The aim of the study was to investigate the process, rationale, and implementation of contracting-out intervention in Tanzania. The specific research questions which gilded the study were: Why and how was the Service Agreement reform initiated and who were the key actors supporting the reform?; and What explains the difference in performance of different districts council in the implementation of the Service Agreement?  The project was funded by the Alliance for Health Policy and Systems Research and the Rockefeller Foundation. The project was implanted from 2015 to 2018. The total budget for the project was $ 120,000