Contracting for the Delivery of Primary Health Care in Cambodia : Design and Inital Experience of Large Pilot Test
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).