Cambodia - Health debt bedevils familes in need

Ten months after taking out a $200 loan with a steep interest rate from a village moneylender in Siem Reap province, a young mother still struggling to pay for her late husband’s AIDS treatment had sunk $500 into debt.

The HIV-positive widow had sold all her property to help pay for her husband’s care and felt that she would “never be able to pay back her outstanding debts”, she told researchers conducting a study on healthcare-incurred debt among poor Cambodians.

The study, published on Tuesday in the health journal BMC Health Services Research, concludes from interviews with 47 indebted Cambodian households that the government needs to regulate interest rates set by informal lenders.

“Access to formal credit suppliers, especially for the poor, is limited,” the study states. “Hence, [the poor] rely on loans with high interest rates from informal creditors. Consequently, many become heavily indebted, with considerable potential for further impoverishment.”

The researchers note that a previous study found that 62 per cent of Cambodians known to have borrowed money to pay for dengue treatment were still paying off their debts and associated interest after one year.

In the present study, “in response to the question of how would they pay off the debt, the large majority of the respondents said that they had no way to do so”, the researchers write.

“For those who thought they were able to repay, most would resort to selling their last piece of land, working more or borrowing from relatives and friends.”

The researchers note that health equity funds provided by Cambodia’s government and development partners often help alleviate pressures to pay off healthcare-related debts by offering poor Cambodians subsidised care from certain providers.

But 82 to 83 per cent of poor Cambodians eligible for such funds still ended up taking loans due to a frequent preference for private rather than public healthcare providers and to associated expenses not covered by the funds, such as transportation, they write.

Officials from the Ministries of Health, Social Affairs and Finance could not be reached for comment yesterday.

Justine Drennan

http://www.phnompenhpost.com/

Cambodia - The social determinants of health and health service access: an in depth study in four poor communities in Phnom Penh Cambodia

Increasing urbanization and population density, and persisting inequities in health outcomes across socioeconomic groupings have raised concerns internationally regarding the health of the urban poor.

These concerns are also evident in Cambodia, which prompted the design of a study to identify and describe the main barriers to access to health services by the poor in the capital city, Phnom Penh. Sources and Methods Main sources of data were through a household survey, followed by in-depth qualitative interviews with mothers, local authorities and health centre workers in four very poor communities in Phnom Penh. Main findings Despite low incomes and education levels, the study communities have moderate levels of access to services for curative and preventive care.

However, qualitative findings demonstrate that households contextualize poor health and health access in terms of their daily living conditions, particularly in relation to environmental conditions and social insecurity. The interactions of low education, poor living conditions and high food costs in the context of low and irregular incomes reinforce a pattern of "living from moment to moment" and results in a cycle of disadvantage and ill health in these communities.

There were three main factors that put poor communities at a health disadvantage; these are the everyday living conditions of communities, social and economic inequality and the extent to which a society assesses and acts on inequities in their health care access.

Conclusions: In order to improve access to health and health services for the urban poor, expansion of public health functions and capacities will be required, including building partnerships between health providers, municipal authorities and civil society.

Author: Sann Chan SoeungJohn GrundyHean SokhomDiana Chang BlancRasoka Thor

Credits/Source: International Journal for Equity in Health 2012, 11:46

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