Vouchers for Reproductive Health Services Project - Epos

5 TH NEWSLETTER
Special points of
interest:
� Challenges in Voucher
Distribution
� Quality Assessment Results
Inside this
issue:
A word from the
Team Leader
Community Based
Health Insurance
(CBHI) & Health
Equity Fund
(HEF) Linkage
with vouchers
Linkages Experiences
(cont’d)
1
1
2
Challenges in
Voucher Distribu- 2
Quality Assessment
Results
3
LSS training 3
Latest News 4
Vouchers for Reproductive
Health Services Project
A word from the team leader
The last months were pivotal in
the lifetime of the Voucher
Project. First of all, we managed
as a team to make important
improvements in
voucher distribution by paying
more attention to the voucher
promoters who are key staff in
the field and to involve them,
together with peripheral management,
in the decision making
process. The results of these
efforts became immediately
visible as some graphs in this
newsletter will show. Besides
the improvement of access to
services, the Voucher Project’s
second aim is to improve quali-
ty of these services. Two major
activities were launched:
trained teams from one operational
district assessed the
quality of health centers in
neighboring districts utilizing
the national tools and we report
the results in Kampot
province. Furthermore, 6 midwives
from Prey Veng Province
Health Centers went to
Battambang Provincial Hospital
for a 3-week hands-on training
course in Life Saving Skills.
More sessions are scheduled
for this year.
A KfW appraisal mission visited
in June Cambodia and the
SUMMER 2012
Minutes of Mission document
was signed by H.E. Prof. Eng
Huot, Secretary of State for
Health and Mr. J. Meilicke,
Senior Project Manager.
Many thanks to my colleagues
of the VMA team, who contributed
to this newsletter!
We cannot change the past
but the future is in our hands!
Marcel Reyners, Team Leader.
Community Based Health Insurance (CBHI) &
Health Equity Fund (HEF) Linkage with
vouchers in Kampong Thom
Background health care and
social health protection support
in Kampong Thom
GIZ supports Kampong Thom
health department since 1997
and a Japanese NGO, Project
Hope Japan, started community
based health care for Mother
and Child in 2004. The
Health Sector Support Project 2
(HSSP2) is the overarching
organization at the Ministry of
Health for Social Health Protection
SHP), including the Health
Equity Funds (HEF). They initi-
Ms Stefanie Ruff, BMZ and Ms Eva Schneider, KfW, and Mr.
Adelbert Eberhardt, GIZ Country Director, during a field visit
in Chhouk Operational District interviewing some voucher
clients during a village meeting in a remote area.
ated a project in 2005 and
assigned AFH as the operator.
CBHI started its activities in late
2006, managed by GRET/SKY
and by AFH since early 2010. A
Mother and Child Health care
project, supported by the Global
Fund round 9, was introduced
in 2011 as well as the
voucher project. AFH thus
manages the three schemes in
the same area.
Dr. Long Leng, AFH’s Executive
Director, presents his experiences
in managing 3 SHP schemes during
a Health Financing Conference.

PAGE 2 VOUCHERS FOR REPRODUCTIVE HEALTH SERVICES PROJECT
Linkages Experiences (Cont’d)
Experiencing Linkages: AFH as the only
operator tried to link these three SHP
projects into one in four Health Centers
of Kampong Operational District
(OD) and, through the voucher project,
signed a collaboration contract with
the Global Fund Round 9/NMCHC project.
AFH had signed MOU with all the four
Health Centers, witnessed by the OD
Directors and the Provincial Health
Department Director. The MOU states
that “The health facility provides free
health care services to all insured
members who are supported to use
The voucher distribution is organized
through voucher promoters, preferentially
selected among experienced
village health support group members.
The promoter receives an incentive for
each voucher distributed and a follow
up incentive when the voucher is used.
After a good start, early 2011, the
number of vouchers distributed surprisingly
decreased and became a concern
for the Project Management. We
organized workshop sessions in each
province where voucher promoters
(VPs) together with central and peripheral
management looked for reasons
why distribution rates are lower than
expected and how to address the issues.
These bottom-up, highly participatory
meetings indicated multiple
reasons asking for a multi-pronged
approach:
Build staff capacity so that everybody
at his/her level has good knowledge on
project related topics and better skills,
more specifically communication and
counseling skills
Improve marketing and promotion by
using simple and appropriate job-aids
to help VPs explaining potential clients
during a village meeting and face-toface
counseling not only the ad-
services in HC except to women who
present a voucher for reproductive
health. In that case, the HC will be paid
by VMA/AFH for safe motherhood, family
planning and safe abortion services” .
AFH, in cooperation with Voucher Management
Agency signed an MOU with
the Global Fund Round 9/NMCHC: for all
deliveries, the Global Fund Round 9/
NMCHC will pay for transportation and
food costs while the HC user fees for
Reproductive Health services will be
covered by the Voucher Project. This
combined HEF, CBHI & VRHSP project is
running smoothly in the 4 health centers.
Challenges of Voucher Distribution
vantages of using project supported
services: Safe Motherhood, Family Planning
and Safe Abortion but also explaining
the direct voucher benefits such as
travel costs, reimbursement, food and
baby package.
Increase financial incentive for VPs and
pay them in advance the running costs.
e.g. to buy the fuel.
Full-time job and fix a minimum number
of vouchers to be distributed every
month.
Support supply side with activities improving
the quality of services, such as
training and refresher courses and increasing
the number of services, especially
provision of long term methods in
public facilities.
An immediate positive effect can be
seen as the figures of quarter 2 are significant
higher than ever before. The
numbers for May June and July are resp.
2,250, 3.060 and 4,226.
Dr. Lim Huy, AFH Voucher Project Manager
Conclusion & Recommendations
The preliminary and limited linkage experience
of three SHP schemes shows that
having one operator is feasible and
makes it easier to manage SHP as several
advantages exist: easier to operate, less
costs by improved purchasing power,
building trust of beneficiaries, avoid
fraud and misunderstanding about the
projects, reduction of administrative
work, less staff expenses, better and
combined M&E and Reporting, etc.
Dr. Long Leng, VMA member and AFH
Executive Director
The number of SMH and FP vouchers distributed
by quarter is increasing rapidly
The voucher distribution numbers by month
are going up since May 2012, when special
attention to voucher promoters started.

