Contracting out to improve the use of clinical health services in low‐ and middle‐income countries
Citation: Odendaal WA, Ward K, Uneke J, et al. Contracting out to improve the use of clinical health services and health outcomes in low‐ and middle‐income countries. Cochrane Database of Systematic Reviews 2018; (4): CD008133
What is this? The COVID-19 pandemic has placed a great strain on government-run healthcare services in low- and middle-income countries (LMICs). Research into alternatives, such as contracting out clinical services to non-governmental providers, may provide information that would help ease these pressures.
In this Cochrane systematic review, the authors searched for randomized trials and quasi-experimental studies of the effects of contracting out of healthcare services on population healthcare use and health outcomes in (LMICs. They did not restrict their search by date or language of publication and did the search in April 2017. They included a cluster randomized trial from Cambodia (implemented 1999-2003) and a controlled before-and-after study from Guatemala (implemented 1997-2007). They also identified 2 studies which are awaiting classification.
What was found: Contracting out of clinical services to non-governmental providers in LMICs is probably no better or worse than usual provision of government services.
Contracting out of clinical services to non-governmental providers in LMICs made no or little difference to the use of healthcare services, such as child immunizations, female contraceptive use and antenatal visits.
Contracting out of clinical services to non-governmental providers in LMICs may reduce people’s own spending on their treatment but increase government spending per person.
What’s uncertain: The effects of contracting out on health outcomes (such as infant mortality or childhood diarrhea) are uncertain.
The effects of contracting out on equal access to health services and on negative outcomes (such as increased fraud or corruption) are uncertain.
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