Successful Contracting of Prevention Services: Fighting Malnutrition in Senegal and Madagascar

Abstract

There are very few documented large-scale successes in nutrition in Africa, and virtually no consideration of contracting for preventive services. This paper describes two successful large-scale community nutrition projects in Africa as examples of what can be done in prevention using the contracting approach in rural as well as urban areas. The two case-studies are the Secaline project in Madagascar, and the Community Nutrition Project in Senegal. The article explains what is meant by 'success' in the context of these two projects, how these results were achieved, and how certain bottlenecks were avoided. Both projects are very similar in the type of service they provide, and in combining private administration with public finance. The article illustrates that contracting out is a feasible option to be seriously considered for organizing certain prevention programmes on a large scale. There are strong indications from these projects of success in terms of reducing malnutrition, replicability and scale, and community involvement. When choosing that option, a government can tap available private local human resources through contracting out, rather than delivering those services by the public sector. However, as was done in both projects studied, consideration needs to be given to using a contract management unit for execution and monitoring, which costs 13-17% of the total project's budget. Rigorous assessments of the cost-effectiveness of contracted services are not available, but improved health outcomes, targeting of the poor, and basic cost data suggest that the programmes may well be relatively cost-effective. Although the contracting approach is not presented as the panacea to solve the malnutrition problem faced by Africa, it can certainly provide an alternative in many countries to increase coverage and quality of services.

The effects of scale on the costs of targeted HIV prevention interventions among female and male sex workers, men who have sex with men and transgenders in India

“…These transaction costs inherent in the contracting out and subsequent management are rarely reported. One study of a large-scale nutrition programmes in Madagascar and Senegal found contracting costs to be between 13% and 17% of total costs 28. Similarly, Guinness (2006) estimated that the costs incurred by the State AIDS Control Societies and other state-level agencies responsible for management of NGO contracts in the delivery of HIV prevention services in India were between 11% and 17% of total costs 29.…”

Malnutrition and health in developing countries

“…6,[68][69][70] As much as functional health services may need to be made available, in order to address infectious diseases as a cause of protein-energy malnutrition it is likewise important to promote breast-feeding, improve the water supply and sanitation, and educate people about hygiene. 7,15,[71][72][73][74] The multifaceted horizontal approach of the WHO-supported Integrated Management of Childhood Illness initiative has recently been shown to be an effective strategy.…”

Engaging the private sector in malaria surveillance: a review of strategies and recommendations for elimination settings

“…However, there is limited evidence on the effectiveness of contracting for malaria services. Contracting of health services to NGOs in Senegal and Madagascar increased coverage of nutritional services and decreased malnutrition rates, notably in areas where public care was less available [97, 115, 116]. In Cambodia, contracting replaced existing public services and resulted in improved access by the poor and lower rates of childhood diarrhea [117].…”