Contracting out of health care provision
Cambodia: using contracting to reduce inequity in primary health care delivery
Health care for the poor in Cambodia: can NGOs do a better job than government?
Authors:
J.B. Schwartz; I. Bhushan
Publisher:
Health, Nutrition and Population Division, Human Development Department, World Bank, 2004
This discussion paper, published by the World Bank, examines the impact on equity of giving contracts to international non-government organisations (NGOs) for the delivery of primary health care. It compares five rural districts in which contracts were given to NGOs, with four districts in which traditional government provision was used. Between 1997 and 2001, coverage of primary health care services had increased substantially in all the districts. But in districts with NGO contracts, people in the poorest half of the population were more likely to receive primary health services than people in similar circumstances in districts where the services were still provided by the government.
The paper concludes that NGOs outperformed the government in targeting services to the poor, even when controlling for expenditure, initial circumstances, and demographics. It notes that it is difficult to generalise these results to other countries, because the lack of physical infrastructure and large numbers of government health workers in rural areas in Cambodia particularly lent themselves to innovative approaches. However, it suggests that similar projects in Bangladesh, Afghanistan and Pakistan may help to clarify whether the Cambodian experiment provides an effective model for other developing countries.
