TY - JOUR
T1 - Can social accountability improve access to free public health care for the poor? Analysis of three Health Equity Fund configurations in Cambodia, 2015-17
AU - Jacobs, Bart
AU - Jacobs, Bart
AU - Sam Oeun, Sam
AU - Ir, Por
AU - Rifkin, Susan
AU - Van Damme, Wim
N1 - Funding Information:
When implementing the initiative of the Pagoda/Community-Managed Health Equity Funds, Buddhism for Health received support from the Royal Government of Cambodia, Enfants & Développement (E&D), Swiss Red Cross, People in Need, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) and the United States Agency for International Development (USAID) through University Research Co., LLC (URC) and Health Policy Plus (HP+). All statements are solely those of the authors and do not necessarily reflect the views of the funders, their employers or affiliated agencies. Sincere thanks to Nate Ives for his assistance with the statistics.
Publisher Copyright:
© 2020 The Author(s) 2020. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved.
PY - 2020/5/25
Y1 - 2020/5/25
N2 - Within the context of universal health coverage, community participation has been identified as instrumental to facilitate access to health services. Social accountability whereby citizens hold providers and policymakers accountable is one popular approach. This article describes one example, that of Community-Managed Health Equity Funds (CMHEFs), as an approach to community engagement in Cambodia to improve poor people's use of their entitlement to fee-free health care at public health facilities. The objectives of this article are to describe the size of its operations and its ability to enable poor people continued access to health care. Using data collected routinely, we compare the uptake of curative health services by eligible poor people under three configurations of Health Equity Funds (HEFs) during a 24-month period (July 2015-June 2017): Standard HEF that operated without community engagement, Mature CMHEFs established years before the study period and New CMHEFs initiated just before the study period. One year within the study, non-governmental organizations (NGOs) stopped operating the HEF nationwide and only the community-participation aspects of New CMHEF continued receiving technical assistance from an NGO. Using utilization figures for curative services by non-poor people for comparison, following the cessation of HEF management by the NGOs, outpatient consultation figures declined for all three configurations in comparison with the year before but only significantly for Standard HEF. The three HEF configurations experienced a highly statistically significant reduction in monthly inpatient admissions following halting of NGO management of HEFs. This study shows that enhancing access to free health care through social accountability is optimized at health centres through engagement of a wide range of community representatives. Such effect at hospitals was only observed to a limited extent, suggesting the need for more engagement of hospital management authorities in social accountability mechanisms.
AB - Within the context of universal health coverage, community participation has been identified as instrumental to facilitate access to health services. Social accountability whereby citizens hold providers and policymakers accountable is one popular approach. This article describes one example, that of Community-Managed Health Equity Funds (CMHEFs), as an approach to community engagement in Cambodia to improve poor people's use of their entitlement to fee-free health care at public health facilities. The objectives of this article are to describe the size of its operations and its ability to enable poor people continued access to health care. Using data collected routinely, we compare the uptake of curative health services by eligible poor people under three configurations of Health Equity Funds (HEFs) during a 24-month period (July 2015-June 2017): Standard HEF that operated without community engagement, Mature CMHEFs established years before the study period and New CMHEFs initiated just before the study period. One year within the study, non-governmental organizations (NGOs) stopped operating the HEF nationwide and only the community-participation aspects of New CMHEF continued receiving technical assistance from an NGO. Using utilization figures for curative services by non-poor people for comparison, following the cessation of HEF management by the NGOs, outpatient consultation figures declined for all three configurations in comparison with the year before but only significantly for Standard HEF. The three HEF configurations experienced a highly statistically significant reduction in monthly inpatient admissions following halting of NGO management of HEFs. This study shows that enhancing access to free health care through social accountability is optimized at health centres through engagement of a wide range of community representatives. Such effect at hospitals was only observed to a limited extent, suggesting the need for more engagement of hospital management authorities in social accountability mechanisms.
KW - Health Equity Funds
KW - access
KW - community participation
KW - social accountability
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U2 - 10.1093/heapol/czaa019
DO - 10.1093/heapol/czaa019
M3 - Article
C2 - 32361731
AN - SCOPUS:85086497268
SN - 0268-1080
VL - 35
SP - 635
EP - 645
JO - Health policy and planning
JF - Health policy and planning
IS - 6
ER -