Privatisation of government services in Australia: what is known about health and equity impacts.

BACKGROUND: Historically in Australia, all levels of government created collective wealth by owning and operating infrastructure, and managing natural assets, key public goods and essential services while being answerable to the public. This strong state tradition was challenged in the 1980s when privatisation became a widespread government approach globally. Privatisation involves displacing the public sector through modes of financing, ownership, management and product or service delivery. The Australian literature shows that negative effects from privatisation are not spread equitably, and the health and equity impacts appear to be under-researched. This narrative overview aims to address a gap in the literature by answering research questions on what evidence exists for positive and negative outcomes of privatisation; how well societal impacts are evaluated, and the implications for health and equity. METHODS: Database and grey literature were searched by keywords, with inclusion criteria of items limited to Australia, published between 1990 and 2022, relating to any industry or government sector, including an evaluative aspect, or identifying positive or negative aspects from privatisation, contracting out, or outsourcing. Thematic analysis was aided by NVivo qualitative data software and guided by an a-priori coding frame. RESULTS: No items explicitly reflected on the relationship between privatisation and health. Main themes identified were the public cost of privatisation, loss of government control and expertise, lack of accountability and transparency, constraints to accessing social determinants of health, and benefits accruing to the private sector. DISCUSSION: Our results supported the view that privatisation is more than asset-stripping the public sector. It is a comprehensive strategy for restructuring public services in the interests of capital, with privatisation therefore both a political and commercial determinant of health. There is growing discussion on the need for re-nationalisation of certain public assets, including by the Victorian government. CONCLUSION: Privatisation of public services is likely to have had an adverse impact on population health and contributed to the increase in inequities. This review suggests that there is little evidence for the benefits of privatisation, with a need for greater attention to political and commercial determinants of health in policy formation and in research.

Social distancing decreases an individual's likelihood of contracting COVID-19.

Past research has established the value of social distancing as a means of deterring the spread of COVID-19 largely by examining aggregate level data. Locales in which efforts were undertaken to encourage distancing experienced reductions in their rate of transmission. However, these aggregate results tell us little about the effectiveness of social distancing at the level of the individual, which is the question addressed by the current research. Four months after participating in a study assessing their social distancing behavior, 2,120 participants indicated whether they had contracted COVID-19. Importantly, the assessment of social distancing involved not only a self-report measure of how strictly participants had followed social distancing recommendations but also a series of virtual behavior measures of social distancing. These simulations presented participants with graphical depictions mirroring specific real-world scenarios, asking them to position themselves in relation to others in the scene. Individuals' social distancing behavior, particularly as assessed by the virtual behavior measure, predicted whether they contracted COVID-19 during the intervening 4 mo. This was true when considering only participants who reported having tested positively for the virus and when considering additional participants who, although untested, believed that they had contracted the virus. The findings offer a unique form of additional evidence as to why individuals should practice social distancing. What the individual does matters, not only for the health of the collective, but also for the specific individual.

Cracks in tensile-contracting and tensile-dilating poroelastic materials.

Fibrous gels such as cartilage, blood clots, and carbon-nanotube-based sponges with absorbed oils suffer a reduction in volume by the expulsion of liquid under uniaxial tension, and this directly affects crack-tip fields and energy release rates. A continuum model is formulated for isotropic fibrous gels that exhibit a range of behaviors from volume increasing to volume decreasing in uniaxial tension by changing the ratio of two material parameters. The motion of liquid in the pores of such gels is modeled using poroelasticity. The direction of liquid fluxes around cracks is shown to depend on whether the gel locally increases or decreases in volume. The energy release rate for cracks is computed using a surface-independent integral and it is shown to have two contributions - one from the stresses in the solid network, and another from the flow of liquid. The contribution to the integral from liquid permeation tends to be negative when the gel exhibits volume decrease, which effectively is a crack shielding mechanism.

50 Years of the steric-blocking mechanism in vertebrate skeletal muscle: a retrospective.

Fifty years have now passed since Parry and Squire proposed a detailed structural model that explained how tropomyosin, mediated by troponin, played a steric-blocking role in the regulation of vertebrate skeletal muscle. In this Special Issue dedicated to the memory of John Squire it is an opportune time to look back on this research and to appreciate John's key contributions. A review is also presented of a selection of the developments and insights into muscle regulation that have occurred in the years since this proposal was formulated.

Effect of social integration on family doctor contracting services among migrant populations in China: a national cross-sectional survey.

