Overview

The Cambodian public health service delivery system is statist in design. The MoH operates 10 National Hospitals, 79 Referral hospitals, 992 health centers, and 113 Health Posts. In theory, these facilities respond primarily to inputs and instructions from MoH departments and national programs and have very little formal input from other government bodies or community structures. The MoH has developed an outreach program through the use of Village Health Support Groups (VHSG) but these serve more as a way of informing the population about services of the MoH than to influence the operation of the health facilities or inform the MoH about what the population might think of the health services. At the same time Cambodia is actively decentralizing and de-concentrating many government functions to the subnational Commune and District levels. There have been three rounds of local elections for Commune Councils and their budgets (which include resources for health related activities) from Phnom Penh have increased significantly over the past several years. The District Councils will also receive their first discretionary budgets in 2012. Working from the principles that Cambodia is moving towards decentralization and that public service delivery will be stronger with inputs from the MOH, local elected authorities, and community representatives, BHS has been working to develop a model for increased levels of local community participation in health service delivery. The CBHC model creates a governance structure which provides formal roles to MOH officials and Provincial/District/Commune authorities to directly manage social health protection systems in their local area. This model is designed to increase the flexibility in the application of HEF, CBHI, and CCT schemes to local needs and increase responsiveness of public health services to the people they serve.

Background

The Better Health Services (BHS) is a USAID-funded health systems strengthening project in Cambodia that began in January 2009 and runs through December 2013. Implemented by the University Research Co., LLC (URC), the project was preceded by the USAID Health Systems Strengthening in Cambodia project, also implemented by URC. The BHS project’s goals dovetail with the mission of the Ministry of Health as stated in the Cambodian Health Strategic Plan 2008-2015 (HSP2) “to provide stewardship for the entire health sector and to ensure a supportive environment for increased demand and equitable access to quality health services in order that all the peoples of Cambodia are able to achieve the highest level of health and well-being.” BHS works to this common end through a variety of efforts that aim to improve the quality of care delivered by public health services, increase the utilization of and demand for such services while maintaining the MOH’s pro-poor goals, and support on-going and new health reform efforts aimed at increasing the transparency and accountability of health services through decentralized, contractual structures.

Project Summary

BHS’ overall aim is to improve the quality of care and use of public health facilities in Cambodia, with a particular emphasis on increasing equity of access for the poor. The BHS project focuses on: Health Financing and Community-Based Health Health Informatics Hospital Improvement Maternal and Newborn Health HIV/AIDS Monitoring and Evaluation Behavior Change Communications Support to RGoC-led health reform efforts.