Purpose
This study explores the readiness of contracted and non-contracted first level healthcare facilities in Pakistan to deliver quality maternal and neonatal health (MNH) care. A balanced scorecard (BSC) was used as the assessment framework.

Design/methodology/approach
Using a cross sectional study design, two Rural Health Centres (RHCs) contracted out to Aga Khan Health Services, were compared with four government managed RHCs. A BSC was designed to assess RHC readiness to deliver good quality MNH care. Twenty indicators were developed, representing five BSC domains: health facility functionality, service provision, staff capacity, staff and patient satisfaction. Validated data collection tools were used to collect information. Pearson Chi-Square, Fisher’s Exact and the Mann-Whitney test were applied as appropriate to detect significant service quality differences among the two facilities.

Findings
Contracted facilities were generally found to be better than non-contracted facilities in all five BSC domains. Patients’ inclination for facility-based delivery at contracted facilities was however significantly higher than non-contracted facilities (80% contracted vs. 43% non-contracted, p= 0.006).

Practical implications
The study shows that contracting out initiatives have the potential to improve MNH care.

Originality/value
This is the first study to compare MNH service delivery quality across contracted and non-contracted facilities using BSC as the assessment framework.