title: Access to Treatment for Diabetes and Hypertension in Rural Cambodia: Performance of Existing Social Health Protection Schemes.
abstract: BACKGROUND
  Non-communicable diseases (NCD) pose challenges to Cambodia's health system. Medicines for NCD are on the National Essential Medicines List but no clinical guidelines support their utilization. Two social health protection schemes aimed at the informal sector population exist (Health Equity Funds and Insurance) together with two disease-specific interventions (a Peer Educator Network and Chronic Diseases Clinics) targeted at NCD patients. This study examines performance of these various schemes in relation to NCD.
  
  
  METHODS
  Cross-sectional household survey among 709 individuals self-reporting diabetes and/or hypertension in three geographical locations in rural Cambodia using a structured questionnaire investigating diagnostic and treatment pathways, health seeking behaviour, health expenditures, and financial coping mechanisms.
  
  
  RESULTS
  Two third of respondents with NCD were female and 55% did not belong to any scheme. The majority (59%) were diagnosed in the private sector and only 56% were on allopathic treatment that was mainly sought in the private sector (49%). Outpatient treatment cost was higher in the private sector and when using multiple providers of care. The majority were indebted, 11% due to health-related expenses. Contrary to social health protection schemes, disease-specific interventions offered better access to allopathic treatment and provided medicines in accordance with NEML.
  
  
  CONCLUSIONS
  The benefit packages of existing social health protection schemes and services in the public health sector should be adjusted to cater for the needs of people living with NCD in rural Cambodia. Initiatives that offer active disease management strategies and promote patients and community participation appear more successful in increasing treatment adherence and decreasing the risk of financial hardship.
authors.affiliation: Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland.
authors.forename: Maryam
authors.initials: M
authors.lastname: Bigdeli
authors.affiliation: Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Phnom Penh, Cambodia.
authors.forename: Bart
authors.initials: B
authors.lastname: Jacobs
authors.affiliation: Chean and Jaco consulting company, Phnom Penh, Cambodia.
authors.forename: Chean Rithy
authors.initials: CR
authors.lastname: Men
authors.affiliation: Department of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom.
authors.forename: Kristine
authors.initials: K
authors.lastname: Nilsen
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Van Damme
authors.affiliation: Centre de Recherches en Politiques et Systèmes de Santé, Santé Internationale, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Bruno
authors.initials: B
authors.lastname: Dujardin
mesh_terms: D000222:Adaptation, Physiological; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use; D002160:Cambodia; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D005260:Female; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011634:Public Health / Q000191:economics*; D012424:Rural Population; D057566:Self Report; D011795:Surveys and Questionnaires
chemical_list: D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents
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