Health center budget

Access to information and open budgets is the first component of the Implementation Plan for the Social Accountability Framework (I-SAF).¹ The other three components are citizen monitoring, facilitation and capacity building, and learning and monitoring.² Three types of local services providers are at the focus: primary health centers, primary schools and commune and sangkat administrations.

According to the Implementation Plan, the access to information and open budget component aims to promote social accountability, transparency and enhance public service delivery. This improvement will strengthen the decentralization process at the grassroots level.³ This component also aims to provide basic budget literacy for all stakeholders. Citizens informed about budget information will be able to increase their engagement and boost social accountability processes. Transparency on budget information for their local primary health center will further improve performance, quality and a demand for a good standard of service delivery.⁴

Since good health services are vital for citizens, the government has committed to strengthening healthcare services and quality, especially in rural areas, by working with many development partners. It is reported that healthcare spending accounted for 485 million USD in 2019.⁵ That’s approximately 6% of the country’s GDP.⁶

Cambodia's healthcare sources of revenue are mainly the government's health budget and official development assistance.⁷ Other sources include out of pocket payments by patients and health insurance schemes such as the National Social Security Fund (NSSF) and Health Equity Fund.⁸ The government collects the main source of the country's health budget through tax revenues. After the tax is collected, the Ministry of Health allocates and distributes the health budget to provinces and districts.

Official development assistance also plays a vital role in funding the country's health sector. Under the Health Sector Support Program (HSPP), a considerable amount of donor funding is combined with the government revenue to support healthcare services. In some cases, donor funds are allocated through donor projects that operate side-by-side with the government. Insurance schemes such as the Health Equity Fund are funded by the government together with the donor. This social protection scheme is district and hospital-based and aims to deliver quality services to the poor using a user-fee exemption mechanism.⁹ 

A local health center locate on the outskirt of Phnom Penh city. Photo by Open Development Cambodia, taken in September 2021. Licensed under  CC BY-SA 4.0.

In the I-SAF first phase (2015–2018), around 605 primary health centers in 98 districts of 18 provinces were covered.¹⁰ To disseminate health centers’ budget information to citizens, I-SAF collects different data of the local primary health centers and simplifies this through an instrument called Information For Citizens (I4C).¹¹ I4C is generated at the local level by the local service providers filling the data collection form.¹² An I-SAF focal person will be appointed to facilitate and coordinate the data collection processes.¹³ Commune-level data on the budget and expenditure of the local service providers are gathered through data collection forms. After simplifying data to develop user-friendly posters, these will be published at the local health center and made publicly accessible. The poster is straightforward and made comprehensible for the locals. The National Committee for Sub-National Democratic Development (NCDD) has also made budget information publicly accessible on their website. Users will find information about their local service providers that are covered under I-SAF. The database contains annual revenue, expenditure and performance of the primary school, health center, and commune administration.

On the I4C poster, citizens will find useful information such as expenditure, revenues and how their local primary health center spends their money. The I4C poster has simplified all necessary funding information for the local health center, such as:¹⁴

• National budget: capital transfers directly from the national budget.
• Health equity fund: these include a beneficiaries’ scheme that aims to improve access to quality healthcare for local citizens, especially those in rural areas. 
• Grants and donations: These funds comes from various donors, NGOs, development partners and money that is provided for emergencies.
• User fees: Income that is generated by patient charges on health services and drugs.

In comparison to the primary school budget, information on the health centers is divided into more categories.¹⁵ Additional details on staff salaries and incentives (basic income, overnight shift, incentive), patient and outreach support (meal for the patient, transportation fee), operating cost (utility fee, office supplies, maintenance, petrol), additional drug and supplies and provincial treasury tax are outlined in the information posters.¹⁶ After the first phase of implementation, local citizens at the targeted districts who can access the I4C posters are aware and well informed about their local service provider's budgets and can utilize the information on the poster.¹⁷

Related to Health center budget

• Health care policy and administration
• Patient rights
• Priority health concerns
• Budget