Although the number of health service provisions in Cambodia tripled after it gained its independence in 1953, the civil war that ravished the country until 1993 saw many of these facilities destroyed.
Since 1993, there has been much progress improving health facilities and access to care. However, an average life expectancy in Cambodia of 62 puts it 177th of 192 countries, and significantly behind most of its Southeast Asian neighbours.
A large majority of the Cambodian population (80.5% according to the World Health Organisation) reside in rural areas. However, as the bulk of development continues to be concentrated within urban economies, there is a widening gap between between the wealthy city dwellers and comparatively poorer population in the countryside.
This income disparity is very much mirrored in the healthcare system, and provisions in rural areas are minimal. According to the World Bank, Cambodia spends a relatively low 5.9% of its GDP on health, and only about a fifth of this amount comes from the government. Conversely nearly 75% of it is from household out-of-pocket payments, and there are frequent cases of individuals and families selling their land in order to pay for healthcare.
These figures can be explained by the fact that only around 30% seeking treatment use public services, whereas over half opt for the private option. There is often little choice in this matter, as rural populations only tend to be provided with ‘minimum level primary health care services’ covering around 10,000-20,000 people each. As such anyone seeking more specialist or quality service will have no choice but to go private.
Along with this, there are issues of inadequate regulation within the private health sector. This is due to a lack of government resources, exemplified by the fact Cambodia only has 13 drug inspectors regulating the quality of medicine for the nation’s thousands of pharmacies and shops, according to UNICEF.
Many of these issues are due to the fact that Cambodia’s health care system, and indeed the government as it is today, are still in relatively fledgling stages. Political democratisation began in the early 1990s, and led to a streamlining of health services through decentralisation of control to regions. Prior to this a history of civil war and instability meant medical infrastructure was minimal, and it wasn’t until 1993 that a Ministry of Health was established.
However, recent history certainly shows hope for the future. The country’s average economic growth of 7.7% between 2001-2010 was in the world’s top ten, although many issues of poverty still remain. It has also seen great success in tackling the HIV rate, having reduced it from a 1998 high of 1.7% for people aged 15-49 to 0.7% for the same demographic in 2012. Thanks to wider distribution of condoms and better treatment; new cases have dropped from an annual average of about 15,500 in the early 90s to about 1,000 in 2011.
Despite this progress, advanced health care remains very limited, even within the major cities. Expats or travellers in Cambodia who fall seriously ill or get badly injured tend to be airlifted to either Singapore or Bangkok where more treatments and a better quality of care are available.