Publication: Contracting-In Management to Strengthen Publicly Financed Primary Health Services--The Experience of Punjab, Pakistan
No Thumbnail Available
Published
2009
ISSN
0168-8510
Date
2012-03-30
Author(s)
Editor(s)
Abstract
OBJECTIVES: In response to low utilization of primary health services in rural areas, the Government of Punjab contracted with a local non-governmental organization (NGO) to manage the basic health units in one district. METHODS: To evaluate the performance of the contractor, health facility surveys, household surveys, and routinely collected information were used to compare the experimental district (Rahim Yar Khan, RYK) with a contiguous and equally poor district (Bahawalpur, BWP). RESULTS: The evaluation found that contracting led to more than a 50% increase in out-patient visits in RYK compared to BWP. There was also increased satisfaction of the community with health services. Technical quality of care was equally poor in both districts and contracting also had little effect on the coverage of preventive services. The latter was likely the result of the NGO not being given managerial responsibility over vaccinators and other community health workers. CONCLUSIONS: Despite methodological limitations, this study found that contracting in management achieved important goals at the same cost to the Government, implying a large increase in efficiency. Contracting in management worked reasonably well in this context and has now been significantly expanded. The approach provides a plausible means for large-scale improvements of poorly performing primary health care systems.
Link to Data Set
Digital Object Identifier
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Nepal : The Distributional Impact of Participatory Approaches on Reproductive Health for Disadvantaged Youth(World Bank, Washington, DC, 2005-05)This paper presents findings from a community-based study testing the effectiveness of participatory approaches in improving services and outcomes for youth reproductive health in Nepal. The study was motivated by the desire to test the impact of participatory approaches in improving youth reproductive health. Nepal was chosen because it is a country where youth reproductive health needs are especially acute and little is being done to meet them. In this study, the authors test whether many of the key principles advocated by development practitioners for making services work for poor people can be effectively operationalized through small, community-based programmatic interventions. In particular, the study seeks to establish whether participatory intervention programs can increase empowerment of poor and disadvantaged populations and accountability to them.Publication Strengthening Monitoring and Evaluation of HIV/AIDS Components in Road Projects(World Bank, 2009-05-19)This report aims to strengthen the monitoring and evaluation (M&E) aspects of HIV/AIDS components in road projects. Result-based M&E helps decision makers assess whether and how goals are being achieved over time, while at the same time identify problems that need to be tackled. The report assesses the extent of M&E in current HIV/AIDS components in the portfolio of road projects financed by the World Bank. It provides an overview of work to date to identify core indicators for measuring results of HIV and AIDS prevention, specifically focusing on the monitoring of results of transport related activities, proposing a menu of HIV and AIDS indicators and a sample results framework.Publication Demand-side Financing for Sexual and Reproductive Health Services in Low and Middle-Income Countries : A Review of the Evidence(World Bank, Washington, DC, 2012-10)Demand-side financing approaches have been introduced in a number of low and middle-income countries, with a particular emphasis on sexual and reproductive health. This paper aims to bring together the global evidence on demand-side financing mechanisms, their impact on the delivery of sexual and reproductive health services, and the conditions under which they have been effective. The paper begins with a discussion of modalities for demand-side financing. It then examines 13 existing schemes, including cash incentives, vouchers, and longer term social protection policies. Based on the available literature, it collates evidence of their impact on utilization of services, access for the poor, financial protection, quality of care, and health outcomes. Evidence on costs and cost-effectiveness are examined, along with analysis of funding and sustainability of policies. Finally, the paper discusses the preconditions for effectiveness of demand-side financing schemes and the strengths and weaknesses of different approaches. It also highlights the extent to which results for sexual and reproductive health services are likely to be generalizable to other types of health care. It is clear that some of these policies can produce impressive results, if the preconditions for effectiveness outlined are met. However, relatively few demand-side financing schemes have benefited from robust evaluation. Investigation of the impact on financial protection, equity, and health outcomes has been limited. Most importantly, cost effectiveness and the relative cost effectiveness of demand-side financing in relation to other strategies for achieving similar goals have not been assessed.Publication Rapid Youth Assessment in Port Moresby, Papua New Guinea(World Bank, Washington, DC, 2008-09-04)The objective of this rapid assessment is to inform the design of an Urban Youth Empowerment Project by providing information on youth and youth serving initiatives. Terms of reference crime and violence in Port Moresby and the National Capital District (NCD) are widespread and costly. In 2004, 68 percent of households reported that they had been victims of crime at least once in the past year and 51 percent had been victims of multiple crimes. Violence against women is pervasive, with domestic violence and rape, including gang rape, routine. By 2005, there had been small decreases in reported victimization; however, 61 percent of households still reported being victims of at least one crime and 46 percent reported being victims of multiple crimes. At the same time, costs associated with security and theft amounted to an estimated 15 percent of business turnover and law and order problems serve as a deterrent to investment. Young people account for the greatest share of crime and violence, so tackling the problem means addressing the underlying causes of youth crime and violence. This report provides a rapid assessment of youth and youth serving institutions in Port Moresby. The report relies on extensive consultations held in Port Moresby from July 23, 2008. Meetings were held with over 100 young people, their parents, community leaders, government officials, researchers, youth workers, leaders of youth groups and youth serving agencies, and representatives of the international non-governmental and donor agencies.Publication Addressing Adolescent Sexual and Reproductive Health in Niger(World Bank, Washington, DC, 2016-01)The aim of the study is to better understand adolescents’ sexual and reproductive health (SRH) needs in order to inform the design of interventions and policies that improve access to and use of adolescent SRH services in Niger. A mixed-methods study was conducted and included: (i) a quantitative analysis of Niger’s Demographic Health Survey/Multiple Indicator Cluster Survey (DHS/MICS) 2012; (ii) 17 focus group discussions conducted in urban and rural areas among 128 adolescents; and (iii) a set of recommendations to improve access to and use of SRH services for adolescents in the country. The study found that age at first marriage among adolescent females is 15.7 years and is followed soon thereafter by sexual debut (15.9 years). According to focus group discussions (FGDs), adolescent’s boys and girls start spending time together at 12 years in urban areas and 10 years in rural areas; this may lead to sexual intercourse in exchange for material and financial resources. Over 70 percent of adolescents have given birth by 18 years of age. Although knowledge about modern contraception is high (73 percent among female adolescents 15-19 years of age), the majority of adolescent girls do not use contraception due to societal and cultural beliefs. Moreover, FGDs reveal that the main barriers to use of SRH services is a lack of privacy and confidentiality, as well as finances, despite the government’s elimination of user fees. The government has increased supply side interventions for adolescents and prioritized adolescents on the national agenda by approving the Family Planning Action Plan (2012-2020) and the National Plan for Adolescent Sexual and Reproductive Health (2011), however these plans need to be monitored and evaluated to determine their effectiveness in reaching this population group. There is also a need to increase multi-sectoral demand-side interventions in the country.
Users also downloaded
Showing related downloaded files
No results found.