56616 Volume 8, Number 1/2 January - February 2010 Health Equity Fund Brings Medical Care to the Poor R ith Roeung, 51-year-old mother of sea and vomiting. But Roeung manages uity Fund, I wouldn't be able to bring him eight, sits beside her sick husband, a smile for the visiting World Bank team: here. I hope he gets better soon." Tuy Muy, 52, in Battambang Pro- "I am happy because I can bring my hus- Yav Neang, a villager from Bour in vincial Referral Hospital. He is lying on a band here for treatment," she says. "If I Phnom Prek district, 60 km from bed with a stomach problem, battling nau- didn't get support from the Health Eq- Battambang provincial town, has brought her eight-month son to the hospital to get treatment for his serious lung disease. Her family is very poor and the local health center couldn't treat her son, but Neang was told to bring him to Battambang Hos- pital where she would get free treatment and free meals, and have her transport paid for. After two days' treatment her son has improved. "Now my son is getting better and I don't feel so worried," she says, smiling at the boy, who is connected to an intravenous drip. "While I was at home I was so afraid for his life." Neang's family has no land. She and her husband work as day-laborers on lo- cal farms doing tasks such as harvesting corn and rice. A day's work brings in around 10,000 riel (US$2.50) which sup- Rith Roeung and her husband Tuy Muy at Battambang Referral Hospital. see HEALTH page 5 Good Health Comes to Chakrey With a Smile O ne-legged Nurse Pan Hean is a proud man. So are all the staff of Chakrey Health Center, which Pan Hean heads. The new health center opened three years ago with 10 patients a day com- ing for consultation. Now 30 patients come every day. Sitting in his consultation room, Hean smiles and says: "This health center is just the right place for staff to provide good-quality health care, and more and more patients are attracted to it. For in- stance, we have private consulting rooms where we assure patient confidentiality. It's a huge improvement over our old health post." Chakrey is one of 18 health centers that was constructed and a further six reno- vated through the Health Sector Support Project (HSSP), financed by the World Bank. Nurse Pan Hean: "This health center is just the right place for staff to provide see GOOD HEALTH page 7 good-quality health care, and more and more patients are attracted to it." 2 The World Bank Newsletter January-February 2010 Improvements in Health Services for the Poor Challenge: Cambodia's health system has structed and 6 health improved over the past decade resulting centers renovated. in significant reduction of child mortality, reduction of mortality and morbidity due HSSP contributed sig- to communicable diseases such as HIV/ nificantly to the lower- AIDS, TB and malaria, vaccine prevent- ing of dengue out- able diseases, and improvement in fertil- breaks and reduction ity rate and life expectancy. Despite these of dengue case fatal- improvements, Cambodia still faces chal- ity rate, lowering TB lenges. There has been no improvement and malaria case mor- in maternal mortality (472 maternal deaths bidity and mortality, per 100,000 live births in 2005); the lack of strengthening the sanitation and access to clean water are Ministry of Health continuing problems; the level of malnu- (MOH) nutrition pro- trition is high (stunting at 37% among chil- gram and non commu- dren under 5); chronic non-communicable nicable diseases, and diseases and injuries from road traffic ac- improvement of health cidents are on the increase; and signifi- system as general. cant inequalities in health outcomes be- tween the rich and the poor, and urban Several major studies and rural. High level of out-of-pocket ex- have been undertaken penditure leads to problems of that provided new affordability in accessing services. In ad- baselines for health dition there are physical constraints to policy development: access for remote, and rural populations. General Population Census of Cambodia Approach: Supporting the Government's (2008), Anthropomet- Health Strategic Plan 2003-2007, the ric Survey (2008), Equity and Devel- World Bank is managing US$ 82 million World Bank's Health Sector Support opment Report (2007), Health Expen- grant project, of which US$ 30 million is Project (HSSP) is implemented jointly with diture Tracking Survey (2007), Pov- financed by IDA Credit (World Bank) and the Asian Development Bank, the UK's erty Assessment (2006), and a report US$ 52 million by the Multi-Donor Trust Department for International Develop- on the 2005 Demographic and Health