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Community Contribution

Introducing a learning collaborative on how to establish government-led contracting for TB- and other health-related services

Apr 16, 2024
William Wells (USAID), Jacob Hughes, Denise Silfverberg, Sara Wilhelmsen (MSH), James Soki, Rahul S Reddy Kadarpeta (Amref)

Sustainable Financing of Health Services with Contracting

Accelerating progress towards the health-related Sustainable Development Goals (SDGs) requires concerted efforts by all health systems stakeholders. Country governments anchor these efforts, playing a stewardship role, but as part of this stewardship they need to explore ways of leveraging non-state actors to increase health system efficiency, effectiveness and accountability. In the context of declining donor funding for many of these non-state actors, identifying government-led sustainable health financing solutions becomes all the more important. 

Government-led contracting for health services is where the government contracts with nongovernmental organizations (NGOs)/civil society organizations and the for-profit private sector using the country’s own procurement system and domestic funds. This mechanism allows the use of complementary skill sets from the public and private sectors and can support optimization of available resources, especially in mixed health systems in low- and middle-income countries where health systems can be under-resourced or fragmented. 

However, governments in some low- and low-middle income countries are focused almost exclusively on direct implementation of health activities by public sector staffing. For such countries, contracting is a new way of conceptualizing the role of government in health sector stewardship, and understanding these possibilities is challenging without exposure to other health systems that are already implementing such approaches. 

In addition, governments (and other key stakeholders) that are considering contracting often do not have a complete understanding of the essential legal, regulatory, policy and procedural requirements. Decision makers may be unaware of lessons learned elsewhere, and of contracting tools already developed by other countries. This can lead to lost time and unnecessary expenditure of effort and resources, and can be a deterrent to moving forward with contracting.

Practical Learning to Establish Contracting

On the heels of World TB Day, the Joint Learning Network (JLN) is partnering with USAID’s Health Systems for TB (HS4TB) project to offer a Collaborative on Contracting Organizations for Health-Related Services for practical learning on this topic. HS4TB’s analysis of available literature found abundant guidance on ongoing implementation of health contracting, but little available consideration on the qualitative aspects of establishing contracting such as the decision-making, obstacles, opportunities, and processes. 

This finding provides the rationale for focusing the collaborative on the early stages of contracting: navigating the political, legal and regulatory barriers in order to make concrete steps towards establishing contracting for TB- and other health-related services; and the initial establishment of systems to manage the contract management cycle. The offering will be conducted with TB as an example, although the knowledge and tools it produces would be applicable and valuable to any health system leader interested in sustainable health financing options within mixed health systems. 

Strong political will is necessary for sustainable health contracting in any country. In Bangladesh, the National TB Program and the Health Economics Unit of the Ministry of Health and Family Welfare worked together to outline the potential benefits of health services contracting to key stakeholders in the country through meetings and workshops, resulting in a remarkable change in attitudes. This engagement resulted in the inclusion of contracting for TB services in critical policy documents and helped secure a budget for TB contracting in the National TB Program’s Operational Plan.

This HS4TB-JLN collaborative will enable participants to share country experiences on what is needed to initiate the country conversation on health contracting, why challenges and constraints to contracting exist and how to overcome them, and how systems and capacities can be introduced and optimized for the implementation of TB- and health-related contracting. Countries participating in the collaborative will benefit from peer-to-peer learning exchange and sharing of country experiences, which can be used for inspiration as they tackle their own unique contracting challenges. 

Please form a country team and join in this joint learning journey by submitting your EOI by April 22 (deadline may be extended depending on the number of submissions).

About the authors

William Wells is a senior TB technical advisor, USAID;  Jacob Hughes a technical advisor at MSH, Denise Silfverberg is a technical strategy lead at MSH and Sara Wilhelmsen, is a portfolio manager at MSH  while James Soki, is program manager at JLN and Rahul S Reddy Kadarpeta is the executive director, JLN.