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List of Provinces, Ods, Health Facilities Impact Evaluation of Service Delivery Grants Public Disclosure Authorized to Improve Quality of Health Care Delivery in Cambodia Baseline Study Report Public Disclosure Authorized Somil Nagpal, Sebastian Bauhoff, Kayla Song, Theepakorn Jithitikulchai, Sreytouch Vong, Manveen Kohli April 2019 Public Disclosure Authorized Public Disclosure Authorized Acknowledgements This baseline report was a mammoth undertaking. The H-EQIP pooled fund partners and the study authors sincerely acknowledge the support, guidance, inputs and insights received from several institutions and individuals, without whom this study would not have been possible. Our gratitude commences with immense appreciation and kind thanks to the Royal Government of Cambodia team, particularly the project management of H-EQIP (H.E. Prof. Eng Huot, H.E. Dr. Yuok Sambath and Dr. Lo Veasnakiry) as well as all the heads and officials of provincial health departments, operational district offices, and health centers that supported this study. Mr. Khun Vibol provided very valuable coordination support which is deeply acknowledged. Continued support of Australian Aid, German Development Cooperation (through KfW) and KOICA as H- EQIP pooled fund partners with World Bank, jointly provided the financial resources to undertake this impact evaluation. Financial support from KOICA for the baseline survey costs helped commence the baseline effort even before the pooled TA funding mechanism for H-EQIP was set up. Priya Agarwal- Harding closely supported the pooled fund partners’ coordination efforts and her support is gratefully recognized. Sebastian Bauhoff (now at Harvard School of Public Health and then with the Centre for Global Development) provided technical leadership for the research team in the survey design, sampling methodology and data analysis. The development and refinement of baseline survey tools, in addition to the work done by the study authors, received very important contributions from the World Bank team including Sovanratnak Sao, Voleak Van, Tan Try, Ung Vanny and Karishma D'Souza. Our UN partners, particularly Sok Sokun (Reproductive Health Programme Specialist, UNFPA) and Lailou Arnaud (Nutrition Specialist, UNICEF) provided valuable contributions to their respective sections. Guidance received from H.E. Prak Sophorneary (Under Secretary of State, MOH) on the nutrition related questions is also gratefully acknowledged. Our peer reviewers for this study, Son Nam Nguyen (Lead Health Specialist, GHN01) and Jeremy Veillard (Senior Health Specialist, GHNGE) as well as additional review comments provided by Myint Kyaw (Operations Officer, EACMM) helped us make the storyline and content of this report much more reader-friendly and lucid, and we extend our heartfelt thanks for their invaluable contributions. This survey used the World Bank’s Survey Solutions platform for its computer-aided data collection and analysis efforts. We sincerely acknowledge the close coordination by Bruce Lachlan (then with Angkor Research) and Sergiy Radyakin and Michael Lokshin from the World Bank's Development Data Group for their close support and making this a very smooth process. We thank the entire team at Angkor Research led by Ian Ramage and including John Nicewinter, Kimhorth Keo, Lachlan Bruce and Benjamin Lamberet for their persistent and dedicated efforts throughout the baseline survey, especially in trying to keep to the timelines and ensuring effective coordination with the quality assurance efforts. Sreytouch Vong coordinated the field survey from the World Bank side, including the quality assurance efforts. Sovanratnak Sao and Ung Vanny were important contributors for enumerator training, and also for the quality assurance efforts. The quality 1 assurance team also included Voleak Van, Khun Seila, Thorn Rasmy, Em Phalnida and Loeurng Samoeurn, and their efforts are much appreciated and acknowledged. The authors would also like to place on record their gratitude to Nareth Ly, Anne Provo, Sovanratnak Sao and Voleak Van for providing their insights and contributions for the policy discussions section of this study. Karishma D’Souza and Dan Han contributed immensely to the analysis of Operational Districts’ data and the L2 data analysis included in this report. Manveen Kohli, Karishma D'Souza and Miguel San Joaquin Polo coordinated this baseline study during different phases and kept the wheels of the study in motion. Their efforts are very sincerely acknowledged. Excellent editorial support amidst tight timelines from Usha Tankha is gratefully acknowledged. Da Lin and Sophinith Sam Oeun sustained this mammoth task with excellent and consistent administrative support for a very large number of team members and an even larger number of field visits, which was instrumental for this study seeing the light of the day, and we extend our heartfelt thanks and appreciation to them. 2 Table of Contents Acknowledgements .................................................................................................................................. 1 Abbreviations ............................................................................................................................................ 5 Executive Summary .................................................................................................................................. 7 1. Introduction ........................................................................................................................................ 14 1.1 Background and Genesis ............................................................................................................................ 14 1.2 Health Equity and Quality Improvement Project (H-EQIP) ................................................................. 14 1.3 Country and Sector Context ...................................................................................................................... 16 1.4 Current Knowledge on Health Financing Innovations in Cambodia .................................................. 20 Health Equity Fund System ......................................................................................................................................... 21 Service Delivery Grants ................................................................................................................................................ 29 References .......................................................................................................................................................... 34 2. Impact Evaluation and Methodology ............................................................................................. 36 2.1 Intervention: Service Delivery Grants ..................................................................................................... 36 Provincial Health Department and Operational District Level ........................................................................ 36 Hospital Level: CPA-1, CPA-2 and CPA-3 ................................................................................................................ 37 Health Center Level: MPA ........................................................................................................................................... 37 2.2 Theory of Change ........................................................................................................................................ 37 Operational Districts ..................................................................................................................................................... 38 Health Centers ................................................................................................................................................................ 39 Households ...................................................................................................................................................................... 39 Measurable Impact ....................................................................................................................................................... 39 2.3 Impact Evaluation Design .......................................................................................................................... 40 Research Questions ....................................................................................................................................................... 40 Service Delivery Grant Treatment Assignment in Practice ............................................................................... 42 Sample Design ................................................................................................................................................................. 44 2.4 Baseline Data Collection ............................................................................................................................ 44 Sample ............................................................................................................................................................................... 44 Survey Instruments ....................................................................................................................................................... 45 2.5 Ethics ............................................................................................................................................................. 45 3. Findings ...............................................................................................................................................
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