Demographic statistics for Cambodia

Demographic statistics for Cambodia
Cambodia covers an area of 181,035 square kilometers and shares borders with Thailand, Vietnam,and Lao PDR. The Mekong River and Tonle Sap Lake topographically dominate the country, which is divided administratively into 24 provinces.
The capital city is Phnom Penh which has an estimated population of 1.6 million * with the total population estimated at 14.3 million*, with approximately 80% living in rural areas.
Average household size at 4.7 in 2008 decreased slightly in both rural and urban areas since 1998. 27% of the households are headed by women
. The population growth rate is second only to that of Lao PDR among ASEAN nations. Over 45% of the population is under 20 years of age, the growth rate has decreased dramatically from 2.5% in 1998 to 1.54% by 2008. Ethnically, approximately 90% of the population is Khmer, while 10% is minority groups such as Cham, ethnic Chinese, and Vietnamese, approximately 95% speak Khmer. Least densely populated areas are the North and Northeast. Cambodia is one of the poorest countries in Southeast Asia. The periods of war and internal conflict between 1970 to 1993 severely destabilised the health infrastructure and services, recovery was set further back in the 1990s by political upheaval and regional recession.
The Paris Peace Agreements of October 1991enabled peace and stability to be progressively re-established,allowing focus on longer-term development. Despite significant progress, major disparities continue between urban and rural living standards, poverty remains high, with more than 35% below the poverty line and 15% in extreme poverty.
This phenomenon is largely rural, with over 90% of the poorest living in rural areas and is closely linked with access to education. The gross national income is $2230 way below the regional and global average.

Source: * Mid term National Census 2013
Source: Cambodia Demographic and Health Survey 2010 further details can be obtained by clicking open - save
                                                        


The Health System in Cambodia
Kompot Referral Hospital
Kompot Referral Hospital
Cambodia has a mixed service delivery system based on universal coverage the public health service delivery is organized through two levels of services, both are provided in all operational districts:

                  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 Posts

These 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 statistics for Cambodia 2011
Protong Health Centre
Protong Health Centre

       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.

The shortage of health professionals is demonstrated in the table below:

Cambodia % per 10,000 population:               Region % per 10,000 population:
Doctors                      2.3                                                              15.2                 
Nurses/Midwives      7.9                                                              19.5

                                                  

Source: WHO 2012  http://www.who.int/gho/countries/khm.pdf                                
                                                                                   
CMC Registration Statistics                                                               

CMC started the process of registering midwives and collecting registration fees of US$5 per year in 2012 since that time over 4,000 midwives have been registered by the 27 PMC’s details of registration numbers by province/hospital can be viewed or downloaded here open - save