当前位置： SCI文献检索 > International Journal for Equity in Health期刊下所有文献 > Factors influencing performance by contracted non-state providers implementing a basic package of health services in Afghanistan.

Factors influencing performance by contracted non-state providers implementing a basic package of health services in Afghanistan.

Abstract：

BACKGROUND:In 2002 Afghanistan's Ministry of Public Health (MoPH) and its development partners initiated a new paradigm for the health sector by electing to Contract-Out (CO) the Basic Package of Health Services (BPHS) to non-state providers (NSPs). This model is generally regarded as successful, but literature is scarce that examines the motivations underlying implementation and factors influencing program success. This paper uses relevant theories and qualitative data to describe how and why contracting out delivery of primary health care services to NSPs has been effective. The main aim of this study was to assess the contextual, institutional, and contractual factors that influenced the performance of NSPs delivering the BPHS in Afghanistan. METHODS:The qualitative study design involved individual in-depth interviews and focus group discussions conducted in six provinces of Afghanistan, as well as a desk review. The framework for assessing key factors of the contracting mechanism proposed by Liu et al. was utilized in the design, data collection and data analysis. RESULTS:While some contextual factors facilitated the CO (e.g. MoPH leadership, NSP innovation and community participation), harsh geography, political interference and insecurity in some provinces had negative effects. Contractual factors, such as effective input and output management, guided health service delivery. Institutional factors were important; management capacity of contracted NSPs affects their ability to deliver outcomes. Effective human resources and pharmaceutical management were notable elements that contributed to the successful delivery of the BPHS. The contextual, contractual and institutional factors interacted with each other. CONCLUSION:Three sets of factors influenced the implementation of the BPHS: contextual, contractual and institutional. The MoPH should consider all of these factors when contracting out the BPHS and other functions to NSPs. Other fragile states and countries emerging from a period of conflict could learn from Afghanistan's example in contracting out primary health care services, keeping in mind that generic or universal contracting policies might not work in all geographical areas within a country or between countries.

journal_name

Int J Equity Health

journal_title

International journal for equity in health

authors

Salehi AS,Saljuqi ATK,Akseer N,Rao K,Coe K

doi

10.1186/s12939-018-0847-4

subject

Has Abstract

pub_date

2018-10-05 00:00:00

pages

128

issue

issn

1475-9276

pii

10.1186/s12939-018-0847-4

journal_volume

pub_type

杂志文章

在线工具

Factors influencing performance by contracted non-state providers implementing a basic package of health services in Afghanistan.