Strengths, weaknesses, and future research opportunities
Cambodia’s health system is in a period of transition as policy innovation and reform has only begun as of 1996. Importantly, the Ministry of Health (MoH) and donor agencies have undergone a series of innovations in an attempt to grow capacity as well as equitable access of the health system. There must, however, be more encompassing research in the context of Cambodia that will allow for greater interactions with implementing policy. Cambodia’s health system literature must be focused on knowledge translation and research must be expanded to incorporate local contexts and challenges. Using a knowledge translation framework, Ir, Bigdeli, Meessen & Van Damme (2010) suggest that knowledge translation is rarely a linear process and involves the interaction between wide ranges of partners. Their proposed framework for analysing the knowledge translation of the Health Equity Fund (HEF) process includes four stages: 1) exploiting existing knowledge; 2) creating new knowledge or innovations; 3) transferring new knowledge; and 4) adopting and using knowledge. Essential and connecting all four stages is the context environment for which knowledge is produced. In addition, the WHO World Report on Knowledge for Better Health (2004) states that: “Every country should have a national health research system that focuses its energies on health problems of national interest, especially those which will strengthen health systems” (p. xv). Therefore, for translation of knowledge into policy, the Cambodian health system requires a continued and comprehensive assessment of the “stock of knowledge” (Ir, Bigdeli, Meessen & Van Damme, 2010, p. 202) available within the health system from which to build. The following paper will assess the literature according to three of the primary functions of the Cambodian health system: 1) health system governance; 2) health financing; and 3) health 2
service delivery. Such classification methods are based on an assessment approach for health systems strengthening (Islam, 2007). Despite these classifications, literature on the Cambodian health system is not well-defined in such boxes. Studies, interventions, and innovations that have been underway are multifaceted as the challenges faced by the Cambodian health system are complex and interdisciplinary. For example, innovations in health financing have significant impacts on governance, and issues faced in service delivery have been tackled though governance and financing interventions. Multidimensional strategies are required for the MoH to achieve its goal of meeting Cambodia’s essential health needs by “improving the population’s confidence in public health services, clarifying and reinforcing the role of hospitals and health centers, establishing each facility’s catchment area to ensure coverage of this population, [and] rationalizing the allocation and use of resources” (Char, 2008, p. 6).
The population of Cambodia is predominantly rural and the economy is growing rapidly, yet income disparities are widening and poverty remains widespread. Approximately 35% of the population lives below the poverty line and the majority of the 80% rural population rely primarily on subsistence agriculture (CIA, 2012). Furthermore, the bulk of the development is occurring in the urban economy and disparities are growing in the distribution of income (Annear, 2009). Ensuring widespread access by creating an equitable health system is hindered by these ongoing challenges. Moreover, Cambodia’s total health expenditure is low at 5.9% of GDP (2009). Currently Cambodia has 0.23 physicians per 10,000 of the population, ranking 148 out of 192 countries (CIA, 2012). The current life-expectancy of Cambodia is 62.67 years (60.31 for men and 65.13 3
for women), ranking as 177 out of 192 countries (CIA, 2012). As a result of...