Nguyen thu trang ros vanchhay ICSE

Solutions for the sustainable development of Kantha Bopha Children ‘s Hospital 1

Solutions for the sustainable development of Kantha Bopha Children Hospitals
as a model of social enterprise in Cambodia
Ros Vanchhay and Nguyen Thu Trang
Young Economics Scientist
National Economics University



Hanoi, Vietnam
Abstract
Dr. Beat Richner, a famous doctor from Switzerland – is the head of Kantha Bopha
Children’s Hospital Chain in Cambodia since 1992. Over past 24 years, these hospitals have
provided free treatment to more than 10 million of Cambodian children and pregnant women
infected with HIV. Currently, the Kantha Bopha Children’s Hospital Chain has five hospitals in


Solutions for the sustainable development of Kantha Bopha Children ‘s Hospital 2
Phnom Penh and Siem Reap. Most of the children treated at Kantha Bopha come from families
with difficult circumstances, without paying for hospital fees.
From 1992 to 2016, the Kantha Bopha Children’s Hospital Chain paid $563,000,000
hospital fees for Cambodia children, 4.7% of which was donated by the Cambodian government,
and 8.9% from the Swiss government and 86.4% donated by citizens, most of the people are
Swiss citizens. Currently, there are many people support Kantha Bopha in the form of charitable
programs.
Maintaining a stable source of income is always a big problem for Kantha Bopha because
the medical services are free. The paper reviews some of the hospital issues encountered and
proposes more sustainable development solutions for Kantha Bopha Hospital through
development in the form of social enterprise.
Keywords: Dr. Beat Richner, Kantha Bopha, social enterprise, free treatment, health

insurance.
Organizational structure, operation of Kantha Bopha hospitals
The Kantha Bopha hospital was named as daughter of King Norodom Sihanouk who lost
her life due to leukemia. Norodom Sihanouk built a hospital with first named “Bopha Hospital”
in 1963 and after that called “Kantha Bopha Hospital”. Beat Beatocello Richner or Beat Richner
was born in Zurich Switzerland on March 13, 1947. From 1974 to 1975, he arrived Cambodia to
worked at the Kantha Bopha children’s Hospital. He came back his country in 1975 because of
avoiding Khmer Rouge genocide disaster.
In December 1991, the Cambodian government asked Dr. Beat Richner to return and
manage the Kantha Bopha Children’s Hospital. In 1992, Dr. Beat Richner created the foundation
in Zurich and then he arrived Phnom Penh and started his worked in Kantha Bopha I.
In 1996, the Kantha Bopha II which the second hospital was built because of increasing
of patients overcrowded Kantha Bopha I so King Norodom Sihanouk offered land at his Royal
Palace in Phnom Penh to build this hospital. The Jayavarman VII is the third hospital of Kantha
Bopha hospitals. In 1998, Prime Minister of Cambodia donated land at Siemreap province near
the Angkor Wat temple for built this hospital. In the Jayavarman VII children’s hospital in Siem
Reap had Maternity for HIV position mothers. In 2005, the Kantha Bopha IV was inaugurated.
The Kantha Bopha V was inaugurated in 2007. The Kantha Bopha hospitals have become a
highly respected model for the entire southwest Asia region.


Solutions for the sustainable development of Kantha Bopha Children ‘s Hospital 3
The Kantha Bopha Hospital has an organizational structure and operates differently from
conventional hospitals. From 1992 to 2016, the Kantha Bopha Children’s Hospital Chain paid
$563,000,000 hospital fees for Cambodia children, 4.7% of which was donated by the
Cambodian government, and 8.9% from the Swiss government and 86.4% donated by citizens,
most of the people are Swiss citizens. In addition to this form of funding, Dr. Beat Richner
organized concerts by himself at tourist sites in Angkor Wat and other parts of the world. At each
concert, Beat Richner was the performer, earning the entire proceeds for the hospital operation.
Currently, there are many people support Kantha Bopha in the form of charitable programs.

