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Health project reduces fees

090928_03
A young child receives medical care at Treal Health Centre in Kampong Thom province. Vouchers that can be exchanged for medical treatment have proved a success, NGOs said in a new report.

A joint project between the Ministry of Health and local NGOs reduces debt from health-care expenditures for thousands of Cambodian families, study shows.

AMINISTRY of Health programme designed to minimise health care fees for the poor has saved thousands of families from millions of dollars of debt, according to a report released today by University Research Co (URC), a local NGO.

The URC report evaluates the performance of Health Equity Funds (HEFs), a health-financing scheme operated jointly by the government and NGOs that offers financial support to poor Cambodians who make use of public health facilities. “This is done,” the report explains, “by purchasing health services on [poor people’s] behalf, providing them with transport reimbursements and providing the patients’ caretakers with money to cover food expenses.”

Health-care debts force 100 million people worldwide into poverty each year, Oxfam International said in May 2008. It is this threat, said Minister of Health Mam Bunheng, that HEFs have been urgently addressing.

“This project has been successful because it allows poor people to access services at hospitals or health centres without paying fees out-of-pocket,” the minister said.

While there are more than 30 separate HEF schemes currently operating in Cambodia, just 22 schemes on which URC cooperated were supporting 20 percent of all inpatients in the Cambodian public health system as of December 2008. Residents of communities served by HEFs, URC said, are making increased use of public health facilities while at the same time incurring significantly less health care-related debt compared with their counterparts in areas lacking HEFs.

In 2007, according to the government’s Cambodia Socio-Economic Survey, there were 27 operational districts in Cambodia supported by HEFs, compared with 49 without them. In those 27 districts, URC estimated that equity funds reduced health-care debt for nearly 20,000 households, saving them US$7.2 million in total.

Tapley Jordanwood, the URC health-financing team leader and one of the authors of today’s report, said that candidates for HEF support are identified on a local level, as local residents and commune council members deliberate on which community members should receive HEF cards that can be redeemed for treatment at public health facilities. “The actual mechanisms by which [HEF distribution] works are very unique to Cambodia,” Jordanwood said.

Mam Bunheng said the government was pleased with the development of the programme and hopes to implement it more widely in the near future. Funding is currently in place from both the government and other institutions, including the World Bank and the United States Agency for International Development, to expand HEF coverage across the Kingdom in the next few years.

Though there are still thousands of Cambodians who are at risk of falling into poverty from health costs, Jordanwood said that the distribution of HEF cards in poor communities is hoped to coincide with greater reliance on public health facilities nationwide.

“People make decisions in their home when they get sick,” Jordanwood said. “When they have a card, then they have some confidence.”

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