Government Contracting of Non-State Providers for Health Services: A Synthesis of Key Practices and Lessons

The project is a five-year USAID contract focusing on health systems priorities that most directly support achievement of TB outcomes, with a focus on health financing and governance in the USAID TB priority countries. HS4TB is led by Management Sciences for Health (MSH) in partnership with Open Development. The project helps countries increase domestic financing, use key TB resources more efficiently, build in-country technical and managerial competence and leadership, and support policy formation and dissemination. Key areas of focus include health financing, governance, and policy formation, with the goal of improving TB control and elimination outcomes. A synthesis of key practices and lessons from the HS4TB project has identified six areas of importance for establishing and sustaining government contracting to non-state providers. These areas include political will and advocacy, legal and regulatory environment, governance structures and processes, financing and budget, evaluation, learning, and adapting, and development partners and their roles. Political will and advocacy are critical for establishing and sustaining government contracting to non-state providers. This includes the impetus for contracting, the importance of the government's will to contract to non-state partners, and advocacy efforts to garner acceptance by stakeholders to spend public funds to hire non-state partners. The legal and regulatory environment also plays a crucial role, including identification of barriers to contracting and how they were overcome. Governance structures and processes are essential for effective contracting, including the part of the government and level of the health system at which various decisions and functions of contracting take place, the mechanisms for allocating roles and responsibilities, and the process to build capacity for contracting. Financing and budget are also critical, including sources of funding, linkages to budget cycles, the guidance followed if using domestic funds, provider payment systems, and issues with payments. Evaluation, learning, and adapting are essential for the contracting process, including practices used to assess contracting processes and the use of evaluation results to inform future contracting decisions. Development partners and their roles also play a crucial role, including their involvement in the contracting process and their support for capacity building and technical assistance. The HS4TB project has identified several key lessons and common factors in establishing and sustaining government contracting to non-state providers. These include the importance of political will and advocacy, the need for a supportive legal and regulatory environment, the importance of effective governance structures and processes, and the need for adequate financing and budget. The project has also highlighted the importance of evaluation, learning, and adapting, and the role of development partners in supporting capacity building and technical assistance.