Progress Report SOCIAL HEALTH PROTECTION PROJECT KAMPOT AND KEP. Partnership Between: BUDDHISM FOR HEALTH AND

Transcription

1 Progress Report SOCIAL HEALTH PROTECTION PROJECT KAMPOT AND KEP Partnership Between: BUDDHISM FOR HEALTH AND Deutsche Gesellschaft Für Internationale Zusammenarbeit, (GIZ) GmbH October to December P a g e

2 I. INTRODUCTION Since August 2014, BfH in partnership with GIZ, has been successfully implementing CMHEFs (Community Managed Health Equity Funds) in all 43 Health Centers (HCs) of Kep, Kampot, Angkor Chey and Kampong Trach Operational Districts (ODs). The scheme is being managed and funded by local communities, including religious institutions such as pagodas and mosques, with the following objectives: To improve access to healthcare for the most vulnerable groups the elderly (EP) and People with Disabilities () by provision of a complementary benefits package through the National Health Equity Fund (NHEF), which includes among other benefits, support for transport costs from their village to the health center. To enhance community participation and social accountability in the provision of good quality healthcare services to the public. The Client Satisfaction Survey is one of the social accountability tools that was officially endorsed by the Ministry of Health (MoH). This tool has been used by trained members of the CMHEF committees to collect people s perceptions regarding the quality of public healthcare services both at Hospital and Health Center (HC) levels and provide regular feedback to the concerned stakeholders, with a view to improving quality of care. The scheme has been successful in greatly increasing access to public healthcare services for the target beneficiaries. This report narrates the activities implemented by BfH in partnership with GIZ, during the period October to December 2015 in the ODs of Kep, Kampot, Angkor Chey and Kampong Trach. Some of the main activities carried out during this period are the expansion of the CMHEF in Kampong Trach and Angkor Chey ODs, the implementation of the Transport Voucher, the distribution of baby kits and a study of the healthcare seeking behavior of the Beneficiaries. II. ACTIVITIES IMPLEMENTED 2 P a g e 1. Expansion of the CMHEF to Angkor Chey and Kampong Trach ODs In partnership with GIZ, BfH expanded the CMHEF project to Angkor Chey Operational District beginning 24 th July The expansion process was implemented as planned, commencing with a CMHEF Project Orientation Workshop at district level, followed by providing ToT training to the District Facilitator Team (DFT), conducting a CMHEF establishment meeting and a CMHEF launching meeting and providing training on community fund management and feedback mechanism. The CMHEF project was launched on 1 st November 2015, with BfH staff working closely with the community in activities such as preparing a list of People with Disabilities (PWD), filling target group information in transport vouchers and promoting the CMHEF in the community in order to urge the People with Disabilities (PWD) and Poor (EP) to use the Government Public Health Service when they get sick. After launching the project, BfH provided a training on how to conduct the Client Satisfaction Survey (CSS) for

3 members of the CMHEF feedback sub-committee in Angkor Chey OD on 14th December A total of 29 participants including 15 females attended the training. 3 persons were selected from each HC. As a result, 11 CMHEF committees were established at 11 leading pagodas in the coverage area of 11 Health Centers in Angkor Chey OD (100%). A total of 57 CMHEF fund boxes were placed in all pagodas in the district and a total of 2,817 transport vouchers were filled-out and distributed to PWD and EP. The utilization data was recorded in the H-SPIS system. Beginning 25 th September 2015, a CMHEF was started in Kampong Trach OD. 14 CMHEF committees were established in 14 leading pagodas and a total of 71 CMHEF fund boxes were placed in all 71 pagodas. The CMHEF launching is scheduled to take place in January 2016 by using the GIZ seed fund. 2. Transport Voucher Distribution : Based on the number of persons on the PWD list prepared by commune and village chiefs and the EP list sorted from the PMRS, BfH printed Transport Vouchers, filled-in the required information and distributed to the target group in Kampot, Kep and Kampong Trach ODs. Learning from previous experience, BfH encouraged community members to actively participate, take ownership and make a positive contribution to their own communities. Most of the vouchers were filled-in by students. The Village Chiefs distributed the completed vouchers to the target group based on the list of PWD and EP. More vouchers were placed at each Health Center (HC), in case new turned up. The table below shows the number of vouchers distributed by quarter in 2015: Q1 Q2 Q3 Q4 1 OD Kampot # People 60 1, ,459 # , ,166 2 OD Angkor Chey # People ,375-1,375 # - - 1, , ,7 70 2,817 3 OD Kg Trach # People ,405 2,405 # ,237 1,237 4 OD Kep 3,642 3,642 3 P a g e

