA 92093-0812, USA, Child and Adolescent Services Research Center, University of California, San Diego, 3665 Kearny Villa Rd., San Diego, CA 92123, USA
| | - Gregory Aarons
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (8012), La Jolla, CA 92093-0812, USA, Child and Adolescent Services Research Center, University of California, San Diego, 3665 Kearny Villa Rd., San Diego, CA 92123, USA
| | - Cathleen Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106 USA
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Batlle JC, Dreyer K, Allen B, Cook T, Roth CJ, Kitts AB, Geis R, Wu CC, Lungren MP, Patti J, Prater A, Rubin D, Halabi S, Tilkin M, Hoffman T, Coombs L, Wald C. Data Sharing of Imaging in an Evolving Health Care World: Report of the ACR Data Sharing Workgroup Part 2: Annotation, Curation, and Contracting. J Am Coll Radiol 2021:S1546-1440(21)00581-0. [PMID: 34607753 DOI: 10.1016/j.jacr.2021.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/12/2021] [Indexed: 12/29/2022]
Abstract
A core principle of ethical data sharing is maintaining the security and anonymity of the data, and care must be taken to ensure medical records and images cannot be reidentified to be traced back to patients or misconstrued as a breach in the trust between health care providers and patients. Once those principles have been observed, those seeking to share data must take the appropriate steps to curate the data in a way that organizes the clinically relevant information so as to be useful to the data sharing party, assesses the ensuing value of the data set and its annotations, and informs the data sharing contracts that will govern use of the data. Embarking on a data sharing partnership engenders a host of ethical, practical, technical, legal, and commercial challenges that require a thoughtful, considered approach. In 2019 the ACR convened a Data Sharing Workgroup to develop philosophies around best practices in the sharing of health information. This is Part 2 of a Report on the workgroup's efforts in exploring these issues.
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Roos AF, O'Donnell O, Schut FT, Van Doorslaer E, Van Gestel R, Varkevisser M. Does price deregulation in a competitive hospital market damage quality? J Health Econ 2020; 72:102328. [PMID: 32599157 DOI: 10.1016/j.jhealeco.2020.102328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
Regulators may be hesitant to permit price competition in healthcare markets because of its potential to damage quality. We assess whether this fear is well founded by examining a reform that permitted Dutch health insurers to freely negotiate prices with hospitals. Unlike previous research on hospital competition that has relied on quality indicators for urgent treatments, we take advantage of a plausible absence of selection bias to identify the effect on the quality of elective procedures that should be more price responsive. Using data on all admissions for hip replacements to Dutch hospitals and a difference-in-differences comparison between more and less concentrated markets, we find no evidence that price deregulation in a competitive environment reduces quality measured by hip replacement readmission rates.
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Affiliation(s)
- Anne-Fleur Roos
- Netherlands Bureau of Economic Policy Analysis (CPB) & Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), Netherlands.
| | - Owen O'Donnell
- Erasmus School of Economics (ESE) & ESHPM, EUR, Tinbergen Institute (TI), Netherlands.
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Albis MLF, Bhadra SK, Chin B. Impact evaluation of contracting primary health care services in urban Bangladesh. BMC Health Serv Res 2019; 19:854. [PMID: 31752843 PMCID: PMC6956513 DOI: 10.1186/s12913-019-4406-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 08/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Urban Primary Health Care Project (UPHCP) was implemented by the Government of Bangladesh in response to rapid urbanization and growing inequalities in access to and quality of primary health care. The goal of the project was to improve health status of the urban poor living in city corporations and municipalities through the provision of health care services by NGOs that are contracted through public-private partnership. The first phase of the project started in 1998 and the project is currently in its fourth phase covering more urban areas than the first three phases. This study evaluates the impact of the second phase project (UPHCP-II) on health outcomes, mainly child diarrhea, acute respiratory infection, antenatal and postnatal care, skilled birth attendance, breastfeeding prevalence, contraceptive prevalence, sexually transmitted infections, and HIV/AIDS awareness. METHODS The effect of the project was estimated through propensity score matching between project and non-project areas comparing baseline and endline surveys over a six-year period from 2006 to 2012. An innovation of this study is the recalibration of the sampling weights that allows the use of these two independent surveys in impact evaluation. RESULTS Over the six-year period, UPHCP-II improved the health status of the population in project areas compared to non-project areas. The study found significant improvement in health outcomes in terms of reduced diarrhea and acute respiratory infection in children, which explains the downward trend in child mortality rate. Moreover, the project also improved antenatal care and skilled birth attendance. Contraceptive prevalence and HIV/AIDS awareness and avoidance increased, and sexually transmitted infections decreased. CONCLUSIONS UPHCP-II was effective in achieving its health outcome targets, while previous studies show that it was efficient in the delivery of health care and clients were highly satisfied because health facilities were in close proximity, and doctors and staff were perceived as responsive in delivering high quality of care. The results of this study could help inform future design and implementation of urban health interventions that involve contracting primary health care service delivery in Bangladesh and other similar settings.
