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Literature Review of the Cambodian Health Care system:
Strengths, weaknesses, and future research opportunities

1

Introduction:
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;



Cited: Annear, P. (2009). Cambodia: Developing a strategy for social health protection in Cambodia. In Promoting Sustainable Strategies to Improve Access to Health Care in the Asian and Pacific Region (pp. 1-36). United Nations Economic and Social Commission for Asia and the Pacific. Annear, P., Bigdeli, M., Eang, R., & Jacobs, B. (2008). Providing access to health services for the poor: Health equity in Cambodia. In Health and social protection: experiences from Cambodia, China and Lao PDR (pp. 189-226). Antwerp, Belgium: ITG Press. Annear, P., Bigdeli, M., & Jacobs, B. (2011). A functional model for monitoring equity and effectiveness in purchasing health insurance premiums for the poor: Evidence from Cambodia and the Lao PDR. Health Policy, 102(2), 295– 303. Atun, R., Weil, D., Eang, M., & Mwakyusa, D. (2010). Health-system strengthening and tuberculosis control. The Lancet, 375(9732), 2169-2178. Barber, S., Bonnet, F., & Bekedam, H. (2004). Formalizing under-the-table payments to control out-of-pocket hospital expenditures in Cambodia. Health Policy and Planning, 19(4), 199-208. Bigdeli, M., & Annear, P. (2009). Barriers to access and the purchasing function of health equity funds: lessons from Cambodia. Bull World Health Organ,87(7), 560-564. Bushan I, Keller S, Schwartz B. 2002. Achieving the twin objectives of efficiency and equity: contracting health services in Cambodia. ERD Policy Brief Series, Number 6. Manila: Asian Development Bank, Economics and Research Department. Char, M. Department of Planning & Health Information. (2008). Health strategic plan 20082015. Phnom Penh: Ministry of Health. Egami, Y., Fujita, N., Akashi, H., Matsumoto, Y., Ohara, H., & Takeuchi, M. (2012). Can health systems be enhanced for optimal health services through disease-specific programs? – results of field studies in viet nam and cambodia. BioScience Trends, 6(2), 1-6. Grundy, J., Khut, Q. Y., Oum, S., Annear, P., & Ky, V. (2009). Health system strengthening in Cambodia—a case study of health policy response to social transition. Health Policy, 92(2-3), 107-115. Hardeman, W., Van Damme, W., Van Pelt, M., Ir, P., Kimvan, H., & Meessen, B. (2004). Access to health care for all? user fees plus a health equity fund in Sotnikum, Cambodia. Health Policy and Planning, 19(1), 22–32. Health Systems 20/20. (2012). Health System Report: Cambodia. Retrieved from http://healthsystems2020.healthsystemsdatabase.org/reports/Reports.aspx Ir, P., Bigdeli, M., Meessen, B., & Van Damme, W. (2010). Translating knowledge into policy and action to promote health equity: The health equity fund policy process in Cambodia 2000– 2008. Health Policy,96(3), 200-209. 31 Ir, P., Horemans, D., Souk, N., & Van Damme, W. (2010). Using targeted vouchers and health equity funds to improve access to skilled birth attendants for poor women: a case study in three rural health districts in Cambodia. BMC Pregnancy & Childbirth, 10(1). Islam, M., ed. 2007. Health Systems Assessment Approach: A How-To Manual. Submitted to the U.S. Agency for International Development in collaboration with Health Systems 20/20, Partners for Health Reform plus, Quality Assurance Project, and Rational Pharmaceutical Management Plus. Arlington, VA: Management Sciences for Health. Jacobs, B., Bigdeli, M., van Pelt, M., Ir, P., Salze, C., & Criel, B. (2008). Bridging communitybased health insurance and social protection for health care – a step in the direction of universal coverage?.Tropical Medicine and International Health,13(2), 140-143. Jacobs, B., & Price, N. (2005). Improving access for the poorest to public sector health services: insights from kirivong operational health district in Cambodia. Health Policy and Planning, 21(1), 27-39. Jacobs, B., Ir, P., Bigdeli, M., Annear, P., & Van Damme, W. (2012). Addressing access barriers to health services: an analytical framework for selecting appropriate interventions in lowincome asian countries. Health Policy and Planning,27(4), 288-300. Jacobs, B., Thome, J., Overtoom, R., Sam, O. S., Indermuhle, L., & Price, N. (2010). From public to private and back again: sustaining a high service-delivery level during transition of management authority. Health Policy and Planning, 25(3), 197–208. Keovathanak, K., & Annear, P. (2011). The transition to semi-autonomous management of district health services in Cambodia: assessing purchasing arrangements, transaction costs and operational efficiences of special operating agencies. In H. Jalilian & V. Sen (Eds.), Improving Health Sector Performance (pp. 45-76). Singapore: Institute of Southeast Asian Studies Publishing. Lane C. (2007) Scaling Up for Better Health in Cambodia. World Health Organization & Ministry of Health, Kingdom of Cambodia: