Evaluation of the impact of the voucher and accreditation approach on improving reproductive behaviors and status in Cambodia

Background: Cost of delivering reproductive health services to low-income populations will always require total or partial subsidization by government and/or development partners. Broadly termed “demand-side financing” or “output-based aid,” these strategies include a range of interventions that channel government or donor subsidies to the user rather than the service provider. Initial pilot assessments of reproductive health voucher programs suggest that they can increase access, reduce inequities, and enhance program efficiency and service quality. However, there is a paucity of evidence describing how these programs function in different settings for various reproductive health services. Methods/Design: Population Council, funded by the Bill and Melinda Gates Foundation, intends to generate evidence around the “voucher and accreditation” approaches to improving the reproductive health of low-income women in Cambodia. The study comprises four populations: facilities, providers, women of reproductive age using facilities, and women and men who have been pregnant and/or used family planning within the previous 12 months. The study will be carried out in a sample of 20 health facilities that are accredited to provide maternal and newborn health and family planning services to women holding vouchers from operational districts in three provinces: Kampong Thom, Kampot, and Prey Veng and a matched sample of non-accredited facilities in three other provinces. Health facility assessments will be conducted at baseline and endline to track temporal changes in quality of care, client out-of-pocket costs, and utilization. Facility inventories, structured observations, and client exit interviews will be used to collect comparable data across facilities. Health providers will also be interviewed and observed providing care. A population survey of about 3,000 respondents will also be conducted in areas where vouchers are distributed and similar non-voucher locations. Discussion: A quasi-experimental study will investigate the impact of the voucher approach on improving reproductive health behaviors, reproductive health status, and reducing inequities at the population level and assess effects on access, equity, and quality of care at the facility level. If the voucher scheme in Cambodia is found effective, it may help other countries adopt this approach for improving utilization and access to reproductive health and family planning services

Self-Reported Serious Illnesses in Rural Cambodia: A Cross-Sectional Survey

BACKGROUND: There is substantial evidence that ill-health is a major cause of impoverishment in developing countries. Major illnesses can have a serious economic impact on poor households through treatment costs and income loss. However, available methods for measuring the impact of ill-health on household welfare display several shortcomings and new methods are thus needed. To understand the potential complex impact of major illnesses on household livelihoods, a study on poverty and illness was conducted in rural Cambodia, as part of an international comparative research project. A cross-sectional survey was performed to identify households affected by major illness for further in-depth interviews. METHODOLOGY AND PRINCIPAL FINDINGS: 5,975 households in three rural health districts were randomly selected through a two-stage cluster sampling and interviewed. 27% of the households reported at least one member with a serious illness in the year preceding the survey and 15% of the household members reported suffering from at least one serious illness. The most reported conditions include common tropical infectious diseases, chronic diseases (notably hypertension and heart diseases) and road traffic accidents. Such conditions were particularly concentrated among the poor, children under five, women, and the elderly. Poor women often reported complications related to pregnancy and delivery as serious illnesses. CONCLUSIONS AND SIGNIFICANCE: Despite some methodological limitations, this study provides new information on the frequency of self-reported serious illnesses among the rural Cambodia's population, which serves as a basis for further in-depth investigation on 'major illnesses' and their economic consequences on poor households. This can in turn help policy makers to formulate appropriate interventions to protect the poor from the financial burden associated with ill-health. Our findings suggest that every year a considerable proportion of rural population in Cambodia, especially the poor and vulnerable, are affected by serious illnesses, both communicable and non-communicable diseases

Lieng Arak : a study of Khmer healing ritual performance

Includes bibliographical references (pages [97]-101).This thesis examines the lieng arak healing ritual, which plays an important role in Khmer traditional medical practice. It demonstrates that the lieng arak ritual is performed as a therapeutic technique, framed within the Khmer belief system, which is made up of Buddhism and Animism. I present various theoretical approaches which attempt to explain the religious complex of mainland Southeast Asia as a single ?total? field of religious system or as two separate systems. However, I propose that this religious complex can better be understand with a model I call ?polyphonic stratification.? Using both primary and secondary data sources, I describe the lieng arak ritual into two phases: first as a diagnostic stage and second as a paying of gratitude. The first stage involves ritual possession as a way to find the nature of illness. Once the cause has been identified, bargains with the spirit can be made to restore the disrupted relationship. The second is performed to re-invite the spirits to come for entertainment and to conduct the healing process. From the analysis of various symbols, I argue that these act as social symbols represented through the ritual performance. The healer, the audience or the community, and the patient him or herself, understand through these symbols that the illness is cured and the ill person is reintegrated into the normal state. Due to lack of ritual specialists, musical ensembles, changes in the conceptualization of spirit categories (which may be due to the physical environment), and the loosening of ties in social relationships, it is not possible to conduct lieng arak healing rituals in the United States. Thus, I argue that the efficacy of the lieng arak healing ritual is embedded in a complex web of social interaction and religious experience. It is the social representations and interpretations of social symbols that make the illness and healing experience meaningful.M.A. (Master of Arts

Cambodia HTA-Diabetes household survey - ATM RPC551

<p>Household survey exploring diagnostic and treatment pathways for people living with diabetes and hypertension in rural Cambodia.</p> <p> </p

Access to treatment for diabetes and hypertension in rural Cambodia: Performance of existing social health protection schemes

BackgroundNon-communicable diseases (NCD) pose challenges to Cambodia’s health system. Medicines for NCD are on the National Essential Medicines List but no clinical guidelines support their utilization. Two social health protection schemes aimed at the informal sector population exist (Health Equity Funds and Insurance) together with two disease-specific interventions (a Peer Educator Network and Chronic Diseases Clinics) targeted at NCD patients. This study examines performance of these various schemes in relation to NCD.MethodsCross-sectional household survey among 709 individuals self-reporting diabetes and/or hypertension in three geographical locations in rural Cambodia using a structured questionnaire investigating diagnostic and treatment pathways, health seeking behaviour, health expenditures, and financial coping mechanisms.ResultsTwo third of respondents with NCD were female and 55% did not belong to any scheme. The majority (59%) were diagnosed in the private sector and only 56% were on allopathic treatment that was mainly sought in the private sector (49%). Outpatient treatment cost was higher in the private sector and when using multiple providers of care. The majority were indebted, 11% due to health-related expenses. Contrary to social health protection schemes, disease-specific interventions offered better access to allopathic treatment and provided medicines in accordance with NEML.ConclusionThe benefit packages of existing social health protection schemes and services in the public health sector should be adjusted to cater for the needs of people living with NCD in rural Cambodia. Initiatives that offer active disease management strategies and promote patients and community participation appear more successful in increasing treatment adherence and decreasing the risk of financial hardship.<br/

Diagnostic and treatment pathways^§.

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Treatment costs in US Dollars by source of treatment for the last outpatient visit ^§.

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Cost of last outpatient consultation in US Dollars ^§.

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