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Affiliation(s)
| | - Subrata K Bhadra
- National Institute of Population Research and Training, Dhaka, Bangladesh
| | - Brian Chin
- Asian Development Bank, Manila, Philippines
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McBeath B, Chuang E, Carnochan S, Austin MJ, Stuart M. Service Coordination by Public Sector Managers in a Human Service Contracting Environment. Adm Policy Ment Health 2018; 46:115-127. [PMID: 30291540 DOI: 10.1007/s10488-018-0899-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite emerging evidence of contracting for evidence-based practices (EBP), little research has studied how managers lead contract-based human service delivery. A 2015 survey of 193 managers from five San Francisco Bay Area county human service departments examined the relationship between contract-based service coordination (i.e., structuring cross-sector services, coordinating client referrals and eligibility, overseeing EBP implementation) and the predictors of managerial role, involvement, and boundary spanning. Multivariate regression results suggested that county managers identified fewer service coordination challenges if they were at the executive and program levels, had greater contract involvement, and engaged in contract-focused boundary spanning. In conclusion, we underscore the organizational and managerial dimensions of contract-based service delivery.
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Affiliation(s)
- Bowen McBeath
- Portland State University School of Social Work, PO Box 751, Portland, OR, 97207, USA.
| | - Emmeline Chuang
- University of California-Los Angeles Fielding School of Public Health, Los Angeles, CA, USA
| | - Sarah Carnochan
- Mack Center on Nonprofit and Public Sector Management in the Human Services, University of California-Berkeley School of Social Welfare, Berkeley, CA, USA
| | - Michael J Austin
- Mack Center on Nonprofit and Public Sector Management in the Human Services, University of California-Berkeley School of Social Welfare, Berkeley, CA, USA
| | - Marla Stuart
- Berkeley Institute for Data Science, University of California-Berkeley, Berkeley, CA, USA
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10
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Rao KD, Paina L, Ingabire MG, Shroff ZC. Contracting non-state providers for universal health coverage: learnings from Africa, Asia, and Eastern Europe. Int J Equity Health 2018; 17:127. [PMID: 30286771 PMCID: PMC6172768 DOI: 10.1186/s12939-018-0846-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Formal 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. METHODS A 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. RESULTS Governments 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. CONCLUSION For 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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Affiliation(s)
- Krishna D. Rao
- Department of International Health, Johns Hopkins University, Suite E-8148 315 N. Wolfe Street, Baltimore, MD 21215 USA
| | - Ligia Paina
- Department of International Health, Johns Hopkins University, Suite E-8148 315 N. Wolfe Street, Baltimore, MD 21215 USA
| | | | - Zubin C. Shroff
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
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Mureithi L, Burnett JM, Bertscher A, English R. Emergence of three general practitioner contracting-in models in South Africa: a qualitative multi-case study. Int J Equity Health 2018; 17:107. [PMID: 30286772 PMCID: PMC6172712 DOI: 10.1186/s12939-018-0830-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/24/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The general practitioner contracting initiative (GPCI) is a health systems strengthening initiative piloted in the first phase of national health insurance (NHI) implementation in South Africa as it progresses towards universal health coverage (UHC). GPCI aimed to address the shortage of doctors in the public sector by contracting-in private sector general practitioners (GPs) to render services in public primary health care clinics. This paper explores the early inception and emergence of the GPCI. It describes three models of contracting-in that emerged and interrogates key factors influencing their evolution. METHODS This qualitative multi-case study draws on three cases. Data collection comprised document review, key informant interviews and focus group discussions with national, provincial and district managers as well as GPs (n = 68). Walt and Gilson's health policy analysis triangle and Liu's conceptual framework on contracting-out were used to explore the policy content, process, actors and contractual arrangements involved. RESULTS Three models of contracting-in emerged, based on the type of purchaser: a centralized-purchaser model, a decentralized-purchaser model and a contracted-purchaser model. These models are funded from a single central source but have varying levels of involvement of national, provincial and district managers. Funds are channelled from purchaser to provider in slightly different ways. Contract formality differed slightly by model and was found to be influenced by context and type of purchaser. Conceptualization of the GPCI was primarily a nationally-driven process in a context of high-level political will to address inequity through NHI implementation. Emergence of the models was influenced by three main factors, flexibility in the piloting process, managerial capacity and financial management capacity. CONCLUSION The GPCI models were iterations of the centralized-purchaser model. Emergence of the other models was strongly influenced by purchaser capacity to manage contracts, payments and recruitment processes. Findings from the decentralized-purchaser model show importance of local context, provincial capacity and experience on influencing evolution of the models. Whilst contract characteristics need to be well defined, allowing for adaptability to the local context and capacity is critical. Purchaser capacity, existing systems and institutional knowledge and experience in contracting and financial management should be considered before adopting a decentralized implementation approach.
