Snell-Rood Claire, Jaramillo Elise, Gunderson Lara, Hagadone Sarah, Fettes Danielle, Aarons Gregory, Willging Cathleen
University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA 94720 USA.
Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106 USA.
Crit Public Health. 2022;32(3):283-294. doi: 10.1080/09581596.2020.1834075. Epub 2020 Oct 16.
Funders increasingly encourage social and health service organizations to strengthen their impact on public health through the implementation of evidence-based interventions (EBIs). Local governments in the U.S. often utilize market-based contracting to facilitate EBI delivery via formal relationships with non-governmental community-based organizations (CBOs). We sought to understand how the discourses embedded within contracting to compete and perform influence how CBOs represent and accomplish their work. We draw on qualitative interviews conducted with government administrators (N=16) overseeing contracts for one child welfare EBI, SafeCare and the leaders (N=25) of organizations contracted to implement this program. Participants endorsed competition, capacity, and collaboration as ideals within marketized contracting. Yet they expressed doubt about marketplace meritocracy and described the costs incurred in building the necessary organizational infrastructure to deliver EBIs and compete for contracts. We discuss the implications of marketized EBI contracting for CBOs and the limitations it poses for evidence-based public health, especially in socially marginalized communities.
资助者越来越鼓励社会和卫生服务组织通过实施循证干预措施(EBI)来增强其对公共卫生的影响。美国地方政府经常利用基于市场的合同承包方式,通过与非政府社区组织(CBO)建立正式关系来促进EBI的提供。我们试图了解合同承包中隐含的竞争和绩效话语如何影响CBO对其工作的呈现和完成方式。我们借鉴了对监督一项儿童福利EBI(SafeCare)合同的政府管理人员(N = 16)以及受雇实施该项目的组织领导人(N = 25)进行的定性访谈。参与者认可竞争、能力和合作是市场化合同承包中的理想要素。然而,他们对市场精英制度表示怀疑,并描述了为提供EBI和竞争合同而建立必要组织基础设施所产生的成本。我们讨论了市场化EBI合同承包对CBO的影响以及它对循证公共卫生构成的限制,特别是在社会边缘化社区。