Health Official Reflects on Cambodia’s Changes and Challenges

When Jim Tulloch arrived in Cam­bodia in February 2002 to take up his post as head of the World Health Organization, he had just spent two years helping East Timor rebuild its health system de­molished in the campaign of violence that had erupted after its vote for independence in 1999.

“My first impression of Cambodia’s health sector was that it was very dynamic in the sense that there were a lot of things going on,” which was in sharp contrast with the situation in East Timor, he said.

Cambodia was breaking ground in some areas such as malaria and HIV/AIDS programs and, Tulloch said, “The infrastructure was in place, underutilized, but in place.”

On the other hand, the health system was re­ceiving little funding from the government, children and women’s health was getting little at­tention, and this, in spite of some progress, re­mains the case today, he said.

Tulloch left Cambodia on July 31 to become senior health adviser to AusAID in Canberra, on loan from WHO. Before he left, he talked of changes in Cam­bodia’s health­care system over the last three years and of challenges ahead.

Shortly after his arrival in 2002, Tulloch said, “The Global Fund [set up by donor countries and private organizations to support health programs in developing countries] came to town.

“There was nothing in terms of structure [to administer it], nothing except the promise of a lot of money for HIV/AIDS, malaria and tuberculosis programs. I think the Ministry of Health has done a good job to put in place management for the fund,” and work with international organizations and NGOs in these areas.

As a result, some programs have done well. For example, in 2002, Tulloch said, “There was no question on putting [HIV/AIDS] patients on treatment,” because the government could not assume the cost. Today, about 7,000 patients are on treatment, and the number should increase to 10,000 patients by the end of the year.

The lack of resources makes it difficult to ad­dress some health issues, such as diabetes—a serious problem according to a recent survey—and smoking, the effects of which will soon weigh heavily on healthcare as the country’s numerous smokers suffer lung cancer and hearth ailments, he said.

The health sector needs far more money from the government and donors, but management re­form in the health industry is also necessary to pre­vent “leak­age” and use every dollar, Tulloch said.

One of the major obstacles plaguing this sector is the lack of trained people—a lingering legacy of the Khmer Rouge era, he said.

“I think the effects on the health system have been, and continue to be, profound. Many trained people died during the Khmer Rouge period who would have continued to make a con­tribution today, through their work but also their thinking.”

“In addition, anyone who is today between the ages of 30 to 50 had either their primary, secondary or tertiary education disrupted in some way, often very seriously. So we have a health system staffed with less trained people than it needs, and by people who have not had the educational opportunities that they should have,” Tulloch said.

This is one of the reasons why the government still cannot offer basic healthcare in hospitals and health centers throughout the country, which is essential to reduce child and maternal mortality rates, he said.

Tulloch first joined WHO in 1976, working on small pox eradication in Bangladesh. A career WHO medical doctor specializing in child health, he took three years off from the organization to work on malaria research in Papua New Guinea.

From 1990 to 1999, he was director of child and adolescent health de­velopment at WHO headquarters in Geneva. In 2003, he spent four months in Iraq to help prepare healthcare services for the imminent war.


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