Introduction
Over the last two decades, Cambodia has implemented several policy initiatives and interventions to
improve health service delivery. The contracting of services in the health sector has been happening since
the late 1990s. Since 2009, an internal contracting model, Special Operating Agencies (SOA), with
performance incentives, monitoring mechanisms and a greater level of autonomy for district health
management has been followed.
This study aims to address research gaps on the drivers for change in contracting models, and on the
current contracting arrangement in Cambodia. It seeks to understand the change process in health
contracting arrangements in Cambodia by identifying the drivers for change and to document the
implementation processes of the current SOA contracting model. Lastly, it examines the perceived
implications of the SOA on service coverage and equity. This report presents findings from the qualitative
methods conducted in this study.
Methods
The study was carried out in four districts, located in different provinces, where SOAs have been
implemented since 2009/10. In depth interviews were conducted with managers of SOAs and health
facilities(12), and with health care providers from referral hospitals and health centres(13). Key informant
interviews were conducted with representatives of the Ministry of Health (MoH) and donors (12).