kanal_mnh financing i equity fund – cambodia

8/2/2019 Kanal_MNH financing I Equity fund Cambodia

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Health Equity Fund

Implementation in Cambodia

Dhaka,2-6 May 2012

Prof. KOUM KANALMOH Advisor


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Introduction

1996 User Fee schemes at facility levelestablished .

User fees for poor and indigent patients wasfunctioning relatively well at Health Centre

level, but not as effectively at Hospital level.

Health Equity Funds were introduced as ademand-side financing mechanism to

improve access for the poor. Health Equity Funds first covered the user

fees related to hospitalization (CPA health

services),


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Introduction

In 2003 HEFs became an integral component of: the Health Sector Strategic Plan (2003-2007) and theNational Poverty Reduction Strategy (2003-2006),

and later the National Strategic Development Plan

(2006-2010). Health Equity Funds are also animportant element of the new Strategic Framework forHealth Financing (2008-2015) and the second HealthSector Strategic Plan (2008-2015).

In 2007, Inter Ministerial Prakas 809 established asubsidization mechanism call Government HealthEquity Fund


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What is a Health Equity Fund?

A Strategy to Promote Access to BasicPublic Health Services among the Poor

Equity fund is an alternative financing strategyinitiated in selected areas in Cambodia to promote

the use of priority public health services among thepoorest by lowering financial barriers to access.

Equity fund reimburse public facilities for healthcare expenses and associate cost of the poor.


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HOW HEFs WORK ?

Funding Government&

DPs

Health Equity Fund Implementer (HEFI)/Health Equity Fund Operators (HEFO)

and

PHD/ OD Office, National Hospitals

Purchasingservices

from

HCPs

Identification of

poor

households

Management &operate schemes

Activities andServices


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Models of HEF

Model 1: National hospitals

Operate on government subsidy

No third party operator

Direct medical benefit

No transport, food or funeral allowance

Pre- and Post-Identification

Accountable for use of funds to MOH


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Models of HEF (Cont)

Model 2: Operational District Offices

Operate on government subsidy

Third party operator is the ODO whomanages the fund used by facilities at districtlevel


No transport, food or funeral allowance Pre- and Post-Identification

Accountable for use of funds to MOH


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Model 3- 4: Health Equity Fund Implementers(HEFI) and Operators (HEFO)

Operate on donor funding (HEFI), some channelledthrough MoH, some are not channelled throughMOH

Third party operator is a local NGO (HEFO)


Transport, food and funeral allowance

Pre- and Post-Identification Accountable for use of funds to the MoH/ DPs


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Voucher scheme (MNH)

Large NGOs purchase maternal health

services for all clients:- 4 ANC visits

- Delivery at facility

- Postnatal check up (24 hrs)=> free for client, facility gets 10 $


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Voucher scheme (FP)

Large NGOs purchase FP services for all

clients:- IUD

- VSC

=> free for client, and transport, facility gets$ based on user fee scheme


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Community Based Health Cooperation (CBHC)

1 district + 1 province only, yet

Local authority creates CBO board, thatcombines services for all clients:

- HEF

- CBHI (insurance paid by non-poor)

- Conditional cash transfers (CCT)

=> all basic care; CCT for pregnancy, birth,growth monitoring+immunization (5+5+5$)


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Government incentive

In 02 February 2007 , RGC givingthe financial incentives to motivatethe midwives to provide services.

Samdech Decho HUN SEN, PrimeMinister of The RGC has committedand supported these


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Source: National Health Statistics MoH 2002-2011. Mainly public sector

Interventions for Maternal Health In Cambodia

Peace, growth,

education Roads, phones Health centers, midwives


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Source: National Health Statistics MoH 2002-2011. Mainly public sector

Interventions for Maternal Health In Cambodia

Peace, growth,

education Roads, phones Health centers, midwives

Removing financial barriers:

- Health equity funds,vouchers

- Live birth incentive ($15)


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MMR development in Cambodia 1990-2010. Estimates for 1990 and 1995 from WHO, the remainder from CDHSFor 2005 and 2010 with 95% confidence intervals

Maternal Mortality Ratio in Cambodia


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Achievements 2011Total ODs implemented HEF & Subsidy 58( voucher 9ODs)

Number ODs with Government subsidy-Group2 12(implement.11ODs) HEF with Gvt & DPs funding -Group 3&4 48Total RHs with HEF & subsidy 58Total HCs With HEF 362

NHs with government subsidyGroup 1

6

Total poor pop cover by HEF within 58ODs 3,231,282/11,180359% poor pop with HEF coverage 79%

No,proportion of RHs with HEF 58(73% of total RH)Total CBHI beneficiaries 237,670New CBHI benificiaries registered 69,124Total CBHI benificiaries drop out 9,079


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Challenges and policy questions

Benefit package

Coverage and strategies for scaling-up

Linkages

Poverty identification

National Agency

kanal_mnh financing i equity fund – cambodia

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