Some Things Have Changed Little in That Time, He Says
When Maurits Van Pelt arrived here in 1989 as head of the Medecins Sans Frontiere mission, he found the government was the main obstacle preventing the humanitarian group from doing its job.
Still under Vietnamese rule, the communist government towed the official line that everything was fine in Cambodia. Even simple requests were bogged down with bureaucracy. MSF workers had to obtain permission from two ministries before they could travel within the country.
More than 10 years later, Van Pelt is still finding that the government isn’t as cooperative as it could be, but the battles have changed just as the country has.
Until “today, we have not been able to reach our goal of getting the provincial hospitals going and improving the level of services so that they are of good quality,” Van Pelt, 44, said. “That’s why when MSF won the Nobel Peace Prize last year, we expressed our frustration of not being able to get there.”
Van Pelt leaves Cambodia Sunday, after more than 10 years as head of the MSF Holland-Belgium-Switzerland mission here. He is going back to school to study public health and health financing in a joint program of the London School of Hygiene and Tropical Medicine and the London School of Economics.
Marc Hermant, 37, who worked with MSF in Africa for five years, is replacing Van Pelt. He arrived from the MSF mission in Angola.
Cambodia’s health system has gone through many improvements since the Vietnamese left shortly after Van Pelt arrived and the UN transition team came, he said.
The country has introduced birth spacing and other modern health policies deemed too sensitive to discuss during the communist regime. MSF has also been able to work in such former Khmer Rouge strongholds as Malai and Anlong Veng, areas that were previously too dangerous.
But Cambodia cannot make any more progress if the government does not change the way it finances the health system, Van Pelt said.
Despite continued efforts pushing for transparency and increased salaries, the health budget remains out of the hands of the Ministry of Health, and the pay for public health workers remains below subsistence level.
“The issues of transparency and salaries are highly political and difficult to solve,” Van Pelt said. “We keep it very close as a yardstick for progress.”
Though the country was still in turmoil after the UN-sponsored elections in 1993, MSF still thought there was hope because hospital staff were ready to work and the quality of services was reasonable.
“But when the hospitals started to see there was no prospect for things to improve while their leaders were fighting, they went private,” Van Pelt said.
Because the salaries for public health workers was $10 to $20 a month, they supplemented their salaries by taking bribes or opening private practices. That situation is little changed today.
Although progress has been made with more money being funneled into the health budget, the Ministry of Health still lacks control and even knowledge of how much money health directors receive.
Since late last year, MSF has been considering its role in Cambodia and whether it should pull out of public projects.
The situation became serious enough that after MSF won the Nobel Peace Prize last December, Van Pelt placed an ad appealing to the government to push through reforms.
Both Van Pelt and Hermant said MSF cannot make any more progress without significant evidence that the government plans to change the way it finances the health system.
“We don’t want to be in a situation where three years has passed and nothing has really changed and we’re still here,” Hermant said. “We don’t want to seem like we’re giving credit to the situation.”
Chiv Bunthy, acting executive director of the health-care umbrella NGO group Medicam, said Van Pelt and MSF have been leading advocates in the push for health-care budget reforms.
“Maurits is the one who called for a working group on the health budget in Medicam and has helped the country a lot in its advocacy role,” Chiv Bunthy said.
Mam Bun Heng, secretary of state for the Ministry of Health, said MSF has played a key role in helping improve health care, including financing issues.
Van Pelt began pushing for budget reforms when he realized three years ago that the Ministry of Health had no control over the health budget.
And until that changes, Cambodia’s poor will continue to suffer, he said.
“It’s like you are waiting at a restaurant and you are waiting for the food to come out,” Van Pelt said.
“You smell all these great things but you are not getting your food. The cooks have stopped fighting, so it’s time to bring the food out.”