Fund (DFID and AusAID). Together with ment (DFID) and the United Nations Popu- Survey. other development partners, the World lation Fund (UNFPA). The project aims Bank provided the Royal Government of to improve the health of people, particu- An ongoing study, the Cambodia Cambodia (RGC) with financial and tech- larly poor women and children ­ predomi- Health Sector 2015, is looking at both nical assistance in designing Cambodia's nantly in rural areas through (i) develop- demand- and supply-side financing, Health Strategic Plan (2008 ­ 2015). ing affordably and accessible basic cura- as well as policy options to integrate tive and preventive health services of ap- private providers better into the health HSSP2 support includes the following: (i) propriate quality; (ii) strengthening insti- system. the construction and renovation of health tutional capacity to plan, manage, finance centers and referral hospitals in line with and implement the health sector strategic Second Health Support Program 2009- the MOH's Health Coverage Plan; (ii) fi- policies and manage resources effec- 2013 (HSSP2): The World Bank, to- nance innovative sub-national funding ar- tively; (iii) increasing utilization of health gether with Australia Agency for Inter- rangements in line with the RGC policy on services, especially for women and the national Development (AusAID), DFID, Public Service Delivery and Decentraliza- poor; and (iv) controlling and mitigating Agence Française Développment (AFD), tion and Deconcentration, such as Special the effects of infectious disease epidem- the Belgian Technical Cooperation Operating Agencies,; (iii) strengthen health ics and of malnutrition, with an emphasis (BTC), United Nations Children's Fund finance management with a particular em- on the poor. (UNICEF) and UNFPA, is continuing phasis on social health protection, which support to Cambodia's health sector will have direct positive effects on the HSSP Results: through HSSP2. The objective of HSSP2 health of poor populations in remote areas In 2008, an estimated 2.3 million poor is to support the implementation of by increasing their access to public health people were covered by Health Eq- Cambodia's Health Strategic Plan 2008- care services and protecting people from uity Fund (HEF) schemes, which paid 2015 that aims to ensure improved and catastrophic out-of-pocket health costs; for the health care of 227,457 cases. equitable access to, and utilization of, es- (iv) strengthen human resources in health Financing was provided by HSSP, sential quality health care and preven- and human resource planning and man- United States Agency for International tive services with particular emphasis on agement in the public health system; and Development (USAID), UNFPA, other women, children and the poor. (v) help to improve the Government's gov- donor partners, and RGC. ernance and stewardship of the sector. 18 health centers have been con- IDA/World Bank Contribution: The January-February 2010 The World Bank Newsletter 3 Project Director Describes Health Sector Success The Health Sector Support Project (HSSP), which is supported financially by the World Bank, has been implemented by the Ministry of Health for seven years. The HSSP was scaled up to HSSP II in the context of better harmonization among development partners and alignment to government policies, strategies and system. The World Bank Cambodia monthly Newsletter interviewed H.E. prof. Eng Huot, HSSP Project Director, on the project's achievements and the challenges it faces. Please could you let us know what the to be key challenges in goal of HSSP is? the sector. HSSP1 was the flagship Project of the How has HSSP helped Ministry of Health from 2003 through to deal with these chal- 2009, with some civil works activities con- lenges? tinuing into 2010. It was the principal ve- hicle through which the MOH imple- HSSP helps in six mented its sector wide management ap- main ways: proach as a prelude to a full scale sector wide approach. Four of the MOH's key First, in terms of health development partners ­ Asian De- availability of public velopment Bank (ADB),World Bank, UK health services, HSSP1 Department for International Development funded the renovation (DFID), and United Nations for Popula- and expansion of tion Fund (UNFPA) -- joined together with health infrastructure in the MOH under the HSSP1 umbrella to line with the Health launch a range of strategies and interven- Coverage Plan. This tions in line with the first Health Sector includes referral hospi- Strategic Plan, 2003-07. HSSP1 has three tals and health centers. components: (i) improved delivery