Geneva, Switzerland. Lo, V., & Sao, S. Ministry of Health, Department of Planning & Health Information. (2007). Cambodia health information system: Review and assessment. Phnom Penh: Ministry of Health. Marchal B, Cavalli A, Kegels G (2009) Global Health Actors Claim To Support Health System Strengthening—Is This Reality or Rhetoric? PLoS Med 6(4):e1000059. doi:10.1371/journal.pmed.1000059 Meessen, B., Bigdeli, M., Chheng, K., Decoster, K., Ir, P., Men, C., & Van Damme, W. (2011). Composition of pluralistic health systems: how much can we learn from household surveys? an exploration in cambodia. Health Policy and Planning, 26(1), 30-44. Men, B., Grundy, J., Cane, J., Lon Chan, R., Nguon, S. A., Sann, C. S., Jenkinson, K., & Boreland, M., Maynard, J., Biggs, B. (2005). Key issues relating to decentralization at the 32 provincial level of health management in Cambodia. International Journal of Health Planning and Management, 20, 3-19. Ministry of Health. (2006). National guidelines on complementary package of activities for RF development from 2006 to 2010. Retrieved from Ministry of Health website: ftp://ftp.wpro.who.int/scratch/HSD/Service_delivery_profiles/Cambodia/Documents from country/CPA Guidelines Eng.pdf Ministry of planning (2010). Achieving Cambodia’s Millennium Development Goals. Retrieved from:http://www.un.org.kh/undp/media/files/CMDG%20Report%202010.pdf National Institute of Statistics, Directorate General for Health, and ICF Macro, 2011. Cambodia Demographic and Health Survey 2010. Phnom Penh, Cambodia and Calverton, Maryland, USA: National Institute of Statistics, Directorate General for Health, and ICF Macro. Noirhomme, M., Meessen, B., Griffiths, F., Ir, P., Jacobs, B., Thor, R., Criel, B., & Van Damme, W. (2007). Improving access to hospital care for the poor: comparative analysis of four health equity funds in Cambodia. Health Policy and Planning, 22(4), 246–262. Okamoto, M., Nhea, S., Akashi, H., Kawaguchi, L., Ui, S., Kinoshita, M., & Aoyama, A. (2009). Developing institutional capacity of health service system management at the district level in rural Cambodia. BioScience Trends, 3(6), 239-246. Overseas Development Institute (2010). Cambodia: Case study for the MDG gap task force report. Retrieved from: http://www.un.org/en/development/desa/policy/mdg_gap/mdg_gap2010/mdggap_cambodia_ca sestudy.pdf Ozawa, S. & Walker, D. (2011a).Community-based health insurance schemes in Thmar Pouk. In H. Jalilian & V. Sen (Eds.), Improving Health Sector Performance (pp. 365-384). Singapore: Institute of Southeast Asian Studies Publishing. Ozawa, S., & Walker, D. (2011b). Comparison of trust in public vs private health care providers in rural Cambodia. Health Policy and Planning, 26(1), 20-29. Ozawa, S., Walker, D. (2009),"Trust in the context of community-based health insurance schemes in Cambodia: Villagers ' trust in health insurers", Dov Chernichovsky, Kara Hanson, in (ed.) Innovations in Health System Finance in Developing and Transitional Economies (Advances in Health Economics and Health Services Research, Volume 21), Emerald Group Smith, S. (2011). Factors influencing health-seeking behaviour in Siem Reap: A qualitative analysis. In H. Jalilian & V. Sen (Eds.), Improving Health Sector Performance (pp. 353-364). Singapore: Institute of Southeast Asian Studies Publishing. Soeters, R., & Griffiths, F. (2003). Improving government health services through contract management: a case from Cambodia. Health Policy and Planning,18(1), 74-83. Tangcharoensathien, V., Patcharanarumol, W., Ir, P., Aljunid, S., Mukti, A., Akkhavong, K., Banzon, E., & Huong, D. (2011). Health-financing reforms in Southeast Asia: challenges in achieving universal coverage. The Lancet, 377(9768), 863-873. 33 UNDP (2011). What Are the Cambodian Millennium Development Goals. Retrieved from:http://www.un.org.kh/undp/mdgs/cambodian-mdgs/what-are-the-cambodia-millenniumdevelopment-goals UNICEF (2009). Achieving Cambodia’s Millennium Development Goals: GAP Analysis. Retrieved from: http://www.unicef.org/cambodia/CMDG_Gap_Analysis_FINAL.pdf Van Damme, W., Van Leemput, L., Ir, P., Hardeman, W., & Meessen, B. (2004). Out-of-pocket health expenditure and debt in poor households: evidence from Cambodia. Tropical Medicine and International Health, 9(2), 273–280. World Bank, (2008). Cambodia health pets: Public expenditure tracking survey. Phnom Penh: World Bank. World Bank Databank. (2012). Retrieved from http://databank.worldbank.org/ February 12, 2012. World Bank World Development Indicators. (2012). Retrieved from http://data.worldbank.org/indicator/ February 12, 2012 World report on knowledge for better health: strengthening health systems. Geneva: World Health Organization; 2004. WHO. (2010). WHO Western Pacific Region - Cambodia - Home. Cambodia: Country Health Information Profiles. Retrieved July 17, 2012, from http://www.wpro.who.int/countries/khm/4cam_pro2011_finaldraft.pdf 34

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