In Cambodia, only 30 % of the population benefits from health insurance. How to ensure universal access to health services and improve the quality of healthcare? In order to address these challenges, GRET is working in close collaboration with institutional actors to sustainably extend social security coverage in the country.
After the fall of the Khmer Rouge regime, Cambodia opened up economically and politically in the 1990s, and its healthcare system was reconstructed. Life expectancy increased from 55 in 1990 to 75 in 2022, but there are still some healthcare challenges to be resolved. Public funding of healthcare remains low, at 1.4 % of GDP in 2017, and users contribute significantly more (62 %) than the State (23.8 %). The majority of health infrastructures and professionals are located in cities, despite the fact that the majority of the population live in rural areas. The Cambodian healthcare system must meet two major challenges: ensure fair access to health services for its users and improve the quality of healthcare.
In this context, since the end of the 1990s, GRET has been providing technical support to Cambodia to test health insurance policies that are appropriate, for example to rural areas, with the creation of a community-based health insurance programme (Sky micro health insurance project) and the implementation of a compulsory health insurance system in the formal textile sector (HIP health insurance project, funded by AFD in partnership with the Cambodian Social Security Fund, the NSSF). These initiatives were gradually transferred to local authorities or local operators supported by grants.
Learn more: 25 years of action to promote access to healthcare in Cambodia (April 2023)
With the SPIN project [1], GRET is supporting the NSSF to roll out a pilot project extending health insurance to the informal sector. In Cambodia, out of a total labour force of 7.9 million people, it is estimated that 6.1 million work in the informal sector. With SPIN, GRET’s support is no longer based on knowledge of tools and systems, it focuses on strategic advice and support for the implementation of activities aimed at maximising health coverage for vulnerable populations. In this context, SPIN, which was launched at the end of 2018, is initially targeting particularly vulnerable populations that are difficult to reach: Tuk-tuk drivers and domestic workers. Through this system, for a contribution of less than 4 euros per month, Tuk-tuk drivers can avail of ambulatory care, hospitalisation, maternity and emergency services.
“We had been hoping for a long time to become members of the NSSF”
“I barely earn enough to make ends meet, and sometimes I don’t have enough money to pay for medical treatments… I earn between 30,000 and 50,000 riels per day (between around 7 and 10 euros). Now that I have access to social security, I can save a little money in case I fall ill. If I did not have this access, I would have to spend all the money I earn and it wouldn’t even be enough to cover the costs. Myself and all those who work in the informal sector or as freelance workers are happy to be able to avail of health services… We had been hoping for a long time to become members of the NSSF.”
Phy Samoul, tuk-tuk driver in Phnom Penh
