Does contracting out services improve access to care in low- and middle-income countries?

Contracting out of health services is a formal contractual relationship between the Government and a non-state provider to provide a range of clinical or preventive services to a specified population. A contract document usually specifies the type, quantity and period of time during wich the services will be provided on behalf of the government. Contracting external management to run public services (contracting in) is a particular type of contracting.

Key messages

• There is low quality evidence from three studies that contract-ing out services to non-state not-for-profit providers can in-crease access to and utilisation of health services.
• Patient outcomes may be improved and household health ex-penditures reduced by contracting out. However, these effects may be attributed to causes unrelated to contracting.
• None of the three studies presented evidence on whether con-tracting out was more effective than making a similar invest-ment in the public sector.