Bloom 2006.
| Methods | Randomized Controlled Trial | |
| Participants | Countries: Cambodia Participants: District health systems managers. Sample: Three districts were randomized to receive a contracting‐in treatment while four districts served as controls. |
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| Interventions | In districts receiving the contracting‐in treatment, district managers were hired through private contracts to work within the Ministry of Health system. Management of control districts remained the responsibility of managers employed directly by the Ministry of Health |
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| Outcomes | Health facility staffing and supervision, maternal and child health service use (e.g., immunization, antenatal care), and population health outcomes (e.g., diarrhea incidence) | |
| Notes | None | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Randomization was quasi‐stratified by province; the provincial health systems director randomly drew districts to assign them to the three experimental groups. |
| Allocation concealment (selection bias) | High risk | Allocation performed centrally at start of study. However, one district randomized to receive the contracting‐in treatment was unsuccessful in establishing a working contractual relationship. |
| Baseline outcome measurements | Low risk | At baseline, one outcome differed between treatment and control (at 5% significance), but that was expected by chance with 22 outcomes. |
| Baseline characteristic measurements | Unclear risk | Not reported. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | No missing data. |
| Blinding (performance bias and detection bias) All outcomes | Low risk | Primary outcomes were objective. |
| Contamination of experimental groups | Low risk | Unlikely that control group received the intervention. |
| Selective reporting (reporting bias) | Low risk | All relevant outcomes in the methods section are reported in the results section. |
| Other bias | High risk | Effect of contracting‐in may be confounded by the 60% higher public spending for health care in the contracting‐in districts compared to the control districts. |