BACKGROUND: The family doctor (FD) contracting system is a key reform in the development of the Chinese health system, and is considered an effective way to ensure equitable access to healthcare services. This study investigates the effects of social integration on FD contracting services among migrant populations. METHODS: In total, 120,106 respondents from the 2018 China Migrants Dynamic Survey were included in this study. Two multivariate regression models were used to estimate the effect of social integration and other factors on FD contracting services among migrant populations. RESULTS: This study found that only 14.0% of the migrant populations had a FD. Multiple dimensions of social integration and some covariates were shown to be positively associated with FD contracting services, including average monthly household income, local medical insurance (odds ratio [OR] = 1.34, 95% confidence interval [CI] = 1.29-1.39), employment status (OR = 0.86, 95% CI = 0.82-0.91), settlement intention (OR = 1.15, 95% CI = 1.09-1.22), received health education (OR = 4.88, 95% CI = 4.51-5.27), sex (OR = 1.16, 95% CI = 1.12-1.20), age (OR = 1.66, 95% CI = 1.51-1.82), marital status (OR = 1.38, 95% CI = 1.31-1.46), sickness within a year (OR = 0.84, 95% CI = 0.79-0.89), and flow range (OR = 1.12, 95% CI = 1.07-1.16). CONCLUSIONS: All dimensions of social integration, including economic integration, social identity, and social involvement, are associated with FD contracting services among migrant populations. Policymakers should focus on improving the signing rates of migrant populations and implement more effective measures to enhance their social integration, such as settlement incentives and encouraging social participation.

The effectiveness of pay-for-performance contracts with non-governmental organizations in Afghanistan - results of a controlled interrupted time series analysis.

BACKGROUND: In many contexts, including fragile settings like Afghanistan, the coverage of basic health services is low. To address these challenges there has been considerable interest in working with NGOs and examining the effect of financial incentives on service providers. The Government of Afghanistan has used contracting with NGOs for more than 15 years and in 2019 introduced pay-for-performance (P4P) into the contracts. This study examines the impact of P4P on health service delivery in Afghanistan. METHODS: We conducted an interrupted time series (ITS) analysis with a non-randomized comparison group that employed segmented regression models and used independently verified health management information system (HMIS) data from 2015 to 2021. We compared 31 provinces with P4P contracts to 3 provinces where the Ministry of Public Health (MOPH) continued to deliver services without P4P. We used data from annual health facility surveys to assess the quality of care. FINDINGS: Independent verification of the HMIS data found that consistency and accuracy was greater than 90% in the contracted provinces. The introduction of P4P increased the 10 P4P-compensated service delivery outcomes by a median of 22.1 percentage points (range 10.2 to 43.8) for the two-arm analysis and 19.9 percentage points (range: - 8.3 to 56.1) for the one-arm analysis. There was a small decrease in quality of care initially, but it was short-lived. We found few other unintended consequences. INTERPRETATION: P4P contracts with NGOs led to a substantial improvement in service delivery at lower cost despite a very difficult security situation. The promising results from this large-scale experience warrant more extensive application of P4P contracts in other fragile settings or wherever coverage remains low.

Applying the practice-based competencies to evaluate and characterize the contracting process within genetic counseling sessions.

Contracting is a skill used by genetic counselors (GCs) to establish a shared vision for the session. Ensuring that patients and GCs are aligned on expectations for the encounter allows GCs to meet patient needs and support patient autonomy. Although contracting is described in the practice-based competencies (PBCs), the process has not been systematically observed in practice. We sought to further elucidate the skills used for contracting within genetic counseling sessions through directed content analysis of transcripts from 148 simulated prenatal and cancer genetic counseling sessions. An a priori codebook and rating scale were developed based on four contracting sample skills described in the PBCs: (a) describing the genetic counseling process, (b) eliciting client concerns, (c) applying client concerns to a session agenda, (d) modifying the agenda in response to emerging concerns. The rating scale described the quality of each skill on a 4-point scale of "absent," "minimal," "adequate," and "excellent." The codebook and rating scale were pilot tested with 40% of transcripts (n = 60). Three authors independently coded and rated the final 60% of transcripts (n = 88), resolving discrepancies via a consensus process. We found that the four PBC skills were present in most sessions (88%-98%), and on average, GCs received "adequate" scores on all four skills. We also identified three additional components of contracting not described in the PBCs: assessing whether client concerns were met, inviting to interrupt, and providing opportunity for partner concerns. This study represents the first attempt to evaluate GC performance of a PBC during a genetic counseling session. Our findings demonstrate that the PBC sample contracting skills reflect practice and suggest that they can be used in assessment of the genetic counseling contracting process. This type of analysis could be adapted in the future to provide support for other standards of practice in the genetic counseling field.

