Reaching out to the poor and the informal sector is a major challenge for achieving universal coverage in lesser-developed countries. In Cambodia, extensive coverage by health equity funds for the poor has created the opportunity to consolidate various non-government health financing schemes under the government's proposed social health protection structure. This paper identifies the main policy and operational challenges to strengthening existing arrangements for the poor and the informal sector, and considers policy options to address these barriers. Conducted in conjunction with the Cambodian Ministry of Health in 2011-12, the study reviewed policy documents and collected qualitative data through 18 semi-structured key informant interviews with government, non-government and donor officials. Data were analysed using the Organizational Assessment for Improving and Strengthening Health Financing conceptual framework. We found that a significant shortfall related to institutional, organisational and health financing issues resulted in fragmentation and constrained the implementation of social health protection schemes, including health equity funds, community-based health insurance, vouchers and others. Key documents proposed the establishment of a national structure for the unification of the informal-sector schemes but left unresolved issues related to structure, institutional capacity and the third-party status of the national agency. This study adds to the evidence base on appropriate and effective institutional and organizational arrangements for social health protection in the informal sector in developing countries. Among the key lessons are: the need to expand the fiscal space for health care; a commitment to equity; specific measures to protect the poor; building national capacity for administration of universal coverage; and working within the specific national context.

译文

接触穷人和非正规部门是在欠发达国家实现全民覆盖的主要挑战。在柬埔寨,卫生公平基金对穷人的广泛覆盖创造了机会,可以在政府拟议的社会卫生保护结构下巩固各种非政府卫生筹资计划。本文确定了加强针对穷人和非正规部门的现有安排的主要政策和业务挑战,并考虑了解决这些障碍的政策选择。该研究于2011-12年与柬埔寨卫生部联合进行,审查了政策文件,并通过与政府,非政府和捐助者官员进行的18次半结构化关键线人访谈收集了定性数据。使用组织评估对数据进行了分析,以改善和加强卫生筹资概念框架。我们发现,与机构,组织和健康筹资问题有关的严重短缺导致分散,并限制了社会健康保护计划的实施,包括健康公平基金,社区健康保险,代金券等。关键文件提议建立一个统一非正规部门计划的国家结构,但仍未解决与国家机构的结构,机构能力和第三方地位有关的问题。这项研究增加了发展中国家非正规部门社会健康保护适当和有效的体制和组织安排的证据基础。主要经验教训包括: 需要扩大医疗保健的财政空间; 对公平的承诺; 保护穷人的具体措施; 建设国家管理全民覆盖的能力; 并在特定的国家背景下开展工作。

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