Performance-Based Contracting for Health Services in Developing Countries: A Toolkit

This toolkit provides practical advice to anyone involved in, or who is interested in becoming involved in, performance-based contracting of health services with non state providers in the context of developing countries. It addresses many of the issues that may be encountered. Input from experienced contracting professionals will give newcomers increased confidence as they go forward. Experts directly involved in contracting on a large scale have contributed to the development of this toolkit. The first section provides summary before moving on to the main part of the toolkit. The section provides background on contracting, including definitions of key terms, the types of services that can be contracted, how contracting relates to other ways of organizing health services, and which contracting approaches work in different settings. The third section provides a systematic way of thinking about contracting and how to do it in practice. It looks at seven aspects of the contracting process from initial dialogue with stakeholders through carrying out the bidding process and managing contracts. This framework will help ensure a systematic consideration of the choices and challenges. The fourth section provides checklist which contains tasks and issues to address while designing and implementing a contract. The checklist can also be used to review an existing contract to see what is missing or could be improved. The fifth and final section reviews the evidence for contracting in developing countries, explores why contracting appears to work, and addresses concerns that have been expressed about contracting.