Substantial improvement in the deliveryof health services will be necessary to achieve thehealth-related Millennium Development Goals (MDGs). A reviewof developing country experience with contracting for healthservice delivery was undertaken to examine itseffectiveness, determine the extent to which the positeddifficulties actually occur in practice, and makerecommendations regarding future efforts in contracting. Thefocus of the review was instances in developing countries ofgovernments contracting with non-state providers (NSPs) todeliver primary health care services including nutrition(but excluding hospital care or ancillary services such asdrug procurement and distribution). Based on the successthus far, health services' contracting should besignificantly expanded in developing countries as a way ofhelping achieve the MDGs, and increasing accountability.While the evidence for contracting is reasonably good,future efforts should still include rigorous evaluations toobtain more robust estimates of the effects under variousconditions and address unresolved issues, such as theeffectiveness of performance bonuses, and means forimproving contract management.
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