Abstract

There are very few documented large-scale successes in nutrition in Africa, and virtually no consideration of contracting for preventive services. This paper describes two successful large-scale community nutrition projects in Africa as examples of what can be done in prevention using the contracting approach in rural as well as urban areas. The two case-studies are the Secaline project in Madagascar, and the Community Nutrition Project in Senegal. The article explains what is meant by 'success' in the context of these two projects, how these results were achieved, and how certain bottlenecks were avoided. Both projects are very similar in the type of service they provide, and in combining private administration with public finance. The article illustrates that contracting out is a feasible option to be seriously considered for organizing certain prevention programmes on a large scale. There are strong indications from these projects of success in terms of reducing malnutrition, replicability and scale, and community involvement. When choosing that option, a government can tap available private local human resources through contracting out, rather than delivering those services by the public sector. However, as was done in both projects studied, consideration needs to be given to using a contract management unit for execution and monitoring, which costs 13-17% of the total project's budget. Rigorous assessments of the cost-effectiveness of contracted services are not available, but improved health outcomes, targeting of the poor, and basic cost data suggest that the programmes may well be relatively cost-effective. Although the contracting approach is not presented as the panacea to solve the malnutrition problem faced by Africa, it can certainly provide an alternative in many countries to increase coverage and quality of services.

PIP:

This paper describes two case studies; namely, the Secaline Project in Madagascar and the Community Nutrition Project in Senegal in Africa as examples of malnutrition prevention using the contracting approach in rural, as well as urban areas. This article explains what is meant by "success" in the context of these two projects, how these results were achieved, and how certain difficulties were avoided. Both projects are very similar in the type of service they provide, and how they combine private administration with public finance. This article illustrates that contracting out is a feasible option to be seriously considered for organizing certain prevention programs on a large scale. Both projects were able to achieve results in providing preventive nutrition services through the private sector, which is outside the dominance of health care professionals. Thus, it shows that this type of service can be contracted out to nonspecialists. The next step is for the two projects to form the basis for a dialogue with Ministries of Health on health sector reforms, in order to extend these examples and to duplicate them in other countries and other preventive services such as AIDS prevention, or family planning services. Although the contracting approach is not presented as the panacea to solve the malnutrition problem faced by Africa, it can certainly provide an alternative in many countries to increase coverage and quality of services.