Sources: U.N. Human Development Report 2006, United Nations Economic and Social Commission for Asia and the Pacific, Population Reference Bureau, Asian Development Bank Key Indicators Report, Yunnan Government.
1. GEOGRAPHY, DEMOGRAPHIC STATISTICS
Cambodia is an agriculture country located in Southeast Asia; it is bounded by Thailand to the west, Lao PDR and Thailand to the north and Vietnam to the east. It has a total land area of 181,035 square kilometers. The maximum extent of the country from the east to the west is approximately 580 kilometers; it extends for 450 kilometers from the north to the south.
The 1962 Census was the last official census to be conducted prior to 1998; it revealed a population of 5.7 million. The population census in 1998 recorded the number of the people in the country at 11,437,656 with an annual growth rate of 2.49 percent. The 1998 census showed that 51.8 percent of the population was female and 48.2 percent was male.
The crude birth rate (CBR) is 2.8 per cent and the total fertility rate is 4.0 per cent (National Institute of Statistic, and Directorate General for Health, 2000). The high percentage of women and children indicates that meeting their health needs should be a high priority. A large proportion of the population, 84 percent, live in rural areas, and only 16 percent live in urban areas. It is estimated that approximately 36 per cent of the total population living below the poverty line (Council for Social Development, 2002).
Since the establishment of the Royal Government of Cambodia in 1993 up to 2002, average GDP growth was 5.5 percent. Agriculture accounts for 33.4 percent of GDP, and employs more than 70.7 per cent of the labor force (Ministry of Planning, 2003).
2. HEALTH STATUS
Cambodian health is still among the lowest in the Western Pacific Region. The infant mortality rate was 95 per 1000 live births in 2000. This is high compared to its neighboring countries (fig.1).
Fig. 1 Infant Mortality in Southeast Asia
Deaths per 1,000 live births
Source: Population Reference Bureau, 2002 World Population Datasheet
The mortality rate of children under five years of age in 2000 was 124 per 1000 live births. The pattern of morbidity and mortality have remained virtually unchanged over years, and most of the population seems to be greatly affected by the same diseases including diarrhea, acute respiratory infections (ARI), dengue hemorrhagic fever, malaria, tuberculosis, malnutrition, and vaccine-preventable diseases.
The maternal mortality ratio (MMR) is also high in the region, which accounted for 437 per 100,000 live births, and it is due mainly to abortion complications, eclampsia, and hemorrhage (fig.2).
Fig.2 Maternal Mortality in Selected Countries in Asia
Source: Maternal mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA, 2003, (unedited version, website).
Malaria is a major cause of morbidity and mortality in all age groups, especially in socio-economically productive groups. The people affected by malaria are forest dwellers and migrant forest workers. The incidence rate of malaria in 1993 was 9.6 per 1000 population (Ministry of Health, 2004).
Tuberculosis is still a main public health problem in Cambodia, and it is classified by the WHO as one of the 23 countries in the world with high burden of tuberculosis. According to the WHO, it is estimated that 64% of Cambodian people were infected by Mycobacterium Tuberculosis. The incidence of smear positive cases (Sm+) is estimated to be 241 per 100, 000 inhabitants, with the death rate accounted for 90 deaths per 100,000 people per year (NTCP, 2001). Since the implementation of directly observed therapy short-course (DOTS) in 1994, the cure rate of tuberculosis reached to more than 85 per cent, and as of 2003, it was 90%, which is well above the international standard. However, of great concern is the increasing incidence of tuberculosis associated with HIV/AIDS, as the HIV sero-prevalence among TB patients is 12% as of 2003 (CENAT, 2003).
HIV/AIDS poses a great serious public health problem in Cambodia and it is currently estimated that 169,000 Cambodian people are living with HIV/AIDS (NCHAD, 2003). Although the estimated sero-prevalence among adults population aged 15-49 years old has shown a steady decline from 3.9% in 1997 to 2.6% in 2003. Further, the number of new HIV infections each year has also dropped, mainly among young people, as prevention strategies take effect. However, the national HIV prevalence in Cambodia remains the highest of any countries in Asia.
