Contracting urban primary healthcare services in Bangladesh - effect on use, efficiency, equity and quality of care

Abstract

Objective: To evaluate a large, ongoing effort to improve urban primary health care (PHC) in Bangladesh through expansion of publicly funded urban health facilities and contracting with partner non-governmental organisations (NGOs).

Methods: A part of Chittagong was assigned to a contracted NGO while the other parts of the city were contracted to the local government. Performance was assessed by baseline and follow-on household surveys, an endline health facility survey and routinely collected data.

Results: The results of a health facility survey indicated that overall quality of care was better in the NGO area, and routinely collected data showed that the NGO provided many more services per capita. Based on household survey data, the NGO area of Chittagong was poorer and had lower coverage at baseline. There were significant improvements in both government and NGO-run areas. However, larger improvements were observed on some coverage indicators in the NGO area compared to the government area. Improvements in coverage among the poorest 50% of the population were greater in the NGO-run area. The cost per service delivered was 47% lower in the NGO area.

Conclusions: Investments in urban PHC led to an improvement in the coverage of basic services. Contracting with an NGO had an additional effect in terms of improving coverage, equity, quality of care and efficiency. Increased investments in PHC facilities and contracting with NGOs may be effective in improving urban health services.