1. Buddhism for Health (BFH) is a local
non- profit, humanitarian organiza-
tion dedicated to working with
communities to enable the poor
and marginalized to integrate in
society through building social
capital. As such, BFH support com-
munities t o identify the poor and
organize fund raising activities to
which they financially contribute.
To ensure that the near poor
and informal sector can also bene-
fit from equitable access to public
health services, in June 2006,
Buddhism for Health established
a Community-Based Health Insur-
ance (CBHI) scheme. The scheme's
name was chosen to be Pagoda
Based Health Insurance (PBHI) to
exemplify its association with the
faith-based organizations concerned.
Currently 10,700 people are vol-
untarily enrolled with this PBHI.
Between 2006 and 2008 the PBHI
scheme was supported by Swiss
Red Cross. However, since 2009,
the scheme has been receiving fund-
ing from AFD through GRET/SKY.
Coverage, enrollment and premium
PBHI operates throughout
Kirivong Operational District (OD),
Takeo Province, covering three and
a half Administrative Districts. The
target population in the OD is
167,170 people (excluding the
poor). A significant number of peo-
ple live in 'enclave' areas where
transportation and communication
is not easy, especially during the
rainy season .
Roughly 80% of the Kirivong popula-
tion lives from farming (rice and
food crops). The others main catego-
ries of employment are garment
work in Phnom Penh, fishing, the
civil service, market sales, and
NGOs. Roughly 95% of the popula-
tion is Buddhist. The remaining 5%
are either Muslims or Christians.
There are more than 90 pagodas (one
pagoda for every two or three vil-
lages) and 6 mosques in the areas
covered by BFH and, as of March
2011, 2,013 families (10,765 mem-
bers) had joined the scheme. This is
equal to 6.44% of the total tar-
geted population.
CBHI NETWORK FACTSHEET
BUDDISHM FOR HEALTH
(BFH)
Background
CBHI members from 2007 to 1st quarter 2011
PBHI has developed its membership
with an impressive growth rate (17%
in 2007; 98% in 2008; 88% in
2009; and 45% in 2010). The
drop-out rate for members was 48%
in 2007; 1.8% in 2008; 5% in 2009;
and14.6% in 2010. However, in
2011, it is expected to be higher
because some members have been
pre-identified as poor by the Min-
istry of Planning and are therefore
eligible to receive access to public
health care services free of charge
through a Health Equity Fund (HEF).
Family mem-
bers
Annual premium
1 28,800 Riel/family
2-4 63,400 Riel/family
5-6 88,800 Riel/family
7-8 114,400 Riel/family
≥ 9 126,000 Riel/family
0
2000
4000
6000
8000
10000
12000
2007 2008 2009 2010 1st
Quarter
2011
2081
4003
7513
10624 10765
Series1

2. PBHI has developed a range of
social marketing approaches
through the community partici-
pation structure of the opera-
tional district ( the Health Cen-
tre Management Committee
(HCMC) and VHSG) and other
channels:
1. BFH is in charge of develop-
ing the marketing plan, and
provides technical support to all
insurance agents , VHIV and
(HCMC) including:
A. Taking the lead information
and sensitization campaigns
B. Leading in the process of
member assembly and other
important meetings
C. Addressing people’s
questions and possible frus-
trations concerning the
functioning of the PBHI.
D. Handling critical incidents
2– The Health Center Man-
agement Committee Chief is
selected per health center.
He/she spend at least two
(continue to next page)
Service providers and quality
Marketing and community engagement strategies
Benefit package and utilization
caused by accidents.
4. Prescription drugs on
Non-Essential Drug List
(applicable at Takeo Pro-
vincial Hospital and at the
contracted private pharmacy
only).
5. Transport in emergencies
and by hospital ambulance for
referral from health centres
to the district hospital and
to the provincial hospital,
(with 20,000 Riel per case
also provided to cover
transport back home ).
6. Grants : in the event of
death, an insured member's
family are provided with
50,000 Riel; and if an insured
person aged ≤ 14 years is
referred from the contracted
district hospital or provincial
hospital to Kunthea Bopha
or National Children Hospi-
tal, his/her family will be
provided with 80,000 Riel.
All insured members are
entitled to receive a range
of specified medical and
non-medical benefits: :
1.Consultations, examina-
tions and procedures at all
contracted health facilities
in-line with the agreed refer-
ral system
2. Inpatient and out-patient
care, including diagnostic
tests.
3. Treatment of injuries
Page 2BUDDISHM FOR HEALTH
Services at the following
public health care provid-
ers are available through
BFH: 20 MPA health
centers (HCs) and two
health posts, Takeo Provin-
cial Hospital (CPA3),
Kirivong Referral Hospital
(CPA2) and Rominh Annex
to Kirivong Referral Hospi-
tal (CPA1).
The referral mechanism
was developed according
to the Ministry of Health
guideline to effectively man-
age the delivery of health
services to all members.
Provider payments are by
capitation at HCs and the
district referral hospital and
through fee-for-service at
two hours in the morning at
health center to facilitate
insured members.
3. BFH medical advisors ob-
serve the quality of clinical
aspects of health centre ser-
vices on a quarterly basis. 4.
Quarterly Member Assembly
Meetings are held to get and
provide feedback from/to
members.
5. Village Health Insurance
Volunteers (VHIVs) provide a
monthly feedback report on
quality of health services and
BFH services.
6. Hotline numbers are
written on each member-
ship card as well as posted
on BFH sign boards at each
health facilities in case of emergency
or for any member inquiries.
