Health outcomes in Cambodia have improved significantly over the past decades. Between 2005 and 2014 the maternal mortality ratio decreased from 472 to 170 per 100,000 live births and the under-five mortality rate decreased from 83 to 35 per 1,000 live births. Yet, inequities in health outcomes persist among different socioeconomic groups and geographical areas, and between urban and rural populations. The country faces a rising disease burden of noncommunicable diseases (NCDs) such as high blood pressure, diabetes and chronic lung disease. Risk factors for NCDs are high, as the proportion of the population over age 60 will increase nearly by twofold in the coming 20 years, from 6.2 percent in 2010 to 11.9 percent in 2030.
For over 15 years, the World Bank has supported Cambodia’s health sector, along with financing from the government and other development partners. Pooling of these funds to support reforms in the healthcare system has strengthened government ownership and accountability and improved coordination among development partners, which has been instrumental in the rapid improvement in coverage and quality of healthcare services.
The H-EQIP project has built on the results and innovations introduced through the First and Second Health Sector Strengthening Programs which have aimed to improve access to health services. Innovations have included results-based financing through instruments such as Health Equity Funds (HEFs) and Service Delivery Grants, which are designed to improve the quality of health service delivery and increase the use of healthcare services by the poor.
HEFs have successfully reduced catastrophic spending, increased utilization of health services by the poor, and provided a reliable source of financing to health facilities. To increase utilization and quality of care in underperforming locations, the Ministry of Health established special operating agencies in selected provincial and district referral hospital ands operational district. Hospital staff collectively and individually signed contracts that set annual performance targets, and achievement of these targets triggered payments in the form of Service Delivery Grants. Targets were revised annually to drive further improvements in service delivery. This has helped increase deliveries in public facilities, allowed more technical staff to be employed as required, and reduced stock-outs of essential drugs and supplies. They have also given facilities extra funds to improve service quality which can be spent partly for bonus payments to individual staff where targets have been achieved or surpassed.