Relationships between contract status and player performance in the Australian Football League.

This study analysed the extent to which player performance differs within the Australian Football League (AFL) with respect to the status of a player's contract. AFL Player Ratings (AFLPR) and contract data were obtained during the 2013-2020 AFL seasons for all 827 players listed by an AFL club at the beginning of the 2020 season. A model of "expected performance" was created allowing for an exploration into the differential with actual performance as a function of contract status. Paired t-tests indicated that there was a difference in performance pre- and post-signing their contract for players who signed mid-season (mean change and 95% confidence interval of -1.48 ± 0.93 and -0.49 ± 0.48 AFLPR, at ten match intervals for those in- and out-of-contract at the conclusion of that year's season, respectively). Further differences existed between the groups of players who signed mid-season, as compared to those who signed during the off-season. Correlation analyses indicated that more consistent performers are somewhat less likely to see a reduction in performance post signing as compared to less consistent performers. The applications of these findings have the potential to support organisational decisions relating to the timing and nature of player contracting.

Race, ethnicity, psychological factors, and COVID-19 vaccine hesitancy during the COVID-19 pandemic.

We examined the associations between perceived risk, perceived severity, and fear of contracting COVID-19 and vaccine acceptance among different ethnic groups in San José, California. We surveyed 3,797 adults living in San José using a multi-stage, clustered sampling design in which we randomly selected census tracts in San José followed by households within each census tract. We estimated the odds ratio (ORs) for perceived risk, perceived general severity, fear of contracting COVID-19, and vaccine acceptance using regression models. Finally, we assessed the differential impacts of perceived risk, perceived severity, and fear of contracting the COVID-19 on vaccine acceptance by controlling for social-demographic variables. Hispanic/Latino respondents reported higher levels of perceived risk and lower fear of contracting COVID-19 than Asians. Hispanic/Latinos (odds ratio [OR] = 0.48, P < 0.05), Whites (OR = 0.61, P < 0.05), and African Americans (OR = 0.28, P < 0.05) were less likely to report intentions to be vaccinated than Asians. Finally, perceived risk and perceived personal severity were not associated with intentions to be vaccinated, while perceived general severity and fear of contracting COVID-19 were stronger predictors of vaccination intentions. The study highlights the importance of psychological factors in understanding vaccine acceptance across race/ethnicity groups.

The trust and insurance models of healthcare purchasing in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in India: early findings from case studies of two states.

BACKGROUND: The Pradhan Mantri Jan Arogya Yojana (PMJAY), a publicly funded health insurance scheme for the poor in India, was launched in 2018. Early experiences of states with various purchasing arrangements can provide valuable insights for its future performance. We sought to understand the institutional agencies and performance of the trust and insurance models of purchasing with respect to; a) Provider contracting b) Claim management c) Implementation costs. METHODS: A mixed methods case study design was adopted. Two states, Uttar Pradesh (representing a trust model) and Jharkhand (representing the insurance model) were purposively selected. Data sources included document reviews, key informant interviews, quantitative scheme data from the provider empanelment and claims database, and primary data on costs. Descriptive statistics were reported for quantitative data, content analysis was used for thematic reporting of qualitative data. RESULTS: In both models, the state was the final authority on empanelment decisions, with no significant influence of the insurance company. Private hospitals constituted the majority of empanelled providers, with wide variations in district-wise distribution of bed capacities in both states. The urgency of completing empanelment in the early days of the scheme created the need for both states to re-review hospitals and de-empanel those not meeting requirements. Very few quality- accredited private hospitals were empaneled. The trust displayed more oversight of support agencies for claim management, longer processing times, a higher claim rejection rate and numbers of queries raised, as compared to the insurance model. Support agencies in both states faced challenges in assessing the clinical decisions of hospitals. Cost-effectiveness showed mixed results; the trust cost less than the insurance model per beneficiary enrolled, but more per claim generated. CONCLUSIONS: Efforts are required to enable a better distribution and ensure quality of care in empanelled hospitals. The adoption of standard treatment guidelines is needed to support hospitals and implementing agencies in better claim management. The oversight of agencies through enforcement of contracts remains vital in both models. Assessing the comparative performance of trusts and insurance companies in more states at later stages of scheme implementation, would be further useful to determine their cost-effectiveness as purchasers.

