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Access to Treatment for Diabetes and Hypertension in Rural Cambodia: Performance of Existing Social Health Protection Schemes

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  • Maryam Bigdeli
  • Bart Jacobs
  • Chean Rithy Men
  • Kristine Nilsen
  • Wim Van Damme
  • Bruno Dujardin

Abstract

Background: Non-communicable diseases (NCD) pose challenges to Cambodia’s health system. Medicines for NCD are on the National Essential Medicines List but no clinical guidelines support their utilization. Two social health protection schemes aimed at the informal sector population exist (Health Equity Funds and Insurance) together with two disease-specific interventions (a Peer Educator Network and Chronic Diseases Clinics) targeted at NCD patients. This study examines performance of these various schemes in relation to NCD. Methods: Cross-sectional household survey among 709 individuals self-reporting diabetes and/or hypertension in three geographical locations in rural Cambodia using a structured questionnaire investigating diagnostic and treatment pathways, health seeking behaviour, health expenditures, and financial coping mechanisms. Results: Two third of respondents with NCD were female and 55% did not belong to any scheme. The majority (59%) were diagnosed in the private sector and only 56% were on allopathic treatment that was mainly sought in the private sector (49%). Outpatient treatment cost was higher in the private sector and when using multiple providers of care. The majority were indebted, 11% due to health-related expenses. Contrary to social health protection schemes, disease-specific interventions offered better access to allopathic treatment and provided medicines in accordance with NEML. Conclusion: The benefit packages of existing social health protection schemes and services in the public health sector should be adjusted to cater for the needs of people living with NCD in rural Cambodia. Initiatives that offer active disease management strategies and promote patients and community participation appear more successful in increasing treatment adherence and decreasing the risk of financial hardship.

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  • Maryam Bigdeli & Bart Jacobs & Chean Rithy Men & Kristine Nilsen & Wim Van Damme & Bruno Dujardin, 2016. "Access to Treatment for Diabetes and Hypertension in Rural Cambodia: Performance of Existing Social Health Protection Schemes," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-18, January.
    • Handle: RePEc:plo:pone00:0146147
    DOI: 10.1371/journal.pone.0146147
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    1. Dell D. Saulnier & Claudia Hanson & Por Ir & Helle Mölsted Alvesson & Johan Von Schreeb, 2018. "The Effect of Seasonal Floods on Health: Analysis of Six Years of National Health Data and Flood Maps," IJERPH, MDPI, vol. 15(4), pages 1-13, April.
    2. Fukushi Morishita & Rajendra-Prasad Yadav & Mao Tan Eang & Saly Saint & Nobuyuki Nishikiori, 2016. "Mitigating Financial Burden of Tuberculosis through Active Case Finding Targeting Household and Neighbourhood Contacts in Cambodia," PLOS ONE, Public Library of Science, vol. 11(9), pages 1-22, September.
    3. Rika Idei & Hironori Kato, 2020. "Medical-purposed travel behaviors in rural areas in developing countries: a case study in rural Cambodia," Transportation, Springer, vol. 47(3), pages 1415-1438, June.
    4. Sokunthea Koy & Franziska Fuerst & Bunnareth Tuot & Maurice Starke & Steffen Flessa, 2023. "The Flipped Break-Even: Re-Balancing Demand- and Supply-Side Financing of Health Centers in Cambodia," IJERPH, MDPI, vol. 20(2), pages 1-20, January.
    5. Miriam Karinja & Goonaseelan Pillai & Raymond Schlienger & Marcel Tanner & Bernhards Ogutu, 2019. "Care-Seeking Dynamics among Patients with Diabetes Mellitus and Hypertension in Selected Rural Settings in Kenya," IJERPH, MDPI, vol. 16(11), pages 1-15, June.
    6. Hiroki Wakamatsu & Seiichi Fukui & Kana Miwa, 2019. "Heterogeneous Preferences for Micro Health Insurance Attributes in Rural Cambodia: Latent Class Analysis," Economics Bulletin, AccessEcon, vol. 39(4), pages 2963-2975.

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