In North West Cambodia on the border with Thailand lies Banteay Meanchey province with 678,033 people (102/km2). The provincial population is divided in 4 operational [health] districts (called “OD”), which are the population units administered by the Provincial Health Department. Thmar Pouk OD has about 120.000 inhabitants, among whom probably 40% are poor and many of whom are trying to eek out a living as laborers in Thailand. People in rural households mostly have 4.6 members per household.  

CAAFW operates Cambodia’s largest community based health insurance (CBHI) with more than 25.000 members in the OD. CAAFW was Cambodia’s first Equity Fund (1999) but transformed itself into a CBHI in 2005 in pursuit of a financially sustainable future, reducing its Health Equity Fund activities gradually and stopping it altogether at the end of 2008. 

As there is currently no functional Health Equity Fund in Thmar Pouk and no pre-identification has ever been carried out, an unknown number of poor households are paying full premium. Very poor households are unlikely to be able to afford the health insurance premium but whether they have enrolled remains to be clarified also once pre identification has taken place and analysis can be done. Targeting the poor with special benefits has to wait until Pre-Identification of poor households in Thmar Pouk is complete. 

The Provincial Department of Planning staff has recently been trained in how to carry out Pre Identification. The NGO Poor Family Development (PFD) is experienced in doing pre-identification in the other 3 OD’s of the province and ready to assist in the pre-identification in Thmar Pouk following a special process agreed by the Ministry of Planning.  

The public health services of Thmar Pouk show relatively good utilization rates in part thanks to the CBHI (CAAFW). The CBHI data show good utilization of the primary care level (the MPA) and CPA levels, when compared to the rest of the country. The CBHI has contracts will all health centres (MPA) and with the Referral Hospital at Thmar Pouk (CPA2) in the OD and with the Provincial Hospital (CPA3) in Monkolborei, where PFD is managing the Health Equity Fund. In 2009 for the first time the Health Equity Fund direct benefits (=poor patient health expenses) are financed directly from resources received from the Ministry of Health based on a PFD contract with the MoH. This was previously an activity taking place under the direct management of URC-CHS, an American NGO entirely funded by USAID, which continues to fund administration costs of NGO’s including Health equity fund operators like PFD.