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Item Factors influencing performance by contracted non-state providers implementing a basic package of health services in Afghanistan(Biomed Central, 2018-10-05) Salehi, Ahmad Shah; Saljuqi, Abdul Tawab Kawa; Akseer, Nadia; Rao, Krishna; Coe, Kathryn; Social and Behavioral Sciences, School of Public HealthBACKGROUND: In 2002 Afghanistan's Ministry of Public Health (MoPH) and its development partners initiated a new paradigm for the health sector by electing to Contract-Out (CO) the Basic Package of Health Services (BPHS) to non-state providers (NSPs). This model is generally regarded as successful, but literature is scarce that examines the motivations underlying implementation and factors influencing program success. This paper uses relevant theories and qualitative data to describe how and why contracting out delivery of primary health care services to NSPs has been effective. The main aim of this study was to assess the contextual, institutional, and contractual factors that influenced the performance of NSPs delivering the BPHS in Afghanistan. METHODS: The qualitative study design involved individual in-depth interviews and focus group discussions conducted in six provinces of Afghanistan, as well as a desk review. The framework for assessing key factors of the contracting mechanism proposed by Liu et al. was utilized in the design, data collection and data analysis. RESULTS: While some contextual factors facilitated the CO (e.g. MoPH leadership, NSP innovation and community participation), harsh geography, political interference and insecurity in some provinces had negative effects. Contractual factors, such as effective input and output management, guided health service delivery. Institutional factors were important; management capacity of contracted NSPs affects their ability to deliver outcomes. Effective human resources and pharmaceutical management were notable elements that contributed to the successful delivery of the BPHS. The contextual, contractual and institutional factors interacted with each other. CONCLUSION: Three sets of factors influenced the implementation of the BPHS: contextual, contractual and institutional. The MoPH should consider all of these factors when contracting out the BPHS and other functions to NSPs. Other fragile states and countries emerging from a period of conflict could learn from Afghanistan's example in contracting out primary health care services, keeping in mind that generic or universal contracting policies might not work in all geographical areas within a country or between countries.Item Sources and Management of Conflict in Blended Organizations(2007-08-08T17:23:08Z) Leinbaugh, Daniel A.; Goering, Elizabeth M.; Sandwina, Ron; Parrish-Sprowl, JohnThe integration of nonstandard (temporary) workers into an organization is called a “blended workforce,” and such an arrangement is a breeding ground for potential conflict. Until very recently, much of the research on nonstandard workers has been limited to exploring those in low-wage positions requiring limited skills and the detriments of such working arrangements. However, with advances in technology that allow working from remote locations and the desire of firms to more quickly adapt to changes in the market, the role of high-skill, high-wage nonstandard workers is steadily growing. Pondy (1967) proposed that conflict episodes are composed of five possible stages: latent, perceived, felt, manifest and the aftermath. These conflict stages provided the framework for the consideration of conflict in blended organizations. Through an extensive literature review of nonstandard workers, this research determined six potential areas of latent conflict in blended organizations. Next, the research determined if those areas of latent conflict move into advanced stages of conflict within blended organizations that integrate high-end nonstandard workers. Finally, the research explored how those conflicts that emerge from the use of a blended workforce are managed.