Monthly Archives: February 2015

Cambodia’s health reformation – The Health Strategic Plan (HSP)

The Ministry of Health, part of the Cambodian government, is currently nearing the end of its 7 yearlong Health Strategic Plan in which it hopes to increase the health and well-being for all Cambodians.Cambodia Healths

The health system in Cambodia has experienced several periods change; from a rudimentary health care system placed by Prince Norodom Sihanouk in the 1960’s and early 1970’s to using a Vietnamese model in the 1980’s. It was not until 1993, however, when the first Royal Government took office that the healthcare service in Cambodia began to improve. The Royal Government reformed the health sector by establishing a Ministry of Health (MoH) that aimed to improve and extend primary health care through the implementation of a
district based health system. In addition, a Health Sector Strategic plan 2003-2007 (HSP1) was formed to help facilitate the process.

More recently, the government developed a second Health Sector Strategic Plan 2008-2015 (HSP2) with its vision to ‘enhance sustainable development of the health sector for better health and well-being of all Cambodian, especially of the poor, women and children, thereby contributing to poverty alleviation and socio-economic development’.

The HSP2 takes a strategic approach in implementing its goals and does this by focusing on three health program areas: reproductive, maternal, new-born and child health; communicable diseases such HIV/AIDs and Malaria; and non-communicable diseases and other health problems. In addition, each of the three main health area programs implement a set of five cross-cutting health strategies which are: health service delivery, health care financing, human resource for health, health information system and health system governance.

The HSP2 also includes a plan of the cost which takes into account many factors, which includes: increased utilisation of services due to population growth as well as increased demand for public health services, scaling-up contracting and the expansion of key interventions aimed at improving maternal and child health.

The financial plan is around $170 million and is funded by the World Bank, Australia Department of Foreign Affairs and Trade (DFAT), Department for International and Development and others, along with a partial pooled fund. As with most financial managements, reporting mechanisms and auditing also occurs.cambodia health

In a recent update report in March 2014, the results from the plan proved successful. For example over 1 million people in Cambodia now have access to a basic package of health, nutrition or reproductive health services compared to just over 150, 000 in 2007. Moreover, 50% of all health centres are now implementing Health Equity Funds compared to only 13% in 2008. In some cases, current results have already surpassed the target; the percentage of birth deliveries by trained health personnel at health facilities it now at 80% although the target is only 75%.

Despite the positive trends, however, there are still a number of significant constraints that limit rapid improvements occurring throughout the health system. This has been foreseen by the MoH and a third Health Strategic Plan 2016-2020 is under the formulation process which plans to increase health spending with improved efficiency, use more stable sources of financing as well as a more effective financial management including budgeting.

Article by Dayle Burnett-Quarry

Tha Kong, nurse and midwife in Northern Cambodia

IMG_0510Today, I’m going with Tha Kong to Samrong hospital.  This young woman, aged 24, has already been studying for two years to become a nurse.  This year she’s going to specialise so she can become a midwife.  Kong is sponsored through Children of the Mekong and comes from Oddar Meanchay, an extremely poor province in the far north of Cambodia.  She entered the COTM education centre in Samrong when she was at high school.  Having passed the baccalaureat, she took an examination and was accepted at the school of nursing in Battambang, a large town in the northwest.  Every year during the summer, she does practical placements at the hospital.  She loves coming back to Samrong, and her dream is to work here when she qualifies, in a year’s time.  It’s here that I meet her.IMG_0511 IMG_0489

This morning, she’s taking me to visit the hospital where she is doing a placement, a few steps away from the EDM centre where she lives.  First of all, the health centre where pregnant women are monitored.  Kong seems very much at ease as she takes the blood pressure and measures the abdomen of the pregnant women.  At the beginning of pregnancy, each woman is offered tests to check for symptoms of aids, malaria or syphilis.  These diseases can prevent the foetus developing properly as well as jeopardising the health of the mother-to-be.

In reception there is a new-born baby, just one day old, with his father and grandmother.  Kong does not hesitate for a moment when asked by the senior midwife to vaccinate the baby against hepatitis B.  Her actions are precise and assured.

The atmosphere is calm, even cheerful.  The children of doctors and midwives come to work with their parents when they aren’t old enough to go to school.  They laugh and play happily in the corridors.  One of them, the 2- or 3-year-old daughter of the senior doctor in maternity, even comes and gives me a hug!  I’m surprised, because the children here aren’t used to seeing “baraings” (white people) and seldom dare to come near them!IMG_0500b

Kong, along with another student whose dream is to go to Paris, takes me to see the maternity ward.  There I visit the labour room where women give birth, not so different from those found in Europe.  I also visit the young mothers who have recently given birth, an opportunity for me to learn how to say “congratulations” in Khmer: “saum abaarsossae”.  There are between 4 and 10 of them per room, each in bed cuddling their baby who is wrapped in the traditional karma to keep warm despite the ambient 30°.  The families are also there.  I meet a row of grandmothers sitting on the floor against the wall of the room.  Each one, with a huge smile, points out which one is her grandson or granddaughter.  I am very moved to see them so happy.  Fathers are there too, getting used to their new role, tentatively – the first time for some of them – dressing their little one, cradling it in their arms.IMG_0496

The visit comes to an end.  Kong, pleased to have shown me her future work, asks me about medicine in France, the hospitals…IMG_0495  She loves taking care of people and dreams of coming back to her native province to work.  She is an example of how Children of the Mekong would like to see each of their sponsored children develop.  Kong has managed to leave poverty behind, take up studies and become a self-confident young woman, someone who is helping her country and hopes that her brothers and sisters in Cambodia will do so too. She is the embodiment of hope.

Thank you to all those who hold out this hope by supporting the actions of Children of the Mekong.

 

Text and photos: Aksinia Boiret – Overseas Volunteer in Samrong, Cambodia