bfh

Buddhism for Health (BFH) is a local non- profit, humanitarian organiza-tion dedicated to working with communities to enable the poor and marginalized to integrate in society through building social capital. As such, BFH support com-munities t o identify the poor and organize fund raising activities to which they financially contribute. To ensure that the near poor and informal sector can also bene-fit from equitable access to public health services, in June 2006, Buddhism for Health established

a Community-Based Health Insur-ance (CBHI) scheme. The scheme's name was chosen to be Pagoda Based Health Insurance (PBHI) to exemplify its association with the faith-based organizations concerned. Currently 10,700 people are vol-untarily enrolled with this PBHI.

Between 2006 and 2008 the PBHI scheme was supported by Swiss Red Cross. However, since 2009, the scheme has been receiving fund-ing from AFD through GRET/SKY.

Coverage, enrollment and premium

PBHI oper a te s t hroughout Kirivong Operational District (OD), Takeo Province, covering three and a half Administrative Districts. The target population in the OD is 167,170 people (excluding the poor). A significant number of peo-ple live in 'enclave' areas where transportation and communication is not easy, especially during the rainy season .

Roughly 80% of the Kirivong popula-tion lives from farming (rice and

food crops). The others main catego-ries of employment are garment work in Phnom Penh, fishing, the civil service, market sales, and NGOs. Roughly 95% of the popula-tion is Buddhist. The remaining 5% are either Muslims or Christians. There are more than 90 pagodas (one pagoda for every two or three vil-lages) and 6 mosques in the areas covered by BFH and, as of March 2011, 2,013 families (10,765 mem-bers) had joined the scheme. This is equal to 6.44% of the total tar-geted population.

CBHI NETWORK FACTSHEET

BUDDISHM FOR HEALTH (BFH)

Background

CBHI members from 2007 to 1st quarter 2011

PBHI has developed its membership with an impressive growth rate (17% in 2007; 98% in 2008; 88% in 2009; and 45% in 2010). The drop-out rate for members was 48% in 2007; 1.8% in 2008; 5% in 2009; and14.6% in 2010. However, in 2011, it is expected to be higher because some members have been pre-identified as poor by the Min-istry of Planning and are therefore eligible to receive access to public health care services free of charge through a Health Equity Fund (HEF).

Family mem-bers

Annual premium

1 28,800 Riel/family

2-4 63,400 Riel/family



≥ 9 126,000 Riel/family

0

2000

4000

6000

8000

10000

12000

2007 2008 2009 2010 1st Quarter 2011

2081

4003

7513

10624 10765

Series1

PBHI has developed a range of social marketing approaches through the community partici-pation structure of the opera-tional district ( the Health Cen-tre Management Committee (HCMC) and VHSG) and other channels: 1. BFH is in charge of develop-ing the marketing plan, and provides technical support to all insurance agents , VHIV and (HCMC) including: A. Taking the lead information

and sensitization campaigns B. Leading in the process of member assembly and other important meetings C. Addressing people’s questions and possible frus-trations concerning the functioning of the PBHI. D. Handling critical incidents 2– The Health Center Man-agement Committee Chief is selected per health center. He/she spend at least two (continue to next page)

Service providers and quality

Marketing and community engagement strategies

Benefit package and utilization caused by accidents.

4. Prescription drugs on Non-Essential Drug List (applicable at Takeo Pro-vincial Hospital and at the contracted private pharmacy only).

5. Transport in emergencies and by hospital ambulance for referral from health centres to the district hospital and to the provincial hospital, (with 20,000 Riel per case also provided to cover

transport back home ).

6. Grants : in the event of death, an insured member's family are provided with 50,000 Riel; and if an insured person aged ≤ 14 years is referred from the contracted district hospital or provincial hospital to Kunthea Bopha or National Children Hospi-tal, his/her family will be provided with 80,000 Riel.

All insured members are entitled to receive a range of specified medical and non-medical benefits: :

1.Consultations, examina-tions and procedures at all contracted health facilities in-line with the agreed refer-ral system

2. Inpatient and out-patient care, including diagnostic tests.

3. Treatment of injuries

BUDDISHM FOR HEALTH

Services at the following public health care provid-ers are available through BFH: 20 MPA health centers (HCs) and two health posts, Takeo Provin-cial Hospital (CPA3), Kirivong Referral Hospital (CPA2) and Rominh Annex to Kirivong Referral Hospi-tal (CPA1).

The referral mechanism was developed according to the Ministry of Health guideline to effectively man-age the delivery of health services to all members. Provider payments are by capitation at HCs and the district referral hospital and through fee-for-service at

two hours in the morning at health center to facilitate insured members.

3. BFH medical advisors ob-serve the quality of clinical aspects of health centre ser-vices on a quarterly basis. 4. Quarterly Member Assembly Meetings are held to get and provide feedback from/to members.

5. Village Health Insurance Volunteers (VHIVs) provide a monthly feedback report on quality of health services and BFH services.

