Community participation has been identified as instrumental in facilitating access to health services. The Community-Managed Health Equity Fund (CMHEF) is a self-funded, sustainable, community-based social structure that operates at the catchment area of the local health center and engages the community in improving access to public healthcare services for poor and vulnerable people in Cambodia. Buddhism for Health (BfH) in partnership with the Health Policy Plus (HP+) project—funded by the U.S. Agency for International Development—initiated the expansion of CMHEF support to include PLHIV and TB patients. This expansion comes as many other civil society and non-governmental organizations (NGOs) reduced support to these target groups due to a shortfall in external funding.
In an effort to ensure long-term sustainability, BfH is strongly advocating that district and provincial government stakeholders support the integration of HIV and TB activities into Commune Investment Plans (CIP) across the four provinces of Battambang, Pailin, Kampong Cham and Prey Veng. BfH provided support to commune and Sangkat councilors, clerks and CMHEF leaders to ensure capacity in managing their respective 2020 CIP budget allocations, as well as plan for future cycles of CIP allocations, in line with government procedures. The capacity building support also focused on using modern communication technologies such as Telegram and Facebook for timely reporting and service promotion and outreach for rural communities. As a result of these efforts, the following achievements were realized during the project period of February 2019 to June 2020:
1. 136 CMHEFs have expanded their support to include HIV/AIDS and TB patients (Target: 122);
2. 143 Communes/Sangkats that were rated as average and fully-functioning integrated CMHEF activities in respective CIPs for 2020, with an estimated budget allocation of $100,653 (Target: 117);
3. 110 communes have disbursed the CIP funds to CMHEFs (Target:78), and
4. 8,310 PLHIV/TB patients, and 24,046 patients of other vulnerable populations have accessed healthcare services with the support of CMHEFs, which is a two-fold increase compared to the early of stage of the project (Target:2,517).
CMHEFs have also worked with the BfH foundation to identify 1,184 poor and vulnerable families suffering from the economic impact of COVID-19, and provided emergency support, including education on measures to mitigate the potential spread of the virus in their communities.
In May 2020 the Oxford University Press, Health Policy and Planning published an article entitled, Can social accountability improve access to free public health care for the poor? Analysis of three Health Equity fund configurations in Cambodia, 2015-17, and concluded that in the CMHEF coverage areas, poor people were using their entitlements to free health care more often and other vulnerable populations were accessing health care services with locally solicited resources.
The incorporation of HIV/AIDS and TB support in CMHEF activities, makes the role of CMHEFs more valuable to local authorities and stakeholders, and more beneficial for communities. Integration of CMHEFs in the CIPs, makes most CMHEFs function better and become more sustainable, and enables HIV/AIDS patients, TB patients and other vulnerable populations to have greater accessibility to healthcare services. Many of the CMHEFs outside of the four BfH-supported provinces continued to operate after BfH withdrew support, but will require technical support to be more effective. BfH staff and its network have played a crucial role in advocating with the concerned provincial governments for their support in advising commune councils, commune council clerks and CMHEF leaders on the planning process and disbursement of the CIP budget. It has become imperative that BfH seek other funding sources to support its network to engage and oversee the continued implementation of the CMHEFs in the four provinces that it currently supports, as well as strengthen CMHEFs in other provinces to enable reach to people living with HIV/AIDS, TB patients and people suffering from other chronic conditions, as well as engage other social assistance for vulnerable populations.
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