“Citizens’ health is guaranteed. The state is taking care of disease prevention and cure. The poor are entitled to get access to health checks without any payment, at any public health center, infirmary and maternity center.

The State shall organize and establish infirmaries and maternity centers.”1

In the wake of the civil war and the Khmer Rouse genocidal regime, Cambodia has put a lot of effort into health sector reforms. Since 1996, all of these efforts have led to the establishment of the health system that we have today, under management at three levels, namely central, Intermediate and lower (see table below).2However, from the central policy central point of view, in pursuing its commitments in the Programme of Action of the International Conference on Population and Development held in Cairo in 1994 to address population issues, the Royal Government of Cambodia places more emphasis on the delivery of reproductive health services.3

Organizational structure of health systemsTop 10 population-related issues in priorities
Central top levelMinistry of HealthResponsible for policies, legislation formulation and strategic planning.High population growth
National institutesHigh fertility
National hospitalsHigh mortality
National programmes and national training institutesHIV/AIDS epidemic
Migration
Intermediate levelProvincial health departmentServed as the linkage between the central level and operational districts, and responsible for implementing national policies.Imbalance in age and sex structure
Provincial hospitalsHigh incidence of poverty as a result of demographic vulnerability
Low levels of human resource development
Lower levelOperational districts (ODs)Responsible for the delivery of the public health services, from a wider range of services at ODs to a limited and basic services at HPs in some villages. Gender inequalities
Referral hospitals (RHs)
Health centers (HCs)Population pressure on natural resources
Health posts (HPs)

Table: Cambodia’s health system4 and the top 10 population-related issues in priorities5

Under the National Population Policy of Cambodia, women, children and infants are the main beneficiaries of the government’s health services schemes.6 This means that the rest rely more on non-state health services schemes: the private health-care providers and non-for-profit organizations. According to the 2010 Cambodian Demographics and Health Survey, “only 29% of unwell or injured patients sought care first in the public sector. 57% sought care for their last episode at private providers.”7 Notwithstanding a gradual improvement in livelihood for the population as a result of the country’s steady economic growth, the country’s health services remain far from the reach of vulnerable populations: the poor, the disabled and indigenous minorities.

The costs associated with using health services pose a major challenge for Cambodia’s poor.8 Seeking support from international donors and input from international organizations and local stakeholders, the Ministry of Planning established the “ID Poor” information system to help with policy and decision making. A number of social health protection (SHP) schemes developed, targeting poor households. The most prominent scheme involved “health equity funds (HEFs)”, enabling access to public health services at minimal cost for the poor.9

According to the 2013 Cambodian Socio-economic Survey (CSES), 4 % of Cambodians live with a disability.10 However, while they are not at the center of the public health policy, the people with disabilities in the country face many constraints preventing them from benefiting from public health services. In GIZ’s 2015 study, barriers to access to public health care services encountered by Cambodians with disabilities were identified as “high direct and indirect costs, physical inaccessibility of health facilities, communication barriers and negative attitudes on the part of health care workers”.11 As a signatory country to the United Nations Convention on the Rights to Persons with Disabilities (CRPD), the government of Cambodia is committed to guarantee that “persons with disabilities are entitled to the highest attainable standard of health without discrimination on the basis of disability.”12

Among the indigenous people in Mondulkiri and Ratanakiri, who make up a significant proportion of the population in those provinces, maternal and infant health and malnutrition among children remain the concerns. Under-five mortality rates in those provinces are twice the national average of 83 deaths per 1,000 live births,13 and the maternal mortality is worrisome since most of the indigenous women deliver their babies at home.14 A majority of indigenous children under five in Cambodia are classified as “underweight” and “stunted in growth”.15

Last update: 20 November 2016

References