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Health Shocks and Their Treatment in Rural Cambodia
បញ្ហា� សុ�ខភាព និ�ងការព�បាល នៅ�តាមជនិ បទប្របនៅទសុកម��ជា
Mr. Saly Koeurn ( នៅ�ក នៅ��និ សាល )Research Team Leader (ប!ធានិក!មសុ!វជ!វ)
និនិនិនិនិនិនិនិនិនិនិនិនិនិនិនិដំ%រ &សុ!វជ!វនិ�ងផ្ត(ល)ប!ក*Raffles Hotel Le Royale Oct 4th, 2011
omrei Research and ConsultingMeaningful research for advocacy and action
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About the studyអំ%ព ការសុ�ក*សុ!វជ!វ
• Data taken from the SKY impact evaluation follow up survey July 2009 – January 2010
ទ�និ,និ-យនៅនិ/យកមកព ការសុ0ង)មតិ�តាមដានិ និ�ងវាយតិ%លៃលឥទ6�ពលធានារ៉ា9ប)រងសុ�ខភាព សា: យ ខែខកក:ដា2009- មករ៉ា 2010
• 5275 households interviewed �!សារចំ%និ=និ5275 តិ!វបានិនៅ�សុ%ភាសុនិ>
• 245 villages in 3 provinces: Takeo, Kandal and Kampot
ភូ@ម�ចំ%និ=និ 245 តិ!វបានិនៅ�យកនៅចំញព នៅខតិ(ចំ%និ=និ
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Health Shocksបញ្ហា� សុ�ខភាព
• An illness that made someone unable to go to work or to school for one week or more
ជាជាជាជាជាជាជាជាជាជាជាជាជាជាជ%ងBខែដំលនៅCD នៅEយនៅ�ម�និEចំនៅFនៅCD ការ ឬនៅFសា�បានិអំសុ)រយHនៅពលម=យ ឬចំ!និជាងម=យសុប្តា( ហ៍>
• A family member passing awayជាការសាK ប)បាតិ)បង)ជ វ Lតិរបសុ)សុមាជ�ក�!សារ
• Spending over 400,000 riel (approx $100) on a single health problem
ជាការចំ%នាយចំ!និជាង400,000 នៅរNល ( ប!ខែហ៍ល100ដំ��K រ) ខែតិនៅFនៅល បញ្ហា� សុ�ខភាព ម=យម�ខ
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• 46% of households reported experiencing one of the above in the 12 months preceding the survey (88% in first category)
មានិ�!សារ46% ជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជា តិ!វបានិនៅ�រ៉ាយការណ៍> មកថាបានិជ=បប!ទ/បញ្ហា� ម=យក,�ងចំ%នៅនាមបញ្ហា� ខាងនៅល នៅ�ក,�ងរយHនៅពល12 ខែខម�និនៅពលនៅCD ការសុ0ង)មតិ� (មានិ88% នៅ�ក,�ងប!នៅភូទទ ម=យ)
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How many health shocks did households experience?
នៅតិ មានិបញ្ហា� សុ�ខភាពបR�នាS និខែដំល�!សារបានិជ=បប!ទ/?
• 23 % of households experienced multiple health shocks
មានិ�!សារ23% ជាជាជាជាជាជាបានិជ=បប!ទ/បញ្ហា� សុ�ខភាពចំ!និម�ខ
1 2 3 4-70
20
40
60
80
100
77
19
3 1
Figure 2: Percent of Households With Health Shocks by Number of
Health Shocks Experienced
Number of Health Shocks
Pe
rce
nta
ge
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What was the effect of health shocks on household productivity?
នៅតិ ផ្តលបR/ពាល)នៅFនៅល ផ្តល�តិភាព�!សារមានិអំD ខK/?
• 97% of households lost productive days as a result of their health shock.
មានិ�!សារ97%បានិបាតិ)បងថ្!ផ្តល�តិកមSនៅដាយសារខែតិបញ្ហា� សុ�ខភាព
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• Both affected family member + other household members lost productive days
ជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាទាំ%ង�!សារខែដំលរងផ្តលបR/ពាល)បញ្ហា� សុ�ខភាពនិ�ងសុមាជ�ក�!សារសុ�ទ6ខែតិបានិបាតិ)បង)ថ្!ផ្តល�តិកមS
• Households lost a median of 30 productive days in total as a result of their health shock. �!សារជាចំ!និបានិបាតិ)បង)ថ្!ផ្តល�តិកមSជាមCWម30 ជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាថ្!ជាសុរ �បនៅដាយសារខែតិបញ្ហា� សុ�ខភាពរបសុ)ព=កនៅ�
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Treatmentsការព�បាល
• Very little forgone care; 97% of households sought treatment for their health shock.
