On a beautiful morning in April 2017, a happy and healthy baby girl was born at Hospitals Beyond Boundaries (HBB) Maternity Health Centre in Phnom Penh, Cambodia. Kandura is not the first pride and joy of her parents, but the first one to be born in a safe environment where giving birth is no longer a matter of life and death for both the mother and the baby.
I founded Hospitals Beyond Boundaries (HBB) with Dr Wan Abdul Hannah during our days in medical school to build hospitals and clinics run by local communities. A Malaysian non-profit organisation, HBB runs the maternity centre with a team of local health practitioners and is dedicated to improving the health of vulnerable communities through sustainable healthcare efforts. Our first clinic was established in 2012 in Phnom Penh and provides healthcare access to more than 300 families from the marginalized Cham minority in Cambodia. The healthcare facilities are run uniquely as social enterprises by the local youth population who are trained and then employed as community health workers alongside doctors, nurses and health professionals. Since its establishment, HBB has trained and served more than 3,000 people.
Sustainable Development Goal 3 asserts that healthy lives should be ensured and well-being should be promoted for everyone at all ages. Although global maternal death rates have fallen by almost 50 per cent since 1990, the maternal mortality ratio in developing regions remains 14 times higher than in developed regions. 17,000 fewer children die each day than in 1990, but more than six million children still die before their fifth birthday each year. This is the challenge that we combat on a daily basis—safely delivering something as simple as healthy lives.
HBB’s clinics and hospitals are run as social enterprises that cross-subsidize the cost of healthcare, meaning that the profits from patients who can afford full coverage are pooled to heavily subsidize treatment for the less fortunate. The idea came about after observing economic inequities in Cambodia, where people of varying economic backgrounds live side-by-side—the affluent accessing for-profit clinics and the less-fortunate having to settle for severely underfunded, underequipped public clinics.
In our early attempts to provide access to quality care for the poor, we piloted community-based health insurance but were met with a low level of enrolment. We then re-evaluated and realized that the concept of health insurance isn’t common among those working in informal sectors—in fact, national data reveals only 0.2% of Cambodia’s total health expenditure is from health insurance and a staggering 61% are from out-of-pocket payments.
Realizing this, we launched the community clinic that runs on out-of-pocket cross-subsidization, which has been rather successful in the community where 60% of paying patients subsidize 40% of those unable to pay in full. This has increased the breadth of coverage offered to those who would otherwise live without basic healthcare, and as our model has matured financially, we’ve been able to provide more comprehensive coverage by including maternity care through the construction of a maternity health centre.
The 6-bedded facility, which opened in early 2017, provides access to safe deliveries to more than 1,500 women in the community. With the help of local doctors and medical professionals, we wish to continue strengthening community support to raise awareness of the importance of financial protection and risk sharing within the community. From the grassroots level progressing upwards, we hope that this will help accelerate the country’s progress towards achieving Goal 3.
Goal 3, Good Health and Well Being, is vital to saving human lives. In the words of Mahatma Gandhi, “it is health that is real wealth and not pieces of gold and silver”. Access to good health and well-being is a human right and is essential to sustaining economic and social development and poverty reduction. Millions of people are driven into poverty every year because they cannot afford healthcare.
But beyond the basics of health-care, Goal 3 also looks at the larger dimension of health and well-being. Health, in all its dimensions—physical, mental and social—should go beyond formal healthcare to actually drive development. To put it simply, every aspect of development should be pursued with health in mind. Public transportation should be built with the purpose of encouraging people to walk, reduce the risk of non-communicable diseases and at the same time reduce carbon emissions for healthier lungs. Roads should be built to accommodate pedestrians and cyclists, and prevent disabilities and death from traffic accidents. Housing areas should be developed to ensure there are no breeding grounds for mosquitoes and other risks of communicable diseases. To do more for Goal 3, we need closer collaboration between sectors working to achieve other SGDs to make health and well-being a central tenet interweaving other SDGs in the pursuit of “health…the real wealth.”
Lutfi Fadil Lokman, Young Leader for the SDGs and CEO of Hospitals Beyond Boundaries.