Department of International Health, Johns Hopkins University, Suite E-8148 315 N. Wolfe Street, Baltimore, MD, 21215, USA.
International Development Research Centre, Ottawa, Canada.
Int J Equity Health. 2018 Oct 5;17(1):127. doi: 10.1186/s12939-018-0846-5.
Formal engagement with non-state providers (NSP) is an important strategy in many low-and-middle-income countries for extending coverage of publicly financed health services. The series of country studies reviewed in this paper - from Afghanistan, Bangladesh, Bosnia & Herzegovina, Ghana, South Africa, Tanzania and Uganda - provide a unique opportunity to understand the dynamics of NSP engagement in different contexts.
A standard template was developed and used to summarize the main findings from the country studies. The summaries were then organized according to emergent themes and a narrative built around these themes.
Governments contracted NSPs for a variety of reasons - limited public sector capacity, inability of public sector services to reach certain populations or geographic areas, and the widespread presence of NSPs in the health sector. Underlying these reasons was a recognition that purchasing services from NSPs was necessary to increase coverage of health services. Yet, institutional NSPs faced many service delivery challenges. Like the public sector, institutional NSPs faced challenges in recruiting and retaining health workers, and ensuring service quality. Properly managing relationships between all actors involved was critical to contracting success and the role of NSPs as strategic partners in achieving national health goals. Further, the relationship between the central and lower administrative levels in contract management, as well as government stewardship capacity for monitoring contractual performance were vital for NSP performance.
For countries with a sizeable NSP sector, making full use of the available human and other resources by contracting NSPs and appropriately managing them, offers an important way for expanding coverage of publicly financed health services and moving towards universal health coverage.
在许多中低收入国家，与非国家提供者（NSP）正式合作是扩大公共筹资卫生服务覆盖范围的重要策略。本文回顾的一系列国家研究 - 来自阿富汗、孟加拉国、波斯尼亚和黑塞哥维那、加纳、南非、坦桑尼亚和乌干达 - 为了解不同背景下 NSP 参与的动态提供了独特的机会。
制定并使用了一个标准模板来总结国家研究的主要发现。然后根据出现的主题对摘要进行组织，并围绕这些主题构建叙述。
政府出于多种原因与 NSP 签订合同 - 公共部门能力有限、公共部门服务无法覆盖某些人群或地理区域、以及 NSP 在卫生部门的广泛存在。这些原因的背后是认识到从 NSP 购买服务对于增加卫生服务覆盖范围是必要的。然而，机构 NSP 面临许多服务提供挑战。与公共部门一样，机构 NSP 在招聘和留住卫生工作者以及确保服务质量方面面临挑战。妥善管理所有相关方之间的关系对于合同成功和 NSP 作为实现国家卫生目标的战略伙伴的作用至关重要。此外，在合同管理中中央和较低行政级别之间的关系以及政府监督合同绩效的能力对于 NSP 的绩效至关重要。
对于拥有相当规模的 NSP 部门的国家来说，通过与 NSP 签订合同并妥善管理它们，充分利用现有人力和其他资源，为扩大公共筹资卫生服务的覆盖范围并迈向全民健康覆盖提供了重要途径。
