Quarterly Review 1 – 2025
(January, February, March 2025)
Primary Prevention: During the first quarter of 2025, the peer educator teams in Operational District (OD) Boribo, (Kampong Chhnang province) conducted health promotion and urine glucose strip distribution in three villages located within three communes in the catchment area of Chhok Tru Health Centre (HC). As part of raising awareness regarding Non-Communicable Diseases (NCDs) and their prevention, 4,801 urine glucose test strips were distributed to adult villagers for self-testing two to three hours after lunch. This was also undertaken in OD Prey Kabas in Takeo Province across 19 villages (two communes) within the catchment area of Tang Yab HC, where 12,165 free urine glucose strips were distributed to adult villagers. The activity has also begun in Krouch Chhmar in Tboung Khmum province.
A New Revolving Drug Fund Deal for 2025: We have been meeting with our counterparts to determine a new method for supplying medicines to patients. More medicines from the Ministry of Health’s Central Medical Store have now arrived at the pharmacies of our counterpart hospitals, following their commencement of patient reporting through the official records, which is a prerequisite for qualifying for government supply. While this is indeed encouraging, several issues still require consideration:
- The hospitals are neither trained in nor using the Electronic Medical Record (EMR) software and computers. Should stocks become integrated, the tracking of medicine inflows from diverse sources by LOT number and their allocation to specific patients is not yet in place, which presents a potential weakness in the system.
- Some directors of public health facilities believe they cannot procure each of the Revolving Drug Fund (RDF) medicines (items) that patients require because these medicines are not included on the Central Medical Store (CMS) list that dictates their allowable expenditure. This is significant as not all necessary items for stabilising patients’ conditions are being supplied, and those that are provided often arrive in insufficient quantities. Without the EMR, healthcare staff at lower levels may alter optimal prescriptions.
- The decades-old regulations within the Health Financing Charter (issued by the Council of Ministers in the 1990s) have not been updated to align with Cambodia’s contemporary public health system. Presently, the Health Financing Charter must also facilitate the recovery of health facility costs associated with chronic maintenance care. The 30-year-old rule, allocating income from User Fees and Reimbursements (1% for MoEF, 39% for quality including medicines, 60% for staff incentives) for acute new cases, is no longer fully adequate. While suitable for its original purpose, reflecting the “cost and staff time” of acute care and a 3-5 day supply of medicine, it now seems appropriate to append (not replace!) it with a revised formula that better reflects the distinct “cost and staff time of chronic-disease-maintenance care provided by government health facilities in partnership with a revolving drug fund”. Based on MoPoTsyo’s own experience with revolving drug funds, an allocation of 1% for MoEF, 80% for quality including medicines, and 19% for staff incentives is considered a more suitable arrangement to finance “revolving” of the medicines.
- While the accounting and utilisation of revenue from Revolving Drug Fund-related user fees are not within MoPoTsyo’s purview, the allocation of 60% for incentives means that 60% cannot revolve and must be covered by the government budget. This raises questions regarding necessity, improvement, optimality, and strategic alignment for financing an RDF in the face of increasing NCD chronic disease prevalence and the growing number of chronic patients in the future.
- Establishing “a split of the accounting of user fee revenue into two categories: 1-month chronic maintenance care user fee revenue and normal acute care user fee revenue seems feasible but requires higher level government bureaucracy permission”, or so we are informed when this matter is raised.
- Currently, stable patients receiving two months’ worth of medication from the RDF consult five to six times per year solely to obtain a repeat prescription. Should these stabilised patients receive only a two-week or one-month supply, would they then consult the doctor 13 to 26 times annually, thus increasing the workload for doctors and healthcare staff in the primary care system? Many of MoPoTsyo’s patients are stable on medicines not available at their Health Centre level, rendering referral to a local health centre for ongoing treatment an unsuitable solution. It is too early to definitively determine the outcomes, and much will depend on the MoH CMS’s medicine supply (including insulin and syringes) for all these stabilised patients. It remains to be seen whether hospital staff will manage the increased workload or identify ways to mitigate it.
Despite the aforementioned challenges, counterparts and MoPoTsyo have continued to operate under the existing arrangements while preparing for the introduction of a new way of working. We have prepared several versions of agreements for discussion with implementing partner hospitals. In the second quarter of this year, we will plan the implementation of a New Deal RDF in at least one hospital expressing interest. With the increased flow of medicines from CMS and their availability, we will transition to a more complementary supply role at the initial health facility. We anticipate that the MoH’s new Electronic Medical Record (EMR) – slated for introduction in the fourth quarter of 2025 – will enable health facilities to view the doctor’s prescription for a registered patient. Subsequently, a patient can be registered at any location, while the local Health Centre (HC) and the Referral Hospital (RH) can dispense medication based on the same EMR prescription. Such patients could then receive monthly medication from the HC with check-ups and referrals to the RH as per guidelines.
Other issues: An independent assessment of the 2 RDF’s in Cambodia, conducted by a World Bank consultant, has presented its findings in a Non-Communicable Diseases Learning event Ministry of Health. On balance a positive view of MoPoTsyo’s RDF emerged.
During the annual review workshop in Banteay Meanchey province, MoPoTsyo received a Certificate of Appreciation from the Provincial Health Department for its work in Thmar Pouk Operational District where a peer educator network for diabetes and hypertension has been active since 2009.
Oudong Referral Hospital: In March, we met with our counterparts who wish to initiate laboratory services and include MoPoTsyo members. Currently, MoPoTsyo provides this service there once per month. In May 2025, the hospital will begin offering the laboratory profile service at the same prices as MoPoTsyo to its members, but on a weekly basis. Over time, we anticipate a decline in demand for MoPoTsyo’s lab service. However, to ensure a smooth transition, both parties have agreed to maintain the MoPoTsyo laboratory session once a month as usual, allowing patients to choose their preferred service. For medical consultation activities, they still prefer to maintain the existing system.