Strengthening district health service management and delivery through internal contracting: Lessons from pilot projects in Cambodia

► Cambodia shows 'internal contracting' methods promote local responsibility and restore local ownership in health services. ► Performance incentives are more effective when supported by adequate management and governance activities. ► A clear separation of contracting functions, local autonomy and sufficient resources are essential to improve efficiency. ► Effective contract implementation depends on clear guidelines, sufficient resources and sound contract monitoring.