Non-state Providers Research Articles

Engaging non-state providers towards PHC in South Asia: considerations for policymakers

Engaging non-state providers towards PHC in South Asia: considerations for policymakers

Dynamics of socially oriented non-profit organizations development as providers of socially important services in the regions of the Northwestern Federal District of the Russian Federation

The article analyzes the dynamics of socially oriented non-profit organizations (hereinafter – SONPOs) development in the context of their role in the social service system transformation. The study is based on the data of departmental statistics for 2018–2022 for the Northwestern Federal District regions using the comparative analysis methods. The analysis revealed that in all selected federal subjects the benchmarks for the non-state providers share in the total number of social service providers have been achieved. Among them, the SONPOs share ranges from 13 to 86 %. The assessment of the SONPOs development rates for all types of socially important services contained in the official statistical information has shown that, while their number is practically unchanged, the increase in the financial support volume leads to an increase in their consumers’ number. The most noticeable expansion of the target audience is observed in the field of culture and cinematography, but in general, there is a noticeable differentiation of regions in terms of the increase rate in the socially important services volume in various spheres. The identified discrepancies in various departmental registers of SONPOs are related to their inability to adapt to new conditions and may indicate the failure to overcome barriers that prevent these organizations from participating in providing social services commissioned by the state.

CURRENT ISSUES OF THE PURCHASE OF SOCIAL SERVICES IN INTERNATIONAL PRACTICE

The article reveals issues of social order that are relevant for modern Ukraine. It is emphasized that social ordering contributes to the development of social services. It is designed to improve the quality of such services in the community, create conditions for the activation of the public sector, and promote the effective and joint use of budget funds. The purpose of the article is to analyze the international experience of procurement of social services; description of the features of the modern process of introducing the purchase of social services by local authorities from non-state providers in different countries of the world. Based on the study of the provisions of regulatory and legal sources, the analysis of modern scientific sources of foreign researchers on the research topic, a generalization is made that social services form a general system of protection and inclusion of the European Community. The development of social order has become an effective tool of the market of social services, part of the neoliberal agenda of the countries of Western and Central Eastern Europe, one of the components of the change of the general system of public administration. It was noted that developed countries in the field of social protection followed a common trend of delegating their own powers to provide social services to non-state providers. At the same time, European countries paid attention to their own socio-cultural prerequisites and traditions. In particular, it was important for Germany to apply the principle of subsidiarity, to give greater initiative and authority to local communities to solve their own problems. For Great Britain, the competitive system of selecting a provider of social services in market conditions became a decisive factor. For the countries of Central and Eastern Europe, the acquired experience of other countries in combining both of these factors worked. The development of the individual dimension of social order took place in the Scandinavian countries, Germany, France, the Netherlands and other countries.

Refugee Networks, Cooperation, and Resource Access

Without formal avenues for claims-making or political participation, refugees must find their own means of securing services from state and non-state providers. This article asks why some refugee communities are more effective than others in mitigating community problems. I present a framework for understanding how refugees’ social networks shape the constraints and capabilities for collective action. I analyze a field experiment where I organized community meetings with Syrian refugees in Lebanon and Jordan, randomly assigning the recruitment method for meetings to introduce exogenous variation in network structure. During meetings, participants were tasked with resolving collective action problems. I examine the dynamics of subsequent group discussion. Results show that although densely networked refugee groups exhibit more cooperation, they suffer from a resource diversity disadvantage. Group diversity facilitates access to resources that may help refugee communities confront community problems. The novel experimental design allows for separately identifying group-level and individual-level mechanisms.

INTERNATIONAL EXPERIENCE ON SOCIAL COMMISSIONING IN THE BEST INTERESTS OF THE CHILD

The urgency of the research under consideration is determined by the need to speed up the process of introducing a social order in Ukraine. At the same time, conceptual issues regarding the social ordering of social services for children and their families in accordance with the international standards are not sufficiently substantiated. The purpose of the article: analysis of the international experience of social ordering of services for children and their families in the system of providing the social services in the best interests of a child. The article uses a theoretical analysis of modern scientific literature by Ukrainian and foreign researchers on the research topic, methods of generalization and systematization to deepen the understanding of social order, modern trends in the system of providing social services, as well as the specifics of purchasing social services by local authorities from non-state providers in EU countries. Social order in Ukraine is defined as a means of regulating activities in the system of providing social services by engaging social service providers on a contractual basis to meet the needs of individuals/families in social services in accordance with the results of determining the needs of the population of the administrative-territorial unit/territorial community in social services. Research attention is paid to the fact that in the process of social ordering, the power to protect children cannot be delegated, that is, local authorities should remain the only responsible body for key decisions in the best interests of the child.

Repositioning urban bias: Non‐state providers' use of spatialised networks in Bangladesh

AbstractUrban bias theory predicts urban areas of developing countries receive disproportionately more resources than rural areas due to their concentration of numerically large, politically important “vote banks.” This has not been the case in Bangladesh. This study finds that this variation occurs due to non‐state providers (NSPs) changing the landscape of resource allocation. Operating on the premise that state control leads to more services in urban areas, urban bias fails to account for NSPs as critical service providers. Employing a grounded theory strategy to explore urban‐rural dynamics in service provision and to build on urban bias theory, this research highlights interactions between state and non‐state actors. It argues that spatialized political networks, networks of formal and informal leadership more difficult to access in urban areas, influence the locality of service provision. Though NSPs recognize increased need in urban areas of Bangladesh, their interventions in those areas remain peripheral due to differing structures of government accountability and differing levels of community acceptance facilitating these networks. The need for NSPs to adapt their activities to restrictive governance mechanisms reflects the changing space for NSPs in the context of semi‐democratic regimes.

Review of international practice of health care provider network planning

Objevtive: to identify and systematize the main approaches to planning health care provider network used in foreign countries.Material and methods. Preliminary search for countries who had an experience of systematical planning of health care provider network and tools that they used for planning was conducted in regular health system reviews made by the European Observatory on Health Systems and Policies. Identified tools became a subject of general Internet search for the official publications about goals, mechanisms and results of their usage. The findings were analysed to reveal the similarities and differences between national health care provider network planning policies as well as the objective preconditions for the formation of such policies.Results. Three main approaches to health care provider network planning were identified in the analysis: (1) through establishing state-owned health care providers, (2) through granting the right to deliver guaranteed health care or (3) through granting the right to deliver health care of all categories. A close relationship between the choice of prevailing approach to planning and specific planning tools and the national health care model and structure of health services supply was shown. The typical policy of countries most similar to Russia on these parameters (“young” insurance systems, operating under conditions of predominant state supply of medical services) is the protection of key providers on the basis of minimum activity or income guarantees with the gradual development of a competitive health care market based on the rest of the Compulsory Health Insurance program.Conclusion. Current Russian health care provider network planning regulation based on the direct control over the state-owned health care providers does not correspond to the changed health care model and does not allow taking full advantages of the social health insurance. The results of the review can be used to develop new tools for planning health care provider network spanning on non-state providers.

From marketisation to self-determination: Contesting state and market through ‘justice reinvestment’

Movements for racial and Indigenous justice are targeting rapidly expanding budget allocations for prisons and police. In Australia, Indigenous Communities are seeking to redirect public money from the criminal justice system to Indigenous-controlled services and infrastructure through ‘justice reinvestment’. This article explores the possibilities and tensions of justice reinvestment as a strategy for exercising Indigenous self-determination in a marketised policy landscape. Focusing on the case of Just Reinvest NSW and the Maranguka initiative in Bourke, we compare justice reinvestment to neoliberal ideas of social investment, exemplified by social impact bonds (SIBs). We identify three tools of marketisation in SIBs – liability budgeting, pricing evidence, and devolution to non-state providers – and analyse how these are being engaged, and contested, by Indigenous Communities through justice reinvestment. While incomplete, we discuss how Indigenous-run justice reinvestment initiatives are creatively using these tools against the settler-colonial, carceral state to claim fiscal resources, develop bureaucratic capacity, and institute territorial governance. We argue that justice reinvestment demonstrates the potential to repurpose the tools of marketisation to create alternative ‘hybrid’ spaces of governance that contest both the state and the market.

Barriers in social commissioning implementation in Ukraine

The article contains theoretical and practical principles on barriers for social commissioning implementation in Ukraine. Social commissioning is an instrument satisfaction of vulnerable groups’ social service needs by means of non-state providers contracting by local authorities. 
 As a prevention mechanism, community-based social services are considered to be an effective tool for mitigation the risk for vulnerable groups, especially families with children, to get in difficult life conditions without possibility to overcome them independently. 
 As a response measure, social services are called to support vulnerable families with children, who appeared to be in crisis. Social services also can decrease the negative impact of difficult life conditions on vulnerable groups of population. New categories emerged among social service beneficiaries in Ukraine which include children and their families who suffered of armed conflict; combatants and their families; children and youth who need the reintegration to biological families and communities after deistitualization; families with children who became poor as a result of COVID-19 pandemics and other groups. The increased number of beneficiaries in need requires the increased number of social service providers. Social commissioning is recognized to be a tool for diversification of important community-based social service providers. 
 Even though social commissioning is available in national legislation for more than 20 years, its practical implementation still is considered to be an innovation. The author identified the following groups of barriers which constrains development of social commissioning: proсedural, financial, informational and psychological. The results of an expert survey which complement and enrich the theoretical conclusions on social commissioning development barriers in Ukraine are presented in the article.

Does contracting-out of primary health care services to non-state providers reduce child mortality in South Sudan? A synthetic control analysis.

Contracting-out is increasingly utilized as a health system strengthening strategy in lower- and middle-income countries (LMICs), to expand access to health interventions known to reduce child mortality. Existing scholarship suggests its effect has been mixed, limiting a definitive conclusion on its magnitude and direction. There are few studies assessing the impact on under-five mortality rate (U5MR) and fewer evaluations to-date have focused on Sub-Saharan Africa. We test the hypothesis that the contracting-out approach implemented in South Sudan in 2012 led to an observable reduction in U5MR. We use a novel approach, the synthetic control method to construct a synthetic South Sudan from a panel of LMICs using data from the World Bank Developmental Indicators (WDI) database. The analysis shows on average, contracting-out had a limited effect on the rate of decline of U5MR; U5MR declined by 5.2% annually between 2000 and 2011, and by 2.58% between 2012 and 2014. Relative to its synthetic control, U5MR is 2% and 5% higher in 2012 and 2013, continuing to diverge during the observation period. These findings suggest limitations in the contracting approach, and we discuss the possible policy implications of these findings.

Subjects of legal relations in the system of non-state pension provision: concept, signs, types

Problem setting. Legal, economic and organizational grounds of the non-state pension provision are crucial for the entire financial services market and significantly affect the organization of the country’s financial system. This level of the pension system is a key element of the non-bank financial services market of Ukraine and therefore deserves special attention. Analysis of recent researches and publications. Among the scientists who study this problem were O. M. Antipov, S. V. Bogoslavets, A. B. Kaminsky, O. Kirilenko, L. P. Londar, N. V. Lugovenko, V. Melnychuk, M. Rippa, M. M. Shumylo, N. M. Khutoryan, L. Yaremenko and others. Target of research. The aim of the article is to investigate certain features and types of subjects of legal relations in the system of non-state pension provision. Article’s main body. Pension relations are one of the types of legal relations formed on the basis of, on the one hand, the principles and approaches inherent in the general theoretical understanding of the category of legal relations, and on the other – the features of social security law as a branch of law, an integral and most important component. Analysis of general theoretical research of non-state pension provision allows us to identify certain features of legal relations in this area. Conclusions and prospects for the development. So, summarizing the above, it should be said that the legal relations arising from non-state pension provision – legal, economic, organizational and social relations that arise between the subjects of the non-state pension system in the process of creating private pension funds, their activities on private pension provision, pension insurance, as well as relations that arise in the process of monitoring the activities of non-state pension providers.

The role of non-state providers in informal science, technology, engineering and mathematics (STEM) education: a Malaysian perspective

ABSTRACT The role of non-state providers in the provision of education has been expanding globally. However, there is a dearth of literature on the role of non-state providers in informal education, especially when delivered alongside formal education in schools predominantly under government purview. Using a mixture of methods designed with surveys and interviews involving 32 non-state providers of informal STEM education in Malaysia, this study provides new empirical material to understand the role of non-state providers in informal STEM education. Non-state providers play a complementary role to the government’s provision of formal STEM education through the informal variant, motivated by concerns of posterity and national development. At the same time, instances of political competition and bureaucratic barriers are at odds with the government’s aspirations for partnership with non-state providers in order to raise students’ interest in STEM.

Political economy analysis of the performance\u2010based financing programme in Afghanistan

BackgroundPerformance-based financing (PBF) has attracted considerable attention in recent years in low and middle-income countries. Afghanistan’s Ministry of Public Health (MoPH) implemented a PBF programme between 2010 and 2015 to strengthen the utilisation of maternal and child health services in primary health facilities. This study aimed to examine the political economy factors influencing the adoption, design and implementation of the PBF programme in Afghanistan.MethodsRetrospective qualitative research methods were employed using semi structured interviews as well as a desk review of programme and policy documents. Key informants were selected purposively from the national level (n = 9), from the province level (n = 6) and the facility level (n = 15). Data analysis was inductive as well as deductive and guided by a political economy analysis framework to explore the factors that influenced the adoption and design of the PBF programme. Thematic content analysis was used to analyse the data.ResultsThe global policy context, and implementation experience in other LMIC, shaped PBF and its introduction in Afghanistan. The MoPH saw PBF as a promise of additional resources needed to rebuild the country’s health system after a period of conflict. The MoPH support for PBF was also linked to their past positive experience of performance-based contracting. Power dynamics and interactions between PBF programme actors also shaped the policy process. The PBF programme established a centralised management structure which strengthened MoPH and donor ability to manage the programme, but overlooked key stakeholders, such as provincial health offices and non-state providers. However, MoPH had limited input in policy design, resulting in a design which was not well tailored to the national setting.ConclusionsThis study shows that PBF programmes need to be designed and adapted according to the local context, involving all relevant actors in the policy cycle. Future studies should focus on conducting empirical research to not only understand the multiple effects of PBF programmes on the performance of health systems but also the main political economy dynamics that influence the PBF programmes in different stages of the policy process.

Development of institute of social contracts for investment of intellectual and innovative projects in modern economy

The problem of providing the low-income families with social contracts is review in this article. Analytics of economic indexes and the comparison with foreign countries’ experience are provided and directions of such contract providing are reviewed. The possibility of social contract providing for development of modern intellectual and innovative business is also mentioned. Social support on the base of social contract was firstly applied in Russia in 2012. The low-income citizen can receive the allowance if he meets successfully the conditions of agreement with social agency: find a work, start the business, pass the advanced courses or other actions on improvement of his conditions. Until 2020, the regions will provide this service voluntary and out of local budget resources. Usual the social workers receive the direct payments for each employed, and he can be resigned from the work if does not meet the requirements. The service is outsourced by non-state providers - non-commercial organizations and private companies - for additional competitiveness.

