Political Economy of NGO Contracting for TB Services through Govt Led Public Procurement System in Bangladesh

OBJECTIVES:

To explore the political barriers and enabling factors for contracting health services; assess the power, interest, and positions of different stakeholders; and to identify threats, opportunities, challenges, and strategies towards political acceptability of contracting health services, especially Tuberculosis care in Bangladesh.

METHODS:

Qualitative data analysis, collected through desk review, key informant interviews, key informant consultations, and anonymous brain mapping during September 2021 to March 2022.

RESULTS:

Public perceptions about procurement and contracting health services are not positive in Bangladesh due to various allegations of corruption. Citizens are less concerned about who provides health services, than about the availability and quality of services. The public procurement system has credibility crises, often believed to be driven by organized interest groups which can resist any potential procurement reforms in health as well as TB services. Informants also indicated that NGO contracting may make publicly funded TB services more accountable, transparent, and efficient. The present government is committed to a private sector led development policy as expressed in the 8^th Five-year plan of the government; however, government capacity for NGO contracting remains a major issue. Bangladesh’s highly centralized system requires political buy-in at the highest level to introduce contracting of health services.

CONCLUSIONS:

As Bangladesh’s economy grows rapidly, the country is taking more and more responsibility to fund health programs using domestic resources. NGOs have an established legacy in partnership with government in the health sector, especially with the National Tuberculosis Program. While NGO partnership in donor-funded health programs is mostly In depth understanding of the political economy of NGO contracting in Bangladesh, will help to facilitate smooth transition and sustainability of the Tuberculosis program in the country.