For Nau Channy, worries about the exorbitant cost of health care for her family

ended when she thumb-printed a contract that made her a party to an innovative

trial micro-health insurance scheme under way in her Kandal village.

GRET doctor Kim Sophat tends to Khun Srey Neth, 9, at her home.

The

scheme was initiated by the French NGO GRET as an adjunct to its already

functional micro-finance programs. Launched in September 1998 with $425,000 in

funding, GRET works in partnership with the Ministry of Health in delivering

affordable in-home health care to the residents of Roluos and Tien communes in

Kandal Steung District.

"GRET's doctor comes to see my son at home

[who's] had heart disease since birth," said Channy, a 36-year-old Tien commune

farmer, of the benefits of the program. "Before I sent him to Phnom Penh and

district hospitals that cost me a lot of money. [Now] I spend little money on

medical bills since we became GRET insurance members."

The GRET program

is designed to provide low-income Cambodians with an alternative to having to

finance costly medical treatment by mortgaging their land - a common route to

the burgeoning problem of landlessness in the Kingdom - or consulting lower cost

kru-Khmer (traditional doctors) of doubtful efficacy.

Begun in 1997, GRET

designed the program as a three cycle medical insurance package with initial

annual premiums of 2,000 riels for the introductory first cycle, rising to 6,000

riels for a widely expanded treatment list in the program's current third

cycle.

"It is too early to say if the project is a success," said Pascale

Le Roy, GRET Project Director. "We are trying to find out the people's need to

make the system sustainable [and] we want the people to understand the insurance

and create a [public health insurance] system which can be generalized in

Cambodia."

According to Le Roy, the GRET micro-health insurance program

would have to be fine-tuned for at least another five years to judge its

effectiveness and sustainability.

A new cycle is scheduled to begin in

September, but Le Roy says that an avalanche of complaints about the doubling of

the cost of premiums from cycle two to cycle three - which led to a drop in the

number of subscribing individuals from 771 to 445 - has led GRET to institute a

bi-annual premium of 3,000 riels.

Phan Oun, 45, a Roluos farmer, was one

of those who dropped out of the program after the premiums were raised 3,000

riels to 6,000 riels. Oun said she could only afford to insure five of her nine

family members, but GRET regulations forbade her from doing so.

Oun was

also critical about the limited hours of participating doctors in the GRET

plan.

"Though I personally continue to use the [GRET] system, I still go

to the private clinic because my children have gotten sick at night when the

GRET doctor is not available," Oun said.

But GRET-employed doctor Kim

Sophat defends the GRET system for delivering a level of care that hospitals and

clinics can't: home visits by professionals.

Each morning, a GRET medical

insurance agent goes house-to-house in the participating communes to check for

villagers in need of medical attention. A GRET doctor is later dispatched to

deliver personal care in the afflicted person's home.

Khun Saveth, a

single mother with a daughter to care for, says the quality of medical attention

she receives under the GRET plan is worth the premiums she pays.

"Before,

I went to hospital [only] when I got seriously sick,"

Saveth said. "But now

even minor problems get treated because the doctor comes to visit my house every

day".