Kantha Bopha's medical examination is also free of charge for patients. Although not for profit
purposes but the Kantha Bopha still uses aid capital and mobilizes itself to provide healthcare
services to people, pay salaries to doctors and other costs. Dr. Richner usually hosts concerts,
fundraising activities to support the hospitals. Therefore, the Kantha Bopha can be regarded as a
business. Kantha Bopha has demonstrated the great role in the development of health care for
Cambodians, especially the poor and the very poor people – who have no access to good health
care. However, the Kantha Bopha is currently facing some of issues such as the increasing
number of patients, unstable income and over-reliance on state aid and support from the people.
Kantha Bopha Hospitals need to be structured and operate more sustainably to develop and
provide the healthcare service for Cambodia ‘s people. Developing into a social enterprise is a
good solution for the problems of Kantha Bopha hospitals. In the next section, research shows
problems that Kantha Bopha is currently experiencing have a negative impact on the sustainable
development of the hospital.
Research Methods
The paper uses qualitative and quantitative methods. Qualitative methods such as policy
research, interviews and analysis of results from previous studies. The study looked at 50 people
on issues such as the frequency of visits to Kantha Bopha Hospital or the reasons for not visiting
to Kantha Bopha, assessments and expectations of hospital operations. The study also examined
people for their opinions on the research solutions proposed to help hospitals grow more
sustainably. Regression models and other quantitative models were not used in this study because
the number of people surveyed was too small and the values of the primary data fields were 1 to
7 (because variables are ordinal variables). The assessment of the impact of these variables on
the psychosocial behavior of Kantha Bopha may not be meaningful without further data on other


Solutions for the sustainable development of Kantha Bopha Children ‘s Hospital 4
quantitative variables for inclusion in the model. This study used statistical analysis and
regression trees to assist in assessing the situation and finding solutions to hospital problems.
Regression Trees is used as a classification algorithm. Regression Trees is a classification
algorithm commonly used in data research. The idea of the algorithm is that at each step dividing

the observations containing the value of the dependent variable into two groups, the criterion of
grouping is based on the value of an independent variable at that observation. The conditions of
the independent variable at each division step are calculated so that dividing into two groups
ensures a certain difference between the observations in the two groups. The result will be that
the observations are divided into groups, each of which has distinct characteristics about the
value of some independent variables. This algorithm is useful for classifying consumers with
different characteristics and needs. In class, it is necessary to maximize I [C, X] - information
about X features. For Regression Tree, it is necessary to maximize I [C, Y], where Y is the
response variable and C is variable says that the leaves of the tree end here. At each iteration
step, find a binary question that maximizes the information about Y, for the node in the tree.
Accuracy determines the criteria for stopping. That criterion can be the sum of the squares for a
fault in a tree. Sum of squares for a tree error is computed as follows:

Where:
Where: is variance of leaf c.
Algorithm to create a division to minimize S.
Here is the basic algorithm:
1) Start with a node containing all the observations. Volume and S.
2) If all the observations in a node have the same value for all input variables then stop. If
not, search across all binary distributions of all variables that reduce S as much as possible. If the
largest decrease in S is less than a certain threshold or the number of observations in a node is
less than a certain value, then stop.
3) Algorithm can be stopped too soon due to the control criteria or the tree grows too
large. The Cross - Validation method checks at the two nodes that the parent should merge or not.
The regression tree is used in the R-3.4.1 software with the rpart function in the rpart
package. The purpose of the Regression Tree in the article is to group customers with the same