of In addition, HSSP1 pro- health services, (ii) support to priority vided medical and es- public health programs, and (iii) strength- sential drug kits per ening of institutional capacity. Minimum package of H.E. Prof. Eng Huot: "HSSP helps the RGC to implement Activities and Comple- its Health Sector Strategic Plan, and strengthen the The objectives of the HSSP were to mentary Package of sector's capacity to manage resources efficiently." increase the accessibility and quality of Activities specifications thus improving services for poor people who might not health services and tossist the Royal Gov- the quality of care, transport such as criti- otherwise be able to afford them. Patient ernment of Cambodia (RGC) to implement cally needed ambulances, and furniture, in- costs that were covered through direct its Health Sector Strategic Plan, and cluding hospital beds. payments to poor people under the strengthen the sector's capacity to man- scheme included consultations and es- age resources efficiently. Second, based on lessons learned from sential drugs, travel costs and food costs the pilot experiments in the previous ADB for accompanying family members. Lo- What are the main challenges facing the funded Basic Health Services Project, cal NGOs were employed to deliver these Health Sector in Cambodia? HSSP1 contributed to the expansion of NGO benefits to poorer clients. Evaluation re- contracting of health services in remote and search shows that support from HEFs di- In common with many low income poor districts of the country, such as rectly contributed to poverty reduction countries, the main challenges facing the Mondulkiri and Ratanakiri provinces. A to- and decline in the household debt bur- health sector in Cambodia include the tal of 11 Operational Districts (ODs) were den for significant sections of the poor. availability, accessibility and affordability contracted to NGOs. A final evaluation of Based on the HSSP1 experience the MOH of health services with low quality of care NGO performance in 2009 showed signifi- has now decided to expand HEFs to all resulting in low utilization and coverage cant increases in utilization and coverage parts of the country. of these services, and weak institutional that were the primary objectives of the ini- Fourth, HSSP1 also contributed to im- capacity to plan, implement, supervise, tiative. proving quality of care through expand- monitor and evaluate health services. Ad- Third, HSSP1 improved the ing support for in service and pre service ditional factors include low motivation of affordability of health services through the training of health workers, particularly health workers and managers due to low establishment of Health Equity Funds at skilled primary and secondary midwives compensation, and lack of clinical skills of health facilities in selected ODs, typically which allowed the MOH to deploy them the required levels to ensure appropriate, those with higher than average poverty to health facilities. By mid 2009, all health timely and cost effective treatment of dis- head count ratios. Over a million people centers in the country had at least one eases and illnesses. Finally, health promo- living under the poverty line were the tar- midwife, a significant improvement over tion and the adoption of healthy lifestyles get beneficiaries. Health Equity Funds the baseline situation when more than by all sections of the population continue (HEFs) are third party purchasers of health see PROJECT page 4 4 The World Bank Newsletter January-February 2010 Project Director Describes... continued from page 3 nity participation activities. HSSP1 sup- At the tail end of the Project, the MOH half of all health centers in the country port also contributed significantly to im- also inaugurated the Joint Annual Plan did not have any. HSSP1 funding also provements through expansion in cover- Appraisal (JAPA) where the MOH and its helped strengthen supervision and moni- age of directly observed short course treat- partners come together to carry out an toring across the health sector at all lev- ment (DOTS) for TB, and training of health appraisal of the sector's Annual Opera- els: central to provincial, provincial to dis- providers, and procurement of larvicides tional Plan and examine patterns of re- trict and provincial hospital, and district for dengue prevention and control. Since source allocation. Project funding and to health center. Expansion of the public a number of other donors were already technical assistance contributed to the health facility network, provision of es- active in providing support to HIV/AIDS development of