A sustainability assessment of a health equity fund initiative in Cambodia

All but one of the health equity funds (HEFs) currently operating in Cambodia, introduced to address the adverse effects of low user fee exemption rates, rely heavily on external funding and have high administrative overheads. This article reports on a study of one type of HEF, based in Kirivong Ope...

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Bibliographic Details
Published in:The International journal of health planning and management 2007-07, Vol.22 (3), p.183-203
Main Authors: Jacobs, Bart, Price, Neil, Sam, Sam Oeun
Format: Article
Language:English
Subjects:
Cambodia
Cost
faith-based organizations
Finance
Financial sustainability
Financing
Funding
Health
Health administration
Health care expenditures
health equity funds
Health policy
Health Services - economics
Health Services - utilization
Health Services Accessibility
Humans
Overhead costs
Program Evaluation
Public health
Public Health - economics
sustainability
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Summary:All but one of the health equity funds (HEFs) currently operating in Cambodia, introduced to address the adverse effects of low user fee exemption rates, rely heavily on external funding and have high administrative overheads. This article reports on a study of one type of HEF, based in Kirivong Operational Health District (KOD) and operated through local pagoda structures, which demonstrates minimal reliance on external funding and low administrative overheads. We utilize an adapted sustainability assessment framework to assess the ability of pagoda structures to enable financial access for the poorest to public sector health services. We further analyse the strengths and limitations of the pagoda‐managed equity fund initiative, with a view to assessing not only its sustainability but its potential for replication in other settings. Our study shows that, against key sustainability indicators (health service utilization and health outcomes; management capacity and financial viability; community mobilization and government support), the pagoda‐managed equity fund initiative scores well. However, it is evident that some external financial support is needed to allow the HEFs to function effectively. We conclude with recommendations for replicating the initiative, which include working innovatively with indigenous grassroots organizations to enhance community HEF ownership and to keep administrative overheads low. Copyright © 2007 John Wiley & Sons, Ltd.
ISSN:0749-6753
1099-1751
DOI:10.1002/hpm.890