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Table 2 Special Operating Agency

From: Internal contracting of health services in Cambodia: drivers for change and lessons learned after a decade of external contracting

What is a Special Operating Agency? Special Operating Agency (SOA) is a supply-side oriented mechanism developed from contracting and implemented by the Cambodian government through the use of government staff as contractors to improve the quality of health care services for people, mainly the poor and vulnerable.
How does it operate? In each Operational District (OD) there are government guidelines for the delivery of the Minimum Package of Activities and Complementary Package of Activities. The SOA is given a degree of autonomy in making decisions about the best use of their human, physical and financial resources to deliver the highest possible quality of services, in the most effective way and to enhance performance and accountability through streamlining administration to be more transparent and responsive to people’s needs. The SOAs are able to hire additional workforce, conduct performance monitoring and evaluation, and provide 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, a feature not usually seen in standard ODs.
Sources of budget for SOA A standard OD has two major income streams: the government budget and user fees. SOAs have these plus a package of budget from the Health Sector Support Program in the form of a Service Delivery Grant (SDG). This additional budget (approximately 40% of the total budget managed by ODs) is mainly used for performance monitoring and incentives. The Ministry of Health (MOH) signs a performance agreement with the Provincial Health Department (PHD), and the PHD in turn signs a services delivery management contract with the SOA.
Role of MoH and PHD The MOH is responsible for timely allocation of funds, provision of policies and guidelines, and enforcement of health legislation, professional ethics and codes of conduct to PHD. The PHD takes responsibilities for providing SOA with financial resources and assistance in human resources and performance management. Under the service delivery management contract, the SOA is responsible for ensuring the management of resources at all facilities. The PHD conducts monitoring of the SOA, usually on joint monitoring visits with the HSSP monitoring team. The HSSP monitoring team includes an external agency.
Extent of SOA operation Thirty SOAs were established by the end of 2010 and six more SOAs were introduced by 2013.