The effect of government contracting with faith-based health care providers in Malawi

Research output: Working paperDiscussion paper


We study the impact of contracting-out of maternal health care by the government of Malawi to providers from the Christian Health Association of Malawi (CHAM) in the form of Service Level Agreements (SLAs). Under a SLA, a CHAM facility provides agreed maternal and newborn services free-of-charge to patients, and is reimbursed on a fixed price per service. We merge data on health facilities in Malawi with pregnancy histories from the 2010 Malawi Demographic and Health Survey, and exploit the staggered
implementation of SLAs across facilities. Using difference-in-differences, we estimate the differential effects on pregnancy- related health care utilisation to mothers residing near and far from facilities with a SLA over time. Our findings show that SLAs reduced home births and increased skilled deliveries at CHAM hospitals. We observe greater provision of prenatal care services at CHAM health centres but no overall increase in the number of prenatal care visits. We find evidence of a reduction in certain
components of prenatal care.
Original languageEnglish
Place of PublicationYork, UK
PublisherCentre for Health Economics, University of York
Number of pages54
Publication statusPublished - Jul 2019

Publication series

NameCHE Research Paper
PublisherCentre for Health Economics, University of York


  • Healthcare
  • Least Developed Country
  • Contracting Out
  • Nonprofit

Cite this