More health for the money: Navigating the ins and outs of contracting of health services together

With the donor funding reductions and challenging economic times, many countries have found themselves in a challenging situation on what gets funded and how to finance their health system.  Mobilizing additional domestic funding for health in Low- and Middle-Income Countries (LMICs) is challenged by highly informal economies, narrow tax bases, which constrains revenue collection, increasing debt, and limited fiscal space. Almost all LMICs are strategizing how to close funding gaps caused by reduced funding for health and how strategic purchasing approaches such as government-led contracting with the private sector can play an important role by offsetting challenges and augmenting both service delivery and financing in LMICs. Contracting has the potential to make the health system more efficient through delivering better value (higher quality care at lower or more efficient costs) achieving more health for the money. 

In response to a rapidly evolving health systems landscape, three members of the Joint Learning Network (JLN)—Bangladesh, Liberia, and South Africa—have come together to strengthen how they contract healthcare services. While each country operates within distinct political and economic contexts, they share a common goal: to institutionalize and improve contracting mechanisms as a pathway to more effective service delivery. To achieve this, the countries have come together for a year-long Contracting Implementation Learning Lab (September 2025–August 2026). The lab is designed by the Management Sciences for Health (MSH) together with the three countries as a dynamic, country-driven platform to foster practical, cross-country learning for action. It is supported by the Joint Learning Fund through a small catalytic grant.  

Though each country brings a unique focus, they are enabled to engage in deeper technical exchange and peer consultation, drawing on a shared understanding of each other’s challenges and progress. Bangladesh aims to leverage new legislation and implement contracting following a successful pilot. Liberia is working to revise its National Private Sector Engagement Strategic Plan to incorporate domestic contracting of health services. South Africa, meanwhile, is advancing plans to establish a public sector entity to oversee contracting for medical examination and compensation services related to occupational lung diseases in miners. Together, these efforts offer a rich opportunity for shared learning and real-time problem-solving across diverse contexts. 

The lab will convene three interactive virtual learning sessions with country teams, and an in-person learning summit in South Africa. These engagements create a structured yet flexible journey to reflect on following themes to address the goal of more health for the money and deepen technical exploration. 

Practical steps include starting with formulation manufacturing before moving to APIs, prioritising essential medicines aligned with national disease burdens, and using public procurement to create predictable demand,

• Improving efficiency of spending domestic resources (e.g. performance-based contracting (PBC), strengthening public financial management, and budget advocacy.   
• Strengthening public-private partnerships (PPPs) with extractive industries and non-state health service providers (mining companies, NGO, faith-based, and for-profits). 
• Ensuring cost-effectiveness of the contracted services using costing techniques and health technology assessments. 

Each session is intentionally shaped through close consultations with Ministry of Health representatives from participating countries, ensuring that discussions remain anchored in real-time challenges, emerging priorities, and practical reform opportunities. This collaborative approach keeps the learning grounded, relevant, and immediately applicable. The in-person summit in South Africa will mark a key milestone – bringing together insights from the virtual sessions, highlighting country progress, and translating shared learning into concrete commitments. By the end of the Lab, countries will not only strengthen their technical understanding but also advance implementation of their plans and reinforce collective momentum toward sustainable, context-specific contracting practices. 

At its core, the Lab offers a unique opportunity to move beyond theory into implementation-focused learning, particularly in the context of a shifting health financing landscape. By leveraging contracting as a strategic purchasing approach, countries are working toward achieving better health outcomes with available resources—and doing so together through a shared journey of learning and action. 

About Authors:

• M.S. Huda, Assistant Surgeon, Health Economics Unit, Ministry of Health and Family Welfare, Bangladesh 
• Barry Kistnasamy, Head of Occupational Health, Medical Bureau for Occupational Diseases / Compensation Commissioner for Occupational Diseases, Department of Health, South Africa; 
• Jacob Hughes, Independent Consultant, Management Sciences for Health; 
• Rufus Saye, Program Manager, National Leprosy and TB Control Program, Ministry of Health; 
• Sara Wilhelmsen, Independent Consultant, Management Sciences for Health; 
• Tushar Mokashi, Technical Lead, Joint Learning Network for Universal Health Coverage, Amref Health Africa. 

Authors thank Dr. Rahul Kadarpeta, JLN and Dan Schwarz, MSH for editorial review.  

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Bangladesh, Liberia and South Africa have been formerly members of JLN’s Collaborative on Contracting Organizations for Health-Related Services, which ended in November 2025, which focused on knowledge exchange on theory and practical guidance on contracting. The JLF supported Lab ensured continued learning through translating knowledge into action.

This blog is also available on the Joint Learning Network website.