title: From public to private and back again: sustaining a high service-delivery level during transition of management authority: a Cambodia case study.
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 period-notably the development of performance indicators and targets and the performance monitoring.
authors.affiliation: Swiss Red Cross, UK.
authors.forename: Bart
authors.initials: B
authors.lastname: Jacobs
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Thomé
authors.forename: Rob
authors.initials: R
authors.lastname: Overtoom
authors.forename: Sam Oeun
authors.initials: SO
authors.lastname: Sam
authors.forename: Lorenz
authors.initials: L
authors.lastname: Indermühle
authors.forename: Neil
authors.initials: N
authors.lastname: Price
mesh_terms: D002160:Cambodia; D003153:Community Health Services / Q000458:organization & administration*; D003266:Continuity of Patient Care; D003284:Contract Services / Q000458:organization & administration*; D006801:Humans; D008137:Longitudinal Studies; D008430:Maternal-Child Health Centers / Q000458:organization & administration; D019982:Organizational Case Studies; D010559:Personnel Management; D015397:Program Evaluation; D055818:Public-Private Sector Partnerships; D019984:Quality Indicators, Health Care; D012040:Regional Health Planning; D017749:Total Quality Management / Q000379:methods / Q000458:organization & administration*