Solutions for the sustainable development of Kantha Bopha Children ‘s Hospital 5
criteria and characteristics. The averaging of the dependent variable in each group predicts the

value of the dependent variable based on some of independent variable values.
The problems that Kantha Bopha Hospital is facing
The costs of medical examination and treatment for patients are free. The increasing
number of patients arriving at Kantha Bopha Hospitals have prompted hospitals to continuously
expand its facilities to meet 24 – year needs. In 1996, Kantha Bopha II is the second hospital was
built because of increasing of patients overcrowded Kantha Bopha. Jayavarman VII is the third
hospital of Beat Richner, was built in 1998. In 2005, Kantha Bopha IV was inaugurated and in
2007, Kantha Bopha V was built in Phnom Penh. Increasingly, the two governments ‘s funding
for hospitals is limited, the support of the people is unstable, but hospitals have to continue to
expand and develop, which has become a seriously problem affected the operation of Kantha
Bopha.
There are many reasons for this: the rapid increase of Cambodia's population since 1992;
the population has grown rapidly and the proportion of Cambodian people is poor and near-poor.
From 1995 to 2017, the population has grown by nearly 60%, with poverty and near – poverty
rates in 2012 at 17,7% and 90% of its lives in suburban and rural areas. In addition, health care
services in many provinces and cities of Cambodia have not developed, knowledge of health care
is limited and most people do not use health insurance. This has made Kantha Bopha ‘s burden
increasingly unattainable after many years.
In addition to the above reasons, the study conducted a survey on the reasons people
often or non – often go to Kantha Bopha Hospital.
Among 50 people surveyed, 37 were admitted to Kantha Bopha Hospital for treatment.
The reason they regularly visit Kantha Bopha for treatment is summarized in the table below.
Table 1. Reasons often comes to Kantha Bopha for healing (the number of people surveyed often comes to
the healing Bopha)
REASON_CHOSE

Frequency

Non-fee
High quality and

modern

26

Good service

11

19

Prob
0.46428
6
0.33928
6
0.19642
9

Source: Survey data


Solutions for the sustainable development of Kantha Bopha Children ‘s Hospital 6
As can be seen, people often go to Kantha Bopha for free is the highest (accounting for
46.42%), often to Kantha Bopha because of high quality and modern methods of treatment
accounted for 33.93% and because of the epidemic. The good ones are the lowest (accounting for
19.64%) among those surveyed to Kantha Bopha for treatment.
The reason people do not often go to Kantha Bopha for medical treatment is that they are
too far away, they want to go some better and faster hospitals. Some people do not want to be
treated at Kantha Bopha because they do not trust the quality of the treatment at Kantha Bopha,
and some people do not like the service and some of the practitioners ‘s lack of courtesy. Can be

seen that the maintenance of free health care can have some consequences as some people do not
believe in the quality of hospital treatment and doctors do not respect patients.
Table 2. Results of a Criteria Assessment for Kantha Bopha Hospital (Ordinary People to Hospitals)
Variable names

Min

Max

Mean

NON_SAFE

1

7

5.324

NON_MODERN

2

7

4.919

BAD_GOOD_ATTITUDE

1

7

4.531

BAD_GOOD_MATERIAL

1

7

4.568

Source: Survey data
The results show that effective, safe treatment (NON_SAFE), modern treatment
(NON_MODERN), employee service attitude, patient physician (BAD_GOOD_ATTITUDE),
facilities (BAD_GOOD_MATERIAL) were evaluated differently by the respondents. However,
the average was only 4-5.5, indicating that the quality of Kantha Bopha's response to these
criteria was not good for most patients. The attitudes of the physician, the staff, and the patients
are the lowest.
Below is a survey of what the surveyed person has helped Kantha Bopha Hospital.
Table 3.What people do to help Kantha Bopha Hospital
Action to help
pay for Kantha Bopha's fun
intern with non - salary or little salary
promoted Kantha Bopha's fun program
study and research to solve any problem of Kantha Bopha
hospital
bought some produce that give some profit for Kantha Bopha

Number
32
2
3
1
1


Solutions for the sustainable development of Kantha Bopha Children ‘s Hospital 7
fun
Other
never help Kantha Bopha

