4.1 Healthcare Access and Availability of Equipment

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4.1 Healthcare Access and Availability of Equipment

Universal Health access is currently a major focus of the Cambodian government, which entails the facilitation of every citizen to be provided with the health care they require in a timely manner. Overcoming barriers such as urban density, geography, lack of trained personnel or financial drawbacks is essential in distributing health care services and products throughout the country effectively. 

Percentage of households with a car and access to health clinics 3

Vitally, people from rural areas and remote provinces are faced with an arduous task in accessing health care. For example, even in Kratie, a provincial capital on the Mekong River, the neonatal mortality is 5 times higher than Phnom Penh and 40 times higher than in a developed country such as Singapore1. Worse yet in the remote province of Ratanakiri, one child in every 30 dies in the first month of life. One in 12 does not make it through her or his first year. One in 10 children dies before reaching her or his fifth birthday – mainly of preventable and easily treatable diseases2

In the current context, it will be difficult to sustain or expand the existing system to provide quality, safe and effective health services without financial hardship. This is evident as the government funds only 23% of the current health care system5, whereby withdrawal of humanitarian aid and foreign investment will cripple the current system.

access-to-health-facilitiesAccess to healthcare facilities in Cambodia4. Click the image for high resolution version.

Furthermore, decentralisation of the health care system has led to privatisation and underpaying of health care staff by less than half the required living wage6, exacerbating the need for more trained workers. 76% of rural health care is private and nation-wide 60% of patients sought care at private providers7, leading to relative disuse by the vulnerable and poor socioeconomic groups8. Kampong Thom province has the highest poverty incidence in Cambodia, 29.1%, but the lowest number of physicians and hospital beds per 1000 population of the three provinces9

The view of the operating room in the Kampong Speu Referral Hospital10. A room had two beds, and surgeries were performed in both beds at the same time. Local anaesthesia and simple general anaesthesia were administered by headlight.

There has been much work done to confront the challenges with quality of healthcare and expand the existing healthcare network, however there are still many who do not have any access to emergency care. Your task is to consider how to ensure those living outside or in poor coverage can be provided with necessary services and have access to essential equipment and supplies. 

Example: Considering the short-sighted nature of the current health system, how would we best supplement or adapt the current infrastructure to guarantee sustained access to safe and effective care for each demographic; whether that be rural, urban, low socioeconomic or other vulnerable groups. 

Example: How could we tackle misinformation and overcome absence of genuine medical equipment using the existing local resources or otherwise. 

Example: How could we provide healthcare for the communities and vulnerable groups that do not have reliable access to the existing network. 

Example: Following weak financial support from the government; the equipment, drug and medical devices markets are largely privatised. This has led to regulatory difficulties, causing issues in quality of medicine, distribution and supply11, while compounded by the belief injections are more effective than drugs, as well as false prescriptions and lack of false or misleading advertising12. Similarly, health care centres experience a constant shortage of medical equipment and critical medical devices – not to mention the training needed to utilise them13. This significantly impacts the quality of healthcare throughout the country, resulting in the unacceptable loss of life. How might we ensure locals are making informed choices and have access to an adequate stockpile of medical supplies and drugs

Example: Current networks in Cambodia encompass a basic level of health care and achieved most of the Millennium Developments Goals on maternal and child health and tackling HIV, tuberculosis and malaria. However, Cambodia underperforms in regard to specialised or intensive care, with services such as Ophthalmology only being offered in 23 per cent of referral hospitals14. What could we do to ensure more hospitals have access to specialised and technical equipment especially in rural areas to help Cambodians with poor healthcare access. 

Related Ideas: Prevention of diseases, Vaccine distribution, Biosafety and protecting local commnities

Further Readings:

[1] A Calling in Cambodia, https://www.hsph.harvard.edu/magazine/magazine_article/a-calling-in-cambodia/
[2] A push to bring healthcare to remote areas, https://www.unicef.org/earlychildhood/cambodia_66038.html
[3] Comparison of Subnational Availability of Women’s Family Planning Services and Women and Children’s Health in Cambodia (2013) and the Philippines (2014) using DHS Program Data
[4] Open Development Cambodia: https://data.opendevelopmentcambodia.net/map-explorer
[5] Cambodia Struggles to expand Health Coverage, https://www.bangkokpost.com/business/1520778/cambodia-struggles-to-expand-health-coverage
[6] Pacific Bridge – Healthcare in Cambodia https://www.pacificbridgemedical.com/publication/healthcare-in-cambodia/#:~:text=Healthcare%20spending%20in%20Cambodia%20is%20divided%20between%20the%20public%20and%20private%20sectors.&text=As%20such%2C%20many%20government%20healthcare,to%20serve%20the%20entire%20population.
[7] Ibid.
[8] Barriers to access and the purchasing function of health equity funds: lessons from Cambodia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704035/
[9] Costing for universal health coverage: insight into essential economic data from three provinces in Cambodia, https://link.springer.com/article/10.1186/s13561-019-0246-6
[10] Medical Service in Cambodia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385327/
[11] Exploring healthcare provision in Cambodia https://www.tandfonline.com/doi/full/10.1080/09581596.2019.1591614
[12] Ministry of Health – Pharmaceutical Sector Strategic Plan, http://www.haiasiapacific.org/wp-content/uploads/2015/02/CambodiaPSSP2013-2018FinalDraftOct2012.pdf
[13] Building a medical system without a foundation?, https://www.phnompenhpost.com/post-weekend/building-medical-system-without-foundation?cf_chl_jschl_tk=02126c40258d3fb1f4eadef50934ce1d95e41eed-1596043603-0-Ad_BkkWz94t1GBlsnnwWG0vx3tXJ8uPF5f__wa1YtWkdHRmj6WQSonm7h4mdOC3Ev0m8F8p082o3pbB0w6FSHN9usJj2Hl0SnrUvckE5SYbzOP8yFAyS3b4lFUcpVqScUh3z62D9zNgnG1pzsCaSZBlD3QN16JQn_UXo-hjJSozjXaXNymFMl_tPYanlqx3aTZx-OmS8I8E36AOgIDZf1d-I5H6MEHwNjqf6pqzLgx_PtSasqu10IrhHuCmisuaXkg_GVh-1ik_7xeky-qk6HjYcuYyiVaVQnPS5s9FDYL1UMCBYh3F5WGH3dj5xql9FmgaTpZUtDN6nIrVcKOvYsySYR0gJfz-pnC2PcRjMdN3K
[14] Department ofHealth and Planning, HEALTH STRATEGIC PLAN 2016-2020, http://hismohcambodia.org/public/fileupload/carousel/HSP3-(2016-2020).pdf
[15] Cambodia’s Main Challenges in Improving Health among the Poor https://openknowledge.worldbank.org/handle/10986/21061
[16] Cambodia’s Healthcare https://southeastasiaglobe.com/taking-back-cambodias-healthcare-system/