POVILL

CAMBODIAN WORKPACKAGE 5

Center for Advanced Study

Study objectives

• To study the institutional arrangement of Health Equity Fund in Cambodia, specifically focusing on the roles of international NGO and Local NGO in the development and implementation of HEF schemes.

Hypothesis

• This study hypothesizes that the effective implementation of HEF schemes depends on the kind of institutional arrangements that base on the effective collaboration and coordination between civil society and the government sectors.

Redressing health seeking behaviors:HEF as part of the solution?

HEF is a mechanism or fund that• is operated by an independent organisation• in the interest of poor people, • purchases health care for those poor people (from a

public health care provider), • and also pays for all the associated costs (from

non-medical providers).

• Independent = purchaser-provider split , the organisation does not belong to the Ministry of Health.

Functions of HEF

Types of HEF schemes

• Today, HEF schemes have expanded across many different area of Cambodia and the schemes have now been classified into four different groups in the National HEF framework, which resulted from the government has decided to allocated government budget to subsidize health services for the poor since November 2006.

• 4 Groups of Schemes

– Group 1 and 2 are subsidy schemes– Group 3 is scheme that is subcontracted by government to 3rd party– Group 4 is a scheme that is solely funded by donor and implemented by

the third party payer.

• But group 3 & 4 are considered to be the real HEF schemes

National HEF Institutional Arrangement

MoH Development Partners &

DonorsMoEF

DPHI & DBF

HSSC

PIU

NHFSC TWG-H

PHFSC PTWG-H

MG

ODO

3rd party HEFI

3rd partyHEFO DHFSC

OD Monitoring Team

HSP

recommendations

disbursement

reports

MoU

MoU

PHD / PHTAT

MoU

Sub MG

EXTERNAL & INTERNAL AUDITS

auditing

auditing

Contract

Report

Qu

arte

rly

disbursement

reports

Quarterly Report

Contract

Contract

ReportsDisbursement

Monitoring

discussions

Technicalstaff

Roles and functions Local NGOs International NGOs

Characteristic HEF Operator HEF Implementer

Budget negotiation Propose budget to INGOs Negotiate budget with donor and MoH

Targeting •Pre-id•Post-id

Payment •Operational cost•Targeting •Reimburse hospital fee

Benefit package for direct and indirect cost

Accountability or issue of corruption

•Account to INGOs•Account to the community

•Account to donors•Account to MoH

Monitoring performance •Monitor community network•Monitor hospitals

Monitoring local NGOs

Responsibility •Empowering and protecting the poor•Civil society building

•Creating and Capacity building of LNGO•Poverty reduction

Questions?

• How do the INGOs see their future role and the role of LNGOs?

• What is the view of different government officials about the

appropriate role of LNGOs? Are they useful and if so how?

• Whether Cambodia is moving towards some kind of partnership between LNGOs and government or whether the former institutions may eventually disappear when donors and INGOs leave?

• Whether the arrangements of HEFs provide a good institutional arrangements upon which any reformed system of health finance can build?