2
12

Source: Survey data
Can be seen that 32 out of 50 respondents (64%) contributed to the Kantha Bopha
Foundation to support the hospital. There are many other ways to help the hospital, such as
practicing unpaid or low wages in hospitals, studying communication methods for Kantha
Bopha's programs, and researching other solutions that support Kantha Bopha. However, some of
the respondents have never helped Kantha Bopha Hospital (24%). As mentioned above, Kantha
Bopha Hospital's financing method is based on external funding, the people can support hospitals
but no stable and long term.
The problem facing Kantha Bopha disease today is the financial difficulties, quality
management services of doctors, research and development. In fact, some high – income families
still go for free treatment in the hospital. Free treatment makes too many patients want to go to
hospitals, leading to overload, causing many patients to wait so long. Can be seen providing free
services to all patients, in difficult hospital conditions, is an unreasonable point. Currently, Dr.
Beat Richner is undergoing intensive treatment, unable to hold concerts to collect hospital

support tickets. This type of concert is not the most sustainable solution for the hospital. These
are all difficulties that affect the sustainability of the hospital.
Proposed solutions for the sustainable development of Kantha Bopha Hospital
As mentioned above, Kantha Bopha hospitals are facing a lot of problems. Most of these
problems come from being completely free to people. Being completely free can cause many
people not to understand the meaning of the helping they received, no respect and non –
responsibility for hospitals. There are some people who have been treated at Kantha Bopha
during difficult times, but when conditions are better they will not go back to help hospitals. The
hospitals have ignored data management and patient information, and did not clearly identify the
patient ‘s economic condition. Some rich people can also go to hospital, which misspend Kantha
Bopha ‘s meager capital. The capital raised by the hospital is now sufficient to meet the needs of
treatment and enable hospitals to develop new research and cost – effective treatments. Unstable
and less financial resources make it more difficult for hospitals. The attitude of doctors in
hospitals with the patients is not good if forever apply free form completely. From the issues
raised and analyzed, we suggest that Kantha Bopha should be developed in the model of social


Solutions for the sustainable development of Kantha Bopha Children ‘s Hospital 8
enterprise in Cambodia. The hospital should manage the patient database, group the patients and
perform contracts based on the patient ‘s economic condition, helping them understand the value
of help and being responsible for the disease. Kantha Bopha should also consider receiving state
assistance in other forms such as receiving a portion of health insurance premiums and taxes
collected from items that are harmful to the health of the population. Collection of fees in the
form of partial or periodic payments reduces the difficulty for both the patient and the hospital.
The collection of hospital fees has helped Kantha Bopha have official revenue, developed into a
social enterprise model stable and sustainable. Doctors will need to adjust their attitudes to the
patient when the patient is one of their clients. The study recommends the following specific
solutions:
- Increasing taxes on health – related goods to raise funds for health. Then get some of
this capital to support Kantha Bopha Hospital.

- Personal income tax exempt for doctors, doctors in Kantha Bopha.
- Store the personal information of children and women who have been treated at Kantha
Bopha. When their family status is above the poverty line or when the child is working, they can
pay the non-interest-rate subsidy over a reasonable period. This is the job of helping the patient
group, managing the database to provide free services to the right people, helping to avoid
wasting resources and increasing revenue for the hospital.
- Implementing the compulsory health insurance policy for people with medium and high
income, increasing rate by income. A definite part of the amount of health insurance used to
provide direct support to Kantha Bopha Hospital.
- Mobilize medical students to meet unpaid internship requirements at Kantha Bopha.
- Enhancing health care and dissemination of disease prevention for the poor to reduce
the burden on the population as well as Kantha Bopha.
- Strengthen the corporate culture in the hospital. Although Kantha Bopha is a provider of
services, there is still money and money, but if a fee is charged, every client remains a client of
the business. There is a need for respect for patients.
- Spending a portion of the capital to support research and development work, linking
with universities to apply more advanced medical technology and methods to save hospital costs.
Among the above solutions, some solutions directly relate to the benefits of people
coming to Kantha Bopha. This is to store patient information, perform a part-time payment of


