On a beautiful morning in April 2017, a happy and healthy little girl was born at the Maternity Health Center of Hospitals Beyond Borders (HBB) in Phnom Penh, Cambodia. Kandura is not the first pride and joy of her parents, but the first to be born in a safe environment where childbirth is no longer a matter of life and death for the mother and the baby .
I founded Hospitals Beyond Boundaries (HBB) with Dr. Wan Abdul Hannah during our medical school days to build hospitals and clinics run by local communities. A Malaysian non-profit organization, HBB runs the maternity center with a team of local health practitioners and is dedicated to improving the health of vulnerable communities through sustainable health care efforts. Our first clinic was established in 2012 in Phnom Penh and provides access to health care to more than 300 families of the marginalized Cham minority in Cambodia. Health facilities are run solely 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 inception, HBB has trained and served more than 3,000 people.
Sustainable Development Goal 3 states that healthy lives should be ensured and that well-being should be promoted for all ages. Although global maternal mortality rates have declined by almost 50% since 1990, the maternal mortality rate 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. It's the challenge we fight every day – by safely providing something as simple as a healthy life.
HBB clinics and hospitals are run as social enterprises that subsidize the cost of health care, which means that the profits of patients who can afford full coverage are heavily subsidized for the less fortunate. The idea was born after observing economic inequalities in Cambodia, where people from different economic backgrounds live side by side – the rich have access to for-profit clinics and the less fortunate have to settle for clinics seriously underfunded and under-equipped.
In our early attempts to provide access to quality care for the poor, we tested community health insurance, but we encountered a low rate of enrollment. We then reevaluated and realized that the concept of health insurance is not common among those working in the informal sectors – in fact, national data reveal that only 0.2% of total health expenditures of the Cambodia come from health insurance and 61% pocket payments.
Realizing this, we started the community clinic that works with cross-subsidies, which worked quite well in the community where 60% of paid patients subsidize 40% of those who are unable to pay in full. This has broadened the scope of coverage offered to those who otherwise would not have access to basic health care and our model has matured financially. We were able to offer more comprehensive coverage by including maternity care through the construction of a maternity center.
The six-bed facility, which opened in early 2017, allows more than 1,500 women in the community to have access to safe deliveries. With the help of local doctors and health professionals, we hope to continue to strengthen community support to raise awareness of the importance of financial protection and risk sharing in the community. From the grassroots level that is progressing upward, 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 lives. In the words of Mahatma Gandhi, "it is health that is the real wealth and not the gold and silver coins". Access to good health and well-being is a human right and is essential to support economic and social development and poverty reduction. Millions of people are pushed into poverty each year because they can not afford health care.
But beyond the basics of health, 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 health care to promote development. Simply put, every aspect of development should be pursued with health in mind. Public transportation should be built to encourage people to walk, reduce the risk of noncommunicable diseases and, at the same time, reduce carbon emissions for healthier lungs. Roads should be built to accommodate pedestrians and cyclists, and to prevent disabilities and deaths due to road accidents. Housing areas should be developed to ensure the absence of breeding grounds for mosquitoes and other risks of communicable diseases. To do more for Goal 3, we need closer collaboration between the sectors working to reach other DMSs to make health and wellness a central, interlocking principle. Other SDOs in pursuit of "health … true wealth".
Lutfi Fadil Lokman, Young Leader for the ODD and CEO of Hospitals Across Borders.