Policy Options for Financing Health Services in Pakistan. Volume 5: Organizing and Financing Rural Health Services

摘要

This is one volume in a set of five reporting on work performed between 1991 and 1993 by the Federal Ministry of Health (FMOH) of Pakistan with the assistance of USAID's Health Financing and Sustainability Project (HFS). The purpose of this study was to design four financial and organizational reform initiatives to improve the delivery of health services in Pakistan. The purpose of this report is to explore an alternative approach to organizing and financing rural health services in Pakistan. The proposed model calls for the government to assign directly to rural communities the financial resources currently allocated to their local health facilities. The communities would then take responsibility for managing a contracting process whereby providers would compete to offer them a basic package of health services using existing government facilities and equipment. At the option of the community, additional services could be asked of the contractor in return for giving the provider the right to charge limited user fees. This report addresses the financing of different packages of services, including the provision of financial support for the needy; the development of a medical referral system; defining the contractual and oversight roles of the community; attracting providers to bid; and implementing, monitoring, and evaluating the proposed approach. Also included are a sample Request for Proposal and contract form that could be used in carrying out this alternative approach to the management of rural health services. The purpose of this report is to explore an alternative approach to organizing and financing rural health services in Pakistan. The proposed model calls for the government to assign directly to rural communities the financial resources currently allocated to their local health facilities. The communities would then take responsibility for managing a contracting process whereby providers would compete to offer them a basic package of health services using existing government facilities and equipment. At the option of the community, additional services could be asked of the contractor in return for giving the provider the right to charge limited user fees. This report addresses the financing of different packages of services, including the provision of financial support for the needy; the development of a medical referral system; defining the contractual and oversight roles of the community; attracting providers to bid; and implementing, monitoring, and evaluating the proposed approach. Also included are a sample Request for Proposal and contract form that could be used in carrying out this alternative approach to the management of rural health services.