Cambodia’s health care system still suffers from a lack of government budget accountability while the high cost of health care is a primary cause of poverty, said a report issued by the umbrella health organization Medicam ahead of next week’s donor meeting in Tokyo.
“Health services remain one of the main causes of indebtedness of the poor and vulnerable….This indebtedness often leads to irreversible poverty,” Medicam’s 2001 position paper said. “Access to health services [in particular by the poor] remains a major challenge to meet in both rural and urban areas.”
The paper cited a September Oxfam UK study that found 43 percent of landlessness came from Cambodians selling land to settle debts related to health costs.
“This brings an always bigger proportion of the population becoming unproductive, which seriously jeopardizes the Royal Government’s economic growth and poverty reduction goals,” the Medicam paper stated.
A February report by the World Health Organization and the Ministry of Health stated that the average household spends $29 a year on health care. At 11 percent of gross domestic product, that rate is one of the highest in the world, the report said.
Medicam, which represents 113 health care NGOs, noted that the government’s health care budget has increased, with spending per Cambodian rising from just $1 in 1998 to $2.10 in 2000. But it said the current budget is “barely enough” to meet the basic minimum required for health services.
“This is attributed mainly to a widespread problem of disbursement and accountability of the funds to health facilities,” the paper said.
An April 2000 Medicam report, also issued ahead of the 2000 meeting of international donors, stated that Cambodia’s health care system suffered from a lack of budget transparency, underfunding and corruption.
Medicam maintained that money coming from the Ministry of Finance to the Ministry of Health is difficult to account for, and vulnerable to corruption on all levels.
The 2001 paper states that quality health care will be difficult to achieve as long as public health professionals do not receive a salary large enough for them to support their family. It noted that health care in the “commercially-driven” private sector is expensive and often of poor quality, “leading sometimes to dangerous practices.”
There is also a lack of enforcement of laws and regulations on pharmaceuticals, the paper said, which means sick customers often buy drugs that are either at or past their expiration date.