The impact of contracting out on health outcomes and use of health services in low and middle-income countries

摘要: Background Recent literature on the lack of efficiency and acceptability publicly provided health services has led to an interest in use partnerships with private sector deliver public services. Objectives To assess effectiveness contracting out healthcare improving access care low middle-income countries and, where possible, outcomes. Search methods We searched a wide range international databases, including Cochrane Central Register Controlled Trials (CENTRAL), MEDLINE EMBASE, addition development studies economic databases. We also websites online resources numerous agencies, organisations universities find relevant grey literature. The original searches were conducted between November 2005 April 2006. An updated search was carried May 2009. Selection criteria Contracting is defined as provision behalf government by non-state providers. Studies had include objective measure at least one following outcomes: utilisation, expenditure, outcomes or equity outcomes. needed study designs: randomised controlled trial, non-randomised interrupted time series analysis before after study. Data collection analysis We made attempt present results from different systematic way, however due diversity sources, contexts methods used, we undertook narrative synthesis. Main results Three met our inclusion criteria (one re-analysis data). These suggest that providers can increase utilisation services. One found reduction out-of-pocket expenditures improvement some However, methodological weaknesses particularities reported programme settings limit strength generalisability their conclusions. Authors' conclusions Three may be appropriate response scale up service delivery particular settings, such post-conflict fragile states. Evidence not presented whether this approach more effective than making similar investment sector, there exact control available any settings. In addition, introduction into others brings many potentially confounding variables, presence additional management expertise expatriate doctors, which improve drug supply utilisation.