Health Equity Fund Utilisation Survey

Location

Cambodia. Location within country: 12 provinces (Banteay Meanchey, Battambang, Kampong Cham, Kampong Chhnang, Kampong Thom, Koh Kong, Kratie, Oddar Meanchey, Preah Sihanouk, Pursat, Takeo, Tbong Khmum)

Project Description

Health Equity Funds (HEF) are grants managed by third party operators (NGOs or CBOs) that aim to increase access of the poor to health services in hospitals and generate additional revenue for referral hospitals. HEFs are now a key building block in the overall strategy being developed by the Government and its development partners for tackling inequities in the health sector. HEFs are being implemented in all of Cambodia’s 23 provinces and Phnom Penh municipality and are fully rolled out (by URC scheme) in 51 (out of 81) ODs (63%). The MoH aims to reach full national geographical coverage in 2014. However, a number of surveys including CDHS 2010 and CSES 2011 have suggested that HEFs may not always be used by their members to receive medical care free of charge. Overall, available data indicates that HEFs may be suffering from underutilization, although these estimates need refining with studies devised specifically to address this question.

The main purpose of this assignment is to measure – using a combination of quantitative and qualitative methods – the level of utilization of Health Equity Funds (HEFs) among the poor and the various factors that explain the utilization pattern observed. This study is expected to help generate evidence that will improve access to health services by the poor in Cambodia as well as inform the policy dialogue with the Royal Government of Cambodia (RGC) with the aim of strengthening RGC capacity to move towards universal health coverage (UHC).

After a public procurement and bidding process, Angkor Research was awarded the contract to conduct HEF Utilisation Survey from the World Bank (Cambodia office). The study combines both quantitative and qualitative components, and includes treatment (HEF members) and control (non-HEF members) groups to understand utilisation patterns of HEF members relative to the general population. The 2,000 household quantitative survey (1,000 treatment and 1,000 control) is also segregated by distance to the nearest public health facilities; and qualitative in-depth interviews (IDIs) were conducted with nearly 300 key informants including HEF members, HEF operators, public hospital/health center directors and doctors, and village health support group volunteers. Angkor Research was responsible for all components of this mixed methods study, including: initial research design and literature review; sample selection methodology, framework and selection; instrument design, translation and pre-testing; national ethical approval (NECHR); field data collection; data entry and data management; transcription, translation and coding of all qualitative data; quantitative and qualitative data analysis; and report writing. The quantitative household survey was conducted among 2,003 households. The response rate was 98.5%, and individual interviewers completed an average of 5.8 interviews per day.

Impact Evaluation of Service Delivery Grants in the Health Sector in Cambodia: Baseline Survey

Impact Evaluation of Community Preschool Expansion: Monitoring Survey

Impact Evaluation of the Voice and Action: Social Accountability for Improved Service Delivery (I-SAF) Project: Baseline Survey

Impact Evaluation of Community Preschool Expansion: Midline Survey

Location

Cambodia. Location within country: 13 provinces (Kampong Chhnang, Kampong Speu, Kampot, Kandal, Koh Kong, Kratie, Mondulkiri, Preah Sihanouk, Prey Veng, Ratanakiri, Steung Treng, Svay Rieng, Takeo)

Project Description

The World Bank, in collaboration with the Ministry of Education, Youth and Sports (MOEYS), supports the Second Education Sector Support Project (SESSP) funded by Global Partnership for Education (GPE). One component of SESSP seeks to expand the availability and quality of Early Childhood Care and Development (ECCD) services. The objectives of the ECCD interventions are to assist MOEYS to expand access to quality Early Childhood Education (ECE) for 3-5 year old’s through construction of facilities, provision of materials and training of staff, as well as to build the demand for ECCD services among families from disadvantaged backgrounds. The program was also designed with a rigorous evaluation to measure the impact of community ECCD services on child cognitive and psychosocial development—with a focus on school readiness. To this end, the World Bank in collaboration with MOEYS is conducting the impact evaluation over three years, from 2016 to 2018.

After having conducted the baseline, Angkor Research was awarded the midline through a rigorous MOEYS procurement process. ARC involvement in this large-scale randomized control trial includes sample selection in isolated communities with insufficient baseline sample, tracking and re-interview of households interviewed at the baseline, instrument review/translation, primary CAPI (tablet-based) data collection and data management, reconciliation and linkages with the baseline for approximately 7,300 households and 305 preschools and villages (divided into treatment and control communities) in 13 provinces, to evaluate the service delivery and effects of preschools. A range of household and child indicators were tested at both rounds, including anthropometrics and cognitive testing for both mothers/caregivers and children. Household and individual data is longitudinal, and linked across survey rounds. Data collection also included interviews with village authorities and community preschool teachers, as well as community preschool facility assessments, photos and GPS locations in all 305 sample villages.

National Multi-tier Framework Energy Access Household Energy Survey

Location

Cambodia. Location within country: All 25 provinces/municipalities

Project Description

The reliable and efficient provision of modern energy services is vital for sustainable development. The Energy Sector Management Assistance Program (ESMAP) – World Bank, in consultation with multiple development partners has developed the Multi-tier Framework (MTF) to monitor and evaluate energy access by following a multidimensional approach. As a starting point for multidimensional measurement of energy access and input for tracking Sustainable Development Goal (SDG) #7 (access to affordable, reliable and sustainable modern energy), ESMAP-World Bank, in collaboration with Sustainable Energy for All (SE4ALL), is carrying out household surveys in 15 countries to establish each country’s baseline towards measuring progress towards the universal energy access goals.

