Assessing TB Contracting Prospects in Nascent Health Service Contracting Environments: A Guide Informed by Implementation Lessons from an Assessment in Kenya

The project focuses on health systems priorities that most directly support achievement of TB outcomes, with a focus on health financing and governance in USAID TB priority countries. The National Tuberculosis, Leprosy and Lung Disease Program's (NTLD-P) assessment of TB contracting prospects in Kenya's nascent health service contracting environment was conducted in 2023. The assessment aimed to generate information required to develop a costed TB service contracting action plan and a TB service contracting capacity building plan. The purpose of this document is to draw from NTLD-P's experiences in assessing the country's health service contracting landscape to provide guidance to other low- and middle-income countries. The document outlines a six-step approach to assessing TB service contracting prospects, starting with selecting appropriate assessment objectives. The six objectives are: assessing the legal, regulatory, and political environment for contracting; uncovering issues with existing legal and regulatory tools; revealing implementation challenges faced by purchasers and contractors; establishing government institutions' capacity to contract TB services; understanding the capacity of contractors to implement such contracts; and evaluating donor-managed TB service contract implementers' interest in engaging in government-managed TB service contracting. The document also emphasizes the importance of reviewing procurement laws, standard tender documents, and other relevant texts to identify legal and regulatory provisions that are either prohibitive, potentially or partially prohibitive, or enabling to government-managed TB service contracting. The assessment team should classify these provisions to determine which ones need to be revised or addressed through sensitization and capacity building. The HS4TB project is funded by the USAID and aims to increase domestic financing, use key TB resources more efficiently, build in-country technical and managerial competence and leadership, and support policy formation and dissemination. The project is led by Management Sciences for Health (MSH) in partnership with Nathan Associates and Open Development. The document provides guidance to low- and middle-income countries on how to assess their health service contracting landscape and develop a costed TB service contracting action plan and a TB service contracting capacity building plan. The guidance is intended for health financing and health systems generalists familiar with broad contracting concepts and basic research methods. The assessment of TB contracting prospects in Kenya's nascent health service contracting environment has provided valuable lessons that can be applied to other countries. The document highlights the importance of understanding the legal, regulatory, and political environment for contracting, as well as the capacity of government institutions and contractors to implement such contracts. The document also emphasizes the need to evaluate donor-managed TB service contract implementers' interest in engaging in government-managed TB service contracting. The HS4TB project has provided technical assistance to the National Tuberculosis, Leprosy and Lung Disease Program (NTLD-P) in Kenya, and the document is a result of this collaboration. The project aims to support the development of a costed TB service contracting action plan and a TB service contracting capacity building plan, which will help to improve the quality, efficiency, and accessibility of TB services in Kenya. The document provides a framework for assessing TB service contracting prospects in low- and middle-income countries, and it highlights the importance of understanding the legal, regulatory, and political environment for contracting, as well as the capacity of government institutions and contractors to implement such contracts. The document also emphasizes the need to evaluate donor-managed TB service contract implementers' interest in engaging in government-managed TB service contracting.