ជាជាជាជាជាជាមានិ�!សារតិ�ចំតិ=ចំបR�នៅXY /ខែដំលម�និទទ=លយក ការព�បាល។ មានិ�!សារ97%សុ!ងរកការ
ព�បាលសុ�ខភាពរបសុ)ព=កនៅ�• Over 50% sought multiple
treatments.មានិ�!សារចំ!និជាង50% ជាជាជាជាជាជាជាជាជាជាសុ!ងរកពហ៍�ព�បាល
NGO Doctor
Other
Kru Khmer
Health Cen-tre
Drug Seller
Private Doc-tor (town)
Public Hospi-tal
Private Doc-tor (village)
0 5 10 15 20 25 30
1
3
7
12
12
18
20
27
Figure 3: Percent of Treatments by Provider of Treatment
Percentage
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• 46% of treatments sought in private sector; 27% in town, 18% village
ការព�បាល 46% តិ!វបានិនៅ�សុ!ងរកនៅ�ក,�ងផ្ត!កឯកជនិ៖28% ជាជាជានៅ�ក,�ងទ ក!ងនិ�ង 18%នៅ�តាមភូ@ម�
• 32% from public sector : 20% public hospital, 12% health centre
ការព�បាល 32% ជាជាជាតិ!វបានិនៅ�សុ!ងរកនៅ�ក,�ងផ្ត!កសាធារណ៍H៖មានិ20% នៅ�តាម នៅពទWរដំ] និ�ង 12%នៅ�តាមមណ̂៍លសុ�ខភាព
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How much did households pay for their treatment?នៅតិ �!សារទាំ%ងនៅនា/ចំ%នាយអំសុ)បR�នាS និសុ%រ៉ាប)ការព�បាលរបសុ)ព=កនៅ�?
• Treatment cost ranged from nothing to $14,000
ជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាចំ%នាយថ្!ព�បាលមានិចាប)ព ម�និបង)ប!ក)រហ៍@តិដំល) 14,000ដំ��K
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• Cost of treatment positively related to wealth; the median treatment cost for poor households $14, for medium households $17, for better off households $24.
ជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាជាចំ%នាយថ្!ព�បាលជាប)ទាំក)ទងជាវLជ̀មានិនៅFនិaងទ!ពWសុមbតិ(�របសុ)ព=កនៅ�។ចំ%នាយថ្!ព�បាលជាមCWមសុ%រ៉ាប)�!សារក!ក!មានិ14 ដំ��K រ សុ%រ៉ាប)�!សារមCWមមានិ17 ដំ��K រ និ�ងសុ%រ៉ាប)�!សារC@ធារមានិ24ដំ��K រ
• The median cost incurred for travel was $2. ជាជាជាតិ%លៃលព�បាលប!នៅcលជាមCWមសុ%រ៉ាប)នៅCD តិ%នៅណ៍ រមានិ2ដំ��K រ។
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How did households pay for their treatment?នៅតិ �!សារទាំ%ងនៅនា/ចំ%នាយនៅល ថ្!ព�បាលរបសុ)ព=កនៅ�cR ងនៅមRចំ?
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
Percent of Households Who Sought Treatment by Source of Payment for Treatment
PoorMediumBetteroff
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Key findings at a glance..ការព�និ�តិWនៅម លរបក�%នៅហ៍ ញតិ!សុៗ
• 46% of households experienced a health shock in last 12 months
មានិ�!សារ46% ជ=បប!ទ/បញ្ហា� សុ�ខភាពក,�ងរយHនៅពល12ខែខចំ�ងក!យ
• 97% of households with health shocks lost productive days as a result of health shock.
មានិ�!សារ97%បានិបាតិ)បង)ថ្!ផ្តល�តិកមSនៅដាយសារខែតិបញ្ហា� សុ�ខភាព
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• Average treatment cost was $17. ចំ%នាយនៅល ការព�បាលជាមCWមមានិ 17ដំ��K រ
• Over 25% of poor households incurred a debt with interest to pay for treatment costs. �!សារក!ក!ភា�ចំ!និចំងការប!ក)នៅ�នៅដំ មb បង)ថ្!ព�បាល