1. Contracting out of a Single Healthcare Package to Non-Governmental Organizations (NGOs)

2. Outline Country profiles Steps in contracting out of a single healthcare package to NGOs Results/contributions of contracting out of a single healthcare package Lessons learnt and recommendations

3. Country profile Area: 647,500 sq. kmPopulation: 28.1 ml GDP per capita: US$ 772Government health budget : 4.2% 3 Life expectancy at birth: 62-64 yearsAdult literacy rate: 31.4. % 5 Improved drinking water: 45.5 %

4. Steps in Contracting out of primacy health care services to NGOs Step 4:Hiring of a third partner to evaluate the BPHS implementation using BSC ( single sector M&E framework) Step 3: Developing of Single tool for evaluation of BPHS implementation: Balanced Scored Card (BSC) Step 2: Policy shift from provision to stewardship of healthcare: Contracting out of the BPHS to NGOs through competitive bidding process Step 1: Definition of a single healthcare provision package ( Basic Package of Health Services- BPHS)

5. Basic Package of Health Services (BPHS)

6. Results/contributions of contracting out of BPHS to NGOs Access to primary healthcare services

7. Results/contributions of contracting out of BPHS to NGOs Midwifery and community education programs

8. Community Midwifery Education

9. Maternal Mortality Ratio per 100,000 live births Maternal Health Percent of married womn knowing or using any modern method of contraception in 2010 Results/contributions of contracting out of BPHS to NGOs

10. Under-5y mortality rate Children Health Under- 1y mortality rate Results/contributions of contracting out of BPHS to NGOs

11. Results/contribution the contracting out of a single healthcare package (BPHS) towards pooled financing 2014: USAID joined to pooled financing of BPHS/Contracting out through MoF and MoPH 2012: EC agreed to channel funding to BPHS/Contracting out through MoF and MoPH 2006 up to now : WB started channeling of funds though the MoF and MoPH to NGOs 2002-2006: WB, USAID and EC were directly contracting out BPHS to NGOs

12. Lessons learnt and recommendations from contracting out of a single healthcare package Rapid expansion of health care coverage Strengthened decentralized management and Decrease Bureaucratic Barriers Increased effectiveness and efficiency through competition More focus on measurable results as the stewardship role of MOPH is Enforced Strengthened a single Monitoring and Evaluation of primary healthcare services Unified Health Management Information System (HMIS) and reporting systems Steps towards pooled financing and using public financing mechanisms

13. High transaction costsContracting may fragment the health system High level of dependency on external aid Concerns over Accountability of NGOs Challenges of Monitoring and Evaluation of NGOs Lessons learnt and recommendations from contracting out of a single healthcare package

14. QUESTIONS