• Spending overview
• Policy overview
• Diseases overview

Spending overview

(This profile was excerpted from the WHO country health information profile on Cambodia.)

The government budget for health has been increasing steadily over recent years, reaching US$ 8 per capita for the recurrent budget of the Ministry of Health in 2008. However, challenges continue to exist in allocation and management. Although overall disbursement at the end of budget execution is acceptable (around 98%), provinces and districts face irregular and untimely disbursement. Cambodia is also still highly dependant on donor funding, and the challenge is to coordinate action to cover national priorities. Despite increasing investment in health from government and external sources, the largest portion of health expenditure comes from out­-of-­pocket sources and goes towards unregulated private health care. The World Bank Poverty Assessment 2006 estimates out-­of-­pocket expenditure to be US$ 15 per capita per year, while the WHO NHA website estimates the figure at US$ 18.

The Ministry of Health’s Health Financing Charter was introduced in 1996 and allows establishment of user-­fee schemes in health facilities. A positive impact of user fees on access has been to reduce under-­the-­table payments, but the costs of health care remain a substantial obstacle for a large portion of the population. In this context, Cambodia has, in recent years, developed several alternative financing mechanisms for health, such as contracting and community­-based health insurance. At the same time, health equity funds have been scaled up to cover 39 districts (out of 77) and six national hospitals.

Policy overview

The three main areas of Cambodia’s Health Strategic Plan 2008-2015 (HSP2) are aimed at reducing maternal, newborn and child morbidity and mortality, morbidity and mortality due to HIV/AIDS, malaria, TB and other communicable diseases, and the burden of noncommunicable diseases and other health problems. The Ministry of Health initiated a health sector reform process in the early 1990s and, in 1996, approved the Health Coverage Plan, formulated with WHO support, which divides the country into 73 operational districts within the 24 provinces. Each operational district covers a population of 100 000-­200 000 and comprises 10-­20 health centres, each covering populations of about 10 000, and a referral hospital.

The private health sector has been expanding rapidly in the past decade, absorbing a substantial part of out­-of-­pocket expenditure. Many public health civil servants have initiated private activities to complement their official government salaries to earn a living wage. In addition, not-­for­-profit NGO providers supply a significant volume of hospital and diagnostic services. Enforcement of private practice regulation needs to become a more prominent aspect of the Ministry of Health’s work. The formulation process of the Health Strategic Plan 2008­-2015 identified a number of key challenges for the health sector, which include improving the quality of care in both the public and private health sectors, the distribution of staff in the health sector and the quality of reproductive and adolescent health services 

Diseases overview

Life expectancy is now 63.1 years for males and 67.5 for females. The total fertility rate dropped from 4.0 births per woman in 2000 to 3.4 in 2005, achieving the Cambodian Millennium target for 2010, predominantly as a result of a decline in fertility among rural women. Infant mortality rates have also declined significantly over the past 25 years. Cambodia has a significant and growing burden of non-communicable disease. In total, 300 000 Cambodians are estimated to have diabetes and, if no action is taken, it is estimated that the number will rise to 1.2 million by 2021. Alcohol consumption is also on the increase, and the number of violent incidents, traffic accidents and domestic violence incidents linked to alcohol is alarming.

Due to rapid economic growth and changes in lifestyle, the burden of environment-related diseases is an increasing concern, accounting for 26% of the total burden of disease, according to recent WHO estimates. When compared with other countries in the region, Cambodia has the second highest environmental disease burden. 

Infectious diseases still constitute the main causes of mortality and morbidity, but Cambodia is facing an epidemiological transition. Currently, acute respiratory infections are the leading cause of both mortality and morbidity, with gastroenteric infections contributing substantially to the morbidity burden of the population and dengue outbreaks exacerbating the situation. In addition, the country is still classified as one of the 22 worldwide with a high burden of tuberculosis. Notably, HIV prevalence has decreased substantially and a high proportion of people living with HIV/AIDS are receiving antiretroviral therapy.