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)
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.