Cambodia - Contracting Health Care Services for the Rural Poor

This brief is an overview of Cambodia’s efforts to reach the rural poor with health care services. In the mid-1990s, the country began an experiment of contracting NGOs to manage the public health care system at the district level in rural areas, with results that show that while all districts increased health service coverage rates, the contracted districts outperformed the government districts in achieving higher coverage rates and providing a more pro-poor distribution of services. In addition, private out-of-pocket health care expenditures in contracted districts were lower than government districts, which clearly benefited those who can least afford to pay. NGOs appear to be more responsive to contractual obligations to effectively and equitably provide health care services than standard government provision of services given the same goals. Overall, the results suggest contracting primary health care may be an efficient and effective means to increase health care coverage rates and better target primary health care services to the poor.