1) The Minimum Package of Activity (MPA) provided at the health centres; and
2) The Complementary Package of Activity(CPA) provided at the referral hospitals
The private sector does not deliver minimum and complementary packages, private practitioners workplaces and international NGOs deliver a limited range of services. Tertiary services are provided by 6 National Hospitals which are based in Phnom Penh and are semi autonomous.
The Ministry of Health administers health services through 24 Provincial Health Departments (PHD),76 Operational Districts (OD), 90 Referral hospitals, and 1,049 Health Centres (HC). NGO’s and private practitioners also provide health services. There are many unregulated traditional medical practitioners prevalent in the difficult to reach communities.
Health Centres and Health PostsThese are minimum level primary health care services mainly for rural populations.1,049 facilities cover around10,000–20,000 people each. Services include initial consultations and primary diagnosis, emergency first aid, chronic disease care, maternal and child care (including normal delivery), birth spacing advice, immunisation, health education and referral. Contraception, ante natal care and tetanus vaccination were the three main type of preventive services provided in 2005. In 2010, only43% of health centres provided the full minimum package of services. Constraints include the absence of key personnel,the inadequacy of essential drugs support and the absence of other operational guideline requirements.NGOs deliver health promotion and disease prevention programs and activities through health centres. The government also has some national level programs.
Referral Hospitals
There are national, provincial and district referral hospitals, classified at three levels based on number of staff, beds, medicines, equipment and clinical activities and in 2011 there were:
CPA-1 hospitals: have no large-scale surgery (no general anaesthesia) no blood bank or blood deposit, but at least has a basic obstetric service
33 hospitals at this level.
CPA-2 hospitals: have CPA1 services plus emergency care services and large-scale surgery (with general anaesthesia), including ICU, and other
specialized services such blood transfusion, Ear, Nose, Throat (ENT), ophthalmology and orthodontics services.
31 hospitals at this level
CPA-3 hospitals: have large-scale surgery (with general anaesthesia) and more activities (in terms of both numbers of patients and activities) than a
CPA-2, and also have various specialized services.
26 hospitals at this level
Referral hospitals are expected to support primary care and have resources and expertise available for the district health services. All 8 national referral hospitals and 21 of 24 provincial referral hospitals provide CPA 3 level services. Provincial referral hospitals cover several operational districts.
The public health service delivery system is oriented towards treating acute illness and diseases.
Private health services
Private practitioners provide services through three types of facilities:
(1) Consultation clinics provide clinical diagnosis(including ultrasound), laboratory, emergency treatment and prescription writing services.
(2) Clinics that have at least 10 beds with outpatient and inpatient services,various medical specialties,laboratory, radiology and pharmacy services.
(3) Polyclinics are larger, with at least 20 beds,and provide more specialized services.
Private services must be licensed and registered with the MOH to operate, and in 2004 there were 2572 private practice facilities. Private providers are restricted to the types of services they can deliver, and must meet specifications on staff experience, facility size and equipment, record keeping, and storing and selling of pharmaceuticals. Doctors, medical assistants,nurses, midwives, pharmacists and pharmacist assistants practice in the private sector, often while also working within the public sector.
Implementation of standards of care are outlined for the minimum and complementary packages through clinical practice guidelines and there are also national Safe Motherhood, Malaria, TB and HIV/AIDS guidelines.
Source: National Health Congress Report 2011.
Health statistic | Cambodia | Regional |
Average life expectancy at birth | 60.4 years (both sexes) | 76 years (both sexes) |
Total fertility rate | 2.5 | 1.7 |
Neonatal mortality rate /1,000 births | 22 | 15.8 |
Under 5 mortality rate /1,000 births | 43 | 16 |
Maternal mortality rate /100,000 births | 206 | 49 |
Births attended by skilled attendants | 71% | 92% |
Ante natal care attendance | 51% | 70% |
Contraceptive prevalence | 59% | 51% |
Prevalence TB / 100,000 population | 817 | 138 |
Prevalence of HIV /100,000 population | 447 | 72 |
Incidence of Malaria /100,000 population | 1353 | 104 |
Cambodia has made some excellent progress over the past 20 years in most of these areas however much still needs to be done especially in reducing maternal and neonatal mortality even further.
The health workforce (2011)
Employed Healthcare Professionals in the public sector | Men | Women | (%) |
Doctors: | 2300 | 375 | 16% |
Specialist doctors | 91 | 7 | 8% |
Primary nurses | 3258 | 1165 | 35% |
Secondary nurses | 5175 | 1629 | 31% |
Primary midwives | | 1823 | 0 |
Secondary midwives | | 1908 | 0 |
TOTAL | 10,824 | 6,907 | 64% |
Source: MOH 2010,Semi-Annual Performance Monitoring Report
Cambodia has had to build its health workforce from scratch following the years of civil unrest and has made good progress however there remains a severe shortage of health professionals in particular Doctors and most importantly specialists in Obstetrics and Gynaecology.