Contracting out of clinical services in Zimbabwe.
Contracting is increasingly recommended to developing countries as a way of improving the efficiency of the health sector.
However, empirical evidence regarding its effectiveness in this respect is almost completely absent.
In Zimbabwe, a long standing contract exists between the Ministry of Health and Wankie Colliery to provide clinical services in the Colliery's 400 bed hospital.
This paper details a study of the Zimbabweans'experience with the contract.
Its success is assessed using comparisons with a neighbouring government hospital of the price of services (vs the cost in the government hospital) ; the situation of hospital worken ; and the quality of services delivered.
The Colliery has established a monopoly position for hospital services in the district.
The study highlights a number of important issues affecting contracting in developing country settings : First, contracted institutions attain powerful bargaining positions if there are no viable competitors and the government does not itself retain capacity to offer an alternative service.
Second, specific skills are needed for the management of contracts at all levels.
If the process of contract development responds to a crisis driven agenda resulting from civil service retrenchment and public expenditure cuts, it is unlikely that adequate consideration will be given to the.
Mots-clés Pascal : Système santé, Organisation santé, Contrat, Secteur public, Secteur privé, Efficacité, Evaluation, Zimbabwe, Economie santé, Coût, Afrique
Mots-clés Pascal anglais : Health system, Public health organization, Contract, Public sector, Private sector, Efficiency, Evaluation, Zimbabwe, Health economy, Costs, Africa
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0378755
Code Inist : 002B30A01B. Création : 01/03/1996.