Meanwhile in Cambodia...

After a journey of 18 hours and a first introduction to the people of Racha (our local partner organization in Phnom Penh) on Tuesday we go to the field for the first time. Pearang, the province in which Racha works on the Community Based Health Insurance, is about a half hour drive from Phnom Penh.

Our first stop is the ‘referral hospital’ that provides secondary health care services in Cambodia. We talked to the district manager and the hospital manager about their experiences with CBHI. All communications need an interpreter, so the discussion is relatively slow. It also needs sensing how to best formulate questions.

Then the hospital manager shows us what health care is like in this hospital. That’s a bit different than in for example the Netherlands: there are not enough beds, so people share a bed or lie on improvised beds in the corridor. It all takes place in public; there is no privacy at all.  The hospital performs as one of the best and is doing very well with the recourses available. Yet it is a huge difference to what we are used to, both in terms of resources, as in ways of working. Infusions are temporarily attached to wooden sticks, beds do not have mattresses, and although staff all wear neatly white robes and masks, this doesn’t apply to the chickens and birds flying in and out.

After our visit to the referral hospital, we visited two health centres, the Cambodian equivalent of GPs. In the health centres births take place, awareness is raised among mothers and medicines and vaccinations are provided. If necessary, the health centre refers patients to the referral hospital.

Discussions with the managers of health services show that here the problem occurs: patients - especially those who have insurance – think they have the ‘right’ to be referred, even if they have a minor problem that can be treated easily in the health centre. But Cambodians believe much more in infusion than in medicine, and the health centre does not provide infusions. Doctors try very hard to provide information on good medication, but patients are still dissatisfied when they do not get an injection. They will tell negative stories in their community about the health centre and its doctors.

At noon we meet at a local office of Racha agents, who promote the insurance scheme in the communities. They are together to make this month’s insurance booklets. No comprehensive policy conditions or fee statements, but just a booklet with the names and pictures of insured family members, the payable premium and a space for the doctors to write down treatments. In the hospital they work with a kind of DBC system which is transparent and public (there is a price list on the wall).

After lunch, we go to a community meeting nearby, where two of the agents provide information about the community based health insurance. Many people have gathered in the local temple and the doctor of the health centre is available to answer questions. Because of the language we cannot understand the presentation, but you can see how people react; still a bit cautious, but positive. That gives hope for the future of CBHI!