Better Health Services (BHS)

The Challenge

Provide support to increase demand and equitable access to quality health services, build capacity of public and private service delivery systems, and improve the quality and impact of MNCH services in Cambodia (Banteay Meanchey, Battambang, Kampong Cham, Kratie, Phnom Penh, Prey Veng, Pursat, and Siem Reap).

Overview and Objectives

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. The work continued under the Social Health Protection and Strengthening Facilities for Health project. Objectives:

• Scale up health equity funds (HEFs) throughout the country and ensure their sustainability to increase the use of public health services by the poor; introduce community-based health insurance schemes to increase health service use by others and reward them for healthy behaviors
• Strengthen the use of quality assurance tools and approaches; improve the health information system; develop or revise policies, guidelines, protocols, and trainings; coach health staff; provide equipment and supplies; and renovate facilities where needed to improve the quality of clinical care at public hospitals and health centers
• Undertake special efforts in maternal and newborn health, where indicators still lag behind
• Support ongoing and new health reform efforts aimed at increasing the transparency and accountability of health services through decentralized, contractual structures based on pay for performance; work 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
• Collaborate 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.
• 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).