Successful contracting of prevention services: fighting malnutrition in Senegal and Madagascar

There are very few documented large-scale successes in nutrition in Africa, and virtually no consideration of contracting for preventive services. Thi s paper describes two successful large-scale community nutrition projects i n Africa as examples of what can be done in prevention using the contractin g approach in rural as well as urban areas. The two case-studies are the Se caline project in Madagascar, and the Community Nutrition Project in Senega l. 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 pr ovide, and in combining private administration with public finance. The article illustrates that contracting out is a feasible option to be ser iously considered for organizing certain prevention programmes on a large s cale. There are strong indications from these projects of success in terms of reducing malnutrition, replicability and scale, and community involvemen t. When choosing that option, a government can tap available private local human resources through contracting out, rather than delivering those servi ces by the public sector. However, as was done in both projects studied, co nsideration needs to be given to using a contract management unit for execu tion and monitoring, which costs 13-17% of the total project's budget. Rigo rous assessments of the cost-effectiveness of contracted services are not a vailable, but improved health outcomes, targeting of the poor, and basic co st 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 alter native in many countries to increase coverage and quality of services.