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Ambassador Mussomeli visits with a young woman whose delivery of twins was covered by the Health Equity Funds program.

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Ambassador Mussomeli visits with a young woman whose delivery of twins was covered by the Health Equity Funds program.

Guaranteed Access to Health Services for Cambodia's Poor

Kratie Province
January 22, 2008

The U.S. Agency for International Development (USAID), in concert with the Royal Government of Cambodia and other major donors, is implementing an innovative program that guarantees access to health services for many of Cambodia's poor. The program is called Health Equity Funds and is implemented by University Research Co. (URC). Poor Cambodian families may pre-qualify for the program through an interview conducted at the community level. Those families that qualify as low-income receive a card which entitles them to fully paid health care at participating Ministry of Health hospitals and health center facilities. A poor family that has not pre-qualified may also receive free care by going directly to a participating hospital when medical attention is needed and completing a quick interview. The program currently provides 700,000 people -- approximately 15 percent of the eligible poor in Cambodia -- with guaranteed access to health care in five provinces.

The health care facility and providers receive a fixed amount for each program patient served. While the amounts are not large, 60 percent stays at the facility and is distributed as salaries, directly addressing the problem of low salaries which is a major disincentive for treating the poorest patients and for staying at work and on the job. The fees that are paid on behalf of the poor are channeled directly to the hospital or health center by URC. This provides a welcome source of additional budgetary support to the facilities and is a strong incentive for them to participate and to receive poor patients.

USAID and the Ministry of Health have used this health financing mechanism to leverage better quality health service through the introduction of tools that measure and catalogue resources available in a facility and by requiring a minimum score to be eligible for Health Equity Funds. In order to serve equity fund patients, each facility must meet quality standards imposed by the Ministry of Health and assessed jointly by the Ministry and URC. Failure to score 65 percent or higher disqualifies a facility from entering the program, and the required minimum score goes up each year. At present, seven referral hospitals and 19 health centers have been certified for reimbursement of services provided to health equity fund recipients, and the number of participating facilities is expanding monthly as the program grows. The level of quality in the participating hospitals – as measured on the MoH-URC assessment – has increased by an average of 62 percent, and in the provinces where the program is being implemented, the poor now utilize health care services more than before the program started.

The value of the hospital assessment tool in quantifying the needs of hospitals and health centers led to a government decree mandating application of the assessment in every hospital. The USAID-URC model has become the Cambodian standard and is cited as such in World Bank and Ministry of Health documents. Similar Belgian and French programs have now adopted the major components of the USAID-URC model. The introduction of the Health Equity Funds program is a proven success and plans are afoot to expand coverage nationwide under the Ministry of Health's new strategic plan. Political will and adequate financial commitments -- on the part of the Cambodian government and key health donors -- will be critical to scaling up these efforts.