Contracting Between Faith-Based Health Care Organizations and the Public Sector in Africa

Boulenger, D.; Barten, Francoise; Criel, Bart

doi:10.1080/15570274.2013.876730

Cited by 16 publications

(41 citation statements)

References 4 publications

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“…All this has created growing mistrust, moral hazard, and in some cases, the termination of SLAs. Such results confirm key findings from the international literature [6,12,13]. …”

Section: Discussionsupporting

confidence: 91%

“…In particular, billing prices for SLA services increased sharply to the extent that a bill from a single CHAM facility exceeded the total budget of the DHO. At first sight, the case studies suggest that contracting may prove more expensive than equivalent government provision [12]. Yet, on closer inspection, a complex picture emerges from the study and it is not easy to tell what an appropriate level of funding would be.…”

Section: Discussionmentioning

confidence: 99%

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Promoting universal financial protection: contracting faith-based health facilities to expand access – lessons learned from Malawi

Chirwa

Kazanga

Faedo

et al. 2013

Health Res Policy Sys

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BackgroundPublic-private collaborations are increasingly being utilized to universalize health care. In Malawi, the Ministry of Health contracts selected health facilities owned by the main faith-based provider, the Christian Health Association of Malawi (CHAM), to deliver care at no fee to the most vulnerable and underserved populations in the country through Service Level Agreements (SLAs). This study examined the features of SLAs and their effectiveness in expanding universal coverage. The study involved a policy analysis focusing on key stakeholders around SLAs as well as a case study approach to analyse how design and implementation of SLAs affect efficiency, equity and sustainability of services delivered by SLAs.MethodsThe study employed both qualitative and quantitative research methods to address the research questions and was conducted in five CHAM health facilities: Mulanje Mission, Holy Family, and Mtengowanthenga Hospitals, and Mabiri and Nkope Health Centres. National and district level decision makers were interviewed while providers and clients associated with the health facilities were surveyed on their experiences. A total of 155 clients from an expected 175 were recruited in the study.ResultsThe study findings revealed key aspects of how SLAs were operating, the extent to which their objectives were being attained and why. In general, the findings demonstrated that SLAs had the potential to improve health and universal health care coverage, particularly for the vulnerable and underserved populations. However, the findings show that the performance of SLAs in Malawi were affected by various factors including lack of clear guidelines, non-revised prices, late payment of bills, lack of transparency, poor communication, inadequate human and material resources, and lack of systems to monitor performance of SLAs, amongst others.ConclusionsThere was strong consensus and shared interest between the government and CHAM regarding SLAs. It was clear that free services provided by SLAs had a great impact on the impoverished locals that used the facilities. However, lack of supporting systems, inadequate infrastructure and shortage of health care providers affected SLA performance. The paper provides recommendations to policy makers for the replication and strengthening of SLA implementation in the roll-out of universalization policy.

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“…All this has created growing mistrust, moral hazard, and in some cases, the termination of SLAs. Such results confirm key findings from the international literature [6,12,13]. …”

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Promoting universal financial protection: contracting faith-based health facilities to expand access – lessons learned from Malawi

Chirwa

Kazanga

Faedo

et al. 2013

Health Res Policy Sys

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“…8,10 The main private health providers were religious organizations, traditional healers and birth attendants. [10][11][12] Following the winds of change in social, political and economic reforms, the role of the public sector in the development process have substantially changed in many countries. Its role now remained mainly that of a facilitator for the private sector-led economic development and growth.…”

Section: Introductionmentioning

confidence: 99%

“…1,8,13 One proposed approach to improve coverage and quality of health care for all citizens was to enter into contract with private organizations to deliver speci c services that are pre-de ned by health authorities. 1,2,10,14,15 Public Private Partnership in the Health and Social Welfare Sector can take a variety of forms with differing degrees of public and private sector responsibility and risk. They are characterized by the sharing of common objectives, as well as risks and rewards, as de ned in a contract or agreement.…”

Section: Introductionmentioning

confidence: 99%

“…They are characterized by the sharing of common objectives, as well as risks and rewards, as de ned in a contract or agreement. [10][11][12][16][17][18][19][20] The private health sector was deemed better to support the government in implementing different projects due to its e ciency, accountability, quality of service and wide coverage nature. 3,12 However, on various occasions there were reported weak collaboration, coordination and cooperation in health services delivery between public and non-government providers including FBOs and private service providers.…”

Section: Introductionmentioning

confidence: 99%

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Opportunities and Challenges of Implementing Service Agreement between the Government and Faith Based Organizations in Ilala Municipality, Dar Es Salaam, Tanzania

luoga

Frumence

2020

Preprint

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Background Access to essential health services is an important aspect of development. Due to the population increase and technological advancement, governments could no longer cater for the services needed. One of the solutions was to involve private sector through Public Private Partnerships (PPPs) in provision of the services. In 2007 Tanzania made a generic Service Agreement (SA) to govern PPPs in health sector. However, since its establishment, less is known on opportunities and challenges of implementing SA in the provision of health services in Tanzania. Therefore, the focus of this study was to assess the opportunities and challenges of implementing SA in Tanzania using a case of SA between the Cardinal Rugambwa Mission Hospital (CRMH) and the Ilala Municipality in Dar es Salaam. Methods The study employed a case study design using qualitative method of data collection. Data were collected by using in depth interview guide. Purposive sampling was used to select participants. The sample size was based on the principle of saturation level of the information collected. Data were analyzed using a thematic analysis approach. Results The opportunities of implementing SA in CRMH, Ilala Municipality include: the existence of guidelines and policies, Patients receive some health Services free of charges, availability of some services at reduced prices, presence of SA review meetings, good coordination, availability of supervision, training and mentorship opportunities, presence of political support, trust of the hospital by suppliers and trust between government and the hospital. The identified challenges in implementing SA include: - partial fulfillment of financial commitment, inadequacy deployment of HRH to CRMH by government, lack of transport for supervision and donor dependence. Conclusion There are a number of available opportunities for partnering between the private sector and the government in the delivery of health services. However, for the PPP to achieve its desired objective of improving access to health services particularly to most vulnerable population such as women and children, there is a need for the two parties (private and public) to address the identified challenges such as partial fulfillment of financial commitment and inadequacy deployment of HRH from the government to the private health facilities as per SA.

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Models of engagement between the state and the faith sector in sub-Saharan Africa – a systematic review

Whyle¹,

Olivier²

2017

Development in Practice

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Contracting Between Faith-Based Health Care Organizations and the Public Sector in Africa

Cited by 16 publications

References 4 publications

Promoting universal financial protection: contracting faith-based health facilities to expand access – lessons learned from Malawi

Promoting universal financial protection: contracting faith-based health facilities to expand access – lessons learned from Malawi

Opportunities and Challenges of Implementing Service Agreement between the Government and Faith Based Organizations in Ilala Municipality, Dar Es Salaam, Tanzania

Models of engagement between the state and the faith sector in sub-Saharan Africa – a systematic review

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