HEALTH CARE

Due to the long time civil war, most of the hospitals and medical equipment have been utterly destroyed. Most of the doctors and nurses have been killed during the Khmer Rouge Regime. Cambodian Red Cross under the leadership of Lok Chumtev BUN RANY HUN SEN has made the great efforts to contact the NGOs and the donor’s countries to seek for the assistance for improvement the hospital equipment and medicines and medical training program for the doctors, nurses and midwives… etc.

According to the Social Economic Survey, it reveals the poverty of Cambodians has declined from 39% in 1993 to 36% in 2000. Although this great improvement is a good sign, the situation is still precarious for many households, especially in rural area. About 40% of population live below the poverty line. The Average Life Expectancy at birth is estimated 54.4 years. On average, females can expect to live 8 years longer than males (58.6 years and 50.3 years respectively).

Nutrition is also a serious problem in Cambodia. Among the children under five, 49.3% is severely underweight. Childhood malnutrition can affect the health because anemia and nutritional disorders can lead to pregnancy complication or even death, 27% of women has a low Body Mass Index (BMI), 43.9% underweight and 7.5% stunted. A large proportion of the population suffers from the poor housing condition, only 32% have access to safe drinking water, 15% to electricity and 14% to toilet facilities. In short, the rural population suffers much worse condition than the urban people.

The government recognizes that the public health system in Cambodia is inadequate; only one-fifth (1\5) of populations has access to health clinic in their own village. Another fifth has to travel more than five kilometers to reach the nearest health facility. The burden of public health care expenses is much greater for the poor than the rich, therefore they don’t use the public health system.

They will self-medicate, that means they buy the medicines directly from the drug store or traditional healer. An average Cambodian has only 0.35 medical contacts with public health service annually. The main cause of mortality is malaria and tuberculosis. Each year 500,000 cases of malaria occur in Cambodia. It is estimated 4.5 per 1,000 people have suffered the above-mentioned disease. As for HIV/AIDS, it is estimated that 250,000 people are affected with this virus.

According to the report from UNICEF, the maternal mortality ratio is estimated to be 900 per 100,000 live birth. 90% of deliveries take place at home or in other-non-medical facilities. Only 8% of births take place in public facility. During delivery, 34% of women is assisted by doctor, nurse or trained midwife, two-third of women receive the assistance from Traditional Birth Attendants (TBA).

Health indicators related to the access of services, safe water and sanitation are also much lower in Cambodia than in the other countries. Cambodian people, both children and adults, are exposed to much higher risk factors in health and higher mortality rates than the other countries in ASEAN.

Provisions of public health services in Cambodia is highly inadequate compared with the neighboring countries. The low public provision of health services put a heavy financial burden on Cambodian people.

* Health System Reform:

The Ministry of Health (MOH) faces the problems concerning the poor access and the quality of public health services and a rapid development of the private hospitals. Due to the low salary, most of staffs are poorly motivated and have inadequate skill. The hospital is equipped with the out of date health infrastructure.

In order to regain people’s confidence, the Ministry of Health under the supported by the donors has increased lots of new medical access to improve the health care for the Cambodian people. At the present, 79 referral hospitals were built and 74 were renovated, of 499 of health centers 446 were built and 53 were renovated, 5 health posts were built and 8 national hospitals for the nationwide health system. Among them, the most famous one is Calmette Hospital with modern medical equipment which is under the support of French Government and NGOs.

According to the report of the Ministry of Public Health in March 2001, there were 2,397 doctors and medical assistants, 6,855 primary and secondary nurses, 2,739 primary and secondary midwives and  23,434 health workers at all levels of Ministry of Health working at municipal and province (district/commune levels).

As for the private sector, it has been rapidly developed in the unregulated manner. The number of registered private clinics, laboratories and supporting clinic facilities was 330 with only 395 beds, they are perceived as having better equipment, more caring and medicines, but are also associated with the high cost. In short, the health expenditure in Cambodia is about US$26.6 per year.

* Structure of the Ministry of Health:

As for the structure of the Ministry of Health (MOH), the health system is organized into central, provincial and district levels. The central level consists of the Central MOH, National Programs and Central Institutions.

Its role mainly relates to the development, implementation and monitoring concerning national health policy, strategy and planning…etc.

The provincial level refers to the 24 Provincial and Municipal Health Departments. Its role is to link the Central Level and the Operational Districts. The Operational Districts Level consists of a referral hospital and health center (HCs). Its main role is to implement OD health objectives. The number of centers and their locations are decided by the population density. There is one health center for every 10,000 people.

The Royal Cambodian Government has paid attention to the health care. At the consultant Group meeting with the donors in February 1999. Cambodian Government delegate listed the following achievements in the health sector.

            1-   A decrease in children under 5 mortality rate from 181 per 1,000 live births in 1993 to 115 per 1,000 lives births in 1998.

            2-   A decrease in the infant mortality rate from 115 per 1,000 live births in 1993 to 89 per 1,000 lives births in 1998.

            3-   The development of First Health Workforce Development Plan for human resource in health care field from 1996 – 2005, including save training.

            4-   The improvement for performance of health care delivery.

            5-   At expansion of the National Immunization Program, the children aged 12-23 months with completing vaccination 68%. 

6-     Contraceptive Prevalence Rate has increased from 7% in 1995 to 18% in 1998.

During the flood in 2000, it is reported that a total of 121 health centers and referral hospitals were flooded and the estimated damage is US$0.63 million. The 2001 new budget for health will be increased 17% to improve the medical facilities, training and health conditions of the people… etc.

THE FACULTY OF MEDICINE, PHARMACY AND DENTISTRY