Improving immunization equity through a public-private partnership in Cambodia

Area of Science:

• Global Health
• Health Services Research
• Public Health Policy

Background:

• Large-scale contracting of primary health care services is a growing trend in developing countries.
• Ensuring equitable access to essential health services, such as immunizations, remains a challenge in rural areas.

Purpose of the Study:

• To evaluate the impact of contracting primary health care services on immunization equity in rural Cambodia.
• To compare immunization coverage and equity between contracted and government-serviced districts.

Main Methods:

• A quasi-experimental design was employed in nine rural Cambodian districts from 1999 to 2001.
• Contracts with non-governmental organizations included specific targets for service coverage and equity, including child immunization.
• Data were collected pre- and post-intervention, with five districts under contract and four using the traditional government model.

Main Results:

• A significant increase in fully immunized children was observed across all districts.
• Children in the poorest 50% of households in contracted districts showed higher likelihood of full immunization compared to similar children in government-serviced districts.
• Multivariate analyses controlled for other factors, confirming the positive association between contracting and immunization equity.

Conclusions:

• The contracting model demonstrated potential for enhancing the equitable distribution of immunization services.
• This approach offers a viable strategy for improving health equity in resource-limited settings.
• Policy implications suggest that performance-based contracting can be an effective tool for achieving public health goals.