Fig. 1

Centralized-purchaser model.The NDOH as the purchaser directly recruits and contracts GPs. Contracts are signed by a district manager (DM) an authorized signatory at NDOH. Placement, orientation, training, supervision and monitoring of GPs are done by staff at the district health office (DHO). GPs provide PHC services to patients attending PHC clinics with day-to-day oversight from a Facility Manager (FM). GPs are paid monthly by an external payroll company on behalf of the NDOH. This is effected on submission of a completed timesheet, signed and verified by the FM, GPCI Coordinator and DM. The DM is the final signatory required to effect payment. The DHO compiles and submits monthly and quarterly reports to the NDOH, containing information on the number of GPs appointed, hours worked and the estimated number of patients seen per hour