Low Income Bites Into Street Vendor’s Ability to Access Healthcare via NSSF

A street vendor, who makes a tiny income, borrowed money to keep her daughter alive. With the extension of the NSSF card coverage for street vendors, they are now covered but only if they can afford the monthly premiums of $3.80, which is an uphill task.
People wait outside a hospital in Phnom Penh, August 29, 2023. Kiripost/Siv Channa
People wait outside a hospital in Phnom Penh, August 29, 2023. Kiripost/Siv Channa

“My family and I borrowed money to finance my daughter’s surgery as she couldn’t give birth and her baby died,” Sor Chantha, a street vendor from Prey Veng recalled her experience with a gloomy face.

Chantha was with her daughter, who was about to give birth in their hometown. She had gone to the provincial health centre early in the morning for her delivery but was told that her baby had passed away after being born.

Apparently, the infant did not cry, and was silent following the delivery.

Her daughter was sent to a private hospital in the province, but they did not have proper facilities and was later transferred to Calmette Hospital, Phnom Penh’s largest hospital.

Between 2018 and 2022, health centres in Cambodia increased to 1,288 from 1,205 while hospitals rose to 132 from 123, according to the Ministry of Health, with the aim of expanding capacity and ensuring public access to healthcare services.

“In the province, there are no large hospitals as in Phnom Penh,” 45-year-old Chantha said. “So, we had to send her to a hospital in Phnom Penh as suggested by the doctor. We wanted her to receive treatment, even though we aren’t rich.”

Her daughter, a 28-year-old garment worker, needed immediate surgery as she only had a two percent chance of surviving as her body was very low on red blood cells.

Sor Chantha, a street vendor from Prey Veng. Kiripost/Mao Sreypich
Sor Chantha, a street vendor from Prey Veng. Kiripost/Mao Sreypich

Didn’t return for review

Upon arrival at Calmette, she instantly underwent surgery to remove her womb and received three pints of blood.

“I was crying outside of the emergency room,” Chantha said. “My daughter was covered. I couldn’t even see or recognise her [when she came out of surgery]. After one night in the emergency room, they allowed my daughter to stay in the room.”

Although her daughter survived the operation, she was frail. She might not be able to keep her job as a garment worker, Chantha said.

In terms of the service, she said the doctor took good care of her daughter and the staff actively helped her. “But we had paid some money at the time,” she added.

After being in the hospital for eight days, her daughter was allowed to return home and was asked to take the prescribed medicines. She was also requested to return to the hospital for a review after a month.

“I got the prescription and went to buy the medicine near Olympic Market,” she said, however, they did not go back for the checkup as they could not afford the treatment in Phnom Penh.

For the surgery, the family spent more than $1,000 and extra for the medication, Chantha said, adding that she did not have an ID Poor card, causing her to spend more money to treat her daughter.

‘Cannot afford’

On June 20, 2023, the National Social Security Fund (NSSF) pilot healthcare project for self-employed individuals was introduced and would operate on a voluntary basis. Self-employed persons can register their name with the NSSF by showing their ID card.

Explainer: NSSF - How Cambodian Workers Are Protected Under A Social Security Safety Net

Chantha said she heard about the registration of the NSSF card for street vendors, but did not know where to get it.

“I have not received any information about where to obtain it because I currently rent a house in Phnom Penh. I don’t know who the village chief is or if there’s anyone who has any information on it,” she added.

She believes that the NSSF card is a good initiative for people like her who cannot afford insurance.

“It can help us to survive,” she said. “My cousin previously got into a traffic accident and survived because she has the ID Poor card. My cousin could have died if she did not have the card. It helped because she could get some money for treatment.”

According to the NSSF, self-employed individuals can access 24-hour health insurance. In addition, they need to only pay 15,600 riels ($3.80) to the NSSF each month, based on a calculated monthly income of 600,000 riel.

Chantha, who makes between 20,000 and 30,000 riel a day but also experiencing some days of no sales, expressed concern that she might not be able to afford the monthly fee for the NSSF card.

She said her income is unstable and she needs to pay for necessities including rent, electricity, water, and other daily expenses.

“For example, this month, I have money to pay but next month, I won’t have enough money since I have to pay bills and soil for farming in my hometown.”

However, that does not mean she cannot afford it every time, only that she needs to take into account her expenses when she travels back home to visit her family every now and then, therefore she might be able to make up the sum all the time.

“I am not stingy but it is true I can’t afford the amount. If the NSSF card can be like the ID Poor card, which doesn’t cost money, I would love to get one.”

Consider reduction

According to the NSSF, by August 7 this year, more than 18,000 self-employed individuals had registered to pay contributions, with the intention of making use of the insurance services offered by the fund.

Pa Chanroeun, president of the Cambodian Institute for Democracy, commented that extending the NSSF card to street vendors was a great initiative as a means of safeguarding them.

However, he suggested that the government look into the feasibility of helping street vendors with contributions as some claim they cannot afford to pay.

“I don't know if the government has investigated the feasibility of paying the street vendors but if they haven’t, they should.

“They should examine the actual feasibility of street vendors’ [capabilities] and whether it can be reduced to $3. The government can contribute to the reduction and enable them to make monthly payments.”

Tim Vora, executive director of the Health Action Coordinating Committee, believed that the NSSF card fee “was not excessive” for them since they would gain a lot from the service.

That said, the NSSF should take into account a small reduction for people who feel it is too expensive.

Apart from the extension of NSSF cards to street vendors, the pension scheme for the private sector under the provisions of the Labour Law came into force in October, according to the NSSF in 2022.

“In addition to the health equity fund cards for medical expenses only, they should get extra benefits, such as occupational risk and benefit and training,” Vora said.

Registered businesses are mandated to pay contributions of four percent to the NSSF each month, with two percent deducted automatically from employees’ salaries and two percent matched by the employer.

‘Easy to use’

Peou Pan, 65, has worked as a street sweeper for more than 10 years in Phnom Penh, where she cleans the roads around the Prampi Makara district every day.

Currently, she is renting a house near her workplace and occasionally returns home to her hometown in Takmao.

Given the nature of her job, Pan has met with a traffic accident where she was hit by the car before. But she received treatment at her company’s panel hospital.

While she also has a NSSF card now, she has not had the need to use it yet.

“When I go to the hospital, it’s not difficult since we go as a group,” she said. “I think the service is good. They take care of me.”

Pan receives $270 per month and is aware of the benefits of using the NSSF card, however, she is unaware that her pay is being deducted monthly in order to use the NSSF card. She said she knows only the amount of payment she gets.

“I think we can use it at the hospital for free. They will look after us,” she said. “Also, I heard it’s easy to use.”

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