Government Launches Plan to Rein In Health Sector

The government on Monday launched a nationwide effort to purge the health care system of unlicensed doctors and unsafe medical practices in response to an outbreak of HIV in Battambang province that has spread to more than 230 villagers, two of whom died last month.

The outbreak in rural Roka commune—which officials have blamed on Yem Chrin, an unlicensed doctor who was charged with murder after admitting to reusing syringes on patients—has shed light on the lack of regulation and oversight within the country’s health care sector.

In the government’s most ambitious response yet to the problem, the ministries of health and interior released a circular during a meeting at the Interior Ministry in Phnom Penh on Monday outlining a plan to rid the country of unlicensed medical workers and clinics.

Em Sam An, a secretary of state at the Interior Ministry, told about 200 police and government officials gathered for the meeting to work together to stamp out the “illegal” and “inhumane” practice of providing medical care without a license.

“Municipal and provincial governors must cooperate with other involved institutions and units to facilitate…investigations, prevention and crackdowns, and prepare complaints for the court to punish [offenders] according to the law.”

The circular, signed on January 16 by Interior Minister Sar Kheng and Health Minister Man Bunheng, calls on provincial, district and commune health officials to work with police to identify unlicensed clinics providing medicine or medical services.

During Monday’s meeting, Mr. Bunheng told provincial-level governors and councilors to take the lead in the new initiative.

“The provincial governors and councilors are the fathers and mothers of provincial health directors, deputy provincial health directors, district health officials and provincial and district referral hospital officials, so I ask our staff to respect them,” Mr. Bunheng said.

Though there is little available information about the extent to which the country’s population relies on unlicensed medical workers, Meach Sophana, an undersecretary of state at the Interior Ministry, said the problem extended beyond Roka commune.

“From the news reports, we have seen that in Battambang province, many people were infected by HIV,” he said. “But there are other places where incidents involving health providers lead to people’s deaths.”

Masami Fujita, the World Health Organization’s HIV team leader in Cambodia, said that raising awareness about risks involved with using unlicensed doctors should be a priority for the government.

“Enforcement is sometimes a challenge. I think raising awareness in the population is important,” he said. He added that anecdotal evidence suggests that the services of unlicensed doctors often prove more convenient than those offered within the formal health care system.

To avoid a repeat of the HIV outbreak in Roka commune, which a government-led study found was most likely spread through injections and intravenous drips, Dr. Fujita said, the government should attempt to change people’s health care preferences.

“In Cambodia, people—particularly in rural areas—have a tendency to rely on injections and infusions for health conditions that do not require them. Many problems can be treated with oral drugs or taking other measures,” he said.

“Addressing these kinds of concerns also needs to be part of the series of actions to be considered.”

(Additional reporting by Maria Paula Brito)

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