afh
TRANSCRIPT
Health's Health Sector Support Pro-ject, the German Federal Government through the Deutsche Gesellschaft fürInternationale Zusammenarbeit (GIZ) GmbH and AusAid.
Founded in 2001, Action for Health (AFH) is a local NGO dedicated to serving the public interest and help-ing people to have better health and quality of life. AFH has extensive experience of managing Health Eq-uity Funds (HEFs) in Cambodia and now manages HEFs in fifteen Opera-tional Districts (ODs) across nine provinces.
In addition to HEF implementation, since 2007 AFH has been delivering a maternal health voucher scheme in Cheung Prey and Prey Chhor ODs, Kampong Cham province and - since January 2010 - a CBHI scheme in Kampong Thom OD, Kampong Thom province.
The CBHI scheme is only the sec-ond scheme in the country operated as an integrated HEF/CBHI, bringing
together two existing health financ-ing schemes in Kampong Thom:
1. A HEF scheme managed by AFH and funded by the Second Health Sector Support Project (HSSP2). This scheme started in 2005, covering hospital costs only for identified poor families in Kampong Thom OD and Stong OD.
2. A CBHI scheme in Kampong Thom OD, established in 2007 and initially managed by GRET-SKY be-fore its handover to AFH in 2010.
To support its work in the health financing sector in Cambodia, AFH has received considerable technical and financial support from a wide range of organisations including: USAID (through University Research Co, LLC (URC)), the Ministry of
Coverage, enrollment and premium Kampong Thom OD covers admin-istrative districts with 47 communes and 320 villages. It has a population of 304,289 people, of whom 106,804 a r e p r e - i d e n t i f i e d p o o r (approximately 35.10% of the total population). The premium is collected every six months or annually by a CBHI
'Access Facilitator' (AF) and, as of June 2011, the coverage of CBHI members is 10,149, which is equiva-lent to 3.33% of the total OD popula-tion. On the same date, a total of 79,325 people were the members of Health Equity Fund which is equiva-lent to 26,06 % of the total popula-tion.
The current drop-out rate for CBHI members is 3.83% by individual and 3.29% by family per month.
CBHI NETWORK FACTSHEET
ACTION FOR HEALTH (AFH)
Background
Family members Annual premium
1 48,000 Riel/ family
2-4 90,000 Riel/ family
5-7 114,000 Riel/family
≥8 132,000 Riel/family CBHI and HEF members, as of June 2011
Orientation on Social Health Protection Scheme s in Kampong Thom
8947
295342
Insured members
Non‐insured population
AFH currently contracts with 21 health centers (HCs) and one provincial hospital. Pay-ments to providers are made through capitation at the health center level while fee for services is used at the provincial hospital.
AFH is working to promote the quality of health services in all its partner health facili-ties with the support of GIZ. In view of this, the following methods are used monitor and improve quality:
1. Patient exit surveys con-ducted by AFH.
2. Client satisfaction surveys
conducted by Village Health Support Groups.
3. Feedback mechanisms between the community, health providers and scheme operators. For instance, through regular meetings of the steering committee (a community gathering provid-ing feedback to the scheme operator).
4. Regular checking of con-tact compliance among con-tracted health providers.
5. Deployment of Member Access Facilitators at health centres and hospital to facili-tate clients coming to use
the
services.
6. Close collaboration with health authorities and health care providers to improve quality and patient satisfaction.
7. Conducting annual client satisfaction surveys in collabo-ration with GIZ.
8. The implementation of performance-based provider payment mechanisms in all contacted health facilities.
9. Regular checks and moni-toring by the AFH medical auditor.
2. Radio programmes to provide information about: benefits; and common mis-conceptions such as bad luck when paying for insur-ance.
3. Organisation of lucky draws.
AFH uses a number of strategies to market the scheme, including:
1. Marketing at grassroots level (village gatherings and promotion; mobile videos; door-to-door promotions; peer-educations etc).
4. Distribution of information and promotional materials.
Service providers and quality
Marketing and community engagement strategies
Benefit package and utilization
Page 2
The benefit package for both CBHI and HEF members consists of both medical and non-medical benefits and includes the following:
1. MPA services delivered by contracted health centres.
2. CPA 3 services delivered by the contracted Provincial Hospital.
3. Transportation costs for members referred from health centres to the Provin-
cial Hospital (and from home to health centres and
back for HEF clients).
