Cambodians receiving their health care under the management of NGOs have fared better than those looking to the Ministry of Health for their health needs, a World Health Organization project has shown.
“We have been able to achieve what the Ministry of Health has never been able to do in Cambodia,” said Laurent Ponta of Save the Children France.
Save the Children France is one of the four NGOs now more than halfway through the four-year project that takes health care out of the hands of the government sector in Takeo, Kompong Cham and Prey Veng provinces.
The Basic Health Services project is funded through a $20 million loan from the Asian Development Bank with an additional $5 million being contributed by the Cambodian government.
Two districts in each province have been picked to study the effects of two types of health-care management.
In one, known as “contracting in,” health services management has been handed over to NGOs but the government’s staff policies remain the same.
In the other, “contracting out,” control of health services is handed over completely to the NGOs, which may change government policies.
A third district has been chosen as a control district, with health services remaining under the government’s management.
Misha Coleman of the NGO Save the Children Australia says the main reason the project is working is because of external management.
“It’s not about pouring money into the health system, it’s about the money being managed properly,” she said. “Our services only used $7 million, the rest went to construction of health centers and hospitals.”
But Minister of Health Hong Sun Huot is not as optimistic about the project. “Some is good, some is not good at all,” he said. “We are evaluating the project and some things need to be revised.”
Hong Sun Huot said he remains concerned about the management of the districts under the control of the NGOs.
“The people of Cambodia have to pay back this loan so we have to make sure they provide the right service,” he said.
Ponta says the Ministry of Health likes contracting out but dislikes contracting in because the NGOs can better see how the money is used and complain about financial mismanagement.
“With contracting out, [the Health Ministry] gives us the money and we go away,” he said. “It’s easier but doesn’t tackle the entrenched problem.”
Both the Ministry of Health and the NGOs agree efficient health services come down to good management.
But the question of how to achieve good management remains. Coleman is adamant about the fact the NGOs can better show where money is being spent, and that is what makes the difference.
“The money that goes in is spent on health services. In other parts of the country we don’t know where it goes,” she said.
