Exploring the determinants of distress health financing in Cambodia

Borrowing is a common coping strategy for households to meet healthcare costs in countries where social health protection is limited or non-existent. Borrowing with interest, hereinafter termed distress health financing or distress financing, can push households into heavy indebtedness and exacerbate the financial consequences of healthcare costs. We investigated distress health financing practices and associated factors among Cambodian households, using primary data from a nationally representative household survey of 5000 households. Multivariate logistic regression was used to determine factors associated with distress health financing. Results showed that 28.1% of households consuming healthcare borrowed to pay for that healthcare with 55% of these subjected to distress financing. The median loan was US$125 (US$200 for loans with interest and US$75 for loans without interest). Approximately 50.6% of healthcare-related loans were to pay for the costs of outpatient care in the past month, 45.8% for inpatient care and 3.6% for preventive care in the past 12 months. While the average period to pay off the loan was 8 months, 78% of households were still indebted from loans taken over 12 months before the survey. Distress financing is strongly associated with household poverty - the poorer the household the more likely it is to borrow, fall into debt and unable to pay off the debt - even for members of the health equity funds, a national scheme designed to improve financial access to health services for the poor. Other determinants of distress financing were household size, use of inpatient care and outpatient consultations with private providers or with both private and public providers. In order to ensure effective financial risk protection, Cambodia should establish a more comprehensive and effective social health protection scheme that provides maximum population coverage and prioritizes services for populations at risk of distress financing, especially poorer and larger households

Realisation d'une encre conductrive chargee au cuivre, serigraphiable et durcissable par rayonnement Ultra-Violet

CNRS AR 11283 / INIST-CNRS - Institut de l'Information Scientifique et TechniqueSIGLEFRFranc

Process evaluation of the scale-up of integrated diabetes and hypertension care in Belgium, Cambodia and Slovenia (the SCUBY Project) : a study protocol

INTRODUCTION: Integrated care interventions for type 2 diabetes (T2D) and hypertension (HT) are effective, yet challenges exist with regard to their implementation and scale-up. The ‘SCale-Up diaBetes and hYpertension care’ (SCUBY) Project aims to facilitate the scale-up of integrated care for T2D and HT through the co-creation and implementation of contextualised scale-up roadmaps in Belgium, Cambodia and Slovenia. We hereby describe the plan for the process and scale-up evaluation of the SCUBY Project. The specific goals of the process and scale-up evaluation are to (1) analyse how, and to what extent, the roadmap has been implemented, (2) assess how the differing contexts can influence the implementation process of the scale-up strategies and (3) assess the progress of the scale-up. METHODS AND ANALYSIS: A comprehensive framework was developed to include process and scale-up evaluation embedded in implementation science theory. Key implementation outcomes include acceptability, feasibility, relevance, adaptation, adoption and cost of roadmap activities. A diverse range of predominantly qualitative tools—including a policy dialogue reporting form, a stakeholder follow-up interview and survey, project diaries and policy mapping—were developed to assess how stakeholders perceive the scale-up implementation process and adaptations to the roadmap. The role of context is considered relevant, and barriers and facilitators to scale-up will be continuously assessed. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Institutional Review Board (ref. 1323/19) at the Institute of Tropical Medicine (Antwerp, Belgium). The SCUBY Project presents a comprehensive framework to guide the process and scale-up evaluation of complex interventions in different health systems. We describe how implementation outcomes, mechanisms of impact and scale-up outcomes can be a basis to monitor adaptations through a co-creation process and to guide other scale-up interventions making use of knowledge translation and co-creation activities

Knowledge, attitudes and practices of Cambodian swine producers in relation to porcine reproductive and respiratory syndrome (PRRS)

AbstractPorcine reproductive and respiratory syndrome (PRRS) was first detected in Cambodia in 2010. The disease was responsible for high morbidity and high mortality in adult pigs and the outbreak had a costly impact on those farmers affected. The aim of this study was to generate a better understanding of Cambodian swine producers’ behaviour, in relation to PRRS and its control, in areas that have previously been affected by the disease. A survey of the knowledge, attitude and practices (KAPs) of pig owners with regard to PRRS was conducted in semi-commercial and backyard farms in Takeo province in southeast Cambodia. The survey was designed to assess knowledge of PRRS disease and its transmission, farmers’ attitudes and practices related to preventive and control measures, knowledge on vaccination and perception towards local veterinary authority activities. Descriptive statistics were used to summarise qualitative data, while multivariate regression analyses were used to assess the association between selected outcomes and a number of hypothetical predictors. When presented with clinical signs typical of PRRS, most farmers identified an infectious disease as the most likely explanation for the listed clinical conditions. Farmers were also confident in recognising direct contact between pigs as one of the main ways of disease transmission; however, other viral transmission patterns typical of PRRS were mostly unknown or ignored. In general, male farmers and farmers with a higher level of education were more likely to have a better knowledge of transmission routes between pigs. In terms of attitude towards control measures, vaccination and disinfection were perceived as the most effective control practices. Farmers with a better knowledge of vaccine protocols were more likely to find vaccination effective. Village animal health workers (VAHWs) were generally in contact more with backyard farmers, while semi-commercial farmers were more prone to treat pigs themselves, raising the issue of easy and uncontrolled access to medication and vaccination. In general, farmers had a positive attitude towards local veterinarians, and lack of contact between farmers and the veterinary authority was associated more with logistic constraints than with farmers’ mistrust towards the authority