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The case discusses the situation of the Basic Services Coverage Extension Program (PECSB) in Guatemala at the beginning of 2000. During its three years of existence, the program has proven to be successful in persuading a large number of NGOs to work with the government in extending health services coverage to poor native populations living in rural areas. The new government is wondering whether the existing "agreements" should be upgraded to contracts that comply with the regulations set forth in the State Contract Act. This upgrade may contribute to the program's institutional sustainability by improving efficiency and quality of care, but it may also interfere with existing operations and generate unwanted strain.