Contracting out of basic health facilities in Pakistan: Are the lessons generalizable?

Amid growing support within international development agencies for the privatization of health facilities in developing countries, contracting out of the Basic Health Units (BHUs) in Pakistan has been presented as a success. This article argues for caution in generalizing results from this model. It shows that the model improved service delivery because the organization taking over the BHUs was itself a government‐owned QUANGO (Quasi‐Autonomous NGO); similar concessions would not have been granted to a private provider. Further, the article shows that, given the strong resistance that the model continues to receive from administrators within the state system, development agencies must consider whether models that try to sidestep the bureaucracy instead of working towards installing good practice within the state system, can be viewed as a success