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The role of contracting in improving health systems performance

The role of contracting in improving health systems performance

The first part of this document describes recent trends in health services organization, more particularly in the developing countries, together with the gradual emergence of contracting as one of the tools available for improving the organization of health system. The second part of the document focuses on the diversity of the situations to which contracting may apply and on the opportunities offered to countries, bearing in mind that the possible choices must above all be based on an analysis of national situations. The third part stresses the risk of uncontrolled development of ad hoc contractual arrangements and examines the need to resort to contractual policies that provide a reference frame for each contractual arrangement, thus making possible a health systems approach. Part four examines the role of the State, and more particularly of the Ministry of Health as the guardian of peoples' welfare; contracting means that the State acts and intervenes in a wholly innovative manner. Lastly, part five highlights a number of lessons to be drawn from the experiments currently under way in both the developed and the developing countries.

Discussion paper by Jean Perrot, WHO, Geneva 2004

Available as PDF in English and French

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