1. Roadmap to Universal Coverage in CAMBODIA Bureau of Health Economics and Financing, DPHI, MoH Ros ChhunEang 4 th TMR Health Policy & Financing, NOSSAL 11 th October 2011

2. Outline 1- Cambodia at a glance 2- Roadmap to UC 3- Progress 4- Challenges

3. 3 1-Cambodia at a glance Population >14 million; >80% are rural farmers 27 % living under poverty line & almost 90% in rural area GDP per capita = US$853 OOP= 2/3

4. Existing HF mechanisms National budget Global free initiatives.... User fee (not cost recovery, not properly cost), with exemption policy Special Operating Agency (SOA+SDG) Fragmented HEF schemes by NGOs Voucher by NGOs CBHI by NGOs

5. 4- Roadmap to UC No Social health Insurance but there are Fragmented Social Health Protection schemes SHP MP development (draft) Vision: To provide effective and equitable access to affordable quality of health services for all Cambodians....?

6. Pluralistic approaches 1. Compulsory Social Health Insurance SHI for formal private sector under NSSF SHI for Civil servantsunder NSSF-C 2. Voluntary Insurance Community-based health insurance (CBHI) 3. Social Assistance (HEF)

7. Progress NSSF: – established – has implemented work injury for 2ys – Legal framework for SHI being developed NSSF: – established, – Legal framework for SHI being developed HEF: covers >80% of the poor - Piloting linkage HEF and CBHI - Preparing expansion plan - Studying on HEF institutional arrangement by NOSSAL CBHI: covers <1% (temporary circular by MEF) Plan to review health financing charter (user fee, benefit, payment mechanism) Plan to review Mater Plan of Social Health Protection

8. 8 – Widespread poverty; civil servants and employees are low paid => Low ability-to-pay. – The majority of the population (>80%) are self- employed/farmers – Limited understanding of the rationale of pre-payment schemes among the population => Low commitment & participation. – The health system constraints : quality of care – Local technical capacity for SHI development is limited – SHP/HEF institutional arrangement – Financial sustainability 5- Challenges