Health Sector Support Project

The success of nongovernment organization (NGO) contracting of health services under the project provided the foundation for Ministry of Health's (MOH) introduction of new contracting arrangements (internal contracting) based on the government's Policy on Public Service Delivery (2006) and adoption of MOH's procedures and guidelines on contracting arrangements. Many innovative features first developed under NGO contracting have been, or are in the process of being, adopted for internal contracting, including performance incentive schemes, monitoring indicators, monitoring and evaluation (M&E) approaches and tools, and supervision arrangements. The internal contracting arrangements include performance agreements between MOH and provincial health departments (PHDs), and service delivery contracts between PHDs and operational districts or referral hospitals; and are drawn directly from the NGO contracting implemented under the project. The success of NGO contracting has thus proved to MOH that internal contracting is feasible, cost- effective, and equitable; and can materially increase the extension of health benefits to the poor.