Health Care in Cambodia –
More Than Money and Medicine
Prof. Dr. Steffen Fleßa Universität Greifswald
Contents
1.
Country Profile2.
Social and Health Care Sector1. Health Care Provision
Health Care in Cambodia
Main Message
•
“Central foundation of health care is not medicine, but historical pathway,population, culture and economy”
Cambodia
Nation – Religion - King
• Size: 180,000 sqkm (=1/2 Germany)
• Population: 14 Million (= 76 p.
sqkm)
• Tribes: 90% Khmer, 5% Vietnamese, 1% Chinese
• The “micracle of Tonle Sap”
Health Care in Cambodia
Historical Pathway
•
Angkor•
French Indochina•
Vietnam War•
Khmer Rouge …Khmer Rouge
•
1975-1979: Communist rulers– Leader: Pol Pot – Backing: China
•
15-30% of population died (killed,Further Development
•
1975-1989: Vietnam invasion, occupation•
1989-1991: Civil war, fighting until 1998•
1991-1993: Ceasefire and “UnitedNations Transitional Authority” (UNTAC)
•
Since 1993: stepwise development towards democracy and market economyHealth Care in Cambodia
Consequences
• At the end of wars Cambodia had lost about half of its population.
• The country is plotted with land mines.
– 35,000 lost disabled
– 500-800 casualties annually – Several thousand victims annually
• There was nobody who was no victim or deliquent – Younger population: there is nobody who has lost a close
relative
• Cambodia is a play-ground for different countries – E.g. Khmer-Soviet Friendship hospital
– E.g. Bank of China – …
Current System
•
Constitutional Monarchy– God-King Norodom Sihamon – Prime Minister Hun Sen
•
Cambodian People's Party•
Market Economy:– strongly China-driven
Health Care in Cambodia
Prime Minister Hun Sen King Norodom Sihamon
Religion
•
BuddhismTheravada Buddhism
•
Oldest form of Buddhism– relatively conservative
•
Features in Cambodia– Animism and syncretism
– Importance of God-King and monks – Importance of “spirits”
– Prevention and “spirits”
– Insurance and “spirits”
– Fate and punishment
Health Care in Cambodia
Economy
• GDP 2016 at market prices (current US$) – $20.01 billion
– Country comparison: No. 108
• GDP - real growth rate (2016):
– +7.0%
– Country comparison: No. 31
• Gross national income p.c. 2016:
– US$ 1269
– Country comparison: No. 184 – Low Income Country
http://data.worldbank.org/indicator/NY.GDP.MKTP.KD.ZG?locations=KH
Sectors
Health Care in Cambodia
GDP Labour Agriculture 35% 58%
Industry 24% 16%
Services 41% 27%
Poverty
Health Care in Cambodia
Development of Poverty
0 10 20 30 40 50 60
2004 2005 2006 2007 2008 2009 2010 2011 2012
Population belownational povertylevel [%]
Time [years]
http://data.worldbank.org/indicator/SI.POV.NAGP?locations=KH
Summary
•
The historical pathway, its culture and economy are unique.•
Every health care system or development aid that does not take this uniqueness into account is due to fail.Health Care in Cambodia
Contents
1.
Country profile2. Social and Health Care
Sector
•
Life expectancy: 63 yrs.•
Population growth: 1.7%•
Urbanisation: 20%•
Prime City: Phnom Penh (1.5 mio.)Health Care in Cambodia
Population D ensity
Health Care in Cambodia
Health Care in Cambodia
Health Care in Cambodia
Burden of Disease in Cambodia (2004)
Condition Death
[‘000] DALYs [‘000]
Communicable, maternal, perinatal and nutritional conditions 83 2903 Noncommunicable
diseases 58 1724
Malignant neoplasms 11 169
Diabetes mellitus 3 39
Neuropsychiatric
conditions 3 451
Cardiovascular
diseases 24 361
Ischemic heart
disease 8 121
Cerebrovascular
disease 7 91
Respiratory diseases 6 132
Digestive diseases 5 122
Other
Total 150 5003
Covid-19
•
Erwartung: Desaster!– 1.000.000 Chinesen leben dauerhaft in Kambodscha
– Millionen Chinesen kommen jedes Jahr zum
Health Care in Cambodia
Covid-19
17.4.20:
Fälle: 122 Präv.: 8,0 p.
100.000 EW Todesfälle: 0
Covid-19
• Verdacht: keine Testung
– Aber: „Italienische Verhältnisse“ würde man sehen!
• Gründe?
– Temperatur???
– Social Distancing als Teil der Kultur
– Importierte Fälle: Touristen sind zu groß??
– Bevölkerungspyramide: die primären Risikogruppen existierten nicht!
•Alte: Opfer von Pol Pot
•Chroniker: haben eh keine lange Überlebenszeit in K.
child mortality within Cambodia
0 20 40 60 80 100 120 140 160 180
child MR infant MR Source: CDHS 2010
Health Care in Cambodia
Service Provision
•
Health Centre– no beds – Staffing: 3-6
Hospitals
•
Hospital (Level II)– 80-200 beds
– Staffing: 100-200, incl. doctors
– Population: 50- 250.000
– NB:
•1 hospital bed for 10.000
•1 doctor for 5000
Health Care in Cambodia
Hospitals
•
National Hospital (Level III)– Only in Phnom Penh – Training Institutions – Highly specialised
•
Kantha Bopha (Beat Richner)health care system
•
Quality of staff– Training of doctors!
•
Availability of drugs•
Transport•
No quality control of private providers•
Traditional medicine: mainly lostHealth Care in Cambodia
Contents
1.
Country profile2.
Social and Health Care Sector1. Demography
Future Development
•
Economic development: “young tiger”•
But: “much more than money”: absorption capacity is very limited•
“Much more than medicine”:– traditional believes make insurances and prevention difficult
•
“A tortured nation with strong inequality”:Revolutionary potential?
Health Care in Cambodia
•
“„If we, as health workers, or teachers, or students, or civil servants do not feel that we, and the groups or organisations we belong to, have some power to alter policy that affects our lives, or the lives of those around us, why get up in the morning?“(Gill Walt 1994).
