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APHA Scientific Session and Event Listing

Public Contracting of Non Government Organizations in El Salvador

Daniel A. Maceira, Ph D, Department of Health Economics, Center for the Study of the State and Society (CEDES), Sánchez de Bustamante 27, Buenos Aires, C1173AAA, Argentina, (54-11) 4861-2126, danielmaceira@cedes.org

The purpose is to analyze the contracting of El Salvador National Government of four NGOs with funds from international loans, specially attending to the characteristics of the contract entered into by the parties and the theoretical incentives it generated. A household survey comprising one thousand families was designed and implemented in order to compare the experience with a relevant control group: the traditional initiative of public promoters developed in El Salvador in cantons other than those incorporated to the SESYN Program. The analysis is complemented with interviews to key actors from the health system. Finally, the document checks a control mechanism that determines the effectiveness not only of the initiative but also of the evaluation model of the program. This mechanism coordinates the information provided by the contracted NGOs to the Project Coordinating Unit (and by the promoters to NGOs), with the results of a logistic model that takes as an information basis a household survey as the one undertaken by this initiative. The paper studies the performance of NGOs in rural communities and compares it with the action developed by public health promoters and in communities without any health promoter. These three groups had the same social and economic indicators. The results obtained suggest that the initiative of contracting NGOs for the expansion of health services has achieved a good performance in most encounters related to preventive medicine as well as to healing care within the health system. The interventions provided within the private promoters' geographical area not always resulted conclusive: they vary when the analysis takes the initiative as a whole, incorporating the performance of the Mobile Health Care Teams organized under the NGO initiative, who acts beyond the borders of the cantons allocated to them. The public initiative of financing private institutions for basic health services provision would let the use of existing human and physical resources, contributing to a more efficiency social allocation, letting the share of experiences to strengthen the public attention net. However, is necessary a strong focalization and pursuit structure to avoid risks associated with the characteristic imperfect information of health care markets.

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Contemporary Issues in Health Care Reform

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA