Contracting-out in public health and water services in Ghana

This article examines contracting-out in practice in public health and water services in Ghana. Drawing on in-depth interviews and discussions with knowledgeable officials, complemented by documentary analysis and secondary sources, the article provides insights into some of the institutional constraints and capacity issues that policy-makers and implementers need to be aware of in seeking to introduce and implement contracting-out policies in a developing country context. Though contracting-out in Ghana's health and water sectors has so far been used in the provision of support services, attempts to broaden its application to include the direct provision of core services raise a number of capacity questions related to regulatory frameworks, enforcement and monitoring mechanisms, development of management information systems and skills for contract management. The capacity and willingness of the private sector to take on direct provision of public services are also crucial.