Civil Law Constructions in Social Service Legislation

The article analyzes the problems of legal regulation of social services that arise in connection with the use of private law principles in the legislation on social services (contractual structures, the involvement of non-state providers of social services, the introduction of competitive principles, etc.). On January 1, 2015, the Federal Law of December 28, 2013 No. 442-FZ “On the Basics of Social Services for Citizens in the Russian Federation” entered into force, which made significant changes to the system of social services. In this regulatory legal act, a complex of legislative novelties was implemented, aimed at overcoming the crisis situation in social services. It was assumed that ensuring a competitive environment, including through the provision of social services on a contractual basis, would improve their quality, and the involvement of non-governmental organizations would solve the problem of the availability of social services. However, an analysis of the provisions of the current federal legislation and the legislation of the constituent entities of the Russian Federation revealed certain problems of legal regulation that impede the achievement of the goals set (violation of the continuity of legislation, the use of certain private law elements of legal regulation in the regulation of public law relations, etc.). Based on the results of the study, the Author concludes that the goals set for the legislator have not been fully achieved. The involvement of non-state providers of social services did not solve the problem of accessibility of social services. At the same time, at the federal and regional levels, a legal space has been created for “delegating” certain state functions to private organizations, the effectiveness of which raises objective doubts. The use of some private law elements of legal regulation (for example, the legal structure “contract”) does not serve the purpose of ensuring the guarantee of social services, but entails further “commercialization” of relations in the field of social services. The article also examines the experience of using so-called hospital-replacing technologies in certain constituent entities of the Russian Federation (creation of foster families for disabled people and citizens living alone). The Author comes to the conclusion that hospitalreplacing technologies can hardly be considered a really effective means of solving the problem of the availability of social services due to the low level of fees received for caring for single citizens and (or) disabled people.

Effect of Resource Factors and Quality of Instruction on Performance in Mathematics of Nigeria Secondary School Students

It seems that educational system in Nigeria has undergone only quantitative improvement in terms of number of schools and students’ enrolment. However, there has been little effort in respect to the capacity to manage them through provisions of adequate financial, human, material and physical resources. Physical and material resources in secondary schools were discovered to be inadequate and poorly equipped. Some of the secondary school buildings were dilapidated, also the allocated financial resource, teaching and non-teaching staff are grossly inadequate compared with the students’ enrolment. The public, the Ministry of Education and other stakeholders in education are expressing serious concern about the consistency of the poor performance of secondary school students especially in mathematics. Increase in population and the government’s free education programs make people want to take advantage of the education provided. Provision of both professionally qualified and non-qualified teachers by government and non-state providers of education also appear not to ameliorate the problem of declining performances in mathematics. The effect of all these on the public secondary school student academic performance in mathematics concern the researchers of this study. It is against this background that the study sought to empirically investigates effect of resource factors and quality of instruction on performance in mathematics of Nigeria secondary school students.

Opportunities for Interaction of the Institute of Social Entrepreneurship and the Institute of Territorial Public Self-Government

The article discusses the role of social entrepreneurship in the municipal economy. The author carries out the analysis of directions of forming regional infrastructure for supporting social entrepreneurship. The complex of measures currently being implemented by federal and regional authorities has allowed the social entrepreneurship sphere to be brought to a qualitatively new level of development. This is manifested in the growing market competition for providing social services to the population and in improving the quality of services provided by increasing the number of non-state providers of social services. In addition, social entrepreneurs together with authorities effectively solve the problem of preserving and developing the social infrastructure. However, non-profit organizations insufficiently use opportunities provided by the sphere of social entrepreneurship. It significantly reduces the effectiveness of their activities and does not allow them to utilize better the existing development potential. The lack of penetration of social entrepreneurship ideas into the sphere of territorial public self-government significantly reduces the activity effectiveness of territorial communities as structural units of this institution. The paper shows that the institution of territorial public self-government is not developing efficiently enough due to the fact that it does not fully implement the existing development potential. Territorial communities first of all implement their electoral potential, while entrepreneurial potential is practically not used. At the same time, these organizations have the right to carry out business activities that do not contradict the objectives stated in their charters, and to direct the proceeds to solve the problems of developing their territory. In this regard, the author proposes to consider the opportunities of introducing tools of social entrepreneurship, social marketing into the practice of managing the development of territorial communities.

