Post-Contracting Assessment Report

The project aims to transform the way country leaders and health system managers understand and work toward TB control and elimination. HS4TB is led by Management Sciences for Health (MSH) in partnership with Nathan Associates and 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. HS4TB is working in five states to support the National Tuberculosis Elimination Program (NTEP) in increasing capacity and efficient use of tools throughout the entire contract management cycle. The NTEP has set an ambitious goal of tuberculosis elimination by 2025. To achieve this target, it is imperative that the NTEP leverage the inputs of diverse organizations, including via the use of contracting. However, delays in contracting and in making payments for services delivered lead to poor contract performance, including disruptions in service delivery. Contract management issues may also lead to reduced interest of the private sector to participate in such contracts. HS4TB conducted an assessment of the invoice submission and payments processes to better understand the reasons behind the invoice and payment delays and to recommend potential solutions to relieve bottlenecks. A four-step approach was used for the assessment: 1) identifying relevant contract information to be used in the analysis, 2) mapping the post-contracting cycle to identify all activities or tasks related to invoicing and payments, 3) collecting data on invoice and payment dates and conducting key informant interviews to identify bottlenecks in the payment cycle, and 4) performing a root cause analysis using responses from key informant interviews and discussions with HS4TB's Project and Innovation Units in five states. Findings showed that the turn-around time (TAT) for payments, based on invoices included in baseline data (July 1, 2021-November 1, 2022), was as high as 296 days with a median of 63 days. Delays in the payment cycle were related to delays in invoice submission, delays in the verification and validation process, and delays in release of payment after administrative approvals. There was large variation across Patient Provider Support Agencies (PPSAs) in the timeliness of invoice submission and across and within states in the time needed to process claims. Recommendations to reduce TAT include improving communication across relevant parties in the process, standardizing memoranda of understanding (MOUs) with clear information on invoicing dates and payment timelines, and introducing improved invoicing, verification and validation tools, and trackers. These interventions should be discussed in the public-private knowledge sharing platforms—the partnerships and learning collaboratives—that are currently being established. Other solutions will vary from PPSA to PPSA and state to state and include capacity building of all contracting parties, improving documentation, granting more authority to local representatives, and adhering to agreed-upon invoice verification and validation processes for payment.