Social health protection

Project description

Title: Social health protection
Commissioned by: German Federal Ministry for Economic Cooperation and Development (BMZ)
Country: Cambodia
Lead executing agency: Ministry of Health, Cambodia
Overall term: 2009 to 2018

Context
Germany has been supporting efforts to reform the Cambodian health system since the mid-1990s. Cambodia has achieved most of the health-related Millennium Development Goals (MDGs) ahead of schedule. The percentage of the population living below the poverty line has fallen from 48 per cent (2007) to 19 per cent (2012), and the maternal mortality rate has halved since 2000.

However, people living in poverty or close to the poverty line as well as persons with disabilities and older persons continue to have inadequate access to appropriate health services. Only approximately one fifth of Cambodians have social health insurance and many households fall into poverty due to the health related expenditures. Health service provider lack materials, equipment and qualified staff. Low wages in the public sector affect the motivation of public servants.

The new Health Sector Strategic Plan (2016-2020) aims to extend social health protection to provide universal health coverage in the long term. In addition, an accreditation system is to be created for both public and private service providers. Further priorities include a reduction in communicable and non-communicable diseases as well as maternal, child and infant mortality.

Objective
Poor and vulnerable groups have more equitable access to health services of appropriate quality.

Approach
GIZ supports the Cambodian Ministry of Health and other partners in four areas of activity:
  1. Health care financing
  2. Improving health services
  3. Citizen participation in the health system
  4. Inclusion of vulnerable groups
The project provides national policy advice and supports the implementation of the national health strategy in the provinces of Kampong Thom, Kampot and Kep. It promotes reform processes on a long-term basis, strengthens state and non-state organisations, and enables specialists and managers to implement sustainable solutions designed to improve the health and social protection of the population.

Results
The access of poor and vulnerable population groups to essential health services has improved as a result of the establishment of a social health insurance system. Poor people are covered without paying contributions. Households living just above the poverty line can voluntarily join the social health insurance scheme for a small annual contribution. Special services, such as the payment of transport costs for persons with disabilities, have been implemented by the project. These measures have contributed to providing social health protection for up to one third of those living in supported provinces.

The project supports pilot processes designed to improve the quality of health care. All public health institutions which are assessed regularly have shown improvements. Training measures for health personnel have also made a substantial contribution to improving quality. Consequently, health institutions are used more frequently. Four out of five births now take place in public health institutions.

In cooperation with selected commune councils and non-governmental organisations, patients are informed of their rights and encouraged to give feedback. Dialogue between service users, sub-national councils and health institutions strengthens mutual understanding and trust as well as transparency and accountability.

Target groups apart from the poor are persons with disabilities, persons with non-communicable diseases and older persons who have specific needs in terms of access to and quality of health care. By implementing inclusive measures, such as strengthening representative organisations and raising awareness among the population and health personnel, health services become more inclusive and responsive.

Contact

Bernd Appelt
bernd.appelt@giz.de