4 3. Bi-monthly meeting with GIZ to review the project activities: A bi-monthly meeting was conducted on 12 th December 2015, to present the activities of BfH during quarter 4, This meeting also provided an opportunity for BfH to receive a project update from AFH and RACHA. The following topics of interest were reported/presented at this meeting: - Utilization Report of PWD and ED generated from H-SPIS: - The Report Format for BfH - Definition of Disabilities from BfH - Actual Transportation Cost from Home to HC - Awareness raising of PWD and EP. - Distribution of transport vouchers to all PWD in Kampot and Kep ODs: - Initiation of a Voluntary Scheme in Kampot : - Study Visit on Performance- Based Payment Method to Kampong Thom - Inclusion of PWD in HIS Database system: - Client Satisfaction Survey Database: - Update from AFH regarding Voucher 4. Client Satisfaction Survey (CSS) Under BfH facilitation, the trained members of the CMHEF conducted the 5 th round of CSS in Kep and Kampot ODs. The results of the survey gave an indication of client satisfaction during quarter 4 and served as a basis for discussion during the monthly OD meeting. It also provided valuable information on the factors that need improvement in each of the 14 HCs in Kampot OD thereby enabling the Chief of Kampot OD to initiate corrective action where necessary. On 14 th December 2015, BfH In collaboration with GIZ, conducted a training on Client Satisfaction Survey for CMHEF sub-committee members in Angkor Chey OD. A total of 29 participants from 11 HCs attended the training. After the training, the trained members conducted the 1 st round of CSS in Angkor Chey OD. The findings from this survey were presented at the Monthly OD meeting and the quarterly District Health Financing Steering Committee (DHFSC) meeting, to seek action to improve the indicators that obtained a lower than minimum score (<75). CSS Findings in Kampot OD: Health Centers- The survey revealed that during this quarter, all HCs achieved a higher score than the minimum score of 75%, for all indicators. This result shows that the OD and the HCs had taken necessary action to improve the weaknesses highlighted in the CSS findings in the previous quarter. 4 P a g e

5 Chak Krey Ting: HC staff avialable at working time Q3 76 Q Kampong Kreng: Enough drug at HC Q3 Referral Hospital The Kampot-RH received a higher score than the minimum of 75% for all indicators. According to the findings in this quarter, the 2 indicators that scored below the minimum in Q3 have shown a marked improvement in Q4, as shown in the chart below. When compared with the CSS results in the previous quarter, the hospital has built a new kitchen for patients and employed a care taker to cook food. It also indicated that the hospital cleaners now clean the latrine in the RH more often than before. 80 Q Kampong kreng: Cleanliness of latrine Q3 83 Q There is a kitchen for care taker in RH Cleanliness of latrine in RH Q3 Q Q3 Q4 CSS Findings in Kep OD: Health Centers- During this quarter, the clients still kept complaining about the three main indicators which need to be improved in Pong Teuk Health Center. Cleanliness of latrine Medical Intruments HC Enviroment Q3 72 Q Q3 Q Q3 Q4 5 P a g e Referral Hospital When comparing the results of quarter 3 and 4, it is clear that 4 indicators which were below 75% in quarter 3 have improved. However one indicator (cleanliness of latrine in RH) achieved only 72% in quarter 4. This indicator was discussed during the Provincial Health Financing Steering Committee in Kep province. The RH agreed with the recommendation of H.E Oeung Chay, Deputy Governor of Kep province and Chief of PHFSC that the RH needs to increase the times of cleaning from 2 to 4 times per day.

6 72% 69% 73% % % Cleanliness of latrine Easy to meet the doctor at night 81% 81% 82% Friendliness of worker at RH The period of service wating is short Q3 69% 73% % % Q4 72% 81% 81% 82% CSS Findings in Angkor Chey OD: Health Centers According to the results of the first round of CSS, 4 HCs out of 11 received a lower score for some indicators. Most of those indicators related to cleanliness of latrine. Ang Phnom Toch Health Center Samlagn Health Center HC enviroument Cleanliness of latrine 60 HC enviroument Cleanliness of latrine Q Q Dem Dong Health Center Q Wat Ang Health Center Staff are available at HC latrine working time Q Referral Hospital- In the first round of CSS in the RH, all indicators scored higher than the minimum of 75%. 6 P a g e

7 5. Database for recording health services utilization by the EP and To follow-up the utilization of healthcare services by the target beneficiaries in Kampot and Kep ODs, BfH trained its staff during the period February to November 2015 and started training in Angkor Chey OD in November. During this training process, we encountered the following difficulties: - The system is not completely ready for use, as it still needs to be up dated - The process of data entry is time consuming - The process of data entry is complicated. - The data is insufficient for the report. These difficulties were reported to SHPA to seek a solution to the problem. 7 P a g e

