Publication: Cambodia : Using Contracting to Reduce Inequity in Primary Health Care Delivery
Loading...
Date
2004-10
ISSN
Published
2004-10
Author(s)
Editor(s)
Abstract
This study examines the equity impact of using private sector contracts for the delivery of primary health care as an alternative to traditional government provision in Cambodia. It does so by using pre- and post intervention data from a large scale contracting experiment to provide primary health care in rural districts of Cambodia between 1998 and 2001. Equity as well as coverage targets for primary health care services were explicitly included in contracts awarded in five of nine rural districts with a population totaling over 1.25 million people. The remaining four districts included in the test were given identical equity and coverage targets and used the traditional government provision of services. After two-and-a-half years of the trial, the results suggest that although coverage of primary health care services in all districts had substantial increases, people in the poorest one-half of households living in contracted districts were more likely to receive these services than similarly circumstanced poor people in government districts, other factors equal.
Link to Data Set
Citation
“Schwartz, J. Brad; Bhushan, Indu. 2004. Cambodia : Using Contracting to Reduce Inequity in Primary Health Care Delivery. HNP discussion paper;. © World Bank. http://hdl.handle.net/10986/13685 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Related items
Showing items related by metadata.
Publication Contracting for the Delivery of Primary Health Care in Cambodia : Design and Inital Experience of Large Pilot Test(World Bank, Washington, DC, 2014)Despite the potential benefits of contracting with the private sector for delivery of publicly-financed health services, its effectiveness and efficiency has rarely been evaluated. This paper describes the design and early implementation experience of a project in Cambodia that is pilot-testing contracting with non-governmental organizations (NGOs) for the delivery of primary health care on a large scale. Three approaches are assessed: Contracting out (CO) in which contractors have complete authority for hiring, firing, and paying staff as well as procuring drugs and supplies; Contracting in (CI) where contractors provide management services within the existing district health structure; and comparison/control (CC) where the existing district health management teams receive a budget supplement (as do CI districts).Publication Benin - Health, Nutrition and Population : Health and Poverty Analytical Report(World Bank, 2009-05-01)This study is a continuation of the previous sector review, conducted in 2004. The 2008 review had two main objectives. This review is primarily an update on the situation. In its development strategy, Benin gave considerable importance to the health of its population. This effort is part of the long-term vision of the country. Improving health status, especially for the poor, is one of eight strategic directions for that vision. Similarly, on a more operational level, this objective is reflected in the current Growth Strategy for Poverty Reduction (GPRS 2007-2009). Benin is particularly committed towards the Millennium Development Goals, including 3 on the health sector. This review was also an opportunity to further analyze the constraints in the health system, consistent with the new strategy Health Nutrition and Population World Bank, Strategy adopted in 2007. But this exercise was not intended merely to be analytical. It also aimed to enrich the political dialogue between, on one hand, the actors in health and, secondly, the World Bank and other development partners. This effort relates more specifically to some themes such as governance, private sector involvement and alignment of partners' efforts (called technical and financial partners in Benin or PTFs). From this perspective, the journal is also a contribution to Benin's efforts to advance the IHP (International Health Partnership Plus). This initiative is now the main tool for implementing the Paris Declaration. In practice, the journal has sought to contribute to the consensus between the Ministry of Health and the donor group on the diagnosis of the health system and the changes needed to strengthen it. Several guidelines have emerged stronger from this discussion, particularly in the area of governance of the health system. Beyond the reinforcement of the various components of the health system, two fundamental principles should guide the transformation of this system: 1) A principle of corporate governance: through decentralization of the health system, health facilities must have their basic needs better taken into account (hence the need for bottom-up planning) and especially as more independent financially administrative; and 2) A principle of individual governance: health workers should be strongly encouraged to improve their performance (competence, productivity and compliance of patients). Given the limited success of measures to strengthen inspections and other controls "top-down, this incentive can only come from clients, either directly (i.e., bonuses based on cost recovery), or preferably indirectly with a mechanism for payment by results funded by the state and possibly partners.Publication Improving Health Outcomes for the Poor in Uganda : Current Status and Implications for Health Sector Development(Washington, DC, 2004-06-30)This study shows that Uganda has similar or somewhat better health indicators than other African countries with a similar income level. However further effort is needed to address inequality in health outcomes and in the health system. Overall recommendations arising from this report, which are discussed in detail in Chapter 8, center on five areas: (a) prioritizing interventions that affect infant and maternal mortality, (b) improving health promotion and disease prevention practices at the family and community level through community mobilization and inter-sectoral collaboration, (c) mobilizing funds for the health sector including strategies that encourage risk polling mechanisms; (d) focusing on human resources and collaboration with the private sector to improve health service delivery, and (e) improving accountability through improving information systems and supervision.Publication Improving Primary Health Care Delivery in Nigeria : Evidence from Four States(World Bank, 2010-04-01)This study aims mainly at understanding the performance of primary health care (PHC) providers in four Nigerian states and the variables driving this performance. The study is primarily based on quantitative surveys at the level of primary health care facilities, health care personnel, and households in their vicinity. These surveys were implemented in four states: Bauchi, Cross River, Kaduna, and Lagos. This study represents the second phase of the Nigeria Health, Nutrition, and Population Country Status Report (CSR). The first phase aimed at analyzing the health situation of the poor and how the health system was performing in terms of meeting their needs. This first phase identified PHC as the weakest chain in the entire health sector and the level of care the