How Cambodia can meet its challenges of financing the health system and responding to the pandemic


Cambodia has made great strides in recent years, both in terms of economic growth and key health indicators such as life expectancy and infant, child and maternal mortality rates. The country achieved lower middle income status in 2015 and was making steady progress towards universal health coverage (UHC) with significant improvements in its health services.

However, just as Cambodia began to face challenges to the health system, including disparities in health outcomes and access to services by location, gender and declining development assistance – a feature of its economic progress – these problems were compounded by a one – COVID-19.

The pandemic threatens not only to disrupt the delivery of essential services in Cambodia, but also to counterbalance some of the progress made in the delivery of health care in recent years. A study by the Global Financing Mechanism found that under-five mortality could increase by 35% and maternal mortality by 50% by 2020 if essential maternal and child health services are severely affected.

COVID-19 has also severely shaken the economy, with potentially disastrous consequences for public health financing. The tourism, manufacturing for export and construction sectors, which contributed more than 70% of growth and almost 40% of paid employment in 2019, have been the hardest hit by the pandemic . This is likely to lead to a fall in tax revenues, considerably reducing the national budgetary resources available for health in the short to medium term.

HFSA to assistance

To understand what Cambodia could do to mitigate the impact of the pandemic and get back on track to achieve universal health coverage under these challenging circumstances, the World Bank and the Australian government conducted a systematic assessment of the financing system. health of the country. The study, called the Cambodia Health Financing System Assessment (HFSA), is being conducted under the Advance UHC multi-donor trust fund and aims to provide an in-depth assessment of critical interventions covering maternal, newborn and child health. designed to close equity gaps due to gender inequalities, income disparities and remoteness.

The Cambodia HFSA is also assessing the potential impact of COVID-19 on health financing and service delivery and it identifies priority areas where reforms of health service delivery and financing systems could accelerate progress towards universal health coverage.

Among the key recommendations:

Investing in health and nutrition could pay off by developing human capital

Continued investment in health and nutrition is a priority. Improving maternal and child nutrition, addressing emerging challenges such as noncommunicable diseases, and providing equitable access to quality health care could be of crucial importance for national development. However, the expected drop in income from the pandemic means Cambodia will likely need to increase its health budget to accelerate and sustain progress towards universal health coverage. Funding needs to expand coverage in 2020-2023 are estimated at $ 2.9 billion, according to the assessment.

Increase the efficiency and equity of public spending to reach underserved populations

The health care system is still hampered by inefficiency and inequity. Resources are concentrated in urban areas and in hospital and primary care services; while rural areas, where maternal mortality rates are highest, remain underfunded. These needs should help guide the allocation of health resources. Increased funding for primary care services will help promote prevention services in frontline health facilities and in communities. Providing high-quality, reliable and equitable health and nutrition services and better managing service delivery should be priorities.

Strengthening financial protection could reduce costs for beneficiaries

Only 30% of Cambodia’s 15.5 million people are currently covered by social health insurance schemes. The Health Equity Fund (HEF) and National Social Security Fund (NSSF), the main providers, account for only a small fraction of total health expenditure, while personal household expenditure accounts for the lion’s share at over 60. %. This exposes households to the risk of catastrophic spending, a major cause of impoverishment. Extend social health protection schemes under the NSSF to include dependents and under the HEF to cover vulnerable populations, such as people with disabled and the elderly would mitigate these risks and provide a safety net. In addition, ensuring that HEF beneficiaries understand their rights and know how to access them could promote higher uptake of HEF benefits.

Preparing for greater national funding of health programs will help maintain key coverage

As Cambodia’s economy grows, the country must prepare for a smooth transition to a greater reliance on domestic budgetary resources to support essential health programs. Cambodia reacted quickly to the changing fiscal environment and incorporated HIV and TB coverage for poor families, who depended heavily on external aid, into the government-funded HEF program.

Closing the gender gap will expand coverage

Cambodia ranks medium-low equality in the achievement of human development indicators between men and women. Women lag behind men in decision-making positions, but are more likely to be on the front lines as caregivers both in hospital and at home, putting them at greater risk of contracting the virus. Closing the gender gap will help improve the health and well-being of its entire population. Thus, planning and policies are needed to reduce the shortage and maldistribution of health professionals by gender and geographic location, especially in rural areas, to ensure equal access and health services. quality to all.

Cambodia faces a number of important policy choices that can strengthen its development strategy and accelerate its progress towards universal health coverage even as it faces the challenge of COVID-19. The right choices will help the country strengthen its health financing system and respond effectively to the pandemic.


Michael J. Birnbaum

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