the move also entails a shift in stewardship arrangements in contrast to its traditional command and control role of direct management the ministry of health is expected to exercise influence via its newly adopted role as the contractor of services the contracts were heavily redacted when presented in the public domain and have been referred to the national audit office for scrutiny by the ministry of health the reform will need to be monitored carefully not least to ascertain whether it is contributing to the fiscal sustainability of the health system and meeting other goals such as maintaining equitable access and improved quality of care