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From public to private and back again: sustaining a high service-delivery level during transition of management authority: a Cambodia case study

From public to private and back again: sustaining a high service-delivery level during transition... Contracting non-governmental organizations (NGOs) has been shown to increase health service delivery output considerably over relatively short time frames in low-income countries, especially when applying performance-related pay as a stimulus. A key concern is how to manage the transition back to government-operated systems while maintaining health service delivery output levels. In this paper we describe and analyse the transition from NGO-managed to government-managed health services over a 3-year period in a health district in Cambodia with a focus on the level of health service delivery. Data are derived from four sources, including cross-sectional surveys and health management and financial information systems. The transition was achieved by focusing on all the building blocks of the health care system and ensuring an acceptable financial remuneration for the staff members of contracted health facilities. The latter was attained through performance subsidies derived from financial commitment by the central government, and revenue from user fees. Performance management had a crucial role in the gradual handover of responsibilities. Not all responsibilities were handed back to government over the case study periodnotably the development of performance indicators and targets and the performance monitoring. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Health Policy and Planning Oxford University Press

From public to private and back again: sustaining a high service-delivery level during transition of management authority: a Cambodia case study

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Publisher
Oxford University Press
Copyright
Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine The Author 2009; all rights reserved.
ISSN
0268-1080
eISSN
1460-2237
DOI
10.1093/heapol/czp049
pmid
19917650
Publisher site
See Article on Publisher Site

Abstract

Contracting non-governmental organizations (NGOs) has been shown to increase health service delivery output considerably over relatively short time frames in low-income countries, especially when applying performance-related pay as a stimulus. A key concern is how to manage the transition back to government-operated systems while maintaining health service delivery output levels. In this paper we describe and analyse the transition from NGO-managed to government-managed health services over a 3-year period in a health district in Cambodia with a focus on the level of health service delivery. Data are derived from four sources, including cross-sectional surveys and health management and financial information systems. The transition was achieved by focusing on all the building blocks of the health care system and ensuring an acceptable financial remuneration for the staff members of contracted health facilities. The latter was attained through performance subsidies derived from financial commitment by the central government, and revenue from user fees. Performance management had a crucial role in the gradual handover of responsibilities. Not all responsibilities were handed back to government over the case study periodnotably the development of performance indicators and targets and the performance monitoring.

Journal

Health Policy and PlanningOxford University Press

Published: May 16, 2010

Keywords: Health systems contracting user fees service delivery performance management

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