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Strengthening institutional and organizational capacity for social health protection of the informal sector in lesser-developed countries: A study of policy barriers and opportunities in Cambodia

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  • Annear, Peter Leslie
  • Ahmed, Shakil
  • Ros, Chhun Eang
  • Ir, Por

Abstract

Reaching out to the poor and the informal sector is a major challenge for achieving universal coverage in lesser-developed countries. In Cambodia, extensive coverage by health equity funds for the poor has created the opportunity to consolidate various non-government health financing schemes under the government's proposed social health protection structure. This paper identifies the main policy and operational challenges to strengthening existing arrangements for the poor and the informal sector, and considers policy options to address these barriers. Conducted in conjunction with the Cambodian Ministry of Health in 2011–12, the study reviewed policy documents and collected qualitative data through 18 semi-structured key informant interviews with government, non-government and donor officials. Data were analysed using the Organizational Assessment for Improving and Strengthening Health Financing conceptual framework. We found that a significant shortfall related to institutional, organisational and health financing issues resulted in fragmentation and constrained the implementation of social health protection schemes, including health equity funds, community-based health insurance, vouchers and others. Key documents proposed the establishment of a national structure for the unification of the informal-sector schemes but left unresolved issues related to structure, institutional capacity and the third-party status of the national agency. This study adds to the evidence base on appropriate and effective institutional and organizational arrangements for social health protection in the informal sector in developing countries. Among the key lessons are: the need to expand the fiscal space for health care; a commitment to equity; specific measures to protect the poor; building national capacity for administration of universal coverage; and working within the specific national context.

Suggested Citation

  • Annear, Peter Leslie & Ahmed, Shakil & Ros, Chhun Eang & Ir, Por, 2013. "Strengthening institutional and organizational capacity for social health protection of the informal sector in lesser-developed countries: A study of policy barriers and opportunities in Cambodia," Social Science & Medicine, Elsevier, vol. 96(C), pages 223-231.
    • Handle: RePEc:eee:socmed:v:96:y:2013:i:c:p:223-231
    DOI: 10.1016/j.socscimed.2013.02.015
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    1. Poletti, Tim & Balabanova, Dina & Ghazaryan, Olga & Kocharyan, Hasmik & Hakobyan, Margarita & Arakelyan, Karen & Normand, Charles, 2007. "The desirability and feasibility of scaling up community health insurance in low-income settings--Lessons from Armenia," Social Science & Medicine, Elsevier, vol. 64(3), pages 509-520, February.
    2. Flores, Gabriela & Ir, Por & Men, Chean R. & O’Donnell, Owen & van Doorslaer, Eddy, 2013. "Financial protection of patients through compensation of providers: The impact of Health Equity Funds in Cambodia," Journal of Health Economics, Elsevier, vol. 32(6), pages 1180-1193.
    3. Ahmed, Shakil & Khan, M. Mahmud, 2011. "Is demand-side financing equity enhancing? Lessons from a maternal health voucher scheme in Bangladesh," Social Science & Medicine, Elsevier, vol. 72(10), pages 1704-1710, May.
    4. Mark Pauly & Fredric E. Blavin & Sudha Meghan, 2008. "Is There a Market for Voluntary Health Insurance in Developing Countries?," NBER Working Papers 14095, National Bureau of Economic Research, Inc.
    5. Annear, Peter Leslie & Bigdeli, Maryam & Jacobs, Bart, 2011. "A functional model for monitoring equity and effectiveness in purchasing health insurance premiums for the poor: Evidence from Cambodia and the Lao PDR," Health Policy, Elsevier, vol. 102(2), pages 295-303.
    6. Canagarajah, Sudharshan & Sethuraman, S.V., 2001. "Social protection and the informal sector in developing countries : challenges and opportunities," Social Protection Discussion Papers and Notes 24080, The World Bank.
    7. Li, Cheng & Yu, Xuan & Butler, James R.G. & Yiengprugsawan, Vasoontara & Yu, Min, 2011. "Moving towards universal health insurance in China: Performance, issues and lessons from Thailand," Social Science & Medicine, Elsevier, vol. 73(3), pages 359-366, August.
    8. Nguyen, Ha & Knowles, James, 2010. "Demand for voluntary health insurance in developing countries: The case of Vietnam's school-age children and adolescent student health insurance program," Social Science & Medicine, Elsevier, vol. 71(12), pages 2074-2082, December.
    9. Unknown, 2005. "Forward," 2005 Conference: Slovenia in the EU - Challenges for Agriculture, Food Science and Rural Affairs, November 10-11, 2005, Moravske Toplice, Slovenia 183804, Slovenian Association of Agricultural Economists (DAES).
    10. Mathauer, Inke & Carrin, Guy, 2011. "The role of institutional design and organizational practice for health financing performance and universal coverage," Health Policy, Elsevier, vol. 99(3), pages 183-192, March.
    11. Rebecca L. Thornton & Laurel E. Hatt & Erica M. Field & Mursaleena Islam & Freddy Solís Diaz & Martha Azucena González, 2010. "Social security health insurance for the informal sector in Nicaragua: a randomized evaluation," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 181-206, September.
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    2. Raj Panda & Pradeep Guin & Kumar Gaurav, 2020. "Governance in Public Purchasing of Tertiary-Level Health Care: Lessons From Madhya Pradesh, India," SAGE Open, , vol. 10(3), pages 21582440209, July.

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