1. Health's Health Sector Support Pro-
ject, the German Federal Government
through the Deutsche Gesellschaft
fürInternationale Zusammenarbeit
(GIZ) GmbH and AusAid.
Founded in 2001, Action for Health
(AFH) is a local NGO dedicated to
serving the public interest and help-
ing people to have better health and
quality of life. AFH has extensive
experience of managing Health Eq-
uity Funds (HEFs) in Cambodia and
now manages HEFs in fifteen Opera-
tional Districts (ODs) across nine
provinces.
In addition to HEF implementation,
since 2007 AFH has been delivering
a maternal health voucher scheme in
Cheung Prey and Prey Chhor ODs,
Kampong Cham province and - since
January 2010 - a CBHI scheme in
Kampong Thom OD, Kampong
Thom province.
The CBHI scheme is only the sec-
ond scheme in the country operated
as an integrated HEF/CBHI, bringing
together two existing health financ-
ing schemes in Kampong Thom:
1. A HEF scheme managed by AFH
and funded by the Second Health
Sector Support Project (HSSP2). This
scheme started in 2005, covering
hospital costs only for identified
poor families in Kampong Thom OD
and Stong OD.
2. A CBHI scheme in Kampong
Thom OD, established in 2007 and
initially managed by GRET-SKY be-
fore its handover to AFH in 2010.
To support its work in the health
financing sector in Cambodia, AFH
has received considerable technical
and financial support from a wide
range of organisations including:
USAID (through University Research
Co, LLC (URC)), the Ministry of
Coverage, enrollment and premium
Kampong Thom OD covers admin-
istrative districts with 47 communes
and 320 villages. It has a population
of 304,289 people, of whom 106,804
a r e p r e - i d e n t i f i e d p o o r
(approximately 35.10% of the total
population).
The premium is collected every six
months or annually by a CBHI
'Access Facilitator' (AF) and, as of
June 2011, the coverage of CBHI
members is 10,149, which is equiva-
lent to 3.33% of the total OD popula-
tion. On the same date, a total of
79,325 people were the members of
Health Equity Fund which is equiva-
lent to 26,06 % of the total popula-
tion.
The current drop-out rate for CBHI
members is 3.83% by individual and
3.29% by family per month.
CBHI NETWORK FACTSHEET
ACTION FOR HEALTH
(AFH)
Background
Family members Annual premium
1 48,000 Riel/ family
2-4 90,000 Riel/ family
5-7 114,000 Riel/family
≥8 132,000 Riel/family
CBHI and HEF members, as of June 2011
Orientation on Social Health Protection Scheme s
in Kampong Thom
8947
295342
Insured members
Non‐insured population

2. AFH currently contracts with
21 health centers (HCs) and
one provincial hospital. Pay-
ments to providers are made
through capitation at the
health center level while fee
for services is used at the
provincial hospital.
AFH is working to promote
the quality of health services
in all its partner health facili-
ties with the support of GIZ.
In view of this, the following
methods are used monitor
and improve quality:
1. Patient exit surveys con-
ducted by AFH.
2. Client satisfaction surveys
conducted by Village Health
Support Groups.
3. Feedback mechanisms
between the community,
health providers and scheme
operators. For instance,
through regular meetings of
the steering committee (a
community gathering provid-
ing feedback to the scheme
operator).
4. Regular checking of con-
tact compliance among con-
tracted health providers.
5. Deployment of Member
Access Facilitators at health
centres and hospital to facili-
tate clients coming to use
the
services.
6. Close collaboration with
health authorities and health
care providers to improve
quality and patient satisfaction.
7. Conducting annual client
satisfaction surveys in collabo-
ration with GIZ.
8. The implementation of
performance-based provider
payment mechanisms in all
contacted health facilities.
9. Regular checks and moni-
toring by the AFH medical
auditor.
2. Radio programmes to
provide information about:
benefits; and common mis-
conceptions such as bad
luck when paying for insur-
ance.
3. Organisation of lucky
draws.
AFH uses a number of
strategies to market the
scheme, including:
1. Marketing at grassroots
level (village gatherings and
promotion; mobile videos;
door-to-door promotions;
peer-educations etc).
4. Distribution of information
and promotional materials.
Service providers and quality
Marketing and community engagement strategies
Benefit package and utilization
Page 2
The benefit package for both
CBHI and HEF members
consists of both medical and
non-medical benefits and
includes the following:
1. MPA services delivered by
contracted health centres.
2. CPA 3 services delivered
by the contracted Provincial
Hospital.
3. Transportation costs for
members referred from
health centres to the Provin-
cial Hospital (and from
home to health centres and
back for HEF clients).
