Ichd 2004 H Pol New Deal

New Deal in Cambodia by MSF-Cambodia Wim Van Damme Health Policy ICHD 2004

Overview of presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Introduction: 3 sectors in health system in Cambodia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Reputation of health services ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Health expenditure, 1998 100% $260M $26 4% $10M $1 Government 7% $20M $2 Private donors 14% $30M $3 Public donors 75% $200M $20 Out-of-pocket (%) total Per capita

Within this context ,[object Object],[object Object],[object Object],[object Object]

New Deal ,[object Object],[object Object],[object Object],[object Object],[object Object]

Basis: general dissatisfaction with ‘Old Deal’ ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Idea to start pilot experience ,[object Object],[object Object],[object Object],[object Object],[object Object]

90 / 110,000 District Hosp (80 beds) District office 4/11 Health centres Thmar Pouck 120 / 228,000 District Hosp (120 beds) District office 17 Health centres Sotnikum Staff / Population Facilities involved

Objectives of New Deal project(s) ,[object Object],[object Object],[object Object]

Human resource management as an entry point in the system ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Approach: New Deal with staff ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Clarify role of different entities in Operational District ,[object Object],[object Object],[object Object],[object Object],[object Object]

Funding of New Deal ,[object Object],[object Object],[object Object],[object Object]

Basic approach ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

How? Basics: ,[object Object],[object Object],[object Object],[object Object]

Main actors All staff involved Health facilities District team; district governor NGO District PHD & PHA (WHO/UNICEF) Prov governor & Prov treasury NGO Provincial MoH: DG Health & DG Admin/fin MoEF WHO / UNICEF NGO Central

Management principles ,[object Object],[object Object],[object Object]

Management mechanisms ,[object Object],[object Object],[object Object]

Special financial mechanisms ,[object Object],[object Object],[object Object],[object Object]

Management: two levels ,[object Object],[object Object],[object Object],[object Object]

Steering Committee: members ,[object Object],[object Object],[object Object],[object Object],[object Object]

P erformance - related pa y ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Part 2: Process & results ,[object Object],[object Object],[object Object],[object Object]

Key issues during negotiation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Progressive build-up of operational district

Sotnikum: Referrals from health centres to the hospital

Sotnikum hospital +65% C-sections +300% to +600% Technical exams (lab, X-ray, Ultrasound, &c) +21% Hospitalisations 2001 compared to 2000

Health centres ,[object Object],[object Object],[object Object],[object Object]

Perceived quality of care ,[object Object],[object Object],[object Object]

Hospital costs ,[object Object],[object Object],[object Object],[object Object]

Budget 2000 30%?? Government: cash 30% Govt: drugs (in kind) 20% MSF/UNICEF 20% Patients

Level of staff income ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Problems with financial management ,[object Object],[object Object],[object Object]

Results ,[object Object],[object Object],[object Object],[object Object],[object Object]

P erception of New Deal by MOH staff ,[object Object],[object Object],[object Object],[object Object],[object Object]

Part 3: Some questions – issues – lessons learnt … ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

New Deal can work in a rural district in Cambodia ,[object Object],[object Object],[object Object]

New Deal = labour intensive ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The New Deal is attractive, for whom? ,[object Object],[object Object],[object Object],[object Object]

Structural bottle-necks ,[object Object],[object Object],[object Object]

Conditions for sustainability (1) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Conditions for sustainability (2) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Strong interest from national level: why? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

But: problems with government budget… ,[object Object],[object Object],[object Object],[object Object]

Issues pending … ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Limitations ,[object Object],[object Object],[object Object],[object Object],[object Object]

Lessons learned ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Lessons not learned (yet?) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ichd 2004 H Pol New Deal

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Ichd 2004 H Pol New Deal