Changkes mouy bach kach min bak. –Khmer saying
(A bundle of sticks cannot be broken.)
One of the most striking discussions during the Regional Forum on Health Care Financing in Phnom Penh on May 2-4, 2012 was the proliferation in the Mekong sub-region of financing schemes aimed to improve access to quality health services.
Cambodia might be an extreme example where you have so many health equity funds –for maternal and child health services, in-patient hospital care, out-patient care, for chronic diseases, et cetera. On top of that, there are various incentive schemes aimed at specific individual providers. Each donor, each disease control program has spawned its own incentive scheme for each specific output. An extreme example is one hospital in Battambang where there are as many as 50 incentive schemes. Is this a perversion of success of the initial pilots? Or a symptom of our collective inability to work together?
It appears to me that it is to a large extent driven by donors, well-meaning ones who want to get on the bandwagon of a successful model. I see no problem with having many players in the same wagon, or with some having their own wagon, if they all want to go together in the same direction. One Cambodian expert notes that fragmentation is not a problem if the various schemes are more or less similar (payment mechanism, incentives etc.); it becomes problematic if the schemes are too different.
The situation underscores the importance of government leadership and stewardship of the health sector, with donors respecting and helping to strengthen that government role. I see no alternative way to avoid the tendency of many good intentions from creating an unintended mess.
The lively discussion on this issue and many others during the forum highlights the value of sharing experiences. There was a strong sense of openness with participants from mostly the Mekong sub-region (but also from Indonesia and the Philippines) to discuss the challenges they face in health financing. A very candid participant from Myanmar pointed out that his country is like the neonate in this forum with so much to learn from the experience of other countries. Indeed universal health care (UHC) is abuzz in the region. Countries, in different stages, are making strides to improve their health systems towards UHC.
It is in this spirit of sharing and learning that the Community of Practice on Health Care Financing in Asia was launched during the forum. The idea is to take off where the forum ended by providing an online platform (mixed with face-to-face meetings) for practitioners and experts in health care financing in Asia to come together.
A bundle of sticks is so much stronger than the strength of each stick added together.