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Title: Impact of the performance-based payments on health workers in contracting out government health services : Cambodia's experience
Author: Abe, Kimiko
ISNI:       0000 0004 5370 2233
Awarding Body: Queen Margaret University
Current Institution: Queen Margaret University
Date of Award: 2014
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Contracting out government health services has been increasing in low and middle income countries (LMICs) and highly valued in improving health service delivery. In some cases, government health workers have been paid performance-based payments; such payments have been quoted to contribute to the achievement. However, impacts of the payments on the health workers’ total income including income from their private practice and the government salaries have been little studied, while their private practice have posed serious issues in the service delivery with the constraint from low government salaries. The impacts at the household level have been unstudied. This study investigated these impacts of the payments paid to the government health workers in a project for contracting out district health service delivery to international NGOs in rural Cambodia. In this study, key informant interviews elaborated payment mechanism and other factors in the incentive environment; household income and expenditure surveys of the hea ascertained their incomes and their households incomes and expenditures and compared these data between the two tyes of distrctircts (N=250); a mini-survey about payment mechanism at the subcontractor-level deepened understanding of important factors on the impacts; regression analyses of the incomes or expenditures confirmed the impacts of payments in relative to other possible influential factors on incomes and expenditures. The payments associated with the contracting settings including the performance-based payments were found to increase the heatlh workers incomes and their households incomes reasonably sufficiently, while non- income mostly consisted of private practice income. The result of regression analyses supported the higher incomes. Therefore, this study tentatively argued,with further support from the interview result that transfers of the health workers labour supply from the private to government sector were brought about by the payments, i.e., labour supply increase in the government sector and reduction of dual practice.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available