Center for Health Market Innovations (CHMI)

Programs

Health Equity Fund Managed by Pagoda

last updated Dec 12, 2011

Overview

Implementing organization: 
Buddhist for Health
Implementation Partner(s): 
Referral Hospital, Health Center, Health Center Management Committee, Monk and Local Authority
Legal Status: 
Private (not-for-profit)
Year Launched: 
2003
Stage: 
Existing/expansion stage
Income Level of Target Population: 
Bottom 20%

Scale

Personnel Employed: 
10-49
Upscaling: 
At first, the HEFP started with around 5,000 poorest people in 20 health centers in a district of Takeo province. Then schemes have spread to another two districts and reached around 100,000 poorest people in 43 health centers in this province. In coming up future, BFH plans to expand the scheme coverage to another province. Moreover, 4 organizations including German Cooperation Technology (GTZ), Reproductive and Child Health Alliance (RACHA), Catholic Relief Services (CRS) and Action for Health Development (AHEAD) have sought experiences from BFH to replicate the schemes in regions where they are implementing their programs. In addition, Laos and Mongolia have come to visit and lean from Buddhist for Health to pilot the schemes in their countries.
Summary: 

With the financial support from Canada, Buddhist for Health (BFH) started Health Equity Fund Managed by Pagoda (HEFP) in Takeo province in 2003. This is a health care financing scheme which is initiated to improve the health of very poor people in rural area.

Program goals/rationale: 

In Cambodia, access to affordable quality health care remains a constraint especially for the poor and vulnerable. A large share of total health expenditure relies on out-of-pocket payments by households, which is one of other major causes contributing to impoverishment and health-related catastrophes, precisely when they are at most vulnerable. Health Equity Fund (HEF) are widely known as financing schemes to facilitate the poor to access quality health service deliveries, however, these schemes not reach universal coverage and furthermore, majority of the schemes do not cover lower level of health care (health center level).

The establishment of HEFPs primarily aims at increasing access to quality service delivery at health center for the very poor and facilitating them to access higher level of care through the use of mechanisms and financial means to identify and facilitate the very poor to use those levels of care, and participate in the improvement of quality of service delivery at health center level.

Key program components: 

Unlike other Health Equity Fund schemes in Cambodia which are donor-funding dependent, HEFPs are community-based funding schemes whose financial sources largely come from the community that the scheme covers. At the first stage, there is a need of external financial support to establish the HEFP committee which is composed of chiefs, those being monk and priest committees and health center management committee members (local existing health structure which is responsible for overseeing the health center service delivery). The committee members are trained by BHF on scheme management such as financial management, data management, report arrangement and service delivery facilitation.The Chief monks are primarily responsible for ensuring the availability of scheme budget by using different methods to raise contribution from pagodas, mosques and commune halls where religious events or ceremonies are generally organized. The health center management committee (HCMC) is more focused on service delivery management. After training, this committee applies their skills and knowledge to manage the schemes by themselves, with continuous technical supports from BFH and operational district (OD). The committee arranges its meeting on a regular basis to update and discuss work progress concerning with budget, service delivery and other relevant issues.

BFH uses its own tools to identify the poorest people in the community. After the process of identification, the poorest are given an Equity Access Card which can be used to pay the user fee at health centers and facilitates a higher level of care. The beneficiaries are educated on the importance of Equity Access Card, and some mechanisms are used to encourage them to actively participate in monitoring the services delivered by health providers at the contracted facilities. HEFP committee applies a fee for services as provider payment method to pay health providers for all service expenses used by scheme beneficiaries. Quality control is applied by using local exiting quality control mechanisms such village health support groups meeting, HCMC meeting and OD meeting.

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