8 6. Healthcare Seeking behavior of the Beneficiaries: Table - A1: Health Services Utilization by the target beneficiaries in Kampot OD Indicator Q1 Q1 Q2 Q3 Q4 Year 2015 HEFB 13,396 14,266 1,158-14,516 1, ,861 1, ,151 1, ,699 1, Nbr. of OPD at HCs Nbr. of OPD at RH 2,244 4, , , , ,584 1, , ,488 4, , , ,348 1, Rate/Pers on #DIV/0! Nbr. of IPD , Rate/100 0 HEFBs #DIV/0! Nbr. of Delivery at RH Nbr. of Delivery at HCs Rate/Targ et Pregnant HEFB* #VALUE! #VALUE! 27.19% 30.04% 27.80% 34.61% 39.60% % 8 P a g e

9 In Q4, the number of EP was 1,401 persons and the number of was 691 people. OPD utilization rate per beneficiary: In Q4, 2015, the utilization rate of EP was 0.34 per beneficiary. It has almost doubled when compared to the utilization rate of general HEFBs in the same quarter of 2014 which was only 0.19 per beneficiary. However, the PWD s utilization rate in Q4 in 2015 was still quite low, only Annually, in 2015 the OPD utilization rate of EP was up to 1.40 while that of general HEF beneficiaries was only The utilization rate of remains quite low, at only 0.35 per beneficiary. IPD utilization rate per 1,000 beneficiaries: In Q4, 2015, the utilization rate of EP was 46. It has increased remarkably when compared to the same quarter of 2014 which was only Annually, in 2015 the IPD utilization rate of EP was up to 144 while that of the general HEF beneficiaries was only P a g e

10 Table A2: Health Services Utilization by the target beneficiaries in Kep OD Indicator Q1 Q1 Q2 Q3 Q4 Year 2015 HEFB 6,731 6, , , Nbr. of OPD at HCs Nbr. of OPD at RH 1,055 1, , , , , Rate/Pers on Nbr. of IPD Rate/100 0 HEFBs Nbr. of Delivery at RH Nbr. of Delivery at HCs Rate/Targ et Pregnant HEFB* 10 P a g e % 26.73% 19.41% 12.96% 15.91%.83%

11 In Q4, the accumulative number of EP was 208 people and that of was 370 people. OPD utilization rate per beneficiary: In Q4, 2015, the utilization rate of EP was It has increased significantly when compared with the utilization rate of general HEFBs in the same quarter of 2014 which was only The PWD s utilization rate in Q4 of 2015 was 0.26, which shows a slight increase when compared to the previous quarters. Annually, in 2015 the OPD utilization rate of EP was up to 3.23 while that of general HEF beneficiaries was only The utilization rate of was only IPD utilization rate per 1,000 beneficiaries: In Q4, 2015, the utilization rate of EP was 31. It has decreased slightly when compared with the utilization rate of general HEFBs in the same quarter of 2014 which was only 8. Annually, in 2015 the IPD utilization rate of EP was up to 337 while that of the general HEF beneficiaries was only 8. Table A3: Health Services Utilization by the target beneficiaries in Angkor Chey OD: Indicator 2015 Q4(Nov) Q1 Q2 Q3 HEFB 12,496 1,375 1,442 Nbr. of OPD at HCs 1, Nbr. of OPD at RH n/a n/a n/a 1, Rate/Person P a g e In Q4, the accumulative number of EP was 1,375 people and that of was 1,442 people.

12 OPD utilization rate per beneficiary at HC level During one month (Dec 2015), the utilization rate of EP was It is significantly higher than the utilization rate of general HEFBs in the same period, which was only The PWD s utilization rate in the same period was Financing Table B1- CMHEF Income and Expenditure in OD Kampot (In USD) Balance brought forward (a) Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec ($) 3, , , , , , , , , , , , Income (b) , , Expense Ending Balance GIZ Seed-Fund Direct Cost CMHEF - Direct Cost CMHEF - In-Direct Cost (d) , , (a+b)-(c+d) 3, , , , , , , , , , , , , The balance brought forward from 2014 was USD 3, and the funds collected in 2015 was USD 4, In Jan 2015, an amount of USD was spent from the GIZ seed fund on direct benefits costs. The total expenditure on direct benefits cost (transport) for 2015 was USD 3, and on indirect costs (community meetings, office supplies etc..) amounted to USD The ending balance as at December 31, 2015 was USD 3, P a g e

13 Table B2- CMHEF Income and Expenditure in OD Kep (In USD) Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec ($) Balance brought forwar Income (b) , GIZ Seed-Fu Expense CMHEF - Dir CMHEF - In-Direct Cost (d) Ending Balan(a+b)-(c+d) The funds collected in 2015 amounted to USD 1, During the first six months of 2015, the amount spent on direct benefits costs from the GIZ seed fund was only USD The expenditure on direct benefits costs (transport) during the period July to December was USD The ending balance as at December 31, 2015 was USD P a g e

