Queen Margaret University logo
    • Login
    View Item 
    •   QMU Repositories
    • eResearch
    • School of Health Sciences
    • The Institute for Global Health and Development
    • View Item
    •   QMU Repositories
    • eResearch
    • School of Health Sciences
    • The Institute for Global Health and Development
    • View Item
    JavaScript is disabled for your browser. Some features of this site may not work without it.

    Contracting out of clinical services in Zimbabwe

    Date
    1995
    Author
    McPake, Barbara
    Hongoro, Charles
    Metadata
    Show full item record
    Citation
    McPake, B. & Hongoro, C. (1995) Contracting out of clinical services in Zimbabwe, Social Science & Medicine, vol. 41, , pp. 13-24,
    Abstract
    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 workers; and the quality of services delivered.The Colliery has established a monopoly position for hospital services in the district. However, it appears to oiler services of at least as good quality at prices which are lower than the unit costs of the government hospital when capital costs are included. Nevertheless, the contract cannot be considered a success due to the failure to contain its total cost. Approximately 70% of provincial non-salary recurrent expenditure is consumed by the contract while only a minority of the province's population have access to the Colliery hospital. Screening patients, both with respect to their ability to pay and to their need for secondary level services does not take place with the result that utilization levels are not controlled.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 development of such skills and the retention of key personnel. If such details are neglected, otherwise feasible efficiency gains will prove elusive.
    Official URL
    http://dx.doi.org/10.1016/0277-9536(94)00303-B
    URI
    https://eresearch.qmu.ac.uk/handle/20.500.12289/324
    Collections
    • The Institute for Global Health and Development

    Queen Margaret University: Research Repositories
    Accessibility Statement | Repository Policies | Contact Us | Send Feedback | HTML Sitemap

     

    Browse

    All QMU RepositoriesCommunities & CollectionsBy YearBy PersonBy TitleBy QMU AuthorBy Research CentreThis CollectionBy YearBy PersonBy TitleBy QMU AuthorBy Research Centre

    My Account

    LoginRegister

    Queen Margaret University: Research Repositories
    Accessibility Statement | Repository Policies | Contact Us | Send Feedback | HTML Sitemap