In October 2000, Cambodia was certified as polio free, with no cases of poliomyelitis reported since March 1997.
Leprosy no longer poses a significant public health problem. The target to lower the prevalence of this disease to less than 1 case among 10 000 people by the year 2000 has already been achieved.
Mine accidents are also a major problem. For almost nearly three decades of prolonged civil war, Cambodia remains one of the worst landmines and unexploded ordnance (UXO) affected countries in the world (Ministry of Planning, 2003). According to a Level One Survey in 2002, it was estimated that 12 per cent of the Cambodian villages have to cope with high contamination by landmines and UXOs. Currently, Cambodia is struggling against millions of landmines and UXOs, which caused more than 50,000 victims so far and still endanger hundreds of lives each year. On the 3rd of December 1997, Cambodia became a signatory of the Ottawa Convention for the prohibition of the use, stockpiling, production and transfer of anti-personnel mines, and their destruction.
Proper sanitation is also a major concern. The majority of Cambodian households (79%) do not have toilet facility. Only thirty one percent (31%) of households with access to safe drinking water during the dry season. Generally, household in rural Cambodia are less access to safe water during the dry season than its urban counterpart with 27 percent and 54 percent respectively (National Institute of Statistic, and Directorate General for Health, 2000).
3- NATIONAL HEALTH SYSTEM
Prior to the 1995 Health Sector Reform, the government policy was to have a clinic in each commune, a hospital in each district capital and a provincial hospital in each provincial capital (Ministry of Health, 1995). However, that system did not meet the essential health needs of the population, as most clinics at commune levels were non-existent or had been demolished; staffs were poorly skilled and motivated.
At district levels, most of the hospitals functioned only as clinics, and only few district hospitals really provided referral services. Medical, surgical, and obstetrical emergencies could only be treated in provincial hospitals, in national hospitals, and in a limited number of district hospitals. In addition, there were neither a clear nor a complementary difference between the first level of care and the referral level. Moreover, the size of the population covered by clinics and hospitals was inappropriate (too large or too small).
In 1995 the Ministry of Health approved a new health system for the organization of provincial health services based upon a redefinition of criteria for location of health facilities and a definition of a basic minimum package of health services to be delivered at each level. The reformed health system was composed of three levels: the first level, the most peripheral was made up of operational district serving about 100,000 – 200,000 populations, and composed of a referral hospital and a network of health centers. Each health center covered the population of 8,000 to 12,000.
The second level or intermediate level was made up of a provincial hospital and provincial health department. The third or central level consisted of Ministry of Health, national institutes, national hospitals, national programs, and training institutions.
As of 2003, there were eight national hospitals, 73 operational districts, 67 referral hospitals, and 823 (87%) health centers out of 942 providing minimum package of activities (MPA). It is planned that by the end of 2005, 46 referral hospitals will provide either Complimentary Package of Activities-2 or 3 (CPA2 or CPA3) (Ministry of Health, 2004).
4- NATIONAL HEALTH STRATEGIC PLAN (2003-2007)
The Health Strategic Plan (HSP), the first of its kind for Cambodia, was launched in August 2002, with the endorsement from the Prime Minister. The strategic plan provides a common framework for all partners in the sector, both government and external for the period 2003-2007. The document outlines strategies of the six key areas of work: health service delivery (HSD), behavioral change (BCC), quality improvement (QI), human resource development (HRD), health care financing (HF) and institutional development (ID) for the key purpose of effective and efficient health services development that improves health for all Cambodians especially the poor and marginalized population.
MISSION STATEMENT OF THE MINISTRY OF HEALTH
The Mission of the Ministry of Health, Royal Government of Cambodia is commitment to ensure sector wide equitable, quality health care for all the people of Cambodia through targeting resources, especially to the poor and to areas in greatest need.
VALUES OF THE MINISTRY OF HEALTH
WORKING PRINCIPLES OF THE MINISTRY OF HEALTH
POLICY STATEMENT (2003 -2007)
The policy statement of the Ministry of Health, Kingdom of Cambodia is based on the national health policy, which composes of 13 elements providing the basis for this strategic plan.