The 130th Annual Meeting of APHA

Abstract #37282

Nary Lim, MD, RACHA, House #30, Street 360, Phnom Penh, Cambodia, (855-23) 213-724, lnary@racha.org.kh and La Ine Pa, Ms, MCH Director Pursat Province, PO Box 2471, Phnom Penh, Cambodia.

Cambodia’s public health system is relatively new; in an impoverished country, the system is severely handicapped by inadequate financial and human resources, especially in rural areas. The majority of rural people do not currently visit government health centers to obtain services for various reasons. Many villages are far from existing health centers and difficult travel conditions results in very few or no visits. This makes delivery of basic MCH services through outreach critically important. The lack of motorbikes to transport health center staff impedes conducting outreach on a regular, systematic basis. Many remote villages receive no outreach visits. RACHA and the Ministry of Health initiated a performance-based approach to overcome this constraint and provide an incentive to health center staff to conduct regular outreach. A contract was created that specifies terms for providing two motorbikes for outreach on a conditional basis. Ten indicators of MCH service coverage with targets define the performance basis of the contract. Continued use of the motorbikes is contingent on making satisfactory progress toward these service targets. Surveys conducted every six months in the health center catchment area assess health center performance. Results are used to score the health center to determine whether it keeps the motorbikes, is warned that is must improve, or loses the motorbike due to unacceptable performance. Data show measurable improvements in MCH service coverage from these contracts. Significant improvements have occurred in MCH services, e.g., child immunizations, and health knowledge, e.g., correct breastfeeding, home care for children with diarrhea, ORS use.

Learning Objectives: At the conclusion of the session, the participant in this session will be able to

• Identify opportunities for improve health care service delivery using performance-based approaches.
• Apply performance-based approaches to create incentives for health care workers.
• Assess improvements in key MCH services delivered by front-line health facilities.

Keywords: Community Outreach, Service Delivery

Presenting author's disclosure statement:
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.