• Right to health
• Equity
• Pro-poor
• Social protection for vulnerable groups
• Listening to what people want
• Affordability and sustainability
• Focus on rural areas and the poor
• Capacity building including human resource development
• Sector wide management
• High quality evidence based interventions
• Good governance and accountability
POLICY STATEMENT 2003 -2007
The policy statement of the Ministry of
Health, Kingdom of Cambodia is based on the national health
policy, which can be found in the booklet called ‘Health
Situation Analysis 1998 and Future Direction for Health
Development 1999-2003’.
The following 13 elements that comprise the policy statement
provide the basis for this strategic plan. The 20 strategies
in the strategic plan flow from these elements.
Policy Statement
• Implement sector wide management through a common vision
and effective partnerships among all stakeholders
• Provision of basic health services to the people of
Cambodia with the full involvement of the community
• Provision of affordable, essential specialised hospital
services
• Decentralization and de-concentration of financial,
planning and administrative functions within the health
sector
• Priority emphasis on prevention and control of
communicable and selected chronic and non-communicable
diseases, on injury, the elderly, adolescents and vulnerable
groups such as the poor, and on managing public health
crises
• Priority emphasis on provision of good quality care to
mother and child especially essential obstetric and
paediatric care
• Active promotion of healthy lifestyles and health-seeking
behaviour among the population
• Emphasis on quality, effective and efficient provision of
health services by all health providers
• Optimisation of human resources through appropriate
planning, management including
deployment and capacity development within the health system
• Increase promotion of effective public and private
partnerships for effective and
efficient basic and specialist care
• Effective use of the health information for evidence-based
planning, implementation,
monitoring and evaluation in the health sector
• Implement health financing systems to promote equitable
access
to priority services especially by the poor
• Further development of appropriate health legislation to
protect the health
of providers and consumers
The health sector strategic
plan:
A SUMMARY
This is a summary
of the strategic plan for the health sector in the Kingdom
of Cambodia.
The vision of the strategic plan is to really make a
difference, for the better, to the health of the people of
Cambodia.
The purpose of the strategic plan is to
provide direction to the development of the health sector
over the next 5 years. The government’s intention is that it
is used to focus and guide the actions of the Ministry of
Health and all stakeholders so that everyone works towards
making a difference, to meeting the government’s planned
outcomes.
To make a difference to the health of people
in this country, we in the Ministry of Health have, in the
strategic plan:
For the first time included everyone who is
working on some aspect of health care, both in the public
and private sectors. In this country we call this approach
sector wide management.
For the first time developed a mission
statement, values and working principles, and a policy
statement. These are crucial to tell everyone what the
Ministry is all about.
For the first time given six priority areas
of work and twenty strategies, eight of them core ones, all
of which have been identified through talking with those
interested in making a difference. Everyone must focus on
these if we are to make a difference.
For the first time given health outcomes for
the whole sector. This means we know what we have to succeed
in doing if we are to make a difference in people’s health.
For the first time paid more attention to
chronic diseases and to emerging public health issues. We
need to try and prevent people getting diseases such as
cancer due to smoking or to having accidents at home, at
work, or on roads which cause health problems.
For the first time developed a strategic
plan that is linked to the planning-budgeting cycle and to a
medium term expenditure framework. Planning what we do to
make a difference, and making sure money is spent on what
will make a difference, are very important.
CURRENT HEALTH
AND DEMOGRAPHIC SITUATION
| |
Life expectancy at birth(1998) |
58.3(females) 54.5(males) |
| |
Total fertility rate* |
4.0 |
| |
Maternal mortality ratio* |
437 deaths per 100,000 live births |
| |
Infant mortalyty rate* |
95 deaths per 1,000 live births |
| |
Under-five mortality rate |
125 deaths per 1,000 live births |
| |
Percentage of children under five years with
stunting* |
45% |
| |
Percentage of children who are underweight* |
45% |
| |
Tuberculosis incidence rate(2001) |
540 per 100,000 population |
| |
Malaria incidence rate(2001) |
8 per 1000 population |
| |
HIV seroprