Research for stronger health systems during and after crisis

ReBUILD's work on understanding contracting models in Cambodia

Various models of contracting to manage health service delivery have been initiated by the government of Cambodia since 1998 as a strategy to improve quality of health care and reduce negative effects of high out-of-pocket expenditures for the poor. The story is complex and changes through time. Contracting out of government health services to the non-state sector no longer exists and instead is institutionalised within Special Operations Agencies. We are exploring the change process in contracting arrangements within the Cambodian health sector, identifying drivers for change and examining the implications of the arrangements for cost, equity, service quality, sustainability, health sector capacity and policy formulation.

Given the multiple phases of contracting implementation, the study focuses primarily on the transition in contracting models that happened during and after 2008. The study aims to answer the following questions: What and who were the drivers for change in contracting process? What are the mediums for communication and diffusion of change in contracting? How were local health providers involved in the planning for change? How coherent was the approach to policy formulation/sector strategy? What were the characteristics of the relationship between local health management, the provincial and national level and development partners (including NGOs and donors)? What are the implications for capacity building of the local, provincial and national health system? What are the costs, equity, and quality of service and sustainability implications?