The impact of contracting on Malawi's faith based health facilities mission and objectives : the case of St John of God mental health services.

Mwafulirwa, Kisakighoghe (2015) The impact of contracting on Malawi's faith based health facilities mission and objectives : the case of St John of God mental health services. Masters thesis, University of Bolton.

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Kisa Mwafulirwa MPA Dissertation 2015.doc - Submitted Version

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Abstract

The contracting health care services features very highly in contemporary health sector reform literature. The model has been implemented both in the developing and developed world in delivery of health care. In Malawi it became widely adopted in 2003 when Malawi Government and the Christian Health Association of Malawi signed a number of service level agreements (SLA) for provision of maternal and other health issues. Key to contracting arrangement is that these agreements address a market failure in the delivery of essential services to those that need them but are unable to pay for them. Hence the realization that Government needed to form partnerships with mission health providers so as to achieve high levels of accessibility, equity and quality in the delivery of health services. Despite its wide application, contracting has had diverse impacts in different areas. In some areas it has proved a success while in others it has simply not worked. In certain cases such as mental health, the application of the contracting model has resulted into unintended consequences. Key to these is the reduced accessibility, and sustainability of the services. This study examines the impact of the Contracting on the provider’s capacity to attain their mission and goals of sustainable and quality services. The study has found that the contracting has led to reduced accessibility to mental health services in Northern Malawi but also it has led to unsustainable service delivery due to a number of challenges that implementation of the SLA has faced. To address these problems the study recommends that for the mutual benefit of both the contractor (Ministry of Health) and the provider (St John of God) future agreements should remove design defects and conditions that only serve to exclude the very same people it is meant to facilitate. The study therefore contributes to the debate on understanding contextual factors in contracting out public health services in developing countries. The main thrust of the study is that much as it has been established that contractual arrangements between faith based health facilities and Government have been said to increase accessibility, this cannot be generalized to all SLAs in the country as the one on mental health is fraught with many challenges and limitations which in turn hinder accessibility and sustainability of mental health service.

Item Type: Thesis (Masters)
Additional Information: Electronic version of the dissertation submitted in partial fulfilment of the requirements for the degree of Master of Public Administration awarded by University of Bolton in conjunction with Malawi Institute of Management
Divisions: University of Bolton Theses > Off-campus Division
Depositing User: Tracey Gill
Date Deposited: 07 Nov 2016 20:19
Last Modified: 07 Jun 2019 07:57
URI: http://ubir.bolton.ac.uk/id/eprint/968

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