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Contracting for Reproductive Health Services

Government contracting of private organizations is an increasingly common tool to meet the growing demand for quality reproductive health care in developing nations. Contracting is not a cure-all for ailing health systems, and there exists relatively little systematic evaluation of the contracting experience in developing countries. Still, many in the field recognize the potential of contracting as a powerful tool to improve reproductive health care.

The Contracting for Reproductive Health Care: A Guide was developed to bring together information about contracting experiences in a way to serve the practical needs of World Bank staff and their government counterparts in developing countries interested in trying contracting.  This guide touches on some of the reasons why governemnts contract out services. However, for a more in-depth look at the pros and cons of contracting the reader should also consult publications such as Mills and Broomberg, 1998 and the World Bank Private Sector Participation in Health Handbook, among others.

The RH contracting guide is intended primarily for use by Bank operations staff, especially task teams for Bank-funded projects that include a reproductive health component. It also can be used by government officials or others interested in pursuing contracting as an option for provision of reproductive health care.

The guide is meant to be used during the development of new projects or during the supervision phase, and assumes that the reader:

  • has identified population and reproductive health as an issue for the health sector in a particular country or region;
  • already has decided to include a reproductive health component in the loan and wants to involve the private sector actively in the project;
  • is considering opportunities for contracting out of reproductive health care; or
  • is looking for ideas and models for contracting.

The guide contains the following sections:

Contracting Basics briefly reviews some of the fundamental concepts of contracting for health care.

The Review of Experiences uses concrete examples to illustrate how contracting principles have been applied to reproductive health care.

The Contracting Checklist contains questions intended to guide the reader through some of the "nuts and bolts" of the contracting process.

Case Examples describe three recent experiences in contracting for reproductive health.

The Suggested Readings summarize key reference materials.

Web-based Resources inventories web sites where the reader can go for more information on contracting.

The Contracting Network provides contact information for individuals with interest or experience in contracting for reproductive health care and willing to serve as a resource for the reader seeking more detailed information.

The Contracting Examples summarizes examples discussed in the Review of Experiences section of the guide.

The Glossary defines some key contracting and reproductive health terms.

Contracting Documents provides a selection of contract-related documents in English, French, and Spanish.

The guide is a first step in a more comprehensive look at the range of contracting issues. It aims to point the reader towards more in-depth sources of knowledge and other resources and products being produced by the World Bank and other organizations.  Governments are continually trying new contracting approaches, evaluation of these experiences is improving, the circle of government, donor, and private sector officials knowledgeable about contracting is growing wider, and, as a result, our knowledge of contracting is expanding rapidly. Future versions of this guide will attempt to maintain pace with these new experiences.

Contracting for Reproductive Health Care: A Guide

Documents embedded into the Guide:

Description of types of services to be contracted:

Scope of work for partnership area activities, Bangladesh urban Primary Health Care Project

Scope of work for contracting under the Contracting Health Services Pilot Project, Cambodia


Bidding Documents

Letter of invitation, Bangladesh Urban PHC Project

Instructions to Bidders, Bangladesh Urban PHC Project

Special procedures and TORs for Contracting NGO Health Services by MOH of El Salvador

Evaluation criteria for technical proposals for administration and management of health services under the contracting health services pilot project, Cambodia


Other Examples of Contract Specifications

TOR for partnership agreement, Bangladesh Urban PHC Project

Sample contract agreement, Bangladesh Urban PHC Project

Sample partnership agreement, from the MSH Manager 1998/99

Agreements between 3 provincial health departments in the Dominican Republic and 3 NGOs (Spanish)

Agreement between the MOH of the Dominican Republic and the NGO PROFAMILIA (Spanish)

Health services contract between the Department of Antioquia, Colombia and the NGO PROFAMILIA (Spanish)

Operations Guide for partnerships between the Government of Senegal and NGOs (French)

Model agreement between the MOH of Senegal and NGOs (French)

Contract between the MOH of El Salvador and the MGO CALMA, (Spanish)

Partnership agreement between the MOH of Peru and the NGO PRISMA for the distribution of contraceptives (Spanish)

TOR for contracting of PHC services in Cambodia


Examples of Institutional Arrangements for Managing Contracts

Procedures for resolving project implementation issues, Bangladesh Urban PHC Project

Contract forms: request for payment, quarterly financial report, program progress report, monitoring report

TOR for NGO management and follow-up unit of the Sector Investment Program

TOR for “Mother NGOs”; national, medium, and small sized NGOs participating in RCH program of the MOHFW of India

Procedures for resolving project implementation issues, Contracting Health Services Pilot Project, Cambodia

Monitoring of contractors under the Contracting Health Services Pilot Project, Cambodia


Evaluation and Monitoring

Performance evaluation and indicators for evaluation of performance, Bangladesh Urban PHC Project

Evaluation of contractors under the Contracting Health Services Pilot Project, Cambodia

Other Resources:

From Competition to Cooperation: Service Agreements in Primary Care - A Handbook for Professionals and Managers, Rod Sheaff and Andrew Lloyd

Community-Based Contracting: A Review of Stakeholder Experience, Samantha de Silva

Franchising in Health: Emerging Models, Experiences, and Challenges in Primary Care, Jeff Ruster, Chiaki Yamamoto, Khama Rogo

Private Health: Policy and Regulatory Options for Private Participation, Tonia Marek, Chiaki Yamamoto, Jeff Ruster

Contracting for the Delivery of Primary Health Care in Cambodia: Design and Initial Experience of a Large Pilot Test, Benjamin Loevinsohn

Accreditation of Providers for the National Health Insurance Fund of Tanzania, Catherine P. Conn and Veronica Walford

Development and Implementation of Prepayment Schemes in Rwanda, Pia Schneider

The Indonesian Private Health Sector: Opportunities for Reform, An Analysis of Obstacles and Constraints to Growth, James R. Marzolf

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