6. Hotline numbers are written on each member-ship card as well as posted on BFH sign boards at each

health facilities in case of emergency or for any member inquiries. 7. Exit interview are conducted with discharged PBHI members to measure perceptions of service qual-ity. 8. A Quality Assurance Committee has been established in tandem with the Continuum of Care Com-mittee (CoC) for People Living with HIV/AIDS (with meetings held monthly after the CoC meeting to avoid paying per diems twice). 9. The district health development committee meets every two months and consider any complaints from members. 10. A health Financing Committee ensures all compliances of both health operators and health provid-ers to the terms set out in the con-tract/ MOU.

the provincial hospital. The PBHI scheme acts as a finan-cial intermediary between its members and con-tracted health care provid-ers to ensure the provision of accessible, affordable health services including provision of quality services to PBHI members.

To ensure quality is main-tained, BFH-PBHI has devel-oped the following meas-ures.

1. A sound contract with respective health facilities; 2. Insurance Agents stay

Utilization at health center and hospital facilities from 2008 to 2010

Income from premium collection V. technical expenses from 2008-2010

Services 2008 2009 2010

Health center

OPD 7904 13759 21854

Delivery 70 138 159

ANC 58 73 93

Hospital OPD 733 626 915

IPD 671 453 767

Delivery 110 95 112

Major surgery

3 5 21

01000020000300004000050000600007000080000

Income from premium coverage

Technical expenses (medical and non‐medical benefits

costs)

73983

58047

Series1

Key challenges faced during the opera-tion of the schemes include:

1. A difficult economic environ-ment has impacted on the scheme’s growth i.e. new registration and premium collection from existing members has been more difficult and drop out remains high.

2. Unregulated private practitio-ners (including contracted health facilities’ staff members).

3. Issues related to quality of OPD consultation at HCs that could be influencing people’s trust and the functioning of the referral system.

4. Lack of medical doctors at the

district referral hospital

5. During the Pre-ID Poor proc-ess of the Ministry of Planning, many PBHI members were identi-fied to be 'level2' poor which means they may be eligible for Health Equity Fund and withdrawn as members.

6. Absence of historical prece-dent with insurance

7. High expectations of insured members.

Future plans include:

1. Strengthen premium collection system, IT system and IA’s per-formance related pay.

2. Strengthen the functioning of the social marketing system in order to attract more voluntary members and obtain economies of scale.

3. Improve transportation mecha-nisms for referral cases from remote/ flood-prone areas.

4. Reconsider the current provider payment mechanism.

5. Pilot integration of CBHI & HEF in Kirivong .

Challenges, lessons learned and future plans

Case study

To contact BFH:

Contact person: Mr.

Sam Sam Oeun

Position: Deputy

Executive Director

a n d P r o g r a m

Director

Mobile no. (+855)

16 731 987

Office no. (+855) 32

6 900 729

E-mai l address :

bfh_pro_mg@mfon

BUDDISM FOR HEALTH

(hours per day in the morn-ing at health centers to facili-tate insured members. The rest of his/her time is spent in outreach activities at pagodas, liaising with HCMC members/monks for PBHI promotion through pago-das, and in regular visits to each village to promote health insurance in close collaboration with VHIGs.

3. Village Health Support Volunteers (VHSV) undertake the following activities:

A. Assisting health center staff in outreach services.

B. Performing health educa-tion activities for villag-ers.

C. Providing feedback reports on health quality of health

services. Further, all HCMC members are requested to disseminate basic informa-tion regarding PBHI to the population who come to the pagoda every week on a Sunday.

Village meeting in Kbal Dromey village, Kork Pich HC

Mrs. Vong Chanthrea is 26 years old and lives with 4 members of her family in Prasat village, Kam Peng Commune, Kirivong district, Takeo province. Her family has been enrolled in the PBHI scheme since 2008.

BFH staff interviewed her in April 2011 at her house and she told them that: "Before my family wasn't a member of health insurance, a majority of our family income from rice planting was spent on health-care. From 2008 until now, we have had many problems with illness. For instance, in 2008, my baby was self-aborted and

couldn't be helped by the health center midwives, and I was referred to Kirivong Refer-ral Hospital and saved by the hospital doctors.

In 2009, I was facing another complicated delivery but this time I could not even be helped by the district hospital, and I was then referred to Takeo Provincial Hospital for surgery. Again, I myself was saved but my child could not be helped. One November 2, 2010, I again came to Kam Peng HC for the birth of my daughter. But after delivery, I was feeling weak because of a lot of bleed-

Ing and was immediately re-ferred by an ambulance to Kirivong Referral Hospital. This time, I and my daughter were safe. We thanked the doctors who saved us a lot. My family has faced many catastrophic illnesses as men-tioned above. However, we didn't need to pay much or sell our assets for these catastro-phes because our family is a BFH member. All expenses related my treatments including costs of many minor healthcare expenses at HC for my family's members during these three years have been covered by the

related to my treatments including costs of many minor healthcare ex-penses at HC for my family members during these three years have been covered by the health insurance. Right now, I and all my family members are in good health. We always seek healthcare on time, and we won’t let our health fall into a serious state as before. This has helped our living conditions we had to become much better than before health insurance".

Mrs. Vong Chanthrea’s family

bfh

Healthcare