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<p>In response to rapid urbanization and the growing health needs of the urban population, the government of Bangladesh, with development partner support, has been implementing since 1998 a large ongoing project that contracts nongovernment organizations (NGOs) to provide primary health care for urban residents, especially the poor, women, and children. We describe the background and rationale of the contracting approach and analyze the experience and lessons learned. Contracting enables the government to improve the access and quality of health services. Comparisons of contracting versus government directly providing health services demonstrate that contracting is more effective, cost efficient, and responsive to clients. Key lessons learned from contracting include: (i) accountability of NGOs to deliver results; (ii) flexibility for NGOs to use their own management capability and develop innovative approaches; (iii) recognition of NGOs as independent entities; (iv) mutual respect; and (v) transparency between the contracting parties. To improve overall urban primary health care, the recommendations highlight a need for: (i) the project to evolve into a broader government program approach; (ii) an enabling policy environment for devolved responsibility to urban local governments; (iii) dedicated budget and human resources; and (iv) coordination and collaboration between health and local government ministries of Bangladesh.</p>

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Experience and lessons learned from contracting urban primary health care in Bangladesh

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年10月1日

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  • Anthony E. Drexler,
  • Md. Nurul Islam,
  • Muhammad Ziaul Hoque,
  • Brian Chin

摘要

In response to rapid urbanization and the growing health needs of the urban population, the government of Bangladesh, with development partner support, has been implementing since 1998 a large ongoing project that contracts nongovernment organizations (NGOs) to provide primary health care for urban residents, especially the poor, women, and children. We describe the background and rationale of the contracting approach and analyze the experience and lessons learned. Contracting enables the government to improve the access and quality of health services. Comparisons of contracting versus government directly providing health services demonstrate that contracting is more effective, cost efficient, and responsive to clients. Key lessons learned from contracting include: (i) accountability of NGOs to deliver results; (ii) flexibility for NGOs to use their own management capability and develop innovative approaches; (iii) recognition of NGOs as independent entities; (iv) mutual respect; and (v) transparency between the contracting parties. To improve overall urban primary health care, the recommendations highlight a need for: (i) the project to evolve into a broader government program approach; (ii) an enabling policy environment for devolved responsibility to urban local governments; (iii) dedicated budget and human resources; and (iv) coordination and collaboration between health and local government ministries of Bangladesh.