Cambodia

La couverture sanitaire universelle fait partie des objectifs de développement durable. Mais une couverture sans services de santé de qualité limite les avantages pour les populations. Les programmes de financement basés sur la performance (FBP) utilisent des achats stratégiques de services pour étendre la couverture et promouvoir la qualité en mesurant la qualité et en récompensant les bonnes performances.

This article describes four approaches that can help improve quality of health services at scale in PBF programs, looking at structural and process measures of quality as well as outcome measures like patient satisfaction and using three types of tools (i.e.

Contracting approaches have been used in various forms to improve the delivery of public health services in low- and middle-income countries. Cambodia has embarked on a public-sector reform that includes a model of internal contracting of health care through the Ministry of Health, supported by incentive payments for staff and facilities.

Dr. Robert Soeters, an independent public health and health financing specialist, shares a personal story about performance-based financing.

Soeters explores the PBF programs he has witnessed in countries such as Burundi, Cambodia, the Democratic Republic of Congo and Rwanda.

The Success Factors for Women’s and Children’s Health report shows that despite political and economic challenges, rapid reductions of maternal and child mortality and dramatic improvements in reproductive health and rights are possible.

The report highlights 10 countries that mobilized action across society, using data to drive decisions to address their unique circumstances. As a result, in the 10 “fast-track” countries, there were 2.4 million fewer child deaths and over 70,000 fewer maternal deaths by 2013 when compared to 1990 mortality rates.

Objective

To evaluate the effect of vouchers for maternity care in public health-care facilities on the utilization of maternal health-care services in Cambodia.

Background
Recent figures from the Cambodian Demographic Health Survey 2010 on maternal health (MH) service utilisation have been impressive. These figures, however, indicate average gains and mask large inequalities in MH service utilisation within Cambodia. In this study, we aim to measure socioeconomic inequities in MH use and to evaluate the impact of a targeted reproductive health (RH) voucher intervention in reducing inequities.
 
Methods

Following a decade of piloting different models of contracting, in mid-2009 the Cambodian Ministry of Health began to test a form of 'internal contracting' for health care delivery in selected health districts (including hospitals and health centres) contracted by the provincial health department as Special Operating Agencies (SOAs) and provided with greater management autonomy. This study assesses the internal contracting approach as a means for improving the management of district health services and strengthening service delivery.

In 1999, Cambodia’s Ministry of Health (MOH) first contracted with non-governmental organizations (NGOs) to provide health services in selected health Operational Districts (ODs) under the Basic Health Services Project, which was funded by the Asian Development Bank (ADB). The success of this first effort led to the incorporation of NGO contracting into the successor project—the Health Sector Support Project 2003-09—which was jointly funded by ADB, The World Bank, DFID, and UNFPA.

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