Vouchers for Reproductive Health Services Cambodia (Phase II)

Country: 
Cambodia
Area of competence: 
Integrated Primary Health Care
Donor organization: 
KfW (KfW Development Bank)
Start of Project: 
08/2013
End of Project: 
02/2018
Staff-month: 
110
Value of service: 
€ 2,014,083
Partner Organisations: 
Action for Health
Description of Project: 

The project aims at the implementation, expansion and further development of the voucher system under the Social Health Protection Programme in Cambodia. The vouchers will cover services for safe motherhood, family planning, safe abortions, child health, cataract and cervical cancer screening in three provinces. Recently, important services on nutrition have been integrated. The voucher scheme is expected to achieve the following objectives and outputs:

1) to promote and improve access to specific reproductive health and nutrition services for poor and vulnerable women as an integrated and complementary financing instrument to existing health equity funds and community based health insurance schemes

2) to contribute to the achievement of the Cambodian Millennium Development Goals

3) to improve quality of care of public and non-public health services providers through enhanced demand-side subsidies and purchasing power of poor patients

4) to strengthen vital elements in the development of an effective social health protection system (i.e. quality assurance, accreditation, output-based reimbursement mechanisms, inclusion of non-public providers)

5) to assist the Ministry of Health as the Project Executing Agency (PEA) and all partners involved in health financing mechanisms in managing the implementation of voucher services

6) to strengthen management structures (institutional development and capacity building of partners involved, i.e. PEA, Provincial Health Departments and health services providers for sustainable implementation of the Strategic Framework for Health Financing in Cambodia

7) to ensure an effective and efficient integration of the voucher approach into existing demand-side financing mechanisms, in particular HEFs, in order to create synergies and strengthen structures

EPOS Health Management implemented the voucher scheme in cooperation with the Cambodian NGO Action for Health. EPOS managed a disposition fund of 6.8 Mio Euro.

Description of Services: 

EPOS together with Action for Health formed the Voucher Management Agency (later Committee) responsible for the following tasks:

  • Increase access to high quality reproductive health and nutrition services, focusing on safe deliveries, long-term family planning, on confidential and safe comprehensive clinical abortion services and quality nutrition
  • Select and determine future project beneficiaries based on developed criteria for the identification of the poor (ID Poor)
  • Select and identify suitable service providers
  • Develop and implement a suitable voucher distribution system which will include effective communication and marketing strategies, awareness campaigns, advocacy for this project approach. Install the financial management system that includes prudent management of the disposition fund, implementation of a system to process and reimburse Voucher Service Provider claims timely, development and implementation of a financial and fraud control system
  • Develop an adequate supply and procurement. Introduce a monitoring and evaluation system

The project achieved the following outcomes:

 

  • Strengthening of RH and CH services, improving quality and availability
  • Establishment of CCST (Cervical Cancer Screening and Treatment) as foundation of nationwide expansion
  • Increased awareness of preventive primary health care services in the public sector
  • Increased motivation of health staff through performance-based payment
  • Development of client mobilization tools (transport, IEC, VP) on community level
  • Continuation of voucher supported services for the poor within the HEF (Health Equity Fund)
  • Contribution to MoH guidelines, SOP and policy development

Furthermore, the project accomplished the following results, which can directly be traced back to the successful implementation of activities:

  • Increased utilization of essential and preventive services by reducing financial barriers and increasing promotion
  • Quality improvement through training, supervision (external consultants) and provision of equipment
  • Improvement of infrastructure (rehabilitation of health facilities for persons with reduced mobility and use of 39% of user fees income)
  • Strengthening utilization of public health facilities
  • Empowerment of clients and increased awareness of client rights
  • Considerable reduction of cataract prevalence and high long acting and permanent methods in family planning (LAPM) prevalence
Project Volume: 
€ 4,028,166