4. A funeral grant of be-
tween 50,000 and 60,000
Riel (depending on length of
membership).
5. A Safe Motherhood Grant
of $10 for attending three
ANC checkups and deliver-
ing in a health facility, and
$20 for attending a PNC
check-up and after a full
cost of vaccinations.
* Chronic diseases are not
covered under the scheme.
HC and
RH
2010 2011(Jan-
April)
IPD 505 204
OPD 11,257 4,605
Utilization of CBHI members at
health center and hospital facilities
from 2010 to April 2011
Income from premium collection V.
technical expenses from January to March,
2011
ACTION FOR HEALTH
CBHI scheme promotion by AFH staff
An insured member receives consultation
A CBHI member recovers from an
operation at hospital
0
2000
4000
6000
8000
10000
12000
Income from premium
collection
Technical expenses
(medical and non‐
medical benefits, and
marketing costs)
5302
11317
Series1

3. sources.
Future plans include:
1. Strengthening the capacity
of Access Facilitators in all
target health facilities.
2. Strengthening the commu-
nication process between all
involved partners.
3. Creating motivational
strategies for members and
staff including:
A. Giving bonuses for mem-
bership. For instance, giving
one or two months member-
ship free of charge.
Challenges and lessons learned
by AFH during the initial phase
of operating the CBHI scheme
include:
1. Constraints on the ability
to increase premiums collec-
tions due to time constraints,
the wide geographic area
covered and the availability
of potential members
2. The relatively low level of
income from premium col-
lections when compared
with the high administration
costs.
3. The dependency of the
scheme on external funding
B. Giving staff a monthly
bonus for successful pre-
mium collection
C. Establishing a fair price
for motorbike maintenance
and gasoline for staff mem-
bers.
4. Strengthening marketing
strategies such as village
meetings, door-to-door
visits etc.
5. Increasing collaboration
and team building with the
HEF and the pagoda compo-
nent team (responsible for
reimbursing travel costs).
Case Study
Page 3ACTION FOR HEALTH
Challenges, lessons learned and future plans
To contact AFH
Contact person:
Dr. Nuth Mony
Position: Health Financing
Coordinator
Mobile no. (+855) 12 612
005/ 16 888 170
E - m a i l a d d r e s s :
afh@ezecome.com.kh
monynuth@yahoo.com
Mr. Lay Thon, 62 years old, and
his wife, Mrs. Ork Khorth, 58
years old, live in Team Chas Vil-
lage, Kampong Svay commune,
Kampong Svay district, Kampong
Tom province. Mr. Lay Thon’s
family is currently covered by the
CBHI scheme. Asked why he
decided to join the scheme, he
answered as follows:
I decided to join CBHI after my
family had experienced financial
constraints during the sickness of my
son.
The main income in our family
comes from farming. Usually, we
spend around 6 months in farming.
Other income comes from the profit
of running a small grocery store .
We have been working very hard.
However, we still struggle to cover
all the expenses in our family.
One day, our son got sick with an
abdominal pain. We took him to
Kampong Tom referral hospital, and
we were told that he had appendici-
tis. He then was hospitalized and
we were asked to pay 800,000
Riel (200 USD) for the user fee.
At that time, we did not have
enough money for the hospital fee,
therefore my wife deiced to borrow
some money from our neighbor.
During our stay at the hospital, we
were surprised to see other pa-
tients who needed the same opera-
tion as my son; however, their
families did not need to worry
about paying user fees since they
were covered by the CBHI scheme.
We saw them holding the CBHI
booklet and we also observed that
they were treated the same as us,
(non- CBHI members). Moreover,
we often saw CBHI project staff
come to visit the patient providing
consultation as well as encourage-
ment.
Seeing this situation, I recalled the
time when CBHI project staff came
to my house for promotion and
registration before my son got
sick. My family did not trust the
project and quality of services
provided at that time.
However, I have now witnessed
the importance of becoming a
CBHI member, and how health
staff are taking good care of both
CBHI members and non-members.
The following day, my son left the
hospital, and I quickly gave a call to
CBHI project staff to register with
the CBHI scheme.
Two months later after enrolling
with CBHI, my wife got sick. She
first came to the health center and
then was referred to Kampong
Thom hospital due to gastritis prob-
lems. She received treatment at the
hospital with good care from both
the medical doctor and the CBHI
project staff. This time was very
different compared to the past and
the financial problems that we used
to face. When my wife was hospital-
ized, the entire user fee was fully
covered by the CBHI project and we
were not asked to spend any addi-
tional money. In addition, we re-
ceived 15,000 Riel for transporta-
tion costs for travelling back home.
Mr. Lay Thon and his wife