The Kingdom of Cambodia health system review

Overview

The national health reforms initiated two decades ago has had a positive impact on Cambodia’s health sector with the country making significant gains in rebuilding the health system. Cambodia’s health status has substantially improved since 1993 and is on track to achieve the Millennium Development Goal targets. Mortality rates have significantly dropped, and life expectancy at birth was 62.5 years in 2010, a 1.6-fold increase from 1980. 

Health reform has been guided by a long-term process of national health planning. More recently, the Ministry of Health (MOH) has assumed the leading role in health-system planning and development, in partnership with the development agencies. Recent health reforms have focused on strengthening the MOH’s capacity to manage health-service delivery. Providing access for the poor is at the heart of health reforms, with long-term goal to move towards universal coverage. However, there are several challenges to this. 

In the absence of strong government policies supporting the development of the social sectors, including health care, there has been a rapid growth of a disparate and largely unregulated but extensive sector of private healthcare providers delivering majority of health services. According to the 2010 Cambodian Demographic and Health Survey, only 29% of unwell or injured patients sought care first in the public sector, while 57% sought care for their last episode at private providers. Private practitioners and clinics are particularly frequented for curative care, whereas health prevention activities (such as immunization, tuberculosis, malaria and HIV/AIDS control) are the domain of the public sector.

While government funding for health care has increased significantly, it remains at only 1.4% of GDP. Official development assistance is stable at 15–20% of total health expenditure. The out-of-pocket payments provided 61% of total health expenditure. National data indicate that the overwhelming proportion of out-of-pocket expenditure is paid to private providers. A number of demand-side financing schemes provide social health protection, including Health Equity Funds, voucher schemes, voluntary community-based health insurance and (to a small extent) private health insurance. 

Achieving the goal of universal coverage requires improved collection and use of health care data and a long-term view. The improvements in government commitment to health need to be maintained. The heavy reliance on out-of-pocket spending must decline. The adoption and effective implementation of the draft Health Financing Policy is the first important step. Donor support is essential, but greater alignment of donor programmes is needed. This is also important when the period of piloting and experimentation, particularly in the supply of services and health financing area, is over. 

Health-system policy needs now to return to strengthening the supply side. Improving the quality of care is now the most pressing imperative in health-system strengthening. In the public sector, this requires attention to funding, management processes and the remuneration of public-sector workers. For the private sector, it poses the immediate need for extended regulation, accreditation and enforcement.