Effect of Contracting Management of Primary Health Care Services on Utilization,Coverage,Quality,and Equity in Low- and Lower-Middle-Income Countries: A Systematic Review and Meta-Analysis

Abstract

This systematic review, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, aimed to synthesize evidence on the effect of contracting the management of primary health care (PHC) services on utilization, coverage, quality of care, and equity in low- and lower-middle-income countries. Published research and gray literature were searched using PubMed, Ovid Medline, and Google Scholar with relevant keywords. Outcome indicators included overall utilization or coverage for any sickness, maternal care, child care, quality of care, and equitable utilization. Meta-analysis was performed using STATA to calculate pooled estimates of percentage differences in outcomes. A total of 47 137 titles were screened, of which 18 studies met the final inclusion criteria. The review found that PHC contracting significantly increased utilization of PHC services for any sickness by 17%, facility deliveries by 19%, and family planning services by 12%. No significant effect was observed for community antenatal care or skilled birth attendance. Positive effects were also seen for patient satisfaction, while equitable utilization of services showed mixed results. Overall, contracting demonstrated benefits in improving service utilization, coverage, quality of care, and equity. However, assessments that are more rigorous are needed to strengthen the quality of evidence.