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Improving the performance of health systems is an essential objective for any person or institution working in the health sector. Health-system reforms, whether in the developed or the developing countries, have generally entailed institutional reshufflings which have led to multiplication, diversification and occasionally specialization of the actors involved in health, whether in the public, private or voluntary sectors.
The isolation that often characterized traditional health actors has become impossible to sustain. In addition, as new independent or autonomous actors come on stage, it becomes impossible to rely on hierarchical authority. This compels health actors to reconsider their relations. The relationships they develop may be based on consultation; however, there are limits to this moral commitment. It is increasingly common for such relations to be based on contractual arrangements, which formalize agreements between actors, who accept mutually-binding commitments.
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