Can contracted out health facilities improve access, equity, and quality of maternal and newborn health services? Evidence from Pakistan

Health Research Policy and Systems
Shehla ZaidiGul Nawaz Khan

Abstract

The case of contracting out government health services to non-governmental organizations (NGOs) has been weak for maternal, newborn, and child health (MNCH) services, with documented gains being mainly in curative services. We present an in-depth assessment of the comparative advantages of contracting out on MNCH access, quality, and equity, using a case study from Pakistan. An end-line, cross-sectional assessment was conducted of government facilities contracted out to a large national NGO and government-managed centres serving as controls, in two remote rural districts of Pakistan. Contracting out was specific for augmenting MNCH services but without contractual performance incentives. A household survey, a health facility survey, and focus group discussions with client and spouses were used for assessment. Contracted out facilities had a significantly higher utilization as compared to control facilities for antenatal care, delivery, postnatal care, emergency obstetric care, and neonatal illness. Contracted facilities had comparatively better quality of MNCH services but not in all aspects. Better household practices were also seen in the district where contracting involved administrative control over outreach programs. Contr...Continue Reading

References

Feb 22, 2005·The Journal of Family Planning and Reproductive Health Care·Karen Forrest KeenanEmma Pitchforth
Aug 23, 2005·Lancet·Benjamin Loevinsohn, April Harding
Oct 18, 2005·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·M T IslamY A Haque
Feb 24, 2006·The Journal of Family Planning and Reproductive Health Care·Edwin van Teijlingen, Emma Pitchforth
Oct 31, 2006·Lancet·Véronique FilippiDavid Osrin
Feb 20, 2007·Bulletin of the World Health Organization·David H PetersGilbert Burnham

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