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Health systems in countries emerging from conflict are often characterised by damaged infrastructure, limited human resources, weak stewardship and a proliferation of non-governmental organisations. This can result in the disrupted and fragmented delivery of health services. One increasingly popular response to improve health service delivery in post-conflict countries is for the country government and international donors to jointly contract non-governmental organisations to provide a Basic Package of Health Services for all the country's population. This approach is being applied in Afghanistan and Southern Sudan and is planned for the Democratic Republic of Congo. The approach is novel because it is intended as the only primary care service delivery mechanism throughout the country, with the available financial health resources primarily allocated to it. Although the aim is to scale up health services rapidly, including sexual and reproductive health services, there are a number of implications for such sub-sectors. This paper describes the Basic Package of Health Services contracting approach and discusses some of the potential challenges this approach may have for sexual and reproductive health services, particularly the challenges of availability and quality of services, and advocacy for these services.
Roberts et al. (Tue,) studied this question.