Abstract
Policy measures for preventive and promotive services are increasingly reliant on contracting of NGOs. Contracting is a neo-liberal response relying on open market competition for service delivery tenders. In contracting of health services a common assumption is a monolithic NGO market. A case study of HIV control in Pakistan shows that in reality the NGO market comprises of parallel NGO networks having widely different service packages, approaches and agendas. These parallel networks had evolved over time due to vertical policy agendas. Contracting of NGOs for provision of HIV services was faced with uneven capacities and turf rivalries across both NGO networks. At the same time contracting helped NGO providers belonging to different clusters to move towards standardized service delivery for HIV prevention. Market based measures such as contracting need to be accompanied with wider policy and system measures that overcome silos in NGO working by facilitating a common construct on the health issue, cohesive priorities and integrated working.
Highlights
There has been an increased emphasis on contracting of Non-Governmental Organizations (NGOs) for service delivery in recent years (Perrot, 2006)
Infection is negligible in the general population and is mainly confined to high risk groups with 5-12 per cent HIV prevalence in Injection Drug Users (IDUs) and male se workers (MSWs), followed by less than five per cent prevalence amongst female sex workers (FSWs), long distance truckers and prisoners (Ministry of Health, 2005)
The RH NGOs had evolved during the 1980s and 1990s as Reproductive Health incrementally received policy recognition and replaced older agendas of population control and primary health care (PHC) implementation
Summary
There has been an increased emphasis on contracting of Non-Governmental Organizations (NGOs) for service delivery in recent years (Perrot, 2006). Contracting is a neo-liberal based measure commonly involving open market competition for specified, time bound and result oriented services (Taylor, Preker, & Harding, 2003). National responses for HIV control often rely on contracting NGOs for reaching disadvantaged groups at high risk for HIV/AIDS such as sex workers, injectable drug users, etc. Policy measures have often assumed a homogenous NGO sector and an even market response to contracting. Non-state actors may well comprise of distinct NGO groups working in parallel. We take up a case study of Pakistan and comment on the parallel NGO networks in existence for HIV response, their distinctive approaches, and the risks and opportunities for market-based approaches such as contracting
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