The Project establishes an equity fund to provide financial support for the catastrophic health expenses of the poor and vulnerable populations. This is aimed to improve the access of the poor and vulnerable population to the health system through the provision of targeted, demand-side subsidies. This is also expected to create significant impact on reducing poverty, as catastrophic health events are a leading cause of impoverishment in Cambodia. The Project works with NGOs to identify the poor within defined geographic area. The Project is located in ten Health Operational Districts where the Health Sector Support Project is providing assistance in the management of the health system through contracted NGOs.
|Project Name||Health Care Financing for the Poor|
|Project Type / Modality of Assistance||Grant
|Source of Funding / Amount||
|Strategic Agendas||Inclusive economic growth
|Drivers of Change|
|Sector / Subsector||
Health / Health care finance
|Gender Equity and Mainstreaming||No gender elements|
|Description||The Project establishes an equity fund to provide financial support for the catastrophic health expenses of the poor and vulnerable populations. This is aimed to improve the access of the poor and vulnerable population to the health system through the provision of targeted, demand-side subsidies. This is also expected to create significant impact on reducing poverty, as catastrophic health events are a leading cause of impoverishment in Cambodia. The Project works with NGOs to identify the poor within defined geographic area. The Project is located in ten Health Operational Districts where the Health Sector Support Project is providing assistance in the management of the health system through contracted NGOs. The Project has five components: (a) establishment of an equity fund, (b) identification of the poor in the ten ODs, (c) support to the fund manager ( a national NGO) in policy dialog with stakeholders on the importance of demand subsidies and in the administration of the equity fund at the national level, (d) monitoring and poverty impact assessment, and (e) local capacity building and management.|
|Project Rationale and Linkage to Country/Regional Strategy||Linked with the priorities of the Millenium Development Goals, Cambodia's development strategies and ADB's country strategy for Cambodia. The Project aims to address two issues: (i) although Government subsidies have increased, the nonpoor capture a larger proportion of these subsidies; and (ii) high cost of a health care shock being one of the leading causes of poverty in Cambodia. International evidence clearly shows that without direct and targeted action, the poor will not fully benefit from developmen and will remain vulnerable to health shocks.|
|Description of Outcome|
|Progress Toward Outcome||
The Project has made an important contribution to the development and operation of health equity funds, to increase access to health services and to improve financial protection for the poor. While implementation has suffered considerable delays in the start-up, the Project has made significant progress in setting up the HEF operational system and in reaching HEF beneficiaries. The Project played a catalytic role in establishing HEFs as an effective social health protection mechanism and in developing a national strategy and policy framework for the implementation of HEF, such as the Strategic Framework for Equity Funds and National Equity Fund Implementation and Monitoring Framework.
ADB's support to the health sector has been highly valued by the MOH in terms of its contribution to the overall health system development and introduction of innovative approaches such as contracting and HEF.
|Description of Project Outputs|
|Status of Implementation Progress (Outputs, Activities, and Issues)||The Project suffered significant delay in the start up caused by the following reasons: (i) policy on health equity funds, including strategic and implementation framework, was under development and not finalized until later in the Project period; (ii) recruitment of HEF consultant, with the prerequisite knowledge and experience was seriously delayed due to lack of qualified HEF implementers; (iii) need to implement a single Implementation Framework regardless of source of funding from various donors, which required extensive consultation with health partners to ensure harmonized arrangements. All of these issues resulted to a shorter implementation period for the Project, i.e., from July 2008 to June 2010.|
|Summary of Environmental and Social Aspects|
|Stakeholder Communication, Participation, and Consultation|
|During Project Design|
|During Project Implementation||The Project established a local equity fund in each of the 10 covered ODs. The local equity funds involve the community directly in the design of the local operation and in strategic management. To ensure participation, a district-level committee is established to advise the equity fund at the local level. The committee has mixed representation, including users and providers. The equity funds work closely with hospital-level and OD-level committees where they exist. The community has actively involved in stipulating the poverty criteria in each OD and the Project seeks guidance from local sources to identify areas with particularly poor communities. At the central level, the national level fund manager has also dialogged with stakeholders. This includes the Government, NGOs, and development partners.|
|Consulting Services||An independent organization will be contracted to carry surveys and assessments of the progress of the project's activities. NGOs will be contracted to manage the equity funds (EF) at the local levels under the supervision of the fund manager. The regional equity fund manager will be responsible for overall EF management, operating policy, operating systems and plans, and will establish OD-level Beneficiary Identification Systems and OD-level Fund Control Systems. The EF Manager will manage and monitor OD-district level EF and linkages to other organizations at the national and international levels. The manager will work with the MOH's working group for health financing, which among other things includes members from the health economics and finance bureau of the MOH's Department of Planning and Health Information, and the MOH's Department of Budget and Finance.|
|Procurement||Only limited procurement is expected and the procurement of goods and services below $100,000 will follow ADB's direct purchase procedure. No procurement of civil works is envisaged.|
|Responsible ADB Officer||Emiko Masaki|
|Responsible ADB Department||Southeast Asia Department|
|Responsible ADB Division||Human and Social Development Division, SERD|
Ministry of Health
Dr. Char Meng Chuor, Project Coordinator
Ministry of Health, No. 11-153 Kampuchea Krom Street, Phnom Penh, Cambodia
|Concept Clearance||11 Mar 2002|
|Fact Finding||19 Aug 2002 to 02 Sep 2002|
|Approval||15 Nov 2004|
|Last Review Mission||-|
|PDS Creation Date||01 Dec 2006|
|Last PDS Update||24 May 2011|
|Approval||Signing Date||Effectivity Date||Closing|
|15 Nov 2004||03 Feb 2005||03 Feb 2005||31 Dec 2008||30 Jun 2010||27 May 2011|
|Financing Plan||Grant Utilization|
|Total (Amount in US$ million)||Date||ADB||Others||Net Percentage|
|Project Cost||1.85||Cumulative Contract Awards|
|ADB||0.00||15 Nov 2004||0.00||1.21||65%|
|Cofinancing||1.85||15 Nov 2004||0.00||1.21||65%|
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