This toolkit provides practical advice to anyone involved in, or who is interested in becoming involved in, performance-based contracting of health services with nonstate providers in the context of developing countries. It addresses many of the issues that may be encountered. Input from experienced contracting professionals will give newcomers increased confidence as they go forward. Experts directly involved in contracting on a large scale have contributed to the development of this toolkit.
Performance-based contracting is a type of contracting with a clear set of objectives and indicators, systematic efforts to collect data on the selected indicators to judge contractor performance, and consequences for the contractor, either rewards or sanctions, based on performance. Intended Audience. This toolkit has been developed for individuals working for government agencies, other purchasing entities (such as insurance companies and social insurance funds), nongovernmental organizations, faith-based organizations, private (for-profit) health care providers, World Bank staff, and development partners.
Where to Start.
The short summary gives an overview of the toolkit. Readers can then delve into increasing levels of detail by working through the various sections and appendixes.
Limitations of the Toolkit. The actual task of contracting is more of an art than a science. Although a reasonable amount of evidence suggests that contracting works (see section 5), many of the “how-to” issues are a matter of experience rather than systematic evidence. As we learn more about contracting, some of what we believe now may change. Keep in mind that contracting occurs in different contexts. Some issues raised in the toolkit are not relevant in certain situations but may be crucial in others.
Outline of the Toolkit
- Section 1: Summary of the Toolkit. This overview is useful for reference and for quick refreshers later. It will be helpful to read the summary before moving on to the main part of the toolkit.
- Section 2: What Is Performance-Based Contracting? This section provides background on contracting, including definitions of key terms, the types of services that can be contracted, how contracting relates to other ways of organizing health services, and which contracting approaches work in different settings.
- Section 3: How to Contract. This section provides a systematic way of thinking about contracting and how to do it in practice. It looks at seven aspects of the contracting process from initial dialogue with stakeholders through carrying out the bidding process and managing contracts. This framework will help ensure a systematic consideration of the choices and challenges.
- Section 4: Checklist for Contracting. This checklist contains tasks and issues to address while designing and implementing a contract. The checklist can also be used to review an existing contract to see what is missing or could be improved.
- Section 5: Whether to Contract. This toolkit assumes that the reader has an interest in contracting, but it is useful to keep asking questions. This section reviews the evidence for contracting in developing countries, explores why contracting appears to work, and addresses concerns that have been expressed about contracting.