4. A funeral grant of be-tween 50,000 and 60,000 Riel (depending on length of membership).
5. A Safe Motherhood Grant of $10 for attending three ANC checkups and deliver-ing in a health facility, and $20 for attending a PNC check-up and after a full
cost of vaccinations.
* Chronic diseases are not covered under the scheme.
HC and RH
2010 2011(Jan-April)
IPD 505 204
OPD 11,257 4,605
Utilization of CBHI members at health center and hospital facilities from 2010 to April 2011
Income from premium collection V. technical expenses from January to March, 2011
ACTION FOR HEALTH
CBHI scheme promotion by AFH staff
An insured member receives consultation
A CBHI member recovers from an operation at hospital
0
2000
4000
6000
8000
10000
12000
Income from premium collection
Technical expenses (medical and non‐
medical benefits, and
marketing costs)
5302
11317
Series1
sources.
Future plans include:
1. Strengthening the capacity of Access Facilitators in all target health facilities.
2. Strengthening the commu-nication process between all involved partners.
3. Creating motivational
strategies for members and staff including:
A. Giving bonuses for mem-bership. For instance, giving one or two months member-ship free of charge.
Challenges and lessons learned by AFH during the initial phase of operating the CBHI scheme include:
1. Constraints on the ability to increase premiums collec-tions due to time constraints, the wide geographic area covered and the availability of potential members
2. The relatively low level of income from premium col-lections when compared with the high administration costs.
3. The dependency of the scheme on external funding
B. Giving staff a monthly bonus for successful pre-mium collection
C. Establishing a fair price for motorbike maintenance and gasoline for staff mem-bers.
4. Strengthening marketing strategies such as village meetings, door-to-door visits etc.
5. Increasing collaboration and team building with the HEF and the pagoda compo-nent team (responsible for reimbursing travel costs).
Case Study
Page 3 ACTION FOR HEALTH
Challenges, lessons learned and future plans
To contact AFH
Contact person:
Dr. Nuth Mony
Position: Health Financing
Coordinator
Mobile no. (+855) 12 612
005/ 16 888 170
E - m a i l a d d r e s s :
Mr. Lay Thon, 62 years old, and his wife, Mrs. Ork Khorth, 58 years old, live in Team Chas Vil-lage, Kampong Svay commune, Kampong Svay district, Kampong Tom province. Mr. Lay Thon’s family is currently covered by the CBHI scheme. Asked why he decided to join the scheme, he answered as follows:
I decided to join CBHI after my family had experienced financial constraints during the sickness of my son.
The main income in our family comes from farming. Usually, we spend around 6 months in farming. Other income comes from the profit of running a small grocery store . We have been working very hard. However, we still struggle to cover all the expenses in our family.
One day, our son got sick with an abdominal pain. We took him to Kampong Tom referral hospital, and we were told that he had appendici-tis. He then was hospitalized and we were asked to pay 800,000 Riel (200 USD) for the user fee.
At that time, we did not have enough money for the hospital fee, therefore my wife deiced to borrow some money from our neighbor.
During our stay at the hospital, we were surprised to see other pa-tients who needed the same opera-tion as my son; however, their families did not need to worry about paying user fees since they were covered by the CBHI scheme. We saw them holding the CBHI booklet and we also observed that they were treated the same as us, (non- CBHI members). Moreover, we often saw CBHI project staff come to visit the patient providing consultation as well as encourage-ment.
Seeing this situation, I recalled the time when CBHI project staff came to my house for promotion and registration before my son got sick. My family did not trust the project and quality of services provided at that time.
However, I have now witnessed the importance of becoming a CBHI member, and how health
staff are taking good care of both CBHI members and non-members.
The following day, my son left the hospital, and I quickly gave a call to CBHI project staff to register with the CBHI scheme.
Two months later after enrolling with CBHI, my wife got sick. She first came to the health center and then was referred to Kampong Thom hospital due to gastritis prob-lems. She received treatment at the hospital with good care from both the medical doctor and the CBHI project staff. This time was very different compared to the past and the financial problems that we used to face. When my wife was hospital-ized, the entire user fee was fully covered by the CBHI project and we were not asked to spend any addi-tional money. In addition, we re-ceived 15,000 Riel for transporta-tion costs for travelling back home.
Mr. Lay Thon and his wife