Bulletin of the World Health Organization

Barriers to access and the purchasing function of health equity funds: lessons from Cambodia

Maryam Bigdeli & Peter Leslie Annear

Volume 87, Number 7, July 2009, 560-564

Table 1. Ability of health equity funds to address access barriers

Access barriers Addressed HEF roles
Financing Community Quality assurance Policy
Physical
Distance No
Means of transport Partly Yes – transport costs
Waiting time Yes Yes – control at facility
Financial
Direct and indirect formal costs Yes Yes – user fees, transport and food Yes
Informal charges Yes Yes – user fees, transport and food Yes – control at facility
Opportunity costs No
Quality of care
Perceived quality Yes Yes – control at facility Yes to all, especially dialogue for a regulatory and monitoring framework
Uneven clinical skills No
Staff attitudes Yes Yes – control at facility
Maintenance of facilities Yes Yes – income for facility
Equipment and material Partly Idem – not valid for capital investment
Drug availability Partly Idem – local purchase only
Regulatory mechanisms Partly
Public–private dual practice Partly
Knowledge of users
Confidence in public facilities Yes Yes to all, active presence in the community, pre-identification Yes, policy dialogue at community level
Information on available services Yes
Knowledge of user fees and other schemes Yes
Uncertainty about informal charges Yes
Understanding of community participation mechanisms Yes
Sociocultural barriers
Intra-household constraints such as age or gender Long-term impact Yes to all. Active presence in the community, post-identification, community participation in pre‑identification Yes, policy dialogue at community level
Preference for home care Long-term impact
Preference for traditional healers Long-term impact
Seasonal ability to pay Partly

HEF, health equity funds.