NGO Performance-Based Contracting
Country of Operation
- Afghan Ministry of Public HealthGovernment
SummaryMinistry of Public Health and its development partners established a formalized contracting program that works with nongovernmental organizations to deliver a basic package of health services.
Key program components
The ministry and donors agreed on the specific provinces to facilitate coordination and established a special grants and contracts management unit to independently manage the contracting process and channel donor funds. The nongovernmental organizations enter into performance-based agreements with the Ministry of Health or donors after being recruited based on availability of personnel and adequate facilities, quality of patient-provider interaction, staff knowledge, and patient satisfaction. Nongovernmental organizations are expected to provide a mix of preventive and promotive services for a nominal fee. The Ministry of Health retains responsibility for program planning and monitoring, while UN agencies provide substantial material support and technical assistance. Key program components include: * Basic package of health services. The basic package of health services was developed in 2003 with the assistance of the World Health Organization and includes the services likely to have the most impact on the population and to be cost effective and equitable (deliverable to urban and rural areas equally). They include: maternal and newborn health, child health and immunization, public nutrition, communicable diseases, mental health, disability, and supply of essential drugs. The package will be expanded in 2009 to cover additional services, including community care for the disabled and mental health. * Performance-based contracts. Performance-based partnership agreements were designed based on Cambodia’s experience. The agreements operate in 34 provinces, with the World Bank supporting 8 of them, the European Union supporting 10, the U.S. Agency for International Development supporting 14, and other donors supporting 2. Providers are expected to cover a defined population and provide specified services. Nongovernmental organizations using the facilities of the public health ministry are free to recruit staff from within or outside the country. * Monitoring and evaluation. Progress reports and site visits are part of all contracts. A third-party (Johns Hopkins University and the Indian Institute of Health Management Research) has been hired to undertake household surveys, inspect facilities, and conduct interviews using a balanced scorecard that rates facilities on a scale of 0 to 100. The assessment has been carried out annually since 2004, with more than 600 facilities sampled each year. The report of the third round of sampling (2006) found that in most provinces, the health system had improved between 2004 and 2006, including increased availability of services and products.