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From Health and Social Protection: Meeting the needs of the poor, 9-10 October 2008, www.povill.com
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POVILL
CAMBODIAN WORKPACKAGE 5
Center for Advanced Study
Study objectives
• To study the institutional arrangement of Health Equity Fund in Cambodia, specifically focusing on the roles of international NGO and Local NGO in the development and implementation of HEF schemes.
Hypothesis
• This study hypothesizes that the effective implementation of HEF schemes depends on the kind of institutional arrangements that base on the effective collaboration and coordination between civil society and the government sectors.
Redressing health seeking behaviors:HEF as part of the solution?
HEF is a mechanism or fund that• is operated by an independent organisation• in the interest of poor people, • purchases health care for those poor people (from a
public health care provider), • and also pays for all the associated costs (from
non-medical providers).
• Independent = purchaser-provider split , the organisation does not belong to the Ministry of Health.
Functions of HEF
Types of HEF schemes
• Today, HEF schemes have expanded across many different area of Cambodia and the schemes have now been classified into four different groups in the National HEF framework, which resulted from the government has decided to allocated government budget to subsidize health services for the poor since November 2006.
• 4 Groups of Schemes
– Group 1 and 2 are subsidy schemes– Group 3 is scheme that is subcontracted by government to 3rd party– Group 4 is a scheme that is solely funded by donor and implemented by
the third party payer.
• But group 3 & 4 are considered to be the real HEF schemes
National HEF Institutional Arrangement
MoH Development Partners &
DonorsMoEF
DPHI & DBF
HSSC
PIU
NHFSC TWG-H
PHFSC PTWG-H
MG
ODO
3rd party HEFI
3rd partyHEFO DHFSC
OD Monitoring Team
HSP
recommendations
disbursement
reports
MoU
MoU
PHD / PHTAT
MoU
Sub MG
EXTERNAL & INTERNAL AUDITS
auditing
auditing
Contract
Report
Qu
arte
rly
disbursement
reports
Quarterly Report
Contract
Contract
ReportsDisbursement
Monitoring
discussions
Technicalstaff
Roles and functions Local NGOs International NGOs
Characteristic HEF Operator HEF Implementer
Budget negotiation Propose budget to INGOs Negotiate budget with donor and MoH
Targeting •Pre-id•Post-id
Payment •Operational cost•Targeting •Reimburse hospital fee
Benefit package for direct and indirect cost
Accountability or issue of corruption
•Account to INGOs•Account to the community
•Account to donors•Account to MoH
Monitoring performance •Monitor community network•Monitor hospitals
Monitoring local NGOs
Responsibility •Empowering and protecting the poor•Civil society building
•Creating and Capacity building of LNGO•Poverty reduction
Questions?
• How do the INGOs see their future role and the role of LNGOs?
• What is the view of different government officials about the
appropriate role of LNGOs? Are they useful and if so how?
• Whether Cambodia is moving towards some kind of partnership between LNGOs and government or whether the former institutions may eventually disappear when donors and INGOs leave?
• Whether the arrangements of HEFs provide a good institutional arrangements upon which any reformed system of health finance can build?
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