7. Exit interview are conducted
with discharged PBHI members to
measure perceptions of service qual-
ity.
8. A Quality Assurance Committee
has been established in tandem
with the Continuum of Care Com-
mittee (CoC) for People Living
with HIV/AIDS (with meetings held
monthly after the CoC meeting
to avoid paying per diems twice).
9. The district health development
committee meets every two months
and consider any complaints from
members.
10. A health Financing Committee
ensures all compliances of both
health operators and health provid-
ers to the terms set out in the con-
tract/ MOU.
the provincial hospital. The
PBHI scheme acts as a finan-
cial intermediary between
its members and con-
tracted health care provid-
ers to ensure the provision
of accessible, affordable
health services including
provision of quality services
to PBHI members.
To ensure quality is main-
tained, BFH-PBHI has devel-
oped the following meas-
ures.
1. A sound contract with
respective health facilities;
2. Insurance Agents stay
Utilization at health center and hospital facilities
from 2008 to 2010
Income from premium collection V. technical expenses from 2008-2010
Services 2008 2009 2010
Health
center
OPD 7904 13759 21854
Delivery 70 138 159
ANC 58 73 93
Hospital OPD 733 626 915
IPD 671 453 767
Delivery 110 95 112
Major
surgery
3 5 21
0
10000
20000
30000
40000
50000
60000
70000
80000
Income from premium
coverage
Technical expenses
(medical and non‐
medical benefits
costs)
73983
58047
Series1

3. Key challenges faced during the opera-
tion of the schemes include:
1. A difficult economic environ-
ment has impacted on the scheme’s
growth i.e. new registration and
premium collection from existing
members has been more difficult
and drop out remains high.
2. Unregulated private practitio-
ners (including contracted health
facilities’ staff members).
3. Issues related to quality of
OPD consultation at HCs that
could be influencing people’s trust
and the functioning of the referral
system.
4. Lack of medical doctors at the
district referral hospital
5. During the Pre-ID Poor proc-
ess of the Ministry of Planning,
many PBHI members were identi-
fied to be 'level2' poor which
means they may be eligible for
Health Equity Fund and withdrawn
as members.
6. Absence of historical prece-
dent with insurance
7. High expectations of insured
members.
Future plans include:
1. Strengthen premium collection
system, IT system and IA’s per-
formance related pay.
2. Strengthen the functioning of
the social marketing system in
order to attract more voluntary
members and obtain economies of
scale.
3. Improve transportation mecha-
nisms for referral cases from
remote/ flood-prone areas.
4. Reconsider the current provider
payment mechanism.
5. Pilot integration of CBHI &
HEF in Kirivong .
Challenges, lessons learned and future plans
Case study
To contact BFH:
Contact person: Mr.
Sam Sam Oeun
Position: Deputy
Executive Director
a n d P r o g r a m
Director
Mobile no. (+855)
16 731 987
Office no. (+855) 32
6 900 729
E-mail address:
bfh_pro_mg@mfon
Page 3BUDDISM FOR HEALTH
(hours per day in the morn-
ing at health centers to facili-
tate insured members. The
rest of his/her time is spent
in outreach activities at
pagodas, liaising with HCMC
members/monks for PBHI
promotion through pago-
das, and in regular visits to
each village to promote
health insurance in close
collaboration with VHIGs.
3. Village Health Support
Volunteers (VHSV) undertake
the following activities:
A. Assisting health center
staff in outreach services.
B. Performing health educa-
tion activities for villag-
ers.
C. Providing feedback reports
on health quality of health
services. Further, all HCMC
members are requested to
disseminate basic informa-
tion regarding PBHI to the
population who come to
the pagoda every week on a
Sunday.
Village meeting in Kbal Dromey
village, Kork Pich HC
Mrs. Vong Chanthrea is 26
years old and lives with 4
members of her family in
Prasat village, Kam Peng
Commune, Kirivong district,
Takeo province. Her family
has been enrolled in the
PBHI scheme since 2008.
BFH staff interviewed her in
April 2011 at her house and
she told them that: "Before
my family wasn't a member of
health insurance, a majority of
our family income from rice
planting was spent on health-
care. From 2008 until now, we
have had many problems with
illness. For instance, in 2008,
my baby was self-aborted and
couldn't be helped by the
health center midwives, and I
was referred to Kirivong Refer-
ral Hospital and saved by the
hospital doctors.
In 2009, I was facing another
complicated delivery but this
time I could not even be
helped by the district hospital,
and I was then referred to
Takeo Provincial Hospital for
surgery. Again, I myself was
saved but my child could not
be helped.
One November 2, 2010, I
again came to Kam Peng HC
for the birth of my daughter.
But after delivery, I was feeling
weak because of a lot of bleed-
Ing and was immediately re-
ferred by an ambulance to
Kirivong Referral Hospital. This
time, I and my daughter were
safe. We thanked the doctors
who saved us a lot.
My family has faced many
catastrophic illnesses as men-
tioned above. However, we
didn't need to pay much or sell
our assets for these catastro-
phes because our family is a
BFH member. All expenses
related my treatments including
costs of many minor healthcare
expenses at HC for my family's
members during these three
years have been covered by the
related to my treatments including
costs of many minor healthcare ex-
penses at HC for my family members
during these three years have been
covered by the health insurance. Right
now, I and all my family members are
in good health. We always seek
healthcare on time, and we won’t let
our health fall into a serious state as
before. This has helped our living
conditions we had to become much
better than before health insurance".
Mrs. Vong Chanthrea’s family