guidelines for the health information system (HIS) and training of ... we are well on our way to achieving both health workers at all levels in the compila- tion, analysis and use of health statistics, the NSDP and CMDG targets of 50 deaths per development of a sector wide computer- ized database with provision of computer 1,000 live births by 2015. equipment down to OD levels, develop- H.E. Prof. Eng Huot ment of the monitoring and evaluation sential drugs and consumables, and sup- prevention and control activities, includ- framework of the Second Health Strategic ply of medical equipment, transport and ing global health initiatives such as the Plan, 2008-15, a comprehensive assess- furniture, have also contributed to sus- Global Fund, HSSP1 focused on the pro- ment of the health information system, tained quality of care improvements. curement of ARV drugs for treatment of formulation of an HIS strategic plan for the syndrome. the 2008-15 period, and a number of dif- Fifth, communicable diseases consti- ferent sub-sector reviews and assess- tute a major portion of the burden of dis- Finally, HSSP1 contributed in many ments. ease in the country. Recognizing this, ways to institutional strengthening in the HSSP1 provided varying degrees of fund- health system. Under HSSP1, the MOH If you may, please share with us the ing and support to the prevention and first launched the Joint Annual Health achievements of the HSSP-I in its seven control of malaria, dengue, tuberculosis, Sector Review that was later renamed the years? and HIV/AIDS. HSSP1 support enabled Joint Annual Performance Review (JAPR) the procurement and supply of insecticide and merged with the MOH's annual Na- The period of implementation of treated bed nets, one of the most cost- tional Health Conference (NHC). The HSSP1 has seen a dramatic improvement effective malaria prevention interventions, JAPR/NHC brings together all stakehold- in the health status of our people. For in- to thousands of households in endemic ers in the sector, including provincial and stance, in terms of infant and child mortal- areas, and ensured that they were re- operational district health units, sister min- ity impressive achievements have been treated per extant guidelines. Health pro- istries and government agencies, local documented over this period through the motion was supported through produc- authorities, community members, repre- CIPS 2004, CDHS 2005, and the Census tion and wide dissemination of IEC/BCC sentatives of the private sector, and health 2008. From 95 deaths per 1,000 live births (Information-Education-Communication/ development partners to review the pre- in 2000, infant mortality has declined to 60 Behavior Change Communication) mate- vious year's achievements and set sector in 2008 and we are well on our way to rials, and the implementation of commu- priorities and targets for the coming year. achieving both the NSDP and CMDG tar- gets of 50 deaths per 1,000 live births by 2015. Key output and coverage indicators that contribute to improved infant and child health have also shown sustained improvement from 2000 to 2008: measles immunization coverage has increased from 41% to 91%, children aged 6-59 months receiving vitamin A supplements has shot up from 28% to 79%, and the combined diphtheria, pertussis, tetanus, and Hepa- titis B vaccine coverage has improved from 43% to 92%. More mothers of infants are practicing healthy behaviors: the exclu- sive breastfeeding rate has improved from 11% to 66% over the same period, and we have seen sustained increases in initia- tion of breastfeeding after delivery and complementary feeding as well. Yav Neang, a poor mother of three children who brings her youngest eight-month In terms of the number of maternal son for his serious lung disease treatment at Battambang hospital. Neang said: See PROJECT page 6 "Now my son is getting better and I don't feel so worried again." January-February 2010 The World Bank Newsletter 5 Health Equity Fund Brings Medical Care to the Poor Phoung Pha (right), her twin babies and her neigbors are laughing happilly while describing how much she appreciated the support from HEF delivering her babies. continued from page 1 dian poor people covered by HEF schemes. Lam Sarin, PFD-Battambang project ports the family of five members. But the The Health Equity Fund schemes are cur- manager, said HEF helps reduce the burden work is not regular. rently financed by the Health Sector Sup- of health expenditure for poor people and Phoung Pha, 22, is the mother of twin port Program including funds from the helps them access to quality health services. six-month-old