Public contracting of home respiratory care services through an electronic quasi-market model.

Respiratory diseases are becoming a major challenge in health systems as they cover expanding and diversified pathologies such as chronic obstructive pulmonary disease, chronic bronchitis, emphysema and other types increasing at a fast rate as it is the case of sleep apnoea. Nowadays, most of these pathologies can be treated by home respiratory care services using advanced medical equipment as well as efficient assistance and monitoring services supported by digital technologies. However, the implementation of home respiratory care services implies flexible public contracting of such services to achieve equity conditions of access and to cope with their technological nature, their continuous processes of innovation and their time dependent demand. Unfortunately, traditional procurement processes are not able to meet these challenges explaining their frequent low rates of success and so an alternative procurement approach is proposed in this paper based on an electronic quasi-market model. This new model was successfully applied in Portugal and the evaluated results are also discussed herein.

Does contracting out lead to improvement in service volumes at primary and secondary health services? Evidence from rural districts of Sindh, Pakistan.

OBJECTIVE: To determine the improvement in service volumes from baseline, if any, in the contracted out primary and secondary healthcare facilities against key performance indicators, and to explore the perceptions of health managers and experience of patients in this regard. METHODS: The mixed-method study was conducted at Aga Khan University, Karachi, from November 2019 to April 2020, and comprised secondary data extracted from the district health information system related to Thatta and Sujawal districts of the Sindh province of Pakistan from July 2016 to June 2019. Apart from data analysis for baseline versus end-line comparison of key performance indicators, the study also comprised of a cross-sectional survey of health facilities, patient exit interviews and in-depth interviews with healthcare managers. RESULTS: The key performance indicators showed improved service volumes compared to the baseline. All services, including general outpatient department (33%), consultancy services (91%) and emergency services (106%) increased in volumes. Facility-based deliveries increased by 37% and antenatal care visits increased by 100% but immunisation volumes declined. Specialist workforce increased by 47%. Healthcare managers perceived delayed/partial budget release as the key determinant of staff retention, availability of drugs, equipment, supplies, water and electricity at health facilities. Lack of control over government-appointed employees coupled with political interference created workforce shortage. Patients were satisfied with service delivery, but unavailability of medicine was the main concern for 64.3%. CONCLUSIONS: Contracting out showed improvement in service volumes, but lack of autonomy over budget allocation and utilisation, staff appointment and poor coordination among the stakeholders were key barriers.

Perceived support and preparedness for the next pandemic among Israeli social workers in hospital settings during the COVID-19 pandemic.

This study describes the conditions under which Israeli social workers in hospital settings operated s during the COVID-19 pandemic, and assesses their perceived support (informal and organizational support) and preparedness for the next pandemic. It further assesses correlates for perceived support and associations between perceived support and preparedness. The participants were 163 social workers from four hospitals who completed an on-line survey. The findings revealed that the level of exposure to COVID-19 and fear of contracting COVID-19 were unrelated to perceived informal and organizational support. Age and having children who are minors living at home moderated the relationship between fear of contracting COVID-19 and both types of perceived support. Each type of perceived support was significantly associated with preparedness beyond age, having minors at home, exposure to COVID-19, and fear of contracting COVID-19. Implications for research and practice are discussed.

Investigating students' E-Learning attitudes in times of crisis (COVID-19 pandemic).

With the COVID-19 pandemic affecting the world, the vast majority of students in various educational institutions around the world have changed their learning styles from the physical classroom to digital learning education. Especially the fact that university students take their lessons with e-learning in times of crisis (COVID-19 pandemic) has forced them to spend more time with the computer. This situation will also affect their academic motivation. This research aimed to test whether the fear of contracting COVID-19 (CoVFC) had a moderating effect on the prediction of preservice teachers' academic motivation (AMOTV) with their computer self-efficacy perceptions (CSE). With a combined approach, a single model was employed to test the moderating role of CoVFC and the mediating role of Attitudes towards E-Learning (ATEL) in the prediction of preservice teachers' AMOTV with their CSE. 522 preservice teachers from 21 different branches participated in this research. As a result of the research, the CSE of preservice teachers were determined to predict their AMOTV significantly and positively. The increase in CoVFC was found to have a negative moderating effect on the prediction of AMOTV with the CSE of preservice teachers. Also, ATEL was found to have a partial mediating effect in the relationship between the CSE and AMOTV of preservice teachers.