Angkor Research was the implementing partner of the MTF energy survey in Cambodia The purpose of this activity was to carry out nationally representative energy survey activities including household, community, facility, and mini-grid operator level interviews using the Multi-tier energy access Tracking Framework (MTF). The data collected was analyzed to investigate different energy access tiers, energy access gaps, and to better understanding on the current status of energy use in Cambodia. The sample size for the household survey in Cambodia was 3,300 households. In addition, 275 community and 325 facility interviews were conducted in areas targeted for the household surveys. Approximately 100 mini-grid operator surveys were also included in this project.

Impact Evaluation of Service Delivery Grants (SDGs) in the Health Sector in Cambodia: Endline Survey

Location

Cambodia. Location within country: 23 provinces/municipalities (Banteay Meanchey, Battambang, Pailin, Kampong Cham, Kampong Chhnang, Kampong Speu, Kampong Thom, Kampot, Kep, Kandal, Kratie, Mondulkiri, Oddar Meanchey, Phnom Penh, Prey Veng, Pursat, Ratanakiri, Siem Reap, Sihanoukville, Stung Treng, Svay Rieng, Takeo, Tboung Khmum)

Project Description

The World Bank, in collaboration with the Ministry of Health (MOH), is supporting the redesign of Service Delivery Grants (SDGs) that will be implemented as part of the larger Health Equity and Quality Improvement Project (H-EQIP). H-EQIP aims to increase the sustainability of these innovations by improving their resourcing and management as envisaged in the government’s Health Strategic Plan 2016-2020 (HSP3). It will further strengthen the results-based focus of SDGs with a specific goal of improving quality of health service delivery and utilization of services by the poor and will use a multi-pronged approach to strengthening health systems, especially to support improvements in quality of care.

As part of its support, WB designed a rigorous impact evaluation to measure improvements in quality (and quantity) of health service delivery attributed to the SDGs. The results from this quantitative evaluation are expected to inform the Royal Government of Cambodia (RGC) and Development Partners on the efficacy of the proposed intervention. Impact evaluation will take place at the same 3 levels where SDGs are inputted: health centers, hospitals and operational districts (ODs).

At the endline, Angkor Research’s involvement in this large-scale, randomized control trial included sample selection, instrument review/translation (from the WB RBF IE Toolkit, with back-translation), primary CAPI data collection (tablet-based) and data management for surveys of both the demand-side and supply-side aspects of health care utilization and access, to evaluate the effects of SDGs on a range of household, service delivery and health care indicators.

The sample is nationally representative, and covered 70 ODs in 23 provinces of Cambodia. On the supply-side, Angkor Research conducted interviews with 70 OD directors, health facility evaluations at 140 public health centers (including medical record audits and drug/medical equipment inventories), 545 interviews with medical staff (including situational vignettes), and 1,000 exit interviews with patients. In the catchment areas of the target health centers, 2,500 households were interviewed on a range of indicators, including health equity fund (HEF) status anthropometrics, health-seeking behavior, out-of-pocket health expenditures and maternal/child health. Household data is longitudinal, and can be linked between survey rounds. Data collection also includes interviews with village authorities and GPS locations in all villages. The household survey was completed with a 98.7% response rate.

Focus Group Discussions with the Beneficiaries of the COVID-19 Relief Transfer for the Poor Program in Cambodia

Location

Cambodia. Location within country: 25 provinces/municipalities (Banteay Meanchey, Battambang, Kampong Cham, Kampong Chhnang, Kampong Speu, Kampong Thom, Kampot, Kandal, Kep, Koh Kong, Kracheh, Mondulkiri, Oddar Meanchey, Pailin, Phnom Penh, Preah Sihanouk, Preah Vihear, Prey Veng, Pursat, Rattanakiri, Siem Reap, Stung Treng, Svay Rieng, Takeo, and Tboung Khmum)

Project Description

In June 2020, the Royal Government of Cambodia began providing recurring monthly cash payouts to households with the IDPoor designation throughout the kingdom in response to the COVID-19 global pandemic. The amount offered varies based on locality, household demographics, and IDPoor status (IDPoor Level 1 and IDPoor Level 2). The payout was originally intended to cover two months and has seen extensions since. The project sought to understand the procedure for recipients and needs being addressed by the programme, as well as identify challenges and weaknesses in the cash transfer mechanism to improve future programmes provided by the Royal Government of Cambodia.

After winning the public bid for the project, Angkor Research was awarded the contract from the World Bank. Angkor Research was responsible for all components of the data collection and data management, including: sampling methodology, framework and selection; instrument design, translation and pre-testing; data collection; data entry and data management; transcription, translation and coding of all qualitative data; quantitative and qualitative data analysis; and report writing. Due to COVID-19 restrictions and concerns of widespread transmission, Angkor Research advocated for and succeeded in revising the methodology where 30 FGDs became 180 telephone interviews with cash transfer programme beneficiaries.

Impact Evaluation of Community Preschool Expansion: Endline Survey

Location

Project Description

A range of household and child indicators were tested this round, including anthropometrics and cognitive testing for children. Household and individual data is longitudinal, and linked across survey rounds. Data collection also included interviews with village authorities and community preschool teachers, as well as community preschool facility assessments, photos and GPS locations in all 305 sample villages. Additional endline activities included school mapping of all preschools and primary schools within 3km of target villages, teacher interviews and classroom observations (both in-person and video recorded) were collected in around 327 preschools in target and surrounding villages.

Impact Evaluation of the Voice and Action: Social Accountability for Improved Service Delivery (ISAF) Project: Endline Survey