Center for Health Market Innovations (CHMI)

Programs

Special Operating Agency (SOA)

last updated Nov 15, 2011

Overview

Implementing organization: 
Referral Hospital
Implementation Partner(s): 
Ministry of Health, Provincial Health Department, Operational District
Legal Status: 
State/government
Year Launched: 
2009
Stage: 
Existing/expansion stage
Income Level of Target Population: 
All income levels

Funding

Primary Source of Funding: 
Government
Additional Source(s) of Funding: 
Out-of-pocket payments
Funders: 
Government of Cambodia

Scale

Personnel Employed: 
100<
Summary: 

Special Operating Agency (SOA) in Health is a supply-side oriented mechanism transformed from the contracting and implemented by Cambodian government through the use of government staff as contractors to improve quality of health care services for people, mainly those are poor and vulnerable.

Program goals/rationale: 

Patient trust in the quality of health care services at public facilities is still limited, and quality, equity and affordability of service delivery is often not guaranteed under the private sector, mainly for the poor and vulnerable groups. Limited resources allocated into public health system are widely known as main factors for the poor quality of health care services, however, an inefficient use of the scarce resources also contributes to this poor quality services.

The initiation of SOA intends to strengthen the management quality through an application of performance-based incentives leading to an efficient use of resources to increase accessibility, availability, equity and quality of health care services for users, mainly those are poor and vulnerable.

Key program components: 

At every district, in addition to the government guidelines for standard ODs mandated to deliver Minimum Packages of Activities (MPA) and Complementary Packages of Activities (CPA), SOA applies some autonomy over the management of human resources, incentives for staff, and supply. SOAs are involved in hiring additional staff to work in the public facilities and transferring government staff lacking performance. Staff performance management is the landmark intervention used in SOAs while absent in the standard ODs. This model involves establishment of transparent mechanism in the allocation of workforce, job descriptions, and performance monitoring and evaluation as well as performance incentives. With the conditions set in the contract and penalties involved in underperformance at SOAs, contract monitoring at these ODs takes place more rigorously and with clear criteria for determining level of performance, the feature not usually seen in standard ODs.

Standard OD has only two major income streams: the government budget and user fees. SOAs have these plus a package of budget from Health Sector Support Program (HSSP) in the form of Service Delivery Grant (SDG). The extra budget is mainly used for performance incentive and monitoring. This accounts for approximately 40% of the total budget managed by the ODs.

The Ministry of Health (MOH) signs a performance agreement with Provincial Health Department (PHD), and PHD in turn signs a services delivery management contract with the SOA. MOH is responsible for timely allocating of funds and providing information about policies and guidelines as well as for enforcing health legislation, professional ethics and codes of conduct to PHD. PHD takes responsibilities for providing SOA with financial resources in, drugs, and assistance in human resources and performance management. Under the service delivery management contract, the SOA (as agent) is responsible for ensuring the management of resources (financial, pharmaceutical and human) at all facilities. The PHD conducts monitoring of the SOA, usually on joint monitoring visits with the HSSP monitoring team.

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SOA Guideline.pdf2.31 MB
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