Contracting out to improve the use of clinical health services in low‐ and middle‐income countries

Added April 20, 2020

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.

 

Disclaimer: This summary has been written by staff and volunteers of Evidence Aid in order to make the content of the original document accessible to decision makers who are searching for the available evidence on the coronavirus (COVID-19) but may not have the time, initially, to read the original report in full. This summary is not intended as a substitute for the medical advice of physicians, other health workers, professional associations, guideline developers, or national governments and international agencies. If readers of this summary think that the evidence that is presented within it is relevant to their decision-making they should refer to the content and details of the original article, and the advice and guidelines offered by other sources of expertise, before making decisions. Evidence Aid cannot be held responsible for any decisions made about the coronavirus (COVID-19) on the basis of this summary alone.

Share