Composition of pluralistic health systems: how much can we learn from household surveys? An exploration in Cambodia

Meessen, Bruno; Bigdeli, Maryam; Chheng, Kannarath; Decoster, Kristof; Ir, Por; Men, Chean Rithy; Damme, Wim Van

doi:10.1093/heapol/czr026

Cited by 60 publications

(49 citation statements)

References 20 publications

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“…In general, Cambodian people tend to visit over-the-counter drug stores for their health problem. This is in accordance with the prepondence of studies that have demonstrated patronage of drug stores and the private sector in preference to the public health system in Cambodia (Meessen et al, 2011). This trend is not new, especially in low-income setting where the health system is pluralistic.…”

Section: Discussionsupporting

confidence: 87%

Fairness of Utilizing Health Care Facilities and Out-of-Pocket Payment Burden: Evidence From Cambodia

Dalal

Aremu

2012

J. Biosoc. Sci.

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Catastrophic spending on health care through out-of-pocket payment is a huge problem in most low- and middle-income countries all over the world. The collapse of health systems and poverty have resulted in the proliferation of the private health sector in Cambodia, but very few studies have examined the fairness in ease of utilization of these services based on mode of payment. This study examined the utilization of health services for sickness or injury and identified its relationship with people's ability to pay for treatment seeking at various instances. Based on cross-sectional data from the Cambodian 2007 Demographic and Health Survey, the economic index estimated through principal component analysis and Lorenz curve was used to quantify the degree of fairness and equality in utilization and payment burden among the respondents. A distinct level of fairness was found in health care utilization and out-of-pocket payments. Specifically, use of private health care facilities and over-the-counter remedies dominate, and out-of-pocket payments cut across all socioeconomic strata. As many countries in low- and middle-income regions, and most importantly those in transition such as Cambodia, are repositioning their health systems, efforts should be made towards maintaining equitable access through adoption of finance mechanisms that make utilization of health care services fair and equitable.

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Section: Discussionsupporting

confidence: 87%

Fairness of Utilizing Health Care Facilities and Out-of-Pocket Payment Burden: Evidence From Cambodia

Dalal

Aremu

2012

J. Biosoc. Sci.

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“…From a public policy point of view, it appears more appropriate to try to rationalize the practice than to attempt (often in vain) to prohibit it. In this context, one option would be to focus regulatory efforts on a limited list of drugs whose contraindications and risks are significant [5] and develop programs to promote self-medication practices for mild health problems. Experiments of this type of practice in the DR Congo have already been documented in the two rural HDs of Kasongo and Bwamanda [36].…”

Section: Discussionmentioning

confidence: 99%

Health-seeking behaviour in the city of Lubumbashi, Democratic Republic of the Congo: results from a cross-sectional household survey

Chenge

Vennet

Luboya

et al. 2014

BMC Health Serv Res

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BackgroundConcerns about the occurrence of disease among household members generally initiate treatment-seeking actions. This study aims to identify the various treatment-seeking options of patients in Lubumbashi, analyze their health-seeking behaviour, identify determinants for the use of formal care, and analyze direct health care expenditure.MethodsA cross-sectional survey of households in Lubumbashi was conducted in July 2010. Information was collected from a randomly selected sample of 251 households with at least one member who had been ill in the 2 weeks preceding the survey.ResultsFrequently used initial treatment-seeking options consist of self-medication based on modern medicines (54.6%), the use of first-line health services (23.1%) and hospitals (11.9%), with a perceived effectiveness of 51%, 83% and 91% respectively. If people go for a second option, then formal health care services are most often preferred. The majority (60%) of patients’ spontaneous itineraries reflect the expected functioning of a local health care system, with a patient flow characterised by the use of a first line health facility prior to the use of hospital-based services. Chronicity of the disease is the main determinant of seeking formal care. Analysis of care expenditure reveals that drugs are the only line of expenditure in the informal system and the main source of expenditure in the formal system; costs do not discriminate between first-line health services and hospitals, and the payment system is regressive since the poorest patients pay the same amounts as the richest.ConclusionsThis study points to the importance of self-medication as the first therapeutic option for the majority of patients in Lubumbashi, whatever the nature of the health problem. There is a lot of room to rationalise this practice. Although formal care is not common initial therapeutic option, it is the source of care most patients turn to, especially when they believe having a chronic disease. Patients’ itineraries in this urban environment are complex; health managers should try and deal with this reality. Finally, our study indicates that poor patients face the same level of out-of-pocket payments as the more wealthy ones, hence the need for more equitable health care financing arrangements.

