Contracting private sector providers for public sector health services in Jalisco, Mexico: perspectives of system actors.
BACKGROUND
Contracting out health services is a strategy that many health systems in the developing world are following, despite the lack of decisive evidence that this is the best way to improve quality, increase efficiency and expand coverage. A large body of literature has appeared in recent years focusing on the results of several contracting strategies, but very few papers have addressed aspects of the managerial process and how this can affect results.


METHODS
This paper describes and analyses the perceptions and opinions of managers and workers about the benefits and challenges of the contracting model that has been in place for almost 10 years in the State of Jalisco, Mexico.Both qualitative and quantitative information was collected. An open-ended questionnaire was used to obtain information from a group of managers, while information provided by a self-selected group of workers was collected via a closed-ended questionnaire. The analysis contrasted the information obtained from each source.


RESULTS
Findings show that perceptions of managers and workers vary for most of the items studied. For managers the model has been a success, as it has allowed for expansion of coverage based on a cost-effective strategy, while for workers the model also possesses positive elements but fails to provide fair labour relationships, which negatively affects their performance.


CONCLUSIONS
Perspectives of the two main groups of actors in Jalisco's contracting model are important in the design and adjustment of an adequate contracting model that includes managerial elements to give incentives to worker performance, a key element necessary to achieve the model's ultimate objectives. Lessons learnt from this study could be relevant for the experience of contracting models in other developing countries.
Health Services and Systems Innovations, Health Systems Research Centre, National Institute of Public Health, Cuernavaca, Morelos, Mexico. gnigenda@insp.mx
Gustavo H
GH
Nigenda
Luz María
LM
González