Cambodia Tries Nonprofit Path to Health Care - New York Times

Cambodia Tries Nonprofit Path to Health Care - New York Times: "REAP, Cambodia - Sovan Sna had been in labor all night long. By the 16th hour of contractions, she was in trouble. The baby, her first, was not coming out. And she was so exhausted and in such pain she could barely speak.

Sovan Sna arrives at a district hospital with her husband, Veasna Van.

Her mind churned with fear. In the Khmer language, this most treacherous passage in a woman's life - childbirth - is called crossing the river. Her aunt had died giving birth to a first child who perished in the womb. Mrs. Sna wondered if she and her baby, too, would drown before reaching the other shore.

Not long ago, Mrs. Sna would have had little choice but to give birth at home, like her aunt, and risk both her life and her baby's. But on this morning, Mrs. Sna's terrified husband hired a pony cart and was able to take his wife over a deeply rutted dirt road to a small, no-frills public hospital.

If childbirth is a miracle of nature, then the thriving, honestly run network of clinics and hospitals here is a human marvel, managed not by the government but by one of the nonprofit groups it has hired to run entire public health districts."

The approach is catching on in a growing number of poor countries around the world, from Bangladesh and Afghanistan to Congo and Rwanda, to Bolivia and Guatemala, reaching tens of millions of people.

These contracted services have allowed international donors and concerned governments to cut through dysfunctional bureaucracies - or work around them, and to improve health care and efficiency at modest cost.

Here in Cambodia, the nonprofit groups - all of them international - are instilling discipline and clarity of purpose in a health care system enfeebled by corruption, absenteeism and decades of war and upheaval. They have introduced incentives to draw Cambodia's own doctors and nurses back into the system. Patients, especially the poorest ones, have followed in droves.

"All the evidence is that this worked very well in a situation where nothing much else worked very well," said Shyam Bajpai, the representative here for the Asian Development Bank, which financed the original contracts...