Performance-based Partnership Agreements for the reconstruction of the health system in Afghanistan

Full-text sample article FREE from Taylor & Francis. The reconstruction of the health system in Afghanistan is in its early stages, and donors have proposed Performance-based Partnership Agreements (PPA) through which to subcontract the delivery of health services to private organisations, both for-profit and non-profit. Beyond ideological debates, this article sets out to explain the model underlying the PPA initiative and shed light on empirical data concerning the assumed benefits of such an approach. The article studies privatisation and the contracting-out of health services, though there is as yet no information that can demonstrate the superiority of private provision over publicly provided. Similarly, the appropriateness of subcontracting remains unproved and such arrangements raise several ethical issues. Where PPAs are to be attempted, it is important to remain cautious and to ensure that operations are organised in such a way as to permit proper comparison. The paper concludes with recommendations to organisations involved in or considering the merits of PPAs.