The use of private-strongsectorstrong contracts for strongprimarystrong health care.pdfVIP

The use of private-sector contracts for primary health care: theory, evidence and lessons for low-income and middle-income countries Natasha Palmer1 Contracts for the delivery of public services are promoted as a means of harnessing the resources of the private sector and making publicly funded services more accountable, transparent and efficient. This is also argued for health reforms in many low- and middle-income countries, where reform packages often promote the use of contracts despite the comparatively weaker capacity of markets and governments to manage them. This review highlights theories and evidence relating to contracts for primary health care services and examines their implications for contractual relationships in low- and middle-income countries. Keywords: primary health care; contract services; private sector; review literature; developing countries; United Kingdom. Voir page 826 le re´ sume´ en franc¸ais. En la pa´ gina 827 figura un resumen en espan˜ ol. Introduction theory and practice highlight likely challenges in attempting to introduce a policy of competitive Selective contracting out of services to the private contracting in the context of low- and middle-income sector is often a component of reform packages countries. The implications of this for a policy of promoted by bilateral and multilateral agencies for contracting out in such countries are then discussed. low- and middle-income countries ( 1–6), where the Primary care has been chosen as the focus of private sector is increasingly acknowledged as an this review for several reasons. First, there is an important and often well-resourced provider of inescapable trend in low- and middle-inco