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Donor Involvement in Health Care Financing in Cambodia

Donor Contribution
Best Practices and Challenges

Yogyakarta, November 26, 2008

Sao Chhorn- SN, BBA, MBA

Final seminar on "E-Learning: International Approaches to Helth Financing and Health Insurance November 2008 1
Donor Involvement in Health Care Financing in Cambodia

Outline
• Who are Donors,
• What they have done,
• Highlighted best practices,
• Major challenges,
• Next focuses

Final seminar on "E-Learning: International Approaches to Helth Financing and Health Insurance November 2008 2
Donor Involvement in Health Care Financing in Cambodia

Who Are Donors?


Those who provide financial, technical
assistance, and other contribution to the
development of health sector performance.

Major Donors are:


USAID,BTC, JICA, GTZ, DFID, AusAid, EU, Global
Fund, GAVI, ADB, WB, WHO, UNICEF, UNFPA,
UNAIDS, ILO, and other Private Donors

Final seminar on "E-Learning: International Approaches to Helth Financing and Health Insurance November 2008 3
Donor Involvement in Health Care Financing in Cambodia

What have donors done?

Donors have made huge contributions.


External assistance is up 30% of total
expenditure
Major contribution go to public health
delivery system development interventions
from the supply side

Final seminar on "E-Learning: International Approaches to Helth Financing and Health Insurance November 2008 4
Donor Involvement in Health Care Financing in Cambodia

What have donors done? (Cont)

Supply side interventions:


Infrastructure development,
Human development through training program,
Provision of medical equipment and supplies,
Development of national programs for disease
controls and others,
Development of user-fee system at public health
Facilities,
Contracting for health services,
Development of quality assurance mechanisms.

Final seminar on "E-Learning: International Approaches to Helth Financing and Health Insurance November 2008 5
Donor Involvement in Health Care Financing in Cambodia

What have donors done? (Cont)

Demand side interventions:


Development of direct subsidy mechanisms such
as Health Equity Funds, Coupons for Safe
Delivery, Voucher for Health etc.
Development of social health insurance,
community based health insurance, and social
safety net.

Final seminar on "E-Learning: International Approaches to Helth Financing and Health Insurance November 2008 6
Donor Involvement in Health Care Financing in Cambodia

What are best practices?


Some health facilities with appropriate equipment
according to standard for provision of health care,
Some NGO health care facilities contributing
health outputs to public health care,
Contracting for health services is very effective
to address issues of access to prioritized care,
Development of provider incentive payment
mechanism linking to performance (output based)
National programs are every effective in
addressing issues such as reducing HIV/AIDS
prevalence, TB prevalence etc.

Final seminar on "E-Learning: International Approaches to Helth Financing and Health Insurance November 2008 7
Donor Involvement in Health Care Financing in Cambodia

What are best practices? (cont)

Existence of social protection mechanisms


through effect direct subsidy,
Existence of demand side financing through
social health insurance, CBHI with possible
extension toward universal coverage,

Final seminar on "E-Learning: International Approaches to Helth Financing and Health Insurance November 2008 8
Donor Involvement in Health Care Financing in Cambodia

What are challenges? (cont)


Fragmented health financing schemes,
Too emphasis on public service delivery with
least attention to important roles of private
providers in achieving common MGD,
Private sector growth without proper regulation
and proper partnership agenda,
Sustainability of direct subsidy mechanisms
such health equity funds etc., and funding of
national programs,
Availability and poor quality of health care
services, especially perceived quality,
Slow growth of CBHI and SHI coverage,
Final seminar on "E-Learning: International Approaches to Helth Financing and Health Insurance November 2008 9
Donor Involvement in Health Care Financing in Cambodia

What Should Be Next Focus?


Technical Assistance to Ministry of Economics
and Finance for more efficient taxation system
 Assistance to Ministry of Health to ensure
adequate Quality Assurance and Accreditation
System,
Assistance to Ministry of Health to have clear
partnership agenda with private providers, and
control of dual practices,
Continuation of supports to Contracting for
Health Services, and output based incentive
payment to public providers,

Final seminar on "E-Learning: International Approaches to Helth Financing and Health Insurance November 2008 10
Donor Involvement in Health Care Financing in Cambodia

What Should Be Next Focus? (Cont)

Continuation of direct subsidy initiative to pay


way to provide the poor with protection against
inequity access to health services though HEF,
and other schemes,
Accelerate assistance for expanding CBHI, and
SHI,
Assistance to link all demand side initiatives to
have formulate effective social protection
mechanism,

Final seminar on "E-Learning: International Approaches to Helth Financing and Health Insurance November 2008 11
Donor Involvement in Health Care Financing in Cambodia

Thanks For Your Attention

Final seminar on "E-Learning: International Approaches to Helth Financing and Health Insurance November 2008 12

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