Divided by choice? For-profit providers, patient choice and mechanisms of patient sorting in the English National Health Service.

This paper studies patient choice of provider following government reforms in the 2000s, which allowed for-profit surgical centers to compete with existing public National Health Service (NHS) hospitals in England. For-profit providers offer significant benefits, notably shorter waiting times. We estimate the extent to which different types of patients benefit from the reforms, and we investigate mechanisms that cause differential benefits. Our counterfactual simulations show that, in terms of the value of access, entry of for-profit providers benefitted the richest patients twice as much as the poorest, and white patients six times as much as ethnic minority patients. Half of these differences is explained by healthcare geography and patient health, while primary care referral practice plays a lesser, though non-negligible role. We also show that, with capitated reimbursement, different compositions of patient risks between for-profit surgical centers and existing public hospitals put public hospitals at a competitive disadvantage.

Does the Profit Motive Matter? COVID-19 Prevention and Management in Ontario Long-Term-Care Homes.

We introduce evidence that for-profit long-term-care providers are associated with less successful outcomes in coronavirus disease 2019 outbreak management. We introduce two sets of theoretical arguments that predict variation in service quality by provider type: those that deal with the institution of contracting (innovative competition vs. erosive competition) and those that address organizational features of for-profit, non-profit, and government actors (profit seeking, cross-subsidization, and future investment). We contextualize these arguments through a discussion of how contracting operates in Ontario long-term care. That discussion leads us to exclude the institutional arguments while retaining the arguments about organizational features as our three hypotheses. Using outbreak data as of February 2021, we find that government-run long-term-care homes surpassed for-profit and non-profit homes in outbreak management, consistent with an earlier finding from Stall et al. (2020). Non-profit homes outperform for-profit homes but are outperformed by government-run homes. These results are consistent with the expectations derived from two theoretical arguments-profit seeking and cross-subsidization-and inconsistent with a third-capacity for future investment.

Dans cet article, nous présentons quelques éléments de preuve que les fournisseurs de soins de longue durée à but lucratif ont eu de moins bons résultats dans la gestion de la pandémie de la COVID-19. Nous avançons deux séries d'arguments théoriques qui prédisent la variation dans la qualité du service selon le type de fournisseur : ceux qui ont trait à l'institution contractante (concurrence novatrice versus concurrence érosive) et ceux qui s'intéressent aux caractéristiques organisationnelles des acteurs à but lucratif, sans but lucratif et gouvernementaux (recherche de profit, interfinancement et investissement futur). Nous mettons ces arguments en contexte en discutant les façons dont les contrats sont attribués dans le cas des soins de longue durée en Ontario. Cette analyse nous pousse à exclure les arguments institutionnels et à conserver, comme nos trois hypothèses, les arguments sur les caractéristiques organisationnelles. En utilisant les données relatives à l'épidémie à partir de février 2021, nous constatons que les établissements de soins de longue durée gouvernementaux ont surpassé les établissements à but lucratif et sans but lucratif dans la gestion de l'épidémie, ce qui concorde avec une conclusion antérieure par Stall et ses collègues (2020). Ces résultats concordent avec les attentes dérivées de deux arguments théoriques ­ la recherche du profit et l'interfinancement ­ mais pas avec le troisième, celui de l'investissement futur.

Power and Purchasing: Why Strategic Purchasing Fails.

Policy Points Strategically purchasing health care has been and continues to be a popular policy idea around the world. Key asymmetries in information, market power, political power, and financial power hinder the effective implementation of strategic purchasing. Strategic purchasing has consistently failed to live up to its promises for these reasons. Future strategies based on strategic purchasing should tailor their expectations to its real effectiveness. CONTEXT: Strategic purchasing of health care has been a popular policy idea around the world for decades, with advocates claiming that it can lead to improved quality, patient satisfaction, efficiency, accountability, and even population health. In this article, we report the results of an inquiry into the implementation and effects of strategic purchasing. METHODS: We conducted three in-depth case studies of England, the Netherlands, and the United States. We reviewed definitions of purchasing, including its slow acquisition of adjectives such as strategic, and settled on a definition of purchasing that distinguishes it from the mere use of contracts to regulate stable interorganizational relationships. The case studies review the career of strategic purchasing in three different systems where its installation and use have been a policy priority for years. FINDINGS: No existing health care system has effective strategic purchasing because of four key asymmetries: market power asymmetry, information asymmetry, financial asymmetry, and political power asymmetry. CONCLUSIONS: Further investment in policies that are premised on the effectiveness of strategic purchasing, or efforts to promote it, may not be worthwhile. Instead, policymakers may need to focus on the real sources of power in a health care system. Policy for systems with existing purchasing relationships should take into account the asymmetries, ways to work with them, and the constraints that they create.

