“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 systems||Top 10 population-related issues in priorities|
|Central top level||Ministry of Health||Responsible for policies, legislation formulation and strategic planning.||High population growth|
|National institutes||High fertility|
|National hospitals||High mortality|
|National programmes and national training institutes||HIV/AIDS epidemic|
|Intermediate level||Provincial health department||Served as the linkage between the central level and operational districts, and responsible for implementing national policies.||Imbalance in age and sex structure|
|Provincial hospitals||High incidence of poverty as a result of demographic vulnerability|
|Low levels of human resource development|
|Lower level||Operational 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)|
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
- 1. The Constitution of The Kingdom of Cambodia (1993), article 72.
- 2. Leang Sopheap and Chheng Kannarath (2014). “Addressing the Gaps in Heath System Services Delivery in Cambodia.” Development Research Forum Synthesis Report No.06, June 2014. Phnom Penh: Cambodia Development Resource Institute (CDRI), 2014. Accessed 20 November 2016. http://www.cdri.org.kh/webdata/policybrief/drf/SynthesisReport6.pdf
- 3. Ministry of Planning. National Population Policy of Cambodia (Executive Summary-Final). Accessed 20 November 2016. http://www.mop.gov.kh/Home/TheNationalPopulationPolicy/tabid/202/Default.aspx
- 4. Leang Sopheap and Chheng Kannarath (2014), 1. Peter Leslie Annear, John Grundy et al. The Kingdom of Cambodia: Health System Review. Health System in Transition, Vol.5, No.2, xxvi. World Health Organization (WHO), Asia Pacific Observatory on Health System and Policies, 2015. Accessed on 20 November 2016. http://www.wpro.who.int/asia_pacific_observatory/hits/series/cambodia_health_systems_review.pdf
- 5. Ministry of Planning. National Population Policy of Cambodia, iii.
- 6. It is worth to state here that Cambodia’s government is not the only key player in the areas of the protection and promotion of maternal, newborn and child health and nutrition but also United Nations agencies and other international organizations. Listed as their government partners are Ministry of Health and Council for Agriculture and Rural Development. As underlined in the report, the issue of mal-nutrition among the children and infants remained. UNICEF Cambodia. “Maternal, Newborn and Child Health and Nutrition.” Accessed 20 November 2016. https://www.unicef.org/cambodia/6.Maternal.pdf
- 7. Peter Leslie Annear, John Grundy et al. The Kingdom of Cambodia: Health System Review. Health System in Transition, Vol.5, No.2, xvii. World Health Organization (WHO), Asia Pacific Observatory on Health System and Policies, 2015. Accessed on 20 November 2016. http://www.wpro.who.int/asia_pacific_observatory/hits/series/cambodia_health_systems_review.pdf
- 8. In Phnom Penh, health care access to basic preventive and curative services by the poor were shown relatively high than other parts of the country but the poor health outcomes of the services were frequently complained. John Grundy et al. Health Service Access Among the Poor Communities in Phnom Penh. Phnom Penh: Ministry of Health and UNICEF Cambodia, 2009. Accessed 20 November 2016. https://www.unicef.org/eapro/Health_Service_Access_Among_Poor_Communities_Phnom_Penh_(Low.pdf
- 9. Adélio Fernandes Antunes and Bart Jacobs. “Access to Public Health Services: Why Do Eligible Households Not Make Use of Health Equity Fund Benefits?” Briefings for Health Financing Policy-Making in Cambodia, No.3. Phnom Penh: GIZ, July 2014. Accessed 20 November 2016. http://giz-cambodia.com/wordpress/wp-content/uploads/Briefing-note-3-HEF-non-utilisation-EN.pdf
- 10. National Institute of Statistics (NIS). “CSES Table 2013: Health.” Accessed 20 November 2016. https://www.nis.gov.kh/nis/CSES/Data/CSES_2013/CSES_Health.htm
- 11. Karen Birdsall. Every Person Counts: Promoting the Inclusion of Persons with Disabilities in the Health Sector in Cambodia. Phnom Penh: GIZ, November 2015, 4. Accessed on 20 November 2015. http://health.bmz.de/ghpc/case-studies/Every_person_counts/Every_person_counts_long_ENG.pdf
- 12. The Kingdom of Cambodia has been a signatory to the Convention since October 2007. Ibid, 6.
- 13. Indigenous People NGO Network (IPNN). “The Rights of Indigenous Peoples in Cambodia.” United Nations Committee on the Elimination of Racial Discrimination (76th Session 2010). IPNN, February 2010, 15. Accessed 20 November 2016. http://tbinternet.ohchr.org/Treaties/CERD/Shared%20Documents/KHM/INT_CERD_NGO_KHM_76_9428_E.pdf
- 14. Ponlork Khmer (NGO). “Hearing Indigenous People’s Voices Responding to Health Challenges in Ratanakiri and Modulkiri.” MEDiCAM Meeting, 25 February 2011. Slide presentation, no.30.
- 15. United Nations (2016). “Chapter 2: Access to Health Services by Indigenous Peoples in Asia.” In State of the World’s Indigenous People: Indigenous Peoples’ Access to Health Services, 45. DOI: http://dx.doi.org/10.18356/7914b045-en . Accessed 20 November 2016. http://www.keepeek.com/Digital-Asset-Management/oecd/human-rights-and-refugees/state-of-the-world-s-indigenous-peoples_47f7e4f3-en#page1