A Comparative Exploration of the Motivational Factors of Faith-Based and Secular NGOs and Their Actors in Cambodia

ABSTRACTSecular and faith-based NGOs are significant non-state service providers in the developing world, yet limited research has been conducted comparing their motivational factors. This paper considers the motivations driving the work of Christian faith-based organisations (FBOs) and secular NGOs working with women and children in Cambodia. The qualitative research design included 41 interviews, with respondents from thirteen FBOs and twelve secular NGOs. The paper makes two substantive arguments. First, faith-related motivations were expressions of the ways in which religious faith infused FBOs in the study. Second, the development context in which the organisations worked led to a clear distinction between FBOs and secular NGOs. The paper makes a theoretical contribution about the importance of considering the convergence of both the development context and the infusion of faith in FBOs when examining similarities and differences between these two types of organisations.

Delivering reproductive health services through non-state providers in Pakistan: understanding the value for money of different approaches

BackgroundDelivering Reproductive Health Results(DRHR) programme used social franchising (SF) and social marketing (SM) approaches to increase the supply of high quality family planning services in underserved areas of Pakistan. We assessed the costs, cost-efficiency and cost-effectiveness of DRHR to understand the value for money of these approaches.MethodsFinancial and economic programme costs were calculated. Costs to individual users were captured in a pre-post survey. The cost per couple years of protection (CYP) and cost per new user were estimated as indicators of cost efficiency. For the cost-effectiveness analysis we estimated the cost per clinical outcome averted and the cost per disability-adjusted life year (DALY) averted.ResultsApproximately £20 million were spent through the DRHR programme between July 2012 and September 2015 on commodities and services representing nearly four million CYPs. Based on programme data, the cumulative cost-efficiency of the entire DRHR programme was £4.8 per CYP. DRHR activities would avert one DALY at the cost of £20. Financial access indicators generally improved in programme areas, but the magnitude of progress varies across indicators.ConclusionsThe SF and SM approaches adopted in DRHR appear to be cost effective relative to comparable reproductive health programmes. This paper adds to the limited evidence on the cost-effectiveness of different models of reproductive health care provision in low- and middle-income settings. Further studies are needed to nuance the understanding of the determinants of impact and value for money of SF and SM.

Contracting non-state providers for universal health coverage: learnings from Africa, Asia, and Eastern Europe

BackgroundFormal engagement with non-state providers (NSP) is an important strategy in many low-and-middle-income countries for extending coverage of publicly financed health services. The series of country studies reviewed in this paper - from Afghanistan, Bangladesh, Bosnia & Herzegovina, Ghana, South Africa, Tanzania and Uganda – provide a unique opportunity to understand the dynamics of NSP engagement in different contexts.MethodsA standard template was developed and used to summarize the main findings from the country studies. The summaries were then organized according to emergent themes and a narrative built around these themes.ResultsGovernments contracted NSPs for a variety of reasons – limited public sector capacity, inability of public sector services to reach certain populations or geographic areas, and the widespread presence of NSPs in the health sector. Underlying these reasons was a recognition that purchasing services from NSPs was necessary to increase coverage of health services. Yet, institutional NSPs faced many service delivery challenges. Like the public sector, institutional NSPs faced challenges in recruiting and retaining health workers, and ensuring service quality. Properly managing relationships between all actors involved was critical to contracting success and the role of NSPs as strategic partners in achieving national health goals. Further, the relationship between the central and lower administrative levels in contract management, as well as government stewardship capacity for monitoring contractual performance were vital for NSP performance.ConclusionFor countries with a sizeable NSP sector, making full use of the available human and other resources by contracting NSPs and appropriately managing them, offers an important way for expanding coverage of publicly financed health services and moving towards universal health coverage.