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LESSONS:

Health Sector Support Project

sector: Health | country: Cambodia

The success of nongovernment organization (NGO) contracting of health services under the project provided the foundation for Ministry of Health’s (MOH) introduction of new contracting arrangements (internal contracting) based on the government’s Policy on Public Service Delivery (2006) and adoption of MOH’s procedures and guidelines on contracting arrangements. Many innovative features first developed under NGO contracting have been, or are in the process of being, adopted for internal contracting, including performance incentive schemes, monitoring indicators, monitoring and evaluation (M&E) approaches and tools, and supervision arrangements. The internal contracting arrangements include performance agreements between MOH and provincial health departments (PHDs), and service delivery contracts between PHDs and operational districts or referral hospitals; and are drawn directly from the NGO contracting implemented under the project. The success of NGO contracting has thus proved to MOH that internal contracting is feasible, cost- effective, and equitable; and can materially increase the extension of health benefits to the poor.

Building on lessons from the Basic Health Services Project, the project gave greater emphasis to close monitoring and supervision by MOH to ensure that civil works were closely coordinated with the supply of equipment and drugs under minimum package of activities (MPA) and complementary package of activities (CPA) guidelines. However, efficient planning, a well-executed plan, and close oversight by MOH would have allowed timely completion of civil works and avoided cost overruns. To improve the quality of civil works, implementation arrangements should incorporate closer supervision and monitoring at all levels.

In support of MOH’s sectorwide management strategy, ADB’s participation in the sectorwide management approach along with other partners in a jointly administered project proved the benefits of close collaboration among health partners. While the Health Sector Support Project (HSSP) was cofinanced by different donors and implemented through an integrated project implementation arrangement under the sectorwide management approach, the project was administered by each donor agency with different implementation schedules. The ADB funded activities under HSSP were closed in 2009 while the World Bank portion of HSSP has been extended to complete all the activities including construction of health facilities. This resulted in different reporting arrangements including project completion reports. The sectorwide management approach significantly helped the government improve planning and coordination in project implementation, avoided duplication, and provided the basis for a broader sectorwide approach. However, the process of harmonization and coordination of various activities among the partners has challenged and slowed implementation progress. Considerable time and effort was spent on the process.

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