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Better Health Services (BHS)


Funded by: US Agency for International Development (USAID)

Project Duration: 2009-2013

Countries: Cambodia

Geographic Focus:

Batneay Meanchey, Battambang, Kampong Cham, Kratie, Phnom Penh, Prey Veng, Pursat, Siem Reap



Partners:

Angkor Hospital for Children, Buddhism for Health, Family Health Development, Khan Meanchey Community Based Organization, New Hope for Cambodian Children, Pursat Community Based Organization, Ponleu Sokhapheap, Poor Family Development, the Angkor Chum Operational District Health Insurance Cooperative, and Volunteer Services Overseas (subcontractors)



Overview

URC worked with the Ministry of Health to increase demand for and equitable access to quality health services. The project built the capacity of public and private service delivery systems; expanded models for health financing; improved the quality and impact of maternal, neonatal and child health services; and strengthened the control of infectious diseases. BHS built on the work of the USAID Health Systems Strengthening in Cambodia Project, which URC managed from 2002 to 2008. This work is continuing under the Social Health Protection and Strengthening Facilities for Health projects, also managed by URC.

Key Activities
  • Scaled up health equity funds (HEFs) throughout the country and ensured their sustainability to increase the use of public health services by the poor; introduced community-based health insurance schemes to increase health service use by others and reward them for healthy behaviors
  • Strengthened the use of quality assurance tools and approaches; improved the health information system; developed or revise policies, guidelines, protocols, and trainings; coached health staff; provided equipment and supplies; and renovated facilities where needed to improve the quality of clinical care at public hospitals and health centers
  • Undertook special efforts in maternal and newborn health, where indicators still lag behind
  • Supported on-going and new health reform efforts aimed at increasing the transparency and accountability of health services through decentralized, contractual structures based on pay for performance; worked with the MOH and other stakeholders to develop comprehensive, decentralized reforms using results-based financing and giving more authority, autonomy and accountability to hospital and provincial managers
  • Collaborated with the MOH, the Cambodian Medical Council and the University of Health Sciences to develop a comprehensive approach to continuing medical education and licensing of medical staff (physicians, midwives, and nurses)
Achievements
  • BHS improved coverage of HEFs, health insurance funds that pay for health care and related services for the approximately 35% of Cambodian families that the Government has identified as poor. The project also assisted the MOH to support nationwide scale-up of HEFS and improving their administration.

Utilization rate of hospital services in URC-supported districts

 

  • BHS tested community-based health insurance (CBHI), which involved local government officials and established community-based organizations to manage combined HEF/CBHI programming; this model is called community-based health cooperatives. The project proposed different models for rural and urban areas due to their different contexts.
  • BHS led MOH efforts to rationalize the health information systems, formerly a mix of stand-alone databases with a Microsoft Access database at its center. BHS helped design and implement a web-based system using open-source programs and expanded the system to include more health information.
  • BHS strengthened supervision and introduced quality assurance at health facilities and promoted a patient-centric approach that enables essential case management, including referrals.
  • BHS’s maternal and newborn health team supported improvements in clinical care at health centers and hospitals by helping develop guidelines, protocols, training, and coaching in life-saving clinical interventions, including emergency obstetric and newborn care. BHS supported the national development of Safe Motherhood Protocols (SMPs) for health centers, adopted nationally in 2010, and led the same process for hospital SMPs in 2011. The project also led a collaborative effort with the National Maternal and Child Health Center, local partners, and UNICEF to prioritize the “key interventions” for reducing maternal and neonatal deaths, including the use of active management of the third stage of labor (AMTSL).

Correct Use of AMTSL in deliveries in 9 BHS-supported hospitals, March 2011

 

Expertise
Maternal, Newborn, and Child Health; HIV/AIDS; Tuberculosis; Reproductive Health and Family Planning; Food and Nutrition

Approaches
Quality Improvement; Health Systems Strengthening


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