ESID Working Paper No. 43 The political economy of inclusive healthcare in Cambodia Tim Kelsall 1 and Seiha Heng 2 December, 2014 1 Freelance consultant, researcher, and teacher, Phnom Penh Email correspondence:
[email protected] 2 Cambodia Development Resource Institute Email correspondence:
[email protected] ISBN: 978-1-908749-43-7 email:
[email protected] Effective States and Inclusive Development Research Centre (ESID) School of Environment and Development, The University of Manchester, Oxford Road, Manchester M13 9PL, UK www.effective-states.org The political economy of inclusive health care in Cambodia Abstract Over the past 15 years, Cambodia has made significant strides in expanding effective access to free healthcare for poor people, thanks largely to ‘Health Equity Funds’ (HEFs), a multi-stakeholder health-financing mechanism. HEF operators have helped expand access, incentivise health staff, and lobby on behalf of poor patients. However, despite their successes, they have been unable convincingly to address some of the deeper-seated problems of the Cambodian health system, such as under-resourced facilities, underpaid, poorly qualified staff, and a burgeoning private sector. This paper explains this state of affairs as a product of Cambodia’s ‘political settlement’, in which relatively successful multi-stakeholder initiatives exist as ‘islands of effectiveness’ in a sea of rent-seeking and patronage. While such islands may currently be the best solution available for poor people, the deeper problems are unlikely to be solved without a shift in the political settlement itself. Keywords: politics, political economy, political settlements, inclusive development, Cambodia, healthcare, Health Equity Funds Kelsall, T., and Heng, S.