Research for stronger health systems during and after crisis

Contracting models in Cambodia

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In ReBUILD's work on contracting, we are building knowledge about the implications of contracting models which is applicable to a variety of post-conflict settings. The new public management approaches introducing market mechanisms into the public sector have been widely accepted in countries across the globe. Contracting of health services is one such approach.

Cambodia has seen application of contracting in the health sector since the late 1990s. Since 2009, the model that has been pursued has involved an internal contracting model with performance incentives and monitoring mechanisms and a greater level of autonomy for health district management. Cambodia’s switch from external contracting back to internal contracting, within the public health care system, can generate wider lessons for other post-conflict countries.

Our research has focused on understanding the change process in contracting arrangements identifying the drivers of changes, actors involved and the processes for realisation of the change and examining the implications for service coverage and equity in Cambodia. We have used qualitative interviews to explore experiences and perceptions of contracting from the perspectives of policy makers, managers and health care providers. We have also analysed secondary data from health statistics reports for trends in service utilisation and equity.

The research is complete and draft and published outputs are emerging. Some are here and more will be added over the coming months.