boys. They are one of the Australian Agency for International Devel- "We see the main benefit as improving poorest families in Chi Nek village, opment, the Belgian Technical Coopera- their livelihood by giving them access to Anglong Vel commune, Sangke district in tion, the United Kingdom Department for free and quality health care service," Lam Battambang province. She was asked to International Development, the United Sarin said. "When they are healthy, their pay 370,000 riel ($90) for the delivery of Nations Population Fund , the United Na- community is also healthy and developed. her twins, but her family couldn't afford tions Children's Fund, the World Bank, and Without HEF, when a member of a poor family gets sick, it is very difficult to find money for treatment. If they don't have "In the past, we saw that the poor were afraid money they don't take the sick person to to come to hospital... Now their behavior has hospital. Sometimes, the sickness forces them to sell their land, cows and any other changed. They are starting to use our services property they have. Then they sink further ... They get the HEF support ­ and the attitude and further into poverty." Touch Svang, Anglong Vil commune of our nurses and doctors is also much im- chief, admires and supports the HEF scheme and hopes it will continue to sup- proved." port the poor. In the past, the poor came Dr. Ngo Sitthy to the commune office to ask him for a letter to show that they were poor in the it. "I was so pleased when I learned the the United States Agency for International hope of getting a discount when they went Health Equity Fund would pay," she Development, the Royal Government of to hospital; but now they just show the laughed. "We are safe." Cambodia national budget, and other de- HEF card. Another of Chi Nek's poorest villag- velopment partners. HEF pays for the bill "Whenever I hear or I know of people ers, Veth Sopheap, 36, has been suffering for each patient's treatment fee, meals, getting sick, I tell them to go to hospital; from the chronic disease since she was 13 transport, and other additional costs. don't stay at home and wait to die," he years old. Her husband is disabled and During the World Bank visit, 103 pa- said. "If you are Buddhist, you gain great they have six children. The family could tients were treated at Battambang Refer- merit rescuing the poor." not afford to pay for her treatment, but ral Hospital under the HEF, which is man- Dr. Ngo Sitthy, Director of Battambang now she is being supported by HEF, and aged there by Poor Family Development Provincial Referral Hospital, said that since hopes she will get better some day. (PFD), one of 10 NGOs operating the HEF. his hospital has had the HEF program, the Neang, Roeung, Pha, and Sopheap, are PFD covers three provinces ­ Pursat, number of poor people coming to use the among approximately 2.75 million Cambo- Battambang and Banteay Meanchey. See HEALTH page 7 6 The World Bank Newsletter January-February 2010 Project Director Describes ... Under constructing Kampot hospital is one of hospitals supported by HSSP - I. Continued from page 4 specialties, as well as management and fi- the Project? deaths, evidence from the measurement nance, and strengthened the health infor- I should point out that the MOH has of the maternal mortality ratio will only mation system. recruited an external consultancy team be available from the CDHS 2010. How- of experts to carry out an end of project ever, dramatic declines in the total fertil- What is your view on HSSP2 for improv- assessment of HSSP1, and that they are ity rate from 4.0 in 2000 to 3.1 in 2008, ing health status of Cambodian people? currently engaged in this task. I am look- coupled with significant increases in ing forward keenly to their findings. But maternal health services utilization and In terms of HSSP2, it is designed so from our experience in HSSP1 I can say coverage indicators, such as improve- as to build on the achievements and les- that we have learned that successful ment in the proportion of deliveries at- sons learned from HSSP1 including tran- implementation of the sector wide man- tended by trained health personnel from siting from a sector wide management agement approach can become the basis 32% in 2000 to 58% in 2008, proportion approach to many features of a sector for the introduction of an overall sector of pregnant women with 2 or more ante- wide approach, most notably pooled wide approach in the health sector. This natal care visits from 31% to 81%, and funding arrangements. I expect that many is precisely what we have done in the proportion of pregnant women