Community-based Health Insurance Program Expands in Siem Reap
Often a buffalo is the major asset of a family that is used for plowing the rice fields and can be rented out to other farmers for use. When a family member falls sick, often this is the only resource that can be sold to pay for medical expenses, plunging the family into financial ruin. The community-based health insurance program that CHC is pioneering in Siem Reap is working to ensure people access timely health care and to protect them from financial ruin during family illness. -- A former TB patient who is a rice farmer in Svay Rieng Province.

From the founding of the Cambodia Health Committee (CHC) it was recognized that poverty and rural debt were closely linked to tuberculosis and other diseases. In response, CHC undertook a pioneering and extremely successful village banking initiative in 1995 to support TB patients and their families and to partner microfinance with TB cure and adherence. Using a structure based on the Grameen Bank model, CHC provided loans for small income-generating projects in Svay Rieng and Kampot provinces linked to its community-based TB programs.

Profits from the village banking program were then used to fund village health agents who identified TB patients and delivered basic health information, including messages on AIDS prevention, across the countryside. The village banking program reached more than 13,000 people across seven provinces in Cambodia, achieving very high payback rates among TB patients participating in the program with 100% adherence to TB medicines.

Expanding a Successful Model

The program grew so large and successful that it was spun into an independent microfinance institution in 2006. This experience in a sense provided the launch pad for CHC’s latest initiative – an expansive community-based health insurance program, a plan that is currently serving 28,000 across Siem Reap province. The program is based on the proven CHC approach of striking at the root causes of TB and AIDS, namely malnutrition and poverty. Indeed, underscoring the great need that this program addressed, more than 500 families took advantage of the program during its first month of existence in June 2011.

“Our goal is to provide affordable health insurance coverage to as many families in need as we can,” says Dr. Sok Thim, CHC’s Executive Director. “A number of surveys and studies have shown that health expenses are the major cause of rural debt in the developing world – crippling debt that vulnerable families would have little hope of ever climbing out of.”

A typical scenario that can strike at a family of rice farmers occurs when a child falls ill resulting in financial ruin for this family barely making a living.

“The family would sell whatever assets they might have to pay for the child’s treatment, a water buffalo for example, which would likely be their only asset that enable them to successfully farm to pay for the child’s care,” explains Dr. Anne Goldfeld, President and Co-founder, CHC/Global Health Committee, “this then plunging the family into crushing poverty.”

As of July 2012, the CHC community-based health insurance program has been implemented in eight of 22 health centers in Siem Reap province, with coverage to all 22 centers planned by the end of this year. The program entitles members to health care coverage for all medical costs for services incurred at contracted health centers and referral hospitals. The program also covers non-medical costs such as emergency transportation and funeral expense should a member pass away.

“We have accomplished so much in one year,” Dr. Thim says. “In addition to expanding to all 22 health centers in Siem Reap, we plan to implement the program in other districts as well later this year.”