Marseille 2007
| Abstract #423 - Behind free antiretroviral treatment: impoverishment and economic costs for access to care and treatment in Cambodia | ||||
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Session: 19.7: Universal Access to care (Parallel) on Monday @ 14.00-16.00 in HC Chaired by Shirin Heidari, Jean-Paul Moatti Authors: Presenting Author: Dr Frederic Bourdier - IRD, Cambodia |
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| Additional Authors: | ||||
| Aim: Since 2004 the national programme against HIV/AIDS followed the WHO 3by5 initiative in order to give treatment to an increasing number of infected persons who urgently need the medication. More and more public hospitals, some of them supported by international NGOs, started delivering basic services including testing, continuum of care, opportunistic infections treatments, and other social supports. The health delivery system had the ambition to be extended progressively to the whole country, having in mind that Phnom Penh the capital concentrated most of the referral services up to 2004. In spite of the claim of providing free treatment along with medico-social services, it has been observed that most of the patients have to pay something else or, reciprocally, are loosing some of their wealth and income because of their HIV status. The paper envisages providing data emphasizing this common but not sufficiently recognized phenomenon in a limited resource setting as Cambodia. | ||||
| Method / Issue: The methodology is based on quantitative and qualitative approach. A set of 26 questions is proposed once having previously identified the main sources of expenses that people have to bear. The sample population reaches 50 infected persons (half are men and half are women). Besides, this formal preliminary survey, further enquiries strengthen the quantitative results with open and semi-direct interviews associated with techniques of participant observation. They took place in Phnom Penh and in two provinces surrounding the capital. | ||||
| Results / Comments: The preliminary results show the emergence of two indicators. The first one is effectively associated with the amount of money that infected persons have sometimes to pay - or their family - for different purposes: on the one hand, there are medical fees which are normally free (HIV testing, clinical exams, OI treatment out of stock in the hospital, selection process to receive quickly the ART, etc.) and on the other hand there are extra-medical expenses representing a high burden for the patient (cost of transportation to the hospital, food and nutrition aspects that have to be improved, etc.). The second indicator is the amount of money that people frequently loose because of their HIV status (less work because they are rejected, participation in Buddhist ceremonies, indebtedness, access to traditional medicines, economic perdition due to reduction of their employment). | ||||
| Discussion: Conclusively, the free access to treatment is thwarted by an impressive number of expenses (plus a loss of salary and working opportunities) that infected people have no choice to assume to get the benefit of the health system and if they want to survive when entering in an active file. However, most of these expenses cannot be supported for long by the most deprived population. National policies should take into account this fundamental dimension liable to prevent some persons of respecting ART adherence if they cannot manage anymore to sustain their life conditions. | ||||
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