receiving of the components of HSSP2 including design of HSSP2 where seven health de- iron folate supplementation at 69% in 2008 the innovative use of block grants to velopment partners have joined hands suggest that these numbers have de- implementing units termed service deliv- with the MOH to introduce pooled sec- clined as well. In terms of infectious and ery grants, the introduction of internal tor funding for the very first time, along communicable diseases, the number of contracting arrangements at provincial with non-pooled funding. Second, expe- malaria cases treated at public health fa- and operational district levels, the expan- rience with NGO contracting of health ser- cilities per 1,000 persons has dropped sion of health equity funds to purchase vices under HSSP1 permitted the MOH more than two-fold from 11.4 in 2000 to health services for the poor and the vul- to launch internal contracting with block 4.4 in 2008, the TB cure rate stands at nerable, the strengthening of emergency grants to special operating agencies in 90%, and HIV prevalence among adults and referral systems, improvements to the line with the RGC's Policy on Public Ser- 15-49 years has declined from 1.9% to an health service delivery network, building vice Delivery. Finally, a key lesson estimated 0.7% in 2008. capacity at central and local levels learned is that the three year rolling plans through strengthening training institu- and annual operational plans which form Perhaps the most significant contribu- tions and conducting appropriate train- part of the planning cycle of the MOH tion of HSSP1 has been in the area of in- ing programs, and the piloting of com- can be successful approaches to im- stitutional strengthening through the munity score cards to strengthen ac- proved resource allocation thus contrib- adoption of a sector wide management countability and involvement at commu- uting to the MOH's goals of efficiency, approach. As I said earlier, HSSP1 pio- nity levels will all go a long way to im- equity and effectiveness in service de- neered new approaches to policy dialogue proving health service utilization and livery resulting in the improved health and sector wide management including behavior, and ultimately the health sta- status of our people. All these lessons the JAPR and the JAPA, contributed to tus of our people over the next five years. have been applied to the design and improved sector monitoring and supervi- implementation of HSSP2 for the 2009-13 sion, supported training of staff in clinical What lessons have been learned from period. January-February 2010 The World Bank Newsletter 7 Health Equity Fund Brings Medical Care to the Poor Continued from page 5 health service has doubled. Bed use has increased from 50 percent to 85 percent and he expects it to rise further during 2010. "In the past, we saw that the poor were afraid to come to hospital because they feared they would be asked to pay or might be mistreated," he said. "Now their behavior has changed. They are starting to use our services because they get the HEF support ­ and the attitude of our nurses and doctors is also much im- proved." According to Dr. Ngo, the hospital's revenue has almost tripled from Dr. Ngo Sithy (right) said the numbers of poor people coming to use the health US$4,000 to over US$10,000 per month. service has increase doulbe since the HEF has been introduced in his hospital. The hospital charges $20 for each pa- tient and for poor people this cost is percent for hospital running costs. Dr will be even better development," Dr Ngo now covered by the HEF. Of the $20, 60 Ngo said his hospital still has problems said. percent is used to pay for staff incen- getting medical supplies, so some of the For more information contact: tive, 39 percent for administrative costs extra income will be used to buy more Ms. Ly Nareth and 1 percent for state revenue. But the medicines. Health Operations Officer HEF revenue will be divided only two "HEF funding has led to improved ser- Email: nly1@worldbank.org ways ­ 60 percent for incentive and 40 vices at the hospital, and I hope there soon Good Health Comes to Chakrey With a Smile continued from page 1 Chakrey was the scene of heavy with some of the health center's patients. Chakrey Health Center was opened fighting between the Government and Touch Mao has come with her two in 2007. Most people come for five main the Khmer Rouge in Phnom Phoeuk dis- children from Spien Tom Neap village, 25 services: birth spacing, ante natal care trict, Battambang province, and was km away. Both children have colds. (during pregnancy health checkup) de- where the war