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Background Although contracting out initiatives had been carried out in various countries, this policy has not been a major issue in Indonesia. As a result, efforts to address health problems, especially in remote areas, continue to use the conventional approach which is through the appointment of civil servants. In this situation the three regions of Indonesia took the initiative to do some contracting out of health services and to overcome the shortage of health problems. The objective of this study was to assess the effectiveness of such contracting out initiatives.

The effectiveness of contracting-out of human resources for health in health service