Solutions for the sustainable development of Kantha Bopha Children ‘s Hospital 9
hospital fees, pay 0% of the hospital fee during the agreed period and implement the health
insurance policy. Consequently, the study looked at consumers' opinions about making a partial
payment of hospital fees, purchasing premiums, or supporting Kantha Bopha on the other hand.
Survey results are given in the below table.
Table 4.Ideas of people for helping Kantha Bopha hospitals to have a more stable source of funding for
the survey
Idea for helping Kantha Bopha Hospital
increase tax of not-good for health products

pay for insurance (depend on income of people)
pay in a limit-time after treatment
pay 20% to 30% of full treatment's fee
Non

Frequency
30
19
15
34
4

Source: Survey data
The data show that most respondents did not want to pay for a limited period time (only
15/50 people, equivalent to 30% wanting to pay for a short period of time). Partial payment was
the most chosen option (accounting for 68% of the 50 respondents). Increasing taxes on healththreatening items was chosen by the respondents (60%). However, the number of respondents
who want to pay insurance is quite limited, which is in line with the current state of health
insurance in Cambodia.
The Regression Trees algorithm groups the opinions of the respondents according to the
criteria for the Kantha Bopha Hospital survey. Subgroup results are as follows:
Group 1: Include 8 out of 13 non-regular visitors to Kantha Bopha Hospital for treatment,
who did not evaluate Kantha Bopha ‘s quality.
Group 2: Include 22 out of 37 regular people to Kantha Bopha for medical treatment.
This group came to evaluate the facilities slightly above the normal level (equivalent to 4.5).
Group 3: Includes 5 non-regular patients and 15 regular patients. This group evaluates
hospitals with a material quality of less than 4.5 (ie normal or below normal).
It is possible to see people coming to Kantha Bopha cure different feelings about the
facilities of the hospital. Those who do not regularly visit the hospital also judge that the hospital
has not good facilities. The facilities of Kantha Bopha have not really met the needs of the
people. Collection of hospital fees and management of patient databases for payment, hospital

support will help to generate a portion of the revenue for Kantha Bopha. Therefore, Kantha
Bopha can formally develop into a social enterprise. This suggests that an organization such as
Kantha Bopha Hospital, if transformed into a social enterprise, could be more proactive in


Solutions for the sustainable development of Kantha Bopha Children ‘s Hospital 10
mobilizing capital and maintaining hospital operations, but reducing its reliance on unstable aid.
from the outside. Social enterprise can be a form of sustainable development for Kantha Bopha.
Conclusion
The study gathered information related to the actual situation of Kantha Bopha Hospitals,
the scale development and the increase in the number of children treated at Kantha Bopha
showed the Kantha Bopha hospitals great role in providing healthcare services for Cambodians.
The study also pointed out that Kantha Bopha could develop into a social enterprise to achieve
more sustainable results. In the case of the Kantha Bopha Hospitals, it can be commented that
helping everyone with a free form can have unintended consequences such as: getting people got
help not being aware of the meaning of the support they received, some people who are not
difficult can also receive help, misspend organization resources, limiting the capital for the
development of the organization. Organizations with the same charitable purpose as Kantha
Bopha should develop into social entrepreneurs in order that have more sustainable development
orientations and strategies for the future.
Acknowledgments
We sincerely thank the consumers who helped us complete the survey. I sincerely thank
all my friends, teachers and relatives for their valuable contribution to this study!

References
Dr. med. Beat Richner, (2014). Annual Report of the Foundation of Children‘s Hospitals Kantha
Bopha.
Kantha Bopha Center, (2002). International Symposium on Pediatrics and Perinatology in the
poor world for poor people