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15 Table B2- CMHEF Income and Expenditure in OD Angkor Chey (In USD) Balance brought forward (a) Dec ($) Income (b) 1, ,058.1 Expense Ending Balance GIZ Seed-Fund Direct Cost CMHEF - Direct Cost CMHEF - In- Direct Cost (d) (a+b)-(c+d) funds collected as at the end of 2015 was USD 1, Expenditure on direct benefit costs from the GIZ seed fund in December 2015 amounted to USD The funds collected from the community was kept aside to be used after the expiry of GIZ funding Presentation of data of National Health Equity Funds (NHEFs) Kampot OD Presentation of Referral Hospital Data Services Number of Income per Quarter(USD) HEF %HEF HEF %HEF OPD 1, % $ $ % IPD 2, % $22, $1, % Delivery (normal % $21, $4, % cesarean-section) Surgery % NA NA Referral in and out (ambulance only) Referral out (ambulance only) % NA $48, $20, % NA 15 P a g e

16 Presentation of Health Center Data (Presented by ODs) Services Number of Income per Quarter(USD) HEF %HEF HEF %HEF OPD 13,471 4,728 35% $15, $4, % IPD at FDH Delivery % NA NA Referral out (Referral Letter) % $ 15, $4, % NA Kep OD Presentation of Referral Hospital Data Services Number of Income per Quarter(USD) HEF %HEF HEF %HEF OPD % 1, IPD % 1,945 1,305 67% Delivery (normal % cesarean-section) Surgery Referral in and out (ambulance only) Referral out (ambulance only) % NA , , % NA Presentation of Health Center Data 16 P a g e Services Number of Income per Quarter(USD) HEF %HEF HEF %HEF OPD 5,315 1,785 34% 2, , % IPD at FDH Delivery Referral out (Referral Letter) % 71% $ $ 1, %

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18 Angkor Chey OD Presentation of Health Center Data Services Number of Income per Quarter HEF %HEF HEF %HEF OPD 8,434 2, % $ 1,103,8 $ 3, % IPD at FDH % Delivery N/A N/A N/A Referral out (Referral Letter) $ 1,103,8 $ 3, % 18 P a g e

19 Kampong Trach OD Presentation of Health Center Data Services Number of Income per Quarter HEF %HEF HEF %HEF OPD % % IPD at FDH % % Delivery % Referral out (Referral Letter) 85% Chhouk Presentation of Health Center Data Services Number of Income per Quarter HEF %HEF HEF %HEF OPD % % IPD at FDH % % Delivery % Referral out (Referral Letter) % 35% 51% Baby Kit distribution BfH has an agreement with GIZ beginning May 2015, to distribute Baby Kits to women who have their babies delivered at the Kampot and Kep Referral Hospitals. The project is now requesting BFH to distribute baby kits to women with ID card who are not eligible to receive vouchers but come to deliver at the Provincial Referral Hospital. The purpose of the distribution of Baby Kits is to increase access of women to deliver in Health facilities, motivate women to seek proper health care and to promote the well-being of the baby by using the materials in the kit 19 P a g e

20 Baby kit distribution from June-December 2015 Date # Baby kit in GIZ stock(at PHD) # Baby kit BfH received from GIZ # Baby kit in BfH stock # of baby Kit distributed RH Kpt RH Kep # of Baby kit left June Jul Aug Sept Oct Nov Dec P a g e

21 III. Findings, Conclusions and Next Plan The expansion of CMHEF scheme to the ODs of Kampong Trach and Angkor Chey is progressing well. The scheme has strong support from all stakeholders as well as from the communities. The communities have displayed a willingness to contribute to the scheme and make it work. The benefits of this project have been disseminated to the communities through the relevant CMHEF committees, community events and religious ceremonies. As a result, the utilization of health services by PWD and EP, has increased. However, this message still needs to be promoted to other villages, strengthening the capacity of CMHEF committee members on fund management, preparing the feedback report, making and placing more fund boxes in other places such as churches and mosques, follow up and support for the CMHEF committee members based on their real needs. Next Plan: Expand the CMHEF to OD Chhouk (Q1 2016) Launching of CMHEF activities in the Leading Pagodas in OD Kampong Trach (Q1 2016) Conduct CSS in the ODs of Kep, Kampot, Angkor Chey and Kampong Trach Review the CMHEF committee members in each Health Center in Kep and Kampot ODs. Strengthen the capacity of CMHEF committee members at all HCs in Kampot and Kep by improving their knowledge and skills in financial management, finance and feedback reporting, facilitation etc Improve the H-HISP system in all ODs to be user-friendly and produce better reports. Coordinate with the Leading Pagodas to ensure that the fund collection boxes and the funds collected, are in place, safe and secure in all ODs 21 P a g e