2005年-世界发展银行全球_NGO_Contracting_Evaluation_for_the_HNP_Sector_in_Bangladesh___Evidence_and_Policy_Options_97页_5mb

Summary of NGO Contracting Evaluation for the HNP Sector in Bangladesh

Core Content

This report evaluates the role of NGOs in the Health, Nutrition & Population (HNP) sector in Bangladesh and assesses various contracting models to support the diversification of service delivery. It was prepared by Rafael Cortez for the South Asia Human Development Sector of the World Bank in May 2005, with inputs from various stakeholders including government officials and development partners.

Main Findings

1.1 Mapping of NGO Activity in Bangladesh

• Approximately 769 NGOs are active in the HNP sector in Bangladesh.
• The number of NGOs has been increasing over the years.
• Table 1.1 shows that 71.4% of Thanas (administrative units) have at least one NGO involved in HNP activities.
• Sylhet has the highest NGO coverage at 94.3%, while Barisal has the lowest at 42.1%.

1.2 NGO Profile in the HNP Sector

• Financing: NGOs receive funding from multiple sources:
  • Development Partners (DPs): 73%
  • Government of Bangladesh (GOB): 18%
  • NGO own resources: 9%
• Expenditures: The average annual expenditure of NGOs on HNP activities is estimated at US$125 million, which is 8.4% of total health expenditures.
• Outpatient Visits: Increased from 12.2 million in 1999-2000 to 15.1 million in 2001-2002.
• Outdoor Service Centers: Increased from 6,501 to 7,947 over the same period.
• Services Provided: NGOs offer a range of services, including maternal health, child health, and nutrition promotion.
• Quality of Services: There are mixed reports on the quality of services, with some facilities showing higher satisfaction levels than others.
• Equity: NGOs serve a more equitable distribution of the population compared to the public sector, with the poorest 10% using 14% of NGO expenditures versus only 7.8% of public expenditures.
• Monitoring and Supervision: There is a lack of consistent monitoring and supervision mechanisms, leading to performance issues.

Contracting Models and Evaluation

2.1 Contracting Models in the HNP Sector

• The report outlines several contracting models used in the HNP sector, including:
  • Contracted Manager Model: Examples include the NGO Service Delivery Program (NSDP) and the Bangladesh Population & Health Consortium (BPHC).
  • Direct Government Control Model: Examples include the National Nutrition Project (NNP) and the Urban Primary Health Care Project (UPHCP).
  • Private-for-Profit Model: Some NGOs operate in partnership with private providers.

2.2 Performance Evaluation of Selected Models

• The performance of these models was evaluated using:
  • Facility Survey: Assessing service characteristics and quality.
  • NGO Personnel Survey: Gathering insights from staff on service delivery.
  • Exit Interviews: Collecting feedback from clients.
  • Qualitative Survey: Assessing perceptions and experiences.
• Based on these surveys, the models were ranked according to their performance, with the NSDP and BPHC showing the best results in terms of service delivery and client satisfaction.

2.3 Comparative Advantages

• The report identifies comparative advantages of public, NGO, and private-for-profit providers in terms of cost, pricing, quality, and accessibility.
• NGOs are found to be more effective in reaching the poor and improving service quality, especially in areas where the public system is underperforming.

Policy Options and Recommendations

3.1 Organizing Procurement and Monitoring

• The report suggests the establishment of a Management Support Agency (MSA) to oversee the contracting, monitoring, and financing of non-government and private providers.
• The MSA would be responsible for:
  • Deciding which services to contract out.
  • Selecting providers through a competitive bidding process.
  • Defining payment mechanisms.
  • Monitoring and evaluating performance.
  • Promoting public-private partnerships at the union level.

3.2 Contracting-out Strategy

• The proposed strategy includes:
  • Competitive Bidding: To select the most suitable providers.
  • Social Accountability: Through community participation and feedback mechanisms.
  • Accreditation Systems: To ensure quality standards.
  • Performance Monitoring: To ensure accountability and transparency.
  • Effective Payment Mechanisms: To incentivize good performance.
  • Retention of User Fees: To support financial sustainability.
  • Training and Capacity Building: To improve service delivery and efficiency.
  • Past Performance: To evaluate the reliability of providers.
  • MIS (Management Information System): To ensure accurate data collection and reporting.
  • Fiduciary Arrangements: To manage funds responsibly.
  • Equity, Access, and Financial Sustainability: As key considerations in the contracting process.

Main Messages and Policy Options

4.1 Key Findings

• The public health system in Bangladesh is inefficient and lacks responsiveness and accountability.
• NGOs provide a more equitable and efficient service delivery mechanism, particularly in poor and underserved areas.
• Contracting is a viable strategy to improve service delivery, promote efficiency, and ensure quality.
• There is a need for better monitoring, evaluation, and performance incentives to ensure successful contracting.

4.2 Recommendations

• Establish a Management Support Agency (MSA) to manage the contracting process.
• Improve Monitoring and Evaluation: To ensure transparency and accountability.
• Promote Public-Private Partnerships (PPPs): To enhance service coverage and quality.
• Enhance Training and Capacity Building: For both NGO staff and public officials.
• Develop Clear Contracting Criteria: Including cost-effectiveness, service quality, and financial sustainability.
• Strengthen the Legal and Institutional Framework: To support the contracting process and ensure compliance.

Conclusion

The study concludes that contracting HNP services should be adopted when it benefits society. It proposes a set of policy options to enhance the effectiveness and sustainability of NGO and private sector involvement in the HNP sector, with a focus on transparency, performance, and equity. The MSA is seen as a critical institution to facilitate this process, ensuring that services are delivered efficiently and equitably to the poor.