The political economy of inclusive healthcare in Cambodia

The political economy of inclusive healthcare in Cambodia

Over the past 15 years, Cambodia has made significant strides in expanding effective access to free healthcare for poor people, thanks largely to ‘Health Equity Funds’ (HEFs), a multi-stakeholder health-financing mechanism. This paper argues that HEFs have been a relatively successful mechanism for expanding access to free healthcare to the poor. At the same time, their effectiveness in ensuring quality care, notwithstanding some success in this area, is constrained by prevailing levels of low pay, low resourcing, inadequate training, and burgeoning, unregulated private practice.

The document demonstrates that both the successes and limitation of HEFs can be explained by underlying characteristics of Cambodia’s political settlement. On the one hand, the settlement creates some pressures for performance legitimacy and some space for multi-stakeholder-supported islands of effectiveness. On the other, the dominant logic of patronage politics serves to hollow out the state, constraining the creation of a more genuinely effective, results-oriented health service.

The author concludes that while such islands may currently be the best solution available for poor people, the deeper problems are unlikely to be solved without a shift in the political settlement itself. In this respect, policy-makers need to monitor the situation closely, since it will be important not to overhaul too radically a reasonably effective health-financing model, before the underlying political conditions for a better replacement have emerged.

 

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