This study compares the performance of 13 contracting
(Special Operating Agency (SOA)) districts and 10 noncontracting
(non-SOA) districts across four provinces
of Cambodia in increasing coverage of basic health
services. The four Minimum Package of Activity (MPA)
indicators used are: full immunisation of children under
one, antenatal care (two or more consultations), delivery
by a trained professional, and delivery in a health facility.
Suspicions about the quality of the routine HMIS data
mean that all conclusions about the relative performance
of contracting and non-contracting districts have to be
treated with some caution. This is particularly true of the
data for immunisation and antenatal care.
Placing greater emphasis on the data on deliveries, by
a trained professional and in a health facility, and in the
two provinces included in our study where systematic
comparison of SOA and non SOA districts is possible –
Kampong Cham and Prey Veng – leads to the conclusion
that there is some, but very weak, evidence that SOA
districts perform better than non SOA districts over the
period 2009-12.
However, clear selection bias and the existence of
countervailing factors such as the greater resources
available to SOA districts and the various parallel
initiatives, particularly the nationwide midwifery scheme,
pose considerable problems of attribution of the
observed improvements of the four health indicators.
Overall, there is little reason to believe that the better
performance of SOA districts is due to the contracting
mechanisms in these districts as such.