Institutional and operational barriers to strengthening universal coverage in Cambodia: options for policy development
The government of Cambodia and development partners have indicated in different ways that it is timely to move to greater integration in social health protection schemes—in particular, health equity funds (HEFs) and community-based health insurance (CBHI)—to provide health coverage of the poor and the informal sector. The possibility now exists to establish a national agency for HEF, CBHI, voucher and other schemes as a step towards universal coverage. This would constitute one of the country’s major social reforms of the past two decades.
Health equity funds cover three-quarters of the poor population nationally with subsidised 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 (ODs). The government, the Ministry of Health (MOH) 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.
In this study, we identify the key barriers to policy change and to strengthening national institutions for implementation of universal coverage, and suggest options for overcoming these barriers. The findings indicate that policy makers are generally in favour of establishing an interim social health protection agency for the informal sector, including both HEF and CBHI schemes. Representation of formal-sector workers is being arranged separately through the Ministry of Labour and Vocational Training (MOLVT) and the Ministry of Social Affairs, Veterans and Youth Rehabilitation. Preferably, the HEF-CBHI agency would be autonomous, attached to but independent of the MOH. Experiences from this arrangement would assist in the reformulation and implementation of the broader Master Plan for Social Health Protection (currently in draft form and under consideration within the government), which proposes a single national agency for all sectors and all schemes
While there is as yet no clear, consistent strategic direction for establishing a national agency, carefully identifying the policy and institutional barriers and working out an appropriate response through close and effective collaboration between the government, MOH and development partners is essential.