poor use the most. This second phase of the CSR is therefore focused on the analysis of the delivery of PHC services. In contrast to the first phase, this study is mainly based on primary data, data collected through facility, health personnel, and household surveys. This study follows a similar methodology used by a facility survey implemented in Kogi and Lagos in 2002 (Das Gupta, Gauri, and Khemani, 2003). However, this study is focused in the collection of information not previously available, such as detailed roles and responsibilities of the LGA and states and community perceptions of PHC services.Publication Nigeria—Improving Primary Health Care Delivery : Evidence from Four States(Washington, DC, 2008-06)The delivery of quality primary health care (PHC) services can have a large impact on the health of Nigerians. This study aims mainly at understanding the performance of primary health care providers and the variables driving this performance. The study is primarily based on quantitative surveys at the level of primary health care facilities, health care personnel, and households in their vicinity. These surveys were implemented in four states: Bauchi, Cross River, Kaduna, and Lagos. The purpose of this study is three fold: (i) to contribute to the evidence base of the Federal Government's health system reform efforts; (ii) to inform the Bank's and Canadian International Development Agency (CIDA) sector policy dialogue with the Government; and (iii) to inform the current and eventual health support programs of both donors at state level. This study represents the second phase of the Nigeria Health, Nutrition, and Population Country Status Report (CSR). The first phase aimed at analyzing the health situation of the poor and how the health system was performing in terms of meeting their needs. This first phase identified primary health care as the weakest chain in the entire health sector and the level of care the poor use the most. This second phase of the CSR is therefore focused on the analysis of the delivery of PHC services. In contrast to the first phase, this study is mainly based on primary data, data collected through facility, health personnel, and household surveys. This study is focused in the collection of information not previously available, such as detailed roles and responsibilities of the Local Government Area (LGA) and states and community perceptions of PHC services. This study is also to support on-going or eventual health support programs of CIDA and the World Bank at the state level.
Users also downloaded
Showing related downloaded files
Publication Youth Employment in Sub-Saharan Africa(Washington, DC: World Bank and Agence Française de Développement, 2014-01-27)Sub-Saharan Africa has just experienced one of the best decades of growth since the 1960s. Between 2000 and 2012, gross domestic product (GDP) grew more than 4.5 percent a year on average, compared to around 2 percent in the prior 20 years (World Bank various years). In 2012, the region's GDP growth was estimated at 4.7 percent- 5.8 percent if South Africa is excluded (World Bank 2013). About one-quarter of countries in the region grew at 7 percent or better, and several African countries are among the fastest growing in the world. Medium-term growth prospects remain strong and should be supported by a rebounding global economy. The challenge of youth employment in Africa may appear daunting, yet Africa's vibrant youth represent an enormous opportunity, particularly now, when populations in much of the world are aging rapidly. Youth not only need jobs, but also create them. Africa's growing labor force can be an asset in the global marketplace. Realizing this brighter vision for Africa's future, however, will require a clearer understanding of how to benefit from this asset. Meeting the youth employment challenge in all its dimensions, demographic, economic, and social, and understanding the forces that created the challenge, can open potential pathways toward a better life for young people and better prospects for the countries where they live. The report examines obstacles faced by households and firms in meeting the youth employment challenge. It focuses primarily on productivity, in agriculture, in nonfarm household enterprises (HEs), and in the modern wage sector, because productivity is the key to higher earnings as well as to more stable, less vulnerable, livelihoods. To respond to the policy makers' dilemma, the report identifies specific areas where government intervention can reduce those obstacles to productivity for households and firms, leading to brighter employment prospects for youth, their parents, and their own children.Publication Thirsty Energy (II)(World Bank, Washington, DC, 2016-01)The effect of oil and gas development on local and regional water resources can profoundly change a region’s economic possibilities, its water environment, and the vitality of its ecosystem. It is necessary to tackle the water-energy challenge today through technological innovations and institutional changes, such as integrated planning and valuing water as a resource. More information on the thirsty energy initiative can be found at www. worldbank.org/thirstyenergy.Publication TVET Systems’ Response to COVID-19(World Bank, Washington, DC, 2020-05-14)This note focuses on the role of Technical and Vocational Education and Training (TVET) in the response to the COVID-19 pandemic. It provides guidance on reducing the adverse impact of the pandemic on TVET provision and enhancing the contribution TVET can make to mitigating the health, social, and economic impact of COVID-19.Publication The Other Half of Gender : Men's Issues in Development(Washington, DC: World Bank, 2006)This book is an attempt to bring the gender and development debate full circle-from a much-needed focus on empowering women to a more comprehensive gender framework that considers gender as a system that affects both women and men. The chapters in this book explore definitions of masculinity and male identities in a variety of social contexts, drawing from experiences in Latin America, the Caribbean and sub-Saharan Africa. It draws on a slowly emerging realization that attaining the vision of gender equality will be difficult, if not impossible, without changing the ways in which masculinities are defined and acted upon. Although changing male gender norms will be a difficult and slow process, we must begin by understanding how versions of masculinities are defined and acted upon.Publication State and Trends of Carbon Pricing 2024(Washington, DC: World Bank, 2024-05-21)This report provides an up-to-date overview of existing and emerging carbon pricing instruments around the world, including international, national, and subnational initiatives. It also investigates trends surrounding the development and implementation of carbon pricing instruments and some of the drivers seen over the past year. Specifically, this report covers carbon taxes, emissions trading systems (ETSs), and crediting mechanisms. Key topics covered in the 2024 report include uptake of ETSs and carbon taxes in low- and middle- income economies, sectoral coverage of ETSs and carbon taxes, and the use of crediting mechanisms as part of the policy mix.