3. Abramson W. B. (1999), ‘Partnerships between the Public Sector and Non-Governmental Organizations: Contracting for Primary Health Care Services: A State of the Practice Paper’, Partnerships for Health Reform (PHR), Latin American and Caribbean Health Sector Reform Initiative (LAC/HSR), No. 25, Abt Associates Inc., Maryland.

The cases studied in this paper are PROFAMILIA (Asociación Pro-Bienestar de la Familia, Inc.) and the Ministry of Health, Colombia; COOPESALUD (Cooperativa Autogestionaria de Salud) and the Costa Rican Social Security Fund; the Talita Kumi, Foundation and the Ministry of Health, Guatemala; Local Health Administration Committees and the Ministry of Health, Peru; and PROFAMILIA and the Secretariat of Public Health and Welfare, Dominican Republic. This study is confined to the five aforementioned cases and is not the only instances of public agencies contracting non-governmental organizations (NGOs) for primary health care services but, rather, examples from which other countries in the region may wish to draw conclusions or lessons. For the most part, the public sector chooses to contract out for primary health care services to NGOs in order to extend coverage, increase the availability of medicines and medical supplies, and improve the quality of care. In Peru and Guatemala, NGOs were contracted to provide improved quality of services and extend coverage to indigenous populations. In Costa Rica, the public sector originally contracted out to cooperatives under a strategy aimed at controlling public sector costs by shifting the risks to the cooperatives, while extending services to populations not previously covered.In Colombia, the public sector chose to contract out in order to increase efficient resource use, broaden basic services with the goal of making them universal, and promote quality assurance. In the Dominican Republic, the government is in the process of defining the reasons for contracting out to NGOs, but its major motivation is to improve the quality of care and extend coverage for reproductive health services. From the perspective of the NGOs in the five cases studied, there was a need to increase their financial resources by diversifying revenues while at the same time focusing on their social mission.In viewing public sector contracting capabilities, the study has targeted regulation, information and record-keeping systems, and the frequency of payments. Public sector expertise and competence in purchasing services and making timely payments to NGOs have great impact upon the type of NGO with which the government will contract. This research did not attempt an in-depth analysis of the capabilities that an NGO contractor should have, but the success of a contract is certainly dependent on the capabilities of both parties. Scant empirical information is available on the risks and incentives involved in contracting under each of the payment mechanisms, and their direct and indirect relationship to performance under the contracts studied here.