Because of the disadvantages of both rigid hierarchies and out-of-pocket payment in
the health sector, countries throughout the world are today experimenting with long-term
contracts to achieve the combined advantages of greater flexibility and scope for innovation
while maintaining overall control over strategic objectives and financial protection.
There is already some analysis of experiments with contracting for service provision in low
and middle income countries (39), and much effort has also gone into drawing lessons
from the better documented instances, particularly in the United Kingdom, which may also
be relevant elsewhere (40).