Most mechanisms that use NSPs to deliver services are only being applied at a very small scale in fragile states. There is some evidence that the most widely used mechanism – contracting – can increase service utilisation, increase service quality, improve efficiency, reduce service fragmentation, and support strengthening of national capacity. The basic package of health services (BPHS) contracting approach, in particular, is often cited as an effective mechanism for health service delivery in fragile states. However, some observers have voiced concern that contracting can promote precipitous decentralisation, erode NSP independence, and actually fragment the health system given that NSPs are seldom able to provide an overall framework in which to operate.
The literature offers a number of recommendations for non state provision of health services in fragile contexts, including:
- supporting longer term, inclusive planning and implementation processes
- providing longer term, predictable funding
- carrying out more effective sectoral monitoring and evaluation
- developing mechanisms for improved information exchange
- assuring a minimal stewardship function for the government
- improving both the state and the NSP’s capacity to work together
- identifying and capitalising on existing sources of capacity and political will
- creating incentives for using NGOs and firms to build local capacity and engage with public health system actors.
