Fig. 3

Decentralized-purchaser model.The provincial department of health (PDOH) is the purchaser. The GP enters a contract with the PDOH represented by the DHO, and the contract is signed by the GP and DM (as a representative of the PDOH). Recruitment and placement are done by the sub-district health office in conjunction with the DHO. The sub-district manager (SDM) is responsible for orientation, training, supervision and monitoring of GPs. GPs provide PHC services to patients attending PHC clinics with day-to-day oversight from a Facility Manager (FM). GPs are placed on the DHO payroll and paid at the end of the month based on the number of hours indicated in the contract. The GPs complete monthly timesheets that are in turn verified and signed by the FM, SDM, GPCI Coordinator and DM. These timesheets are not used to effect payment, but rather as an oversight mechanism to confirm the number of hours worked. The sub-district health office compiles and submits monthly and quarterly reports to the DHO and PDOH for review and submission to the NDOH