ended in 1996. Hean lost "I always bring my children here for livery, vaccination, malaria, and general his leg to a land mine in 1982, and sev- treatment," she says, as her son cries with consultation for illnesses such as diar- eral mines and other unexploded ord- his nose running and her daughter sits rhea and fevers. The Chakrey center cov- nance (UXOs) were cleared from the quietly beside them. "I cannot afford to ers eight villages with more than 15,500 grounds of the new health center be- pay for their treatment at a private clinic: inhabitants, but it welcomes other villag- fore it could be built. that is too expensive for my family. Here ers from outside the coverage area. The World Bank Newsletter spoke they charge me only 2,000 riel [50 cents] for my son and my daughter." Leng Sreynou, 21, from Boeung Kap village, Chakrey Commune, has brought her two-year-old daughter, Phath Nita, who also has a cold. She echoes Touch Mao and adds: "The quality of service is good and I rely on this center." On a long cement bench-seat attached to the wall of the health center on the front veranda, pregnant Hak Eng sits waiting for her turn for ante natal care . "I come here regularly to check my health because I want my baby and myself to be healthy," she smiles. "I see a lot of people come here, and they are happy." A 40-year-old farmer, Som Vanny, who has brought his pregnant wife for ante A mother of two, Touch Mao: "I cannot afford to pay for their treatment at a natal care, says he is very confident that private clinic: that is too expensive for my family. Here they charge me only 2,000 the Center is the right place to bring his riel [50 cents] for my son and my daughter." See GOOD HEALTH page 8 January-February 2010 The World Bank Newsletter 8 Good Health Comes to Chakrey With a Smile A pregnant woman Hak Eng:"I come here regularly to check my health because I want my baby and myself to be healthy." continued from page 7 farmers are charged only half price, and of their incentive payments to save wife. "I will bring my wife here again for the very poorest sometimes get the ser- someone's life. "Because we have prob- the baby's delivery," he says "I rely 100 vice for free. lems transferring a seriously ill patient percent on this center and I don't want to "Our center has adequate equipment to hospital, our staff pay towards rent- take any risks by using a traditional birth for delivering babies," Khuy Samnang ing a taxi," he said. "We cannot close attendant." says, "and if we see any danger signals our eyes and let them die. We have to Khuy Samnang, the Deputy Head of of complications we send the pregnant help them." Chakrey Health Center, is pleased because woman to the hospital." Khuy Samnang believes that 30 per- people are using the center for delivering He said the center charges 2,000 riel cent of the successful treatment of pa- their babies and they understand the im- (50 cents) for every new case and 1,000 tients can be attributed to the new build- portance of health care checkups during riel for each return visit. The fees are man- ing, clean facilities and the positive atti- tude of his staff. Some patients bring their relatives to see the new building "The new and smart building, the clean envi- as well. "The new and smart building, the ronment, and the warm welcome by our staff clean environment, and the warm wel- come by our staff are also parts of men- are also parts of mental treatment. When they tal treatment," he laughs. "When they feel welcome, they happy, and when they are feel welcome, they are happy, and when they are happy their illness is also re- happy their illness is also released." leased." Khuy Samnang However, the new health center has its own problems though: it runs short of medicines for a whole month every three pregnancy. He says more than 90 percent ageable for most patients. The center's months. of pregnant women in the villages of the income is around 750,000 riel in average coverage area come to deliver their ba- per month (US$ 180.00). Of this, 60 per- For more information contact: bies at his Center. The small minority con- cent is used for staff incentive; 39 per- Ms. Ly Nareth tinue to use the traditional birth attendant. cent for running the health center and 1 Health Operation Officer The center charges a standard fee of percent for state revenue. Email: nly1@worldbank.org 20,000 riel (US$4.80) per delivery. But poor Sometimes his staff contributes part The World Bank Cambodia Office 113, Norodom Blvd. Phnom Penh, Tel: (855 23) 217 301 Fax (855 23) 210 504 Khmer website: www.worldbank.org.kh and English website: www.worldbank.org/kh