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“…In South-East Asia, U5MR declined from 72 to 27 per 1,000 live births during the period 1990–2015, where NMR declined from 28 to 13 per 1,000 live births during the same time span [3] [4]. Changes in the levels of infant and child mortality also differed by socio-economic status of the household and level of education of the mother and various studies attribute declines in mortality to the combined effects of improved health care practices and socio-economic advancements [5] [6] [7]. In Cambodia, data from Demographic and Health Surveys (DHS) show a substantial decline in mortality rates; yet, NMR remains high at 18 per 1,000 live births [4] [8] [9] [10].…”

Section: Introductionmentioning

confidence: 99%

The unfinished health agenda: Neonatal mortality in Cambodia

Hong¹,

Ahn²,

Wieringa

et al. 2017

PLoS ONE

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BackgroundReduction of neonatal and under-five mortality rates remains a primary target in the achievement of universal health goals, as evident in renewed investments of Sustainable Development Goals. Various studies attribute declines in mortality to the combined effects of improvements in health care practices and changes in socio-economic factors. Since the early nineties, Cambodia has managed to evolve from a country devastated by war to a nation soon to enter the group of middle income countries. Cambodia's development efforts are reflected in some remarkable health outcomes such as a significant decline in child mortality rates and the early achievement of related Millennium Development Goals. An achievement acknowledged through the inclusion of Cambodia as one of the ten fast-track countries in the Partnership for Maternal, Newborn and Child Health. This study aims to highlight findings from the field so to provide evidence for future programming and policy efforts. It will be argued that to foster further advances in health, Cambodia will need to keep neonatal survival and health high on the agenda and tackle exacerbating inequities that arise from a pluralistic health system with considerable regional differences and socio-economic disparities.Methods/FindingsData was drawn from Demographic Health Surveys (2000, 2005, 2010, 2014). Information on a series of demographic and socio-economic household characteristics and on child anthropometry, feeding practices and child health were collected from nationally representative samples. To reach the required sample size, live-births that occurred over the past 10 years before the date of the interview were included. Demographic variables included: gender of the child, living area (urban or rural; four ecological regions (constructed by merging provinces and the capital), mother’s age at birth (<20, 20–35, 35+), birth interval (long, short) and birth order (1st, 2–3, 4–6, 7+). Socio-economic variables included: mother education level (none, primary, secondary+) and household wealth (asset-based index). Data on antenatal care, tetanus injection and skilled assistance at birth were used for the mother's last child.Between 2000 and 2014, Cambodia achieved a considerable reduction in neonatal mortality (46% reduction rate). By 2014, gender inequities became almost non-existent (for all measures of equality); inequity related to mother’s education decreased for all time periods; improvements were observed for differences in neonatal mortality by preceding birth interval; and a reduction in neonatal mortality rates could be noted among all the regional subgroups. Inequities increased between mothers who had limited antenatal care and those who received more than four antenatal care visits. In most scale indicators, the Slope Index of Inequality and Relative Index of Inequality estimates for all four rounds of the survey suggest inequity exacerbated in deprived communities. Also, wealth and residence (urban/rural divide) continued to be major determinants in neonatal m...

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Composition of pluralistic health systems: how much can we learn from household surveys? An exploration in Cambodia

Cited by 60 publications

References 20 publications

Fairness of Utilizing Health Care Facilities and Out-of-Pocket Payment Burden: Evidence From Cambodia

Fairness of Utilizing Health Care Facilities and Out-of-Pocket Payment Burden: Evidence From Cambodia

Health-seeking behaviour in the city of Lubumbashi, Democratic Republic of the Congo: results from a cross-sectional household survey

The unfinished health agenda: Neonatal mortality in Cambodia

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