In a city whose legions of poor are desperate for affordable health care, the Toul Kork Health Center—one of 20 in the city that are contracted to provide free health care to those unable to pay—should be full all day.
Instead, on a typical mid-morning it is nearly deserted. By that time of day, many government doctors, who are paid as little as $10 a month, have left for their private practices.
The health center has 45 medical staffers and is available to more than 18,000 people in Boeung Kak District. But it records only three visits per staff member per week, a study by an international consultant found.
At a tiny municipality-run clinic in a squatter area just a few minutes away, it is different. Patients fill every chair. The so-called Boeung Kak health room is located for the convenience of the squatters, but on one day last week patients were coming from across town, from Kandal province, even from Ratanakkiri province, lured by reputation and the promise of inexpensive care. The small staff sees 40 patients per staff member per week, the consultant found.
“My relatives told me that the center did not ask for any money, and the medicine was good,” said Saing Sokha, 52, who traveled from Ratanakkiri with her infant grandson for treatment of an infected belly button.
The health room is one of two opened in squatter communities last year by the Urban Health Group, a pilot project funded by the British government and operated by the city.
But with neither Britain nor the municipality signaling an intention to make the pilot project permanent, the Boeung Kak health room is scheduled to close at the end of the year.
The second health room, formerly located in a squatter camp along the Bassac river, was demolished Sept 1 when the squatters were relocated.
“We know we have a very good, very important program that shows things can be done in an effective way. [But] we have not been able to get anybody interested in the moment in carrying it on. We’ve been putting it in front of donor governments,” World Health Organization country representative Dr Bill Pigott said.
Health officials acknowledge the city’s program that exempts the poor from paying for care is not working. A study by the Urban Health Group found most poor people were unaware the free care was even available.
“To identify the poor is very difficult. Health staff do not believe that a patient is poor, or they want to charge the patient anyway. If they can’t pay, maybe the staff does not care for them very well,” Municipal Health Department Director Dr Veng Thai said.
To discourage the staff at the health room from demanding money, the Urban Sector Group boosted their salaries to $200 a month for doctors, $160 a month for nurses. The jobs are so valuable, municipal doctors and nurses share them, project evaluation officer Kryvong Sopheap said.
Health room medical staff are given additional training in drug prescription and preventative care, project director Sharon Wilkinson said. Those who still demand extra money are removed, she said.
Patients who can afford it are asked to pay 500 riel (about $0.12) per adult, or 200 riel (about $0.05) per child, upon admission to the health room. The Urban Health Group pays the bill when health room clients requiring operations or intensive treatment are referred to hospitals. The medications are donated by the city.
For poor Cambodians who typically depend on poorly trained pharmacists or traditional healers, the health room offers that rarest of procedures, a checkup.
Like many other patients, Chon Phoan, 28, said she had never been examined by a doctor.
“If I get better, I will come again,” she said.
“If you go to the pharmacy, you don’t get any checkup. We do a follow-up to see if you got better, and ask how you feel,” health room medical assistant Cheang Buntha said.
The three-year program cost $400,000, including preliminary studies and startup costs, Wilkinson said. But a health room that serves as many as 2,000 people a month, and pays for needed operations and deliveries, could be funded for as little as $26,000 a year, she said.
Squatters are an especially unhealthy and needy population, and their numbers are growing fast, Wilkinson said.
“For many of the urban poor, their health is worse than for people in deep rural areas. We cannot claim they are not within reach because they are right on our doorstep….We must bring the services to the people. And this is not an NGO. This is run by the government,” she said.
The pilot project shows medical staff will produce good results if they are paid a living wage, Wilkinson said. But city officials are reluctant to raise fixed salary rates for specific programs, Veng Thai said.
Local representatives of Britain’s Department for International Development, which funded the pilot project, were out of town this week.