Free Health Care for Cambodia’s Poorest

Khmer Times
Tin Sokhavuth

The Health Equity Fund enables poor mothers to access health care services free of charge, for their children, in government facilities. KT/Sonny Inbaraj Krishnan

The Health Equity Fund breaks the link between poverty and ill-health and provides increased access to health services for the poor, writes
Tin Sokhavuth.

Cambodia received a new $130 million funding package from the World Bank last month that focuses on poverty reduction and bettering the lives of poor and vulnerable Cambodians in the country cooperation strategy set out in the new Cambodia -World Bank Group Country Engagement Note (CEN).

Of the $130 million, $30 million will be allocated to the Health Equity Fund (HEF) to increase health care coverage for the poor and the Service Delivery Grant to improve healthcare services, $15 million for the Mekong Integrated Water Resources Program to improve fisheries in the Mekong River basin, $60 million will be for the management of road infrastructure and another $25 million for socio-economic development projects.

The HEF helps close to three million poor Cambodians nationwide get access to free and quality health service by covering the direct costs of health services and medications for the poor. It also provides transport reimbursement for patients and a food allowance for patient caretakers during hospitalization.

By helping to pay for poor patients, who would otherwise stay away from public health facilities due to lack of money, health centers and hospitals can get revenue from the HEF. For instance, a hospital could charge $20 for patients and for poor people this is covered by the HEF. Of the $20, 60 percent will be used to pay for staff incentive, 39 percent for administrative costs and one percent for state revenue.

The World Bank will also help the Ministry of Health redesign the Service Delivery Grant to improve the quality of health services, health facility management, healthcare staff and the coverage of health services.

The HEF is jointly financed by the Cambodian and Australian governments, the World Bank and the German Development Bank, Korea International Cooperation Agency and Japan’s Policy and Human Resources Development. Overall, the amount of funding for the HEF will be more than $51 million.

Because of the HEF, infant mortality rates in Cambodia have fallen dramatically. Last year, 85 percent of live births were in health facilities with deliveries done by trained midwives compared to 58 percent in 2008. Around 80 percent of women nationwide delivered their babies in health facilities last year, up from 39 percent in 2008.

According to the German International Cooperation (GIZ), a German NGO funded by the German Federal Ministry for Economic Cooperation and Development to implement the HEF in Kampong Thom, Kampot and Kep provinces, access to healthcare services for the poor and vulnerable have improved.

The HEF purchases health services from public health providers and signs contracts with NGOs and civil society organizations that act in the interests of the poor, to facilitate access and purchase of health care service from providers.

The GIZ has been working closely with selected commune councils and NGOs. Besides that, they have informed local people about their rights and the possibility to give feedback. According to the GIZ, to strengthen mutual understanding, trust, transparency and accountability, discussion between patients, sub-national councils and health institutions was needed.

The implementation of the HEF by the GIZ also takes into account persons with disabilities, those with non-communicable diseases and the elderly. Hence, special measures for them to access healthcare services have to be included in healthcare services.

According to guidelines issued by the Ministry of Health, the HEF is available for all Cambodians in any province, who are identified as poor. They will be given either special individual or family identity cards entitling them to free medical services.

“This means that if an identified poor person from Rattanakiri happens to fall sick in Banteay Meanchey, he will still be able to get free medical treatment in that province and doesn’t need to go back to his home village,” said the guidelines.