2024-Q4 Quarterly Review
Primary Prevention Activities
In October, our Program team, along with the Peer Educator Networks, conducted primary prevention and health promotion activities focused on high blood pressure and diabetes in two Operational Districts (OD):
- OD Prey Kabas, Takeo Province:
- Communes: Khun Sla, Ang Kanh, Char, Kdach, and Taking Yab.
- Participants: 194 attendees.
- Activities: Distribution of free urine glucose test strips for adult self-testing in 13 villages in Sla commune (5,726 test strips) and 6 villages in AnKanh commune (4,284 test strips).
- OD Boribo, Kampong Chhnang Province:
- Villages: Snor, Doeum Chrey, Kork, PorPel, and Kan Seng.
- Activities: Distribution of 2,380 test strips at the village level and 11,957 test strips across 20 villages in 3 communes.
Short Trainings done in Q4:
- Medical Doctors’ Training:
- Financial support for two medical doctors from Pochentong Referral Hospital to receive a two-week refresher training at Sihanouk Hospital Center of Hope.
- Peer Educator Training:
- Annual refresher training organized for 71 participants, including ODPM and Peer Educators from 26 ODs across 12 provinces.
General Secretariat on Social Health Protection
Cambodia’s Universal Health Coverage Plan (2023 – 2033) mentions a potential role for Revolving Drug Funds (RDFs). There are two RDFs in Cambodia: one funded by KOFIH (covering Pailin, Battambang, and Pursat) and MoPoTsyo’s RDF. The World Bank and development partners supported a study on the experiences with these RDFs. A WB consultant, a former European Vice Minister for Health, visited the Korean RDF in Pursat, Kampong Chhnang, and Kang Meas OD to observe MoPoTsyo’s RDF operations.
Annual Review Meetings with Counterparts
Since 2012, we have held annual Q4 meetings with counterparts in 28 ODs to discuss the progress of the RDF. We use standard performance indicators, including patient feedback and adherence to prescriptions issued by government doctors. Performance scores are used to calculate revenue sharing, which is then divided among local operators and stakeholders using standard formulas. This year, we also discussed important changes that will take place in 2025.
Preparing for Important Changes in 2025
End November 2024, an official meeting at the Ministry of Health (MoH) discussed changes in how MoPoTsyo can continue to support diabetes and high blood pressure care via Cambodia’s public health facilities.
Background to the changes:
When MoPoTsyo’s program started 20 years ago, there were no public health services for patients with non-communicable chronic conditions like diabetes and hypertension. MoPoTsyo began building an affordable and accessible chronic care system, partnering with hospitals and health centers, providing medical supplies through MoPoTsyo’s RDF, organizing short trainings for doctors and community-based peer educators, and maintaining a database with patient electronic medical records. The care system was financed mainly through patient contributions collected by public health staff on behalf of our NGO.
Challenges
As Cambodia’s Social Health Protection mechanisms develop, structural challenges have emerged:
- No operational links exist between the MoPoTsyo system and social health protection schemes.
- MoPoTsyo has relatively low coverage, with only a fraction of diabetes and hypertension patients having access to care.
Changes in 2025
The Ministry of Health (MoH) is prioritizing diabetes and hypertension care, investing in the creation of primary care for these conditions. The MoH aims to supply medicines nationally through hospitals and health centers, not just to MoPoTsyo members at referral hospitals.
- Medicine Supply:
- MoH will supply basic medicines, while MoPoTsyo will provide complementary RDF medicines.
- Hospitals and health centers will use Electronic Medical Records (EMR) to replace MoPoTsyo’s database.
- Financial Changes:
- MoPoTsyo will stop charging patients directly for medication and will sell RDF medicines to public primary care facilities directly.
- Hospitals and health centers will finance MoPoTsyo’s supplies through a combination of user fees (up to 39%) and government budget funds.
Advantages
- Access to medicines for all patients with prescriptions from the facility.
- Social health protection systems will reimburse hospitals for services provided to entitled patients.
- No 10% VAT on the sale of these medicines if public facilities have exemption certificate.
- Patients may receive medicines closer to their place of residence.
The new system will start in 2025, once software tracking medicines from arrival in stock to dispensing to patients is in place. MoPoTsyo will need to find a new financial break-even by complementing MoH supply through revenue from MoPoTsyo sales to health facilities. In 2025 and 2026, we will find out if our RDF supply will be steady and consistent enough to forecast and to be able to plan to continue the Revolving Drug Fund.