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Community Based Health Cooperative

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There are supporting evidence showing that barriers to accessing public healthcare services in Cambodia can lead poor and marginally poor households into deep poverty and worse health conditions. Reports by different media show various types of obstacles for access to healthcare in Cambodia. These include poor roads and long distance to health facilities in many areas, high transportation costs, inability to pay health care expenditures, lack of knowledge and information about services availability. Personal beliefs, trust, perceptions among communities towards the quality of healthcare in public healthcare facilities and socio-cultural practices of health and treatment are also contributing factors (Annear et al 2006; Hardman et al 2004). Among these, lack of financial means to pay for healthcare costs has been considered a major obstacle to the poorest people who want to access care and treatment. However, most of their health-related expenditure is made up of out-of-pocket payments. Limited access to quality public health service leads poor patients to cope with their illness in various ways: reducing household consumption, borrowing money from others, selling land and other assets to pay for healthcare costs or forgoing treatment (Meessen et al 2003).

Cambodian government has developed health financing strategies to improve healthcare access among the poor and poorest. Studies have shown that user fees at public health facilities have become one of the barriers to accessing healthcare for the poorest. But, the failure of healthcare market is common in Cambodia even though there are many health financing schemes which have been introduced such as User Fees (UF), contracting, Health Equity Fund (HEF), Community Based Health Insurance (CBHI), and lastly Service Delivery Grant (SDG) via existing government structure called Special Operation Agency (SOA).

Alternative to this existing practice, our proposal is to develop and implement a programme on social health insurance that is integrated with microfinance to help the poor and marginal poor in need to access to quality health services. We consider that achieving this overarching goal--the goal of changing people's attitude to practice health insurance in a more sustainable way.

To be sustainable, we aim to pilot a programme by establishing and managing an integrated (1) social health insurance with (2) microfinance for household business development and the delivery of optimal health services to the target population in a commune, to be selected and called Commune A. This can be done through local authorities working closely and forging a close relationship with health service providers, health operational district, health centers, and referral hospital in order to generate income, attract health insurance participation, and increase health service utilisation which finally aims to improve health status of the population. Households will be provided



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