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HEALTH EQUITY FUND in Sotnikum & Thmar Pouk operational districts. Dr. Ir Por, Deputy Medical Coordinator MSF H/B & Mr Sour Iyong, Director of CAAFW Presented at Medicam on 06 September 2002. NEW DEAL. ‘Better income for staff in exchange for better service to the population’ - PowerPoint PPT Presentation
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HEALTH EQUITY FUND in Sotnikum & Thmar Pouk
operational districts
Dr. Ir Por, Deputy Medical Coordinator MSF H/B
& Mr Sour Iyong, Director of CAAFW
Presented at Medicam
on 06 September 2002
2
NEW DEAL
‘Better income for staff in exchange for better service to the population’
• Staff receives a living wage income• The hospital is functioning:
– 24 hours services– No extra-payment
3
Why Equity Fund?• Poor patients cannot access to the hospital
care because of financial constraints
=> Better service to the population??
• The hospital to exempt and support poor patients
=> Better income for staff??
Need for a separate fund = ‘Equity Fund’
4
Objective
Develop a sustainable solution to improve financial access to hospital
care for the poor
5
Why managed by local NGO?• The hospital?
– No time– Conflict of interests– Not enough social supporting skills
• MSF/UNICEF?– Expensive– Not sustainable
• Need for a local social NGO– Good ability to identify the poor– Not expensive– Replaceable
6
Constraints to access to adequate basic health care
• Demand-side constraints:– Cost including use fees, transport and food– Distance & geographical access– Information– Health beliefs– Intra-household constraints
• Supply-side constraint is limitation of quantity and quality of services provided.
7
Contractual arrangement• In Thmar Pouk, MSF contracted CAAFW to
implement an Equity Fund in May 2000, and• In Sotnikum, MSF/UNICEF contracted CFDS to
implement an Equity Fund in Sotnikum in September 2000 because these NGOs– are well structured local NGOs– have good social welfare background of the catchment's area– have good reputation – interested in working with the poor (in line with their mission
statement)
• The contract was made on ‘quarterly basis’ in the beginning and later on ‘every six months’
8
Monitoring & evaluation
• MSF field staff working in the hospital who can see and hear what is going on around the Equity Fund
• Regular meetings between MSF/UNICEF and CFDS and CAAFW managers.
• Report regularly to partners involved (e.g. in the Steering Committee meetings).
• Casual in-depth analysis and evaluation
9
How to reach poor patients• Phase I: passive phase
– NGO staff interviews patients referred by the hospital staff and provide support accordingly.
• Phase II: active phase– regularly visit hospital wards.– active promotion and follow-ups through outreach to health
centres and home visits.
• Phase III: pilot extension (only in Sotnikum)– Identification at village level ‘Health Cards’ & ‘Vouchers’.– Recruit a local social worker to finally provide support at
health centre level.
10
Support of CFDS to the beneficiaries
Once identified as poor, the patient and his/her family receive support from CFDS for:
• Hospital admission fees and/or,• Transport cost and/or,• Additional food and basic items
…according to need
11
Support of CAAFW to the beneficiaries
• Transportation, including ambulance• Admission fees• Cost of medical imaging (X-Ray, ultrasound)• Basic materials• Supplementary food• Cost of cremation• Financial support transfers to provincial hospital
12
CFDS’ selection criteria1. Physically and mentally disabled persons2. Chronic disease in household3. No land, rice field, productive assets4. Not able to pay for schooling of children; they have to
work5. Many dependents (small children, elderly)6. Victim of alcoholism, violence, family conflict etc7. Widow with many dependents8. Lack of food security; have to borrow to buy food9. No outside support: apply to all
13
CAAFW’s Selection criteria• Jobless• No guaranteed income (daily labor)• No relatives or caretaker• No land and/or farming equipment• Many dependents, lack of food• Poor living conditions (shelter)• No starting capital or other assets• No skills• (Chronic) disease• Family crisis, etc.
14
Number of patients assisted by CFDSSep 2000 – July 2002
0
50
100
150
200
250
300
350
400
Num
ber o
f in-
patie
nts
0%
5%
10%
15%
20%
25%
30%
35%
40%
Per
cent
age
IPD # patients assisted %
15
Number of patients assisted by CAAFWMay 2000 – July 2002
0
100
200
300
400
500
600
700
May Ju
n
Jul
Aug Sep Oct
Nov
Dec Ja
n
Feb
Mar
Apr
May Ju
n
Jul
Aug Sep Oct
Nov
Dec Ja
n
Feb
Mar
Apr
May Ju
n
Jul
2000 2001 2002
Num
ber
16
Percentage of admissions supported by CAAFW
May 2000 – July 2000
0
10
20
30
40
50
60
May Ju
n
Jul
Aug Sep Oct
Nov
Dec Ja
n
Feb
Mar
Apr
May Ju
n
Jul
Aug Sep Oct
Nov
Dec Ja
n
Feb
Mar
Apr
May Ju
n
Jul
2000 2001 2002
Per
cent
age
17
Distribution of direct project costs in Sotnikum
Sep 2000 – July 2002
Admission fees 74%
Transport costs19%
Patient subsidies
7%
18
Distribution direct project costs in TP May 2000 – December 2001
Admission fees27%
Transportation
20%
Food10%
Basic materials/oth
ers43%
19
Cost of the Health Equity Fund in TPMay 2000 – July 2002
Per diem staff 1600Administration costs 560Direct project costs 9201Total 11361
20
Breakdown of total expenditure of CAAFW
May 2000 – July 2002
Direct project costs81%
Per diem staff14%
Administration costs5%
21
Average total cost per admission supported by Health Equity Fund in Sotnikum
$-
$2
$4
$6
$8
$10
$12
$14
$16
22
Average total cost per admission supported by Health Equity Fund in TP
0
2
4
6
8
10
12
14
16
18
May Ju
nJu
lA
ug Sep Oct
Nov
Dec Ja
nF
ebM
arA
prM
ay Jun
Jul
Aug Sep Oct
Nov
Dec Ja
nF
ebM
arA
prM
ay Jun
Jul
Aug Sep Oct
Nov
Dec
Tot
al
2000 2001 2002
U$
23
Strengths• Supported patients are really poor• Promote utilisation of hospital services• Potential to prevent irrational expenditure in private
sector & unnecessary indebtedness & loss of assets => poverty reduction
• Good solution for both consumers & providers:– poor patients get support
– hospital staff does not loose income
=>no longer discriminate poor patients, nor deny their access or treatment.
24
Weaknesses
• Not all poor patients arrived at the hospital get supported.
• Some potential poor patients are not reached because of other socio-economic constraints.
• Limited awareness of & uncertainty of access to Equity Fund in the community.
• Sustainability is still questioned
25
Conclusion & recommendations• Equity Fund is a very cost-effective way to improve
financial access to hospital care & a very good investment on poverty reduction.
• Equity Fund is only effective if it is part of a much broader package of reforms: hospital provides adequate health care and no un-official payment
• To address the remaining constraints =>– bring identification of & support to the poor closer to the
community (health cards, vouchers, support in HCs)– micro-credit or health insurance should be explored.
• For funding:– Short-term => NGO or private charitable donor– Medium-term => institutional donor– Long-term => government (social affairs)