ReviewHealth system strengthening in Cambodia—A case study of health policy response to social transition
Section snippets
Introduction and background
During the 1975–1979 Khmer Rouge “Democratic Kampuchea” period, up to 1.6 million out of the population of 6.7 million died through execution, starvation or overwork [1]. Due to the targeting of the educated classes by the regime, health services were retained only for a minority of the Khmer Rouge elite, with the rest of the population forced to rely on traditional medicine, care by illiterate or semi-literate “Khmer Rouge doctors” and home based care to survive medical or obstetric conditions
Methods and sources of data collection
An international literature review was conducted of the Cambodian health system and health policy developments. National documents were also accessed, including national strategic health plans [8], [9] and the most recent health sector reviews [10], [11]. Secondary analysis was carried out using data from two successive Cambodian Demographic and Health Surveys in 2000 and 2005. These DHS data were published by the National Institute of Public Health and National Institute of Statistics and are
Recent demographic health trends
Recent demographic health trends have demonstrated significant improvements in population health in Cambodia, particularly in relation to declining fertility rates, improved immunization, and declining HIV prevalence. The most notable finding of the Cambodian Demographic Health Survey in 2005 was the sharp decline of infant mortality (from 109 to 66 per 1000) and child mortality (from 123 to 83 per 1000) in the period from 2000 to 2005. However, maternal mortality increased from 437 to 472 per
Most recent sector analyses and policy responses in Cambodia
The following will describe the most recent health sector analyses and policy responses in Cambodia, in order to understand more fully the systemic and social determinants of inequities in health access.
The social determinants of health outcomes in Cambodia
The DHS results clearly demonstrate the potential for community based interventions to promote equity, as measured by increased coverage and reduced urban–rural disparities in access to health services. Both immunization and birth spacing services are largely delivered within the 13,000 villages of Cambodia either through community based distribution systems for contraceptives via local NGOs or, in the case of immunization, through government health outreach services. In fact, up to 80% of
Conclusion
The case of Cambodia illustrates that policy responses such as health service contracting, public–private collaborations and equity funds, although not universal solutions for health system strengthening, can still be considered as highly adaptive policy responses in a social context. Clearly, the liberalization of the economic and political environment in Cambodia has allowed planners the policy ‘space’ to negotiate the development of these innovations and has no doubt been a contributing
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