The Challenge
Cambodia has made significant progress in economic growth and improvement in key health indicators over the past two decades. However, within the health system, out-of-pocket expenditures remain high (60% of total health expenditures). Although the country has initiatives to provide financial protection to particular populations groups, Cambodia does not have a national system that provides universal health protection to the entire population. In March 2016, the Royal Government of Cambodia (RGC) committed to achieving universal health coverage (UHC) through its recently endorsed Social Health Protection Framework.
The National Social Protection Working Group — led by the Ministry of Economy and Finance (MoEF) and comprised of the Ministry of Health (MoH), Ministry of Labor and Vocational Training (MoLVT), Ministry of Social Affairs, Veterans and Youth Rehabilitation (MoSVY), and representatives from other government entities — was tasked with advancing the development of a social health protection strategy that would help Cambodia achieve its UHC goals. While many of the ministry representatives had direct experience in providing some social protection functions to the people of Cambodia, there was a need to build health financing knowledge within the Social Protection Working Group to develop a responsive strategy that can effectively be scaled-up in the years to come.
A comprehensive social health protection reform required multiple decisions to be made related to the core functions of health financing, such as revenue generation, risk pooling, and the purchasing of health services. For Cambodia to sustainably finance its ambitious SHP strategy, the MoEF needed to identify ways to generate new revenue and improve the efficiency of health spending. Furthermore, international experiences with UHC, particularly those of Cambodia’s neighbors, stood to provide multiple lessons for the various dimensions of a social health protection reform that Cambodia would need to consider.
Our Work
Through the USAID-funded Health Finance and Governance Project (HFG), and in collaboration with Abt Associates, R4D supported the National Social Protection Working Group and the MoEF in the development of their social health protection strategy.
As an initial step, R4D built the capacity of the social protection working group on key tenets of health financing, social health protection and health insurance. R4D also developed policy briefs to help guide the MoEF on key decisions related to the development of their social health protection strategy.
Expanding upon this work, the MoEF requested that R4D provide targeted guidance on the implementation of their social health protection strategy. A key component of R4D’s work was to identify new revenue sources and to provide evidence on how Cambodia could improve the efficiency of health spending. Accordingly, R4D conducted a fiscal space analysis to assess where and to what extent new resources could be generated for health in Cambodia.
Ultimately, R4D’s work supported Cambodia to structure its social health protection initiatives to achieve its goal of UHC in the long-term.
