For very poor communities, the cost of getting to a health centre is one of the major barriers preventing people from accessing healthcare when they need it. This is particularly true in remote parts of Cambodia such as Koh Nheak in Mondul Kiri, where it can be a long and difficult journey to access even basic healthcare services. Many villages in the area are located along dirt roads that can be virtually impassable during the height of the rainy season, making the cost of getting there prohibitively high for some.
To help combat this problem, CARE has been working to set up Village Emergency Referral Systems (VERS), in a number of provinces with support from Global Fund. Kong Sothea has been on the committee for the VERS in his village of Orntres since 2012. Originally set up with funding support from CARE though its local partner IPHIA, the VERS in his village now has 26 members who each pay 1000riel (USD$0.25) per month. This money forms a pool of funds which can be borrowed in the event of an emergency, with members signing an agreement as to when they will pay the money back. Non-members can also access the funds if they need, and are charged interest at 3% per month on the money they borrow―an amount agreed by the community.
Sothea says this service is very important for the village, which is located around 8km from the Koh Nheak health centre. “Travel there by motorbike costs about $5, but for severe cases requiring transport by kor yunn [a local form of homemade car], the costs are much greater,” he says. A combination of difficult roads which larger vehicles find harder to navigate and local spiritual beliefs regarding the fear of people dying in their vehicle mean the cost of getting to the health centre from Orntres can be as high as $80. This is a huge sum for rural farmers, who would not have this kind of money available in the event of an emergency.
The availability of a loan from VERS means that community members have a support system should they need it and loans are sought for a range of reasons. Sothea says that sickness such as severe diarrhea or fevers in children are some of the previous reasons people have had to borrow money for transport to seek medical help and that he has never encountered problems with people paying the money back over time.
For the first three months of 2014 alone, Sothea is able to cite a number of instances where the availability of money for emergency transport had a huge impact on patients. A chainsaw accident severely injured a man’s arm and his loan from VERS ensured he received urgently-needed treatment. Sothea also believes getting to the health centre literally meant the difference between life and death for a mother and her unborn twins when she experience complications as she went into labour. He is very happy that he was able to play a role in ensuring the family received medical care and says that the babies are now doing well.
Global Fund provided $150 seed funding to set up the VERS in Orntres village. The committee has managed the money carefully to ensure this will be able to continue and the VERS now has considerable assets, with over 1 million riel ($250) in funds and money owed from outstanding loans. Sothea is confident about the sustainability of the VERS and plans to continue to provide this service to the community in the future.