The Impact of Contracting in and Contracting out Basic Health Services: The Guatemalan Experience

This paper uses a difference-in-difference strategy to evaluate a program in Guatemala that expanded access to health services through two contracting modalities. In the contracting-out model NGOs were responsible for all administrative and clinical procedures, while in the contracting-in model NGOs focused on administrative tasks and employed public employees to provide services. The evaluation design allows comparing results across both contracting models as well as with an area that did not receive additional services. Both models achieved modest results regarding immunization coverage and prenatal care, though contracting in performed slightly better. We also compare program phases and discuss policy implications.