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Affiliation(s)
- Linda Mureithi
- Health Systems Research Unit, Health Systems Trust, 1st Floor Block B, Aintree Park, Kenilworth, Cape Town, 7700 South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - James Michael Burnett
- Health Systems Research Unit, Health Systems Trust, 1st Floor Block B, Aintree Park, Kenilworth, Cape Town, 7700 South Africa
| | - Adam Bertscher
- Health Systems Research Unit, Health Systems Trust, 1st Floor Block B, Aintree Park, Kenilworth, Cape Town, 7700 South Africa
| | - René English
- Health Systems Research Unit, Health Systems Trust, 1st Floor Block B, Aintree Park, Kenilworth, Cape Town, 7700 South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Shroff ZC, Rao KD, Bennett S, Paina L, Ingabire MG, Ghaffar A. Moving towards universal health coverage: engaging non-state providers. Int J Equity Health 2018; 17:135. [PMID: 30286766 PMCID: PMC6172788 DOI: 10.1186/s12939-018-0844-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 11/10/2022] Open
Abstract
This editorial provides an overview of the special issue "Moving towards UHC: engaging non-state providers". It begins by describing the rationale underlying the Alliance's choice of a research program addressing issues of non-state providers and briefly discusses the research process this entailed. This is followed by a summary of the findings and key messages of each of the eight articles included in the issue. The editorial concludes with a series of reflections regarding lessons learnt about the engagement of non-state providers, methodological challenges, areas for future research as well as the contribution of the research program towards efforts to build capacity and strengthen health systems towards universal health coverage.
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Affiliation(s)
- Zubin Cyrus Shroff
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | | | - Sara Bennett
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Ligia Paina
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | | | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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Vong S, Raven J, Newlands D. Internal contracting of health services in Cambodia: drivers for change and lessons learned after a decade of external contracting. BMC Health Serv Res 2018; 18:375. [PMID: 29788959 PMCID: PMC5964924 DOI: 10.1186/s12913-018-3165-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 04/30/2018] [Indexed: 11/18/2022] Open
Abstract
Background Since the late 1990s, contracting has been employed in Cambodia in an attempt to accelerate rural health system recovery and improve health service delivery. Special Operating Agencies (SOA), a form of ‘internal contracting’, was introduced into selected districts by the Cambodia Ministry of Health in 2009. This study investigates how the SOA model was implemented and identifies effects on service delivery, challenges in operation and lessons learned. Methods The study was carried out in four districts, using mixed methods. Key informant interviews were conducted with representatives of donors and the Ministry of Health. In-depth interviews were carried out with managers of SOA and health facilities and health workers from referral hospitals and health centres. Data from the Annual Health Statistic Report 2009–2012 on utilisation of antenatal care, delivery and immunisation were analysed. Results There are several challenges with implementation: limited capacity and funding for monitoring the SOA, questionable reliability of the monitoring data, and some facilities face challenges in achieving the targets set in their contracts. There are some positive effects on staff behaviour which include improved punctuality, being on call for 24 h service, and perceived better quality of care, promoted through adherence to work regulations stipulated in the contracts and provision of incentives. However, flexibility in enforcing these regulations in SOA has led to more dual practice, compared to previous contracting schemes. There are reported increases in utilization of services by the general population and the poor although the quantitative findings question the extent to which these increases are attributable to the contracting model. Conclusion Capacity in planning and monitoring contracts at different levels in the health system is required. Service delivery will be undermined if effective performance management is not established nor continuously applied. Improvements in the implementation of SOA include: better monitoring by the central and provincial levels; developing incentive schemes that tackle the issues of dual practice; and securing trustworthy baseline data for performance indicators.