Pharmaceutical Products and Their Value: Lessons Learned and the Path Ahead.

Steep increases in prices and spending on prescription drugs in the United States have triggered public outrage and questions over their value. Value-based pricing has emerged as a preferred alternative to prices determined by what the market will bear. In response, manufacturers and health plans have begun to publicize their efforts to engage in outcomes-based contracts and long-term financing agreements, which they describe as value-based. Nevertheless, both contracting approaches perpetuate existing distortions in the financial incentives of supply chain and prescribing intermediaries, and fail to realign the prices of drugs to their value to patients, the healthcare system, or society. This commentary describes the challenges of managing drugs according to their value, and describes several alternatives that promise greater impact than contracting strategies.

Identifying Outcome Measures for Migraine Value-Based Contracting Using the Delphi Method.

OBJECTIVE: To identify meaningful migraine outcome measures among key stakeholders to inform value-based contracts for migraine medications. BACKGROUND: Value-based contracts linking medication payments to predefined performance metrics aim to promote value through aligned incentives and shared risk between manufacturers and payers. The emergence of new and expensive pharmaceuticals for migraine presents an opportunity for value-based contract development. However, uncertainty remains around which outcomes are most meaningful to all migraine stakeholders. METHODS: This study utilized a Delphi survey to incorporate views from 82 stakeholders, including patients (n = 21), providers (n = 23), payers (n = 10), employers (n = 18), and pharmaceutical company representatives (n = 10). A list of 15 migraine-related outcomes was created from a literature review and subject matter expert consultation. Stakeholders reported on the value of these outcomes through a 5-point Likert scale and selection of their top 3 most meaningful outcomes. All participants except patients and employers also used a 5-point Likert scale to rate the feasibility of collecting each outcome measure. Consensus was defined as ≥75% agreement on the importance and feasibility of an outcome (Likert scores ≥4/5 or selection of an outcome as most meaningful). RESULTS: After 2 rounds, consensus was achieved for importance of 9 outcomes on the Likert scale. "Decrease in migraine frequency" reached 100% agreement (82/82), followed by "increased ability to resume normal activities" (96%, 79/82). When asked to choose the 3 most meaningful outcomes, stakeholders selected "decrease in migraine frequency" (88%, 72/82) followed by "decrease in migraine severity" (80%, 66/82). The 2 measures rated as most feasibly collected were "decrease in emergency department/urgent care visits" (95%, 40/42) and "decrease in migraine frequency" (90%, 38/42). There were statistically significant differences between non-patient and patient stakeholders in selection of "decrease in emergency department/urgent care visits" [20% (12/61) vs 0% (0/21), P = .031]; and employer and patient stakeholders in selection of "decrease in work days missed" [44% (8/18) vs 5% (1/21), P = .006] and "decrease in emergency department/urgent care visits" [22% (4/18) vs 0% (0/21), P = .037] as most meaningful outcomes. CONCLUSIONS: The measures "decrease in migraine frequency" followed by "decrease in migraine severity" were identified as top priority migraine outcome measures.

Coping with waste: A government-NGO collaborative governance approach in Shanghai.

Complex environmental issues are leading local governments to collaborate with non-governmental organizations (NGOs) in the urban environmental governance sphere. While previous studies have emphasized how the Chinese government engages NGOs in service contracting to meet rising service demands, they have not provided empirical evidence of the outcomes of these collaborations at a local level. Based on a mixed methods research design developed from May 2016 to February 2017 in Shanghai, the impact of Aifen, an environmental NGO, is assessed in the context of municipal solid waste management. A total of 400 questionnaires were completed. 200 questionnaires in 10 communities where Aifen developed its activities and 200 questionnaires in 10 communities where no environmental NGO activities were accomplished. The results show that a local government-NGO collaborative governance approach enhances public participation and respond to state decentralization and rising environmental issues in urban areas.