Better Health for All Cambodians: Supporting Communities and Health Centers

In a corner of her wooden house, 18-year-old Dam Siv Lean is breast-feeding her three-day-old baby boy. When asked about her treatment at the health center, she smiles and says, “The nurses were nice. Their kind words calmed me down when I was in so much pain.”

Siv Lean went to Pechreada Health Center in Mondulkiri province to deliver her first child. Her family belongs to the Punung ethnic group, and they are among the poorest in their community. They grow their own rice, but this only feeds the family of five for a few months. Siv Lean and her husband work as day laborers for their neighbors when they have the opportunity, making about US$5 per day.

Due to their low income, Siv Lean’s family got an identification card for the poor, which allows them to access resources from the Health Equity Fund (HEF) for free medical treatment. The HEF covered all her delivery expenses at the Pechreada Health Center. Without this fund, she would have borrowed from local money lenders at a very high interest rate.

“People in this area are from ethnic minority groups and many of them are poor. The Health Equity Fund is a great benefit and helps to reduce the rate of illness and death in the community,” said Chang Khun, Chief of Pechreada Health Center. He explained that the HEF is encouraging poor people to use the health center, which they previously could not afford.

HEF is part of the Health Equity and Quality Improvement Project (H-EQIP), which aims to improve access to quality health services. Each year, the HEF supports free access to over 2 million outpatient visits and over 100,000 hospital admissions for the poorest people in Cambodia, nationwide and across all public health facilities in the country.

Service Delivery Grants Enhance Healthcare

In addition to supporting the poorest Cambodians to access healthcare, the project provides service delivery grants to help health facilities upgrade their services.

Dr. Sok Po, Deputy Director of Hospital Service Department of the Ministry of Health, said that both fixed and performance-based grants are deposited electronically and in a timely manner into the bank accounts of health facilities.

Fixed grants are transferred every quarter to health centers and hospitals so they can allocate funds for maintenance and repair of equipment and infrastructure or emergency drug shortages. Performance-based grants are provided based on the assessment of the quality of health services and have been used as incentives and rewards for staff performance.

Dr. Puy Pisey is Chief of Office at Sen Monorom Operational District (OD) of Mondulkiri province, and also an OD Assessor. She has conducted assessments for 12 health centers and explained that during the first round of assessments in 2017 health centers scored very poorly – between 21% and 43%, while the minimum score set by the Ministry of Health is 60%. Now, only two years later, the health centers are scoring between 80-92%.

“It is a great improvement,” she said, “As one of the assessors, I am very proud of this achievement.”

Assessments cover issues such as financial management, HEF management, infection control, hygiene, and medical waste disposal. Random follow-up calls to patients help assess client satisfaction and the performance of service providers.

The US$175.2 million Health Equity and Quality Improvement Project is jointly supported by the Government of Cambodia and development partners including the World Bank, the Government of Australia (through the Department of Foreign Affairs and Trade, DFAT), the Government of Germany (through Kreditanstalt fur Wiederaufbau, KfW), the Government of the Republic of Korea (through the Korea International Cooperation Agency, KOICA), and the Government of Japan through the Policy and Human Resources Development Trust Fund.