Table 1 Characteristics of the different types of contracts
Characteristic | SEHAT (2015–2018) | SEHATMANDI (Intervention) (2019–2021) | MOPH-SM (2015–2021) (Comparison) |
|---|---|---|---|
Performance Aspect of Contract | Up to 10% of contract value based on functionality of health facilities. Up to 10% could be earned based on achievement of pre-set targets. NGOs received average of 80% of “performance” payment (96% of total contract value). | A fixed tariff for each verified service provided. Pay for Performance (P4P) accounted for an average of 60% of total contract value | No performance payment |
Lump sum payment | Based on total bid price, represented at least 80% of total contract value. | Average of 40% of total contract value. Determined through competitive bidding. | Annual fixed budget |
Who was contracted? | NGOs (71% of contracts awarded to Afghan NGOs, 17% to International NGOs, and 12% to joint ventures.) | NGOs (68% of contracts awarded to Afghan NGOs, 22% to international NGOs, and 10% to joint ventures.) | 25 individual Afghan consultants to support 3 provinces. |
Who did the contracting? | MOPH through a grants & contracts management unit (GCMU) | MOPH through a GCMU but performance was managed by a performance management office (PMO) | MOPH through an MOPH-SM unit |
What was contracted for? | 31 BPHSacontracts and 16 separate EPHSb contracts signed with different NGOs | Combined BPHSa and EPHSb contracts in 15 provinces and 16 stand-alone BPHSa contracts. | Combined BPHSa & EPHSb |
How were contractors selected? | Competitive “quality and cost-based selection” where bid price was 25% of the total score | Competitive “quality and cost-based selection” where the “lump sum” bid price was 20% of the total score. | Consultants were selected through quality-based selection |
Autonomy provided to providers | Substantial autonomy around organization & procurement. Had to follow BPHSa & EPHSb staffing norms | Same as during SEHAT. | Limited, bound by civil service regulations |
How was verification done? | Third-party monitor visited randomly selected health facilities to review records for consistency with HMIS reports. Randomly selected patients were visited at home to see whether they had received the services listed in the health facility records. | ||
Ownership of the health facilities | Ministry of Public Health (MOPH) | MOPH | MOPH |
Geographic Extent | 31 provinces | 31 provinces | 3 provinces |
Cost of BPHSa Contracts (Average) | US$5.28 per capita per year | US$4.48 per capita per year | Not applicable |
Cost of combined BPHSa & EPHSb contracts (Average per capita per year) | Not applicable | US$7.12 | US$7.26 (2019–2021) |