Journey Towards Health for All in Cambodia

PHNOM PENH, CAMBODIA, 7 April 2018 – The Ministry of Health along with WHO, JICA and GIZ convened the Cambodia Universal Health Coverage Forum on 5-6 April, 2018 to commemorate World Health Day. This year’s World Health Day marked the 70th anniversary of the establishment of WHO and had as its theme ‘Health for All – Universal Health Coverage: Everyone, Everywhere’. The two-day Cambodia Universal Health Coverage Forum was the first of its kind and convened over 120 stakeholders including policy makers from both national and provincial health departments, representatives from various Ministries, civil society, development partners, and international experts to consider the path towards universal health coverage for Cambodia.

Universal health coverage (UHC) is about making sure all people have access to quality health services where and when they need them, without financial hardship. This entails the provision of various health services throughout the life course —from health promotion to prevention, treatment, rehabilitation and palliative care. The Ministry of Health of Cambodia has committed to moving towards UHC and to achieving the vision of “All people in Cambodia to have better health and wellbeing, thereby contributing to sustainable socio-economic development” (Third Health Strategic Plan 2016-2020 – HSP3).

The UHC Forum provided the opportunity for Cambodia to reflect on its progress on financial health protection, increasing access to quality health services and in improving the health of its citizens. Cambodia is recognized globally as one of the countries with the most impressive health and economic gains in recent decades. Through the leadership of the Royal Government of Cambodia (RGC), most of the health-related Millennium Development Goals were reached before the target of 2015.

As noted by Dr Kumanan Rasanathan, Health Systems Coordinator (WHO Cambodia), “coverage of essential services however remains a challenge globally with over half of the world’s 7.8 billion unable to access needed services.” Cambodia now faces the “dual burden” of both infectious and non-communicable diseases, with the rise in the latter associated with increasing urbanization, demographic and dietary change, and an increase in lack of physical activity. Initiatives by the Ministry of Health of Cambodia are underway to improve the quality of care of health services, and to develop service for chronic diseases.

Other recent initiatives by the government, in collaboration with development partners, are aimed at tackling many of the issues that are key to moving UHC in Cambodia. Building on the existing platform of social health protection schemes – Health Equity Funds and social health insurance for private sector and civil servants, the aim of the RGC as outlined in the National Social Protection Policy Framework 2016-2025 is to expand financial protection to more Cambodians to reduce the barrier of financial cost of care to access use.

Several speakers at the UHC Forum emphasized that the policy direction is set, but concerted actions are needed to support implementation. Efforts are being made to financially cover workers in the informal sector. International technical experts on health from Japan, Thailand and Indonesia shared successes and failures in policies in the inclusion of informal sector on their pathway to achieve UHC providing lessons for Cambodia. Furthermore, the inter-ministerial panel discussion revealed the complexity of operationalizing the introduction of new target groups under the various social health protection schemes and the need to ensure alignment to avoid duplication that can be costly and inefficient. There was consensus that “no one can do this alone” and that achieving UHC will need coordination and collaboration across sectors.

One of the common messages widely discussed throughout the two days was the importance of considering equity, especially in the development of policy. Professor Chhea Chhorvann, Director of the National Institute of Public Health outlined that equity analysis can guide Cambodia towards the objectives laid out in the policy frameworks. In Cambodia, the differences of health outcomes between sub-populations groups where less well-off groups and those living in rural areas tend to access health services less or have worst health outcomes underscores the need to consider equity. As Cambodia strives towards attaining the Sustainable Development Goals by 2030 (in which UHC is one target), highlighting equity as a policy priority is an important dimension to ensure that “no one is left behind.”

Finally, the UHC forum emphasized that UHC is itself an investment to ensure long-term growth, reduce poverty, help children to grow and provide all Cambodians the opportunity to realize their potential. H.E. Professor Eng Huot, Secretary of State for Health, Ministry of Health of Cambodia concluded the UHC Forum stating that “the goal for Cambodia is for all people to access health services that are effective, efficient and where financial burden is not a barrier to access to needed treatment and care.” With the strong government commitment, concrete steps are being made to move forward the UHC agenda in Cambodia. Efforts towards UHC must therefore be at the heart of the development agenda, and require the participation of all sectors, not just the health sector.

“All Cambodians have a role to play in moving the country towards universal health coverage – through building and using health services, and through contributing to the economic growth required to support Cambodia’s ability to provide health services for all,” said Dr Yunguo Liu, WHO representative in Cambodia.