5TH NEWSLETTER
Quality Assessment Results in Kampot Province
In recent years, health coverage in
Cambodia improved considerably as
many more health facilities became
available with greater access for rural
populations but sometimes the quality
of care is not yet at the expected level.
The MOH developed tools for quality
assessment and trained key staff at
provincial, operational and health centre
level to assess facility’s quality. This
5-day orientation training consists of 2
days of classroom teaching and practical
sessions followed by 3 half days of
practice within a HC and 3 half days of
debriefing, and Q&A sessions.
The VRHSP supported QA at 20 HCs in
Kampot province, thus completing the
QA process in the whole province, as
the other centers were already assessed
by GIZ and RACHA.
The activity is implemented as a provincial
internal assessment by using
peer review from one OD to another
OD. The assessor team is trained by
GIZ and the PHD Technical Bureau was
playing an important role for monitoring
and supervision.
From the results of this QA, plans for
quality improvement are developed to fill
the gaps and improve HC functioning.
The results: all HCs in Kampong Trach
show a quality score above the minimal
score of 65%; 8 were even higher than
75% whereas Chhouk OD has an quite
different result as only 3 HCs reached
65% and 13 fell below.
The lower score in Chhouk is more related
to management issues such as documentation,
hygiene and inappropriate
dissemination of information (absence
LSS training in Battambang Province
Life Saving Skills (LSS) training in
Battambang Provincial Hospital. In the
context of supply-side support and
quality improvement of HC staff, the
project supported the training of 6
midwives from Prey Veng Province
health centers. The training is organized
in collaboration with the Provincial
Health Department and the
Battambang Hospital, where the training
team has a more than a decade
long experience in a one-to-one, hands
-on and competency-based training.
AFH executive Director Dr Long Leng
signed an agreement with the Provincial
Hospital representative, Ms Ma
Setha and we like to acknowledge also
the support from RACHA, who started
LSS training sessions in Battambang
Province as well the help from Dr Kak
Seila, Hospital Director.
The training duration is 3 full-time
Dan Kom health center in Angkor Chey
OD, Kampot Province
weeks and all trainees stay in the hospital
compound and remain on call in
case a pregnant woman arrives and
when a delivery is imminent, whether
during day or night time. Training progress
is followed daily and indicated
on the “Tableau de Bord” where each
individual activity is counted.
Each participant received an official
certificate during a closing ceremony,
attended by the Battanbang OD director
and VMA.
PAGE 3
of tableau board) rather than to technical
issues. These HCs can improve considerably
without important interventions from
outside and furthermore, the VRHSP will
support them with training and basic
equipment.
Dr. Sieng Rithy, Deputy Team Leader
A midwife demonstrates ” in vitro” the
aspiration technique for safe abortion during
a supervision visit.
LSS course participants in Battambang,
together with their one-to-one trainers,
show their certificates during the closing
ceremony
Ms Ma Setha, Principal Trainer at
Battambang Provincial Hospital, together
with AFH’s Voucher Project Manager,
Dr. Lim Huy, in front of the trainees’
“tableau de bord”.

PAGE 4
Latest News
Congratulations to the team: the distribution figures for the month of July are
skyrocketing: after months of stagnation, a significant increase started with the
meetings with VPs in May (Hawthorn effect!!??), confirmed by the month of
June results. Once the new contracts signed early July, the results for the
month of July even equal the results of the whole quarter before! For the whole
team: “Orb Or Sar Tor”: congratulations, and “Tveu baan lao”: well done!!
Impact Evaluation: the Project’s Impact evaluation is conducted by Population
Council and the first reports on the baseline survey are in the pipeline for publication.
We hope to report on this in the next Newsletter. Updated information
on the Voucher Project can be found at: www.rhvouchers.org/countryprofile/2012/cambodia-2
KfW Appraisal Mission: in order to evaluate Phase I and to prepare Phase II, a KfW
mission, headed by Mr. Joerg Meilicke, Senior Project Manager, visited Cambodia in
June. At the end , the Minutes of Mission document, with details on the future project
expansion was signed.
VOUCHERS FOR REPRODUCTIVE HEALTH SERVICES PROJECT
Our Champions: two voucher promoters in
Prey Veng and Mr Bo Sophatt, Provincial
Coordinator
Congratulations: Mrs. Seng Phally, AFH’s Provincial Coordinator in Kampong Thom province, gave a birth to a healthy baby girl and
Mrs. Pov Chanthol, AFH’s Voucher Agent in Stong OD, gave a birth to a healthy baby boy.
H.E. Prof. Eng Huot, Secretary of State for Health,
and Mr. Joerg Meilicke sign the Minutes of Mission,
witnessed by Dr. Lo Veasna Kiry, Director of the
DPHI and the Project Executive Agency.
Mr. Joerg Meilicke attends a village meeting in Kampong Thom Province during his appraisal visit in June 2012.