The Department of Planning and Health Information has to provide “Formulation of the Strategic Framework for Health Finances,” led by the Bureau “Health Economics and Financing,” according to the government of Cambodia, the Ministry of Health (MOH) with support from WHO Cambodia and the Western Pacific Regional Office. WHO deals with financing mechanisms for providing the funding required for the delivery of health services to the population, both in terms of sources of funding for the delivery of health care (input) and the way in which these funds are spent (output).
The government of Cambodia and development partners have to move towards greater integration of social health protection schemes- integration in social Health Equity Funds (HEF) and Community-Based Health Insurance (CBHI) - to provide health coverage for the poor and the informal sector. The establishment of HEF and CBHI will also provide the means for addressing the institutional requirements for universal coverage and will provide an impetus for strengthening the key health financing functions related to equity and efficiency. Therefore, this is a unique opportunity in Cambodia to establish an institution for a national social health protection mechanism for the poor and nearly-poor by placing HEF and CBHI administration under a new national agency. This rare opportunity arises from the consistent work that began in 1998 and especially after 2000 and is made possible, in fact necessary, by the unparalleled success in extending coverage of HEF across most operational districts across the country. The long term aim of health financing in Cambodia is to achieve universal coverage of the population with funded pre-payment mechanisms. This, however, is still many years away. Already, besides government budget for health and direct out-of-pocket spending, a number of different health financing mechanisms have emerged independently, such as donor funding, donor funded pools, user fees at public facilities, fee-exemptions for the poor, contracting of public service delivery, Health Equity Funds, Community-Based Health Insurance (CBHI) and proposals for different Social Health Insurance (SHI) schemes. The purpose of the strategic framework is to bring various forms of health financing that will provide the basis for moving to universal coverage in the long term.
As a result, there has been the establishment of a national agency for HEF, CBHI, voucher and other schemes as a step towards universal coverage. Health equity funds cover three-quarters of the poor population nationally with subsidies for free access to government health facilities. Voluntary CBHI schemes, which aim to cover informal-sector people who can afford to pay the premiums, are implemented in many health operational districts. The government, the Ministry of Health and development partners are preparing to scale up and move these schemes, which are currently administered mainly through non-government agencies, under national institutions or administration. The government has declared its support for scaling up HEF to national coverage, and the Prime Minister in mid-2011 publicly endorsed the proposal. Donors and NGOs - including those principally responsible for creating structures for the national administration of the existing HEF system - also understand the need to transfer the NGOs-established SHP mechanisms to government administration.
Cambodia has attracted much attention for its willingness to adopt innovative approaches to both the delivery and financing of health services, having seized opportunities and allowed space for catalysts of change.