While the reform of Cambodia's health system—first advocated in the early 90s by Western donors—in theory emphasizes decentralization, it has, in fact, led to a radical centralization of rural health services. Previously, the health system attempted to provide services down to commune level—small groups of villages. The reforms have withdrawn staff from the commune level to work in health centers planned to serve estimated population catchment areas of ten thousand people. This approach is logical for curative services. However, since 85% of the population are rural farmers, it has created a major challenge for promotive and preventive health services. Villagers may travel long distances for curative services, but are less likely to do so for routine preventive services.
To counter centralization, and issues related to underpaid and poorly motivated providers, the Reproductive and Child Health Alliance (RACHA, a USAID funded program) is using contracts between the district MoH, the health center and communities to engage all available human resources in promotional and preventive health. ANC and birth spacing services have been added to an already poorly working immunization outreach system and all services are improving. The health center staff and community establish the obligations stipulated in the contracts. RACHA provides health center and community focused incentives and assists with monitoring. It is clear that without organized community support, health staff cannot achieve their coverage objectives. With communities involved in stipulating their own obligations, public health contracts are working in Cambodia.
Learning Objectives: Listners will learn of practical procedures for engaging health centers with communities, through establishing contracts
Keywords: Outreach Programs, Health Centers
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
The 128th Annual Meeting of APHA