To achieve the health-related Millennium Development Goals, the delivery of heath services will need to improve. Contracting with non-state entities, including NGOs, as been proposed as means for improving health care delivery.
Benjamin Loevinsohn and April Harding (The World Bank, Washington, D.C., USA) reviewed the global experience of contracting with NGOs to deliver primary health or nutrition services. They looked at 10 studies and found that contracting, which cost between US$3 and US$6 per head per year, led to substantial, rapid improvements in these services. They found, for example, that service delivery contracts in Cambodia increased immunisation coverage by 40 percentage points compared to control districts. Six of the ten studies compared contractor performance with government provision of the same services. All six showed that the contractors were more effective than government, on the basis of several measures related to both quality of care and coverage of services. One study revealed that in India an NGO achieved a treatment completion rate for tuberculosis that was 14 percentage points higher than public services in a nearby area, and at a lower cost.
Dr Loevinsohn concludes: "…the current weight of evidence suggests that contracting with non-governmental entities will provide better results than government provision of the same services. Contracting should no longer be considered an untested intervention or so-called leap of faith."
In an accompanying comment Ian Magrath (Insitut Pasteur, Brussels, Belgium) states: "Health will not be improved unless the necessary infrastructure for effective service delivery to the poorest populations can be developed…Because of their limited resources, the implementation of effective measures to control poverty, illiteracy, and disease in most developing countries will require external assistance."
Contact: Dr Benjamin Loevinsohn, World Bank, 1818 H Street NW, Mailstop MC11-1106, Washington DC 20433, USA. T) +1 202 473 7948 bloevinsohn@worldbank.org
Comment: Dr Ian Magrath, International Network for Cancer Treatment and Research INCTR at Institut Pasteur, Rue Engeland 642, B-1180, Brussels, Belgium. T) +32 2 373 9325 imagrath@inctr.be
Journal
The Lancet