Cambodia: Health Equity Fund Brings Medical Care to the Poor

March 2, 2010

  • Health Equity Fund (HEF) schemes are supported by the Health Sector Support Program and funds from various development partners and the Royal Government of Cambodia national budget

March 2, 2010 — Rith Roeung, 51-year-old mother of eight, sits beside her sick husband, Tuy Muy, 52, in Battambang Provincial Referral Hospital. He is lying on a bed with a stomach problem, battling nausea and vomiting. But Roeung manages a smile for the visiting World Bank team: "I am happy because I can bring my husband here for treatment," she says. "If I didn’t get support from the Health Equity Fund, I wouldn’t be able to bring him here. I hope he gets better soon."

Yav Neang, a villager from Bour in Phnom Prek district, 60 km from Battambang provincial town, has brought her eight-month son to the hospital to get treatment for his serious lung disease. Her family is very poor and the local health center couldn’t treat her son, but Neang was told to bring him to Battambang Hospital where she would get free treatment and free meals, and have her transport paid for. After two days' treatment her son has improved. "Now my son is getting better and I don't feel so worried," she says, smiling at the boy, who is connected to an intravenous drip. "While I was at home I was so afraid for his life."

Neang's family has no land. She and her husband work as day-laborers on local farms doing tasks such as harvesting corn and rice. A day's work brings in around 10,000 riel (US$2.50) which supports the family of five members. But the work is not regular.

Phoung Pha, 22, is the mother of twin six-month-old boys. They are one of the poorest families in Chi Nek village, Anglong Vel commune, Sangke district in Battambang province. She was asked to pay 370,000 riel ($90) for the delivery of her twins, but her family couldn't afford it. "I was so pleased when I learned the Health Equity Fund would pay," she laughed. "We are safe."

Another of Chi Nek's poorest villagers, Veth Sopheap, 36, has been suffering from the chronic disease since she was 13 years old. Her husband is disabled and they have six children. The family could not afford to pay for her treatment, but now she is being supported by HEF, and hopes she will get better some day.

Neang, Roeung, Pha, and Sopheap, are among approximately 2.75 million Cambodian poor people covered by HEF schemes. The Health Equity Fund schemes are currently financed by the Health Sector Support Program including funds from the Australian Agency for International Development, the Belgian Technical Cooperation, the United Kingdom Department for International Development, the United Nations Population Fund, the United Nations Children’s Fund, the World Bank, and the United States Agency for International Development, the Royal Government of Cambodia national budget, and other development partners. HEF pays for the bill for each patient’s treatment fee, meals, transport, and other additional costs.

During the World Bank visit, 103 patients were treated at Battambang Referral Hospital under the HEF, which is managed there by Poor Family Development (PFD), one of 10 NGOs operating the HEF. PFD covers three provinces—Pursat, Battambang and Banteay Meanchey. Lam Sarin, PFD-Battambang project manager, said HEF helps reduce the burden of health expenditure for poor people and helps them access to quality health services.

"We see the main benefit as improving their livelihood by giving them access to free and quality health care service," Lam Sarin said. "When they are healthy, their community is also healthy and developed. Without HEF, when a member of a poor family gets sick, it is very difficult to find money for treatment. If they don’t have money they don’t take the sick person to hospital. Sometimes, the sickness forces them to sell their land, cows and any other property they have. Then they sink further and further into poverty."

Touch Svang, Anglong Vil commune chief, admires and supports the HEF scheme and hopes it will continue to support the poor. In the past, the poor came to the commune office to ask him for a letter to show that they were poor in the hope of getting a discount when they went to hospital; but now they just show the HEF card.

"Whenever I hear or I know of people getting sick, I tell them to go to hospital; don't stay at home and wait to die," he said. "If you are Buddhist, you gain great merit rescuing the poor."

Dr. Ngo Sitthy, Director of Battambang Provincial Referral Hospital, said that since his hospital has had the HEF program, the number of poor people coming to use the health service has doubled. Bed use has increased from 50 percent to 85 percent and he expects it to rise further during 2010.

"In the past, we saw that the poor were afraid to come to hospital because they feared they would be asked to pay or might be mistreated," he said. "Now their behavior has changed. They are starting to use our services because they get the HEF support—and the attitude of our nurses and doctors is also much improved."

According to Dr. Ngo, the hospital's revenue has almost tripled from US$4,000 to over US$10,000 per month. The hospital charges $20 for each patient and for poor people this cost is now covered by the HEF. Of the $20, 60% is used to pay for staff incentive, 39% for administrative costs and 1% for state revenue. But the HEF revenue will be divided only two ways—60% for incentive and 40% for hospital running costs. Dr. Ngo said his hospital still has problems getting medical supplies, so some of the extra income will be used to buy more medicines.

"HEF funding has led to improved services at the hospital, and I hope there soon will be even better development," Dr. Ngo said.