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Affiliation(s)
- Sreytouch Vong
- Research Fellow of ReBUILD Consortium, Phnom Penh, Cambodia.
| | - Joanna Raven
- Liverpool School of Tropical Medicine, Liverpool, England
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Klasa K, Greer SL, van Ginneken E. Strategic Purchasing in Practice: Comparing Ten European Countries. Health Policy 2018; 122:457-472. [PMID: 29502893 DOI: 10.1016/j.healthpol.2018.01.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/23/2017] [Accepted: 01/28/2018] [Indexed: 11/27/2022]
Abstract
Strategic purchasing of health care services is widely recommended as a policy instrument. We conducted a review of literature of material drawn from the European Observatory on Health Systems and Policies Health Systems in Transition series, other European Observatory databases, and selected country-specific literature to augment the comparative analysis by providing the most recent healthcare trends in ten selected countries. There is little evidence of purchasing being strategic according to any of the established definitions. There is little or no literature suggesting that existing purchasing mechanisms in Europe deliver improved population health, citizen empowerment, stronger governance and stewardship, or develop purchaser organization and capacity. Strategic purchasing has not generally been implemented. Policymakers considering adopting strategic purchasing policies should be aware of this systemic implementation problem. Policymakers in systems with strategic purchasing built into policy should not assume that a purchasing system is strategic or that it is delivering any expected objectives. However, there are individual components of strategic purchasing that are worth pursuing and can provide benefits to health systems.
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Affiliation(s)
- Katarzyna Klasa
- University of Michigan, School of Public Health, Department of Health Management and Policy, 1415 Washington Heights, Ann Arbor, MI, 48109, United States of America.
| | - Scott L Greer
- University of Michigan, School of Public Health, Department of Health Management and Policy, 1415 Washington Heights, Ann Arbor, MI, 48109, United States of America.
| | - Ewout van Ginneken
- European Observatory on Health Systems and Policies, Technische Universität Berlin EB2 EB 2, Department of Health Care Management, Strasse des 17. Juni 145, 10623, Berlin, Germany; Berlin University of Technology, Technische Universität Berlin, Department of Health Care Management, Strasse des 17. Juni 145, 10623, Berlin, Germany.
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Siganporia P, Astrakianakis G, Alamgir H, Ostry A, Nicol AM, Koehoorn M. Hospital support services and the impacts of outsourcing on occupational health and safety. Int J Occup Environ Health 2016; 22:274-282. [PMID: 27696988 DOI: 10.1080/10773525.2016.1227035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Outsourcing labor is linked to negative impacts on occupational health and safety (OHS). In British Columbia, Canada, provincial health care service providers outsource support services such as cleaners and food service workers (CFSWs) to external contractors. OBJECTIVES This study investigates the impact of outsourcing on the occupational health safety of hospital CFSWs through a mixed methods approach. METHODS Worker's compensation data for hospital CFSWs were analyzed by negative binomial and multiple linear regressions supplemented by iterative thematic analysis of telephone interviews of the same job groups. RESULTS Non-significant decreases in injury rates and days lost per injury were observed in outsourced CFSWs post outsourcing. Significant decreases (P < 0.05) were observed in average costs per injury for cleaners post outsourcing. Outsourced workers interviewed implied instances of underreporting workplace injuries. CONCLUSIONS This mixed methods study describes the impact of outsourcing on OHS of healthcare workers in British Columbia. Results will be helpful for policy-makers and workplace regulators to assess program effectiveness for outsourced workers.
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Affiliation(s)
- Pearl Siganporia
- a School of Population and Public Health , University of British Columbia , Vancouver , Canada
| | - George Astrakianakis
- a School of Population and Public Health , University of British Columbia , Vancouver , Canada
| | - Hasanat Alamgir
- b Department of Health Policy and Management , New York Medical College , New York , NY , USA
| | - Aleck Ostry
- c Department of Geography , University of Victoria , Victoria , Canada
| | - Anne-Marie Nicol
- d Faculty of Health Sciences , Simon Fraser University , Vancouver , Canada
| | - Mieke Koehoorn
- a School of Population and Public Health , University of British Columbia , Vancouver , Canada
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Montagu D, Goodman C, Berman P, Penn A, Visconti A. Recent trends in working with the private sector to improve basic healthcare: a review of evidence and interventions. Health Policy Plan 2016; 31:1117-32. [PMID: 27198979 DOI: 10.1093/heapol/czw018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2016] [Indexed: 11/14/2022] Open
Abstract
The private sector provides the majority of health care in Africa and Asia. A number of interventions have, for many years, applied different models of subsidy, support and engagement to address social and efficiency failures in private health care markets. We have conducted a review of these models, and the evidence in support of them, to better understand what interventions are currently common, and to what extent practice is based on evidence. Using established typologies, we examined five models of intervention with private markets for care: commodity social marketing, social franchising, contracting, accreditation and vouchers. We conducted a systematic review of both published and grey literature, identifying programmes large enough to be cited in publications, and studies of the listed intervention types. 343 studies were included in the review, including both published and grey literature. Three hundred and eighty programmes were identified, the earliest having begun operation in 1955. Commodity social marketing programmes were the most common intervention type, with 110 documented programmes operating for condoms alone at the highest period. Existing evidence shows that these models can improve access and utilization, and possibly quality, but for all programme types, the overall evidence base remains weak, with practice in private sector engagement consistently moving in advance of evidence. Future research should address key questions concerning the impact of interventions on the market as a whole, the distribution of benefits by socio-economic status, the potential for scale up and sustainability, cost-effectiveness compared to relevant alternatives and the risk of unintended consequences. Alongside better data, a stronger conceptual basis linking programme design and outcomes to context is also required.
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Affiliation(s)
| | | | | | - Amy Penn
- University of California, San Francisco, CA, USA
| | - Adam Visconti
- Georgetown University, Washington, DC, USA Providence Hospital, Mobile, AL, USA
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Abstract
PURPOSE The purpose of this paper is to explore the readiness of contracted and non-contracted first-level healthcare facilities in Pakistan to deliver quality maternal and neonatal health (MNH) care. A balanced scorecard (BSC) was used as the assessment framework. DESIGN/METHODOLOGY/APPROACH Using a cross-sectional study design, two rural health centers (RHCs) contracted out to Aga Khan Health Service, Pakistan were compared with four government managed RHCs. A BSC was designed to assess RHC readiness to deliver good quality MNH care. In total 20 indicators were developed, representing five BSC domains: health facility functionality, service provision, staff capacity, staff and patient satisfaction. Validated data collection tools were used to collect information. Pearson χ2, Fisher's Exact and the Mann-Whitney tests were applied as appropriate to detect significant service quality differences among the two facilities. FINDINGS Contracted facilities were generally found to be better than non-contracted facilities in all five BSC domains. Patients' inclination for facility-based delivery at contracted facilities was, however, significantly higher than non-contracted facilities (80 percent contracted vs 43 percent non-contracted, p=0.006). PRACTICAL IMPLICATIONS The study shows that contracting out initiatives have the potential to improve MNH care. ORIGINALITY/VALUE This is the first study to compare MNH service delivery quality across contracted and non-contracted facilities using BSC as the assessment framework.
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Affiliation(s)
- Fauziah Rabbani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Khim K, Annear PL. Strengthening district health service management and delivery through internal contracting: lessons from pilot projects in Cambodia. Soc Sci Med 2013; 96:241-9. [PMID: 23489889 DOI: 10.1016/j.socscimed.2013.02.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 12/13/2012] [Accepted: 02/18/2013] [Indexed: 11/23/2022]
Abstract
Following a decade of piloting different models of contracting, in mid-2009 the Cambodian Ministry of Health began to test a form of 'internal contracting' for health care delivery in selected health districts (including hospitals and health centers) contracted by the provincial health department as Special Operating Agencies (SOAs) and provided with greater management autonomy. This study assesses the internal contracting approach as a means for improving the management of district health services and strengthening service delivery. While the study may contribute to the emerging field now known as performance-based financing, the lessons deal more broadly with the impact of management reform and increased autonomy in contrast to traditional public sector line-management and budgeting. Carried out during 2011, the study was based on: (i) a review of the literature and of operational documents; (ii) primary data from semi-structured key informant interviews with 20 health officials in two provinces involved in four SOA pilot districts; and (iii) routine data from the 2011 SOA performance monitoring report. Five prerequisites were identified for effective contract management and improved service delivery: a clear understanding of roles and responsibilities by the contracting parties; implementation of clear rules and procedures; effective management of performance; effective monitoring of the contract; and adequate and timely provision of resources. Both the level and allocation of incentives and management bottlenecks at various levels continue to impede implementation. We conclude that, in contracted arrangements like these, the clear separation of contracting functions (purchasing, commissioning, monitoring and regulating), management autonomy where responsibilities are genuinely devolved and accepted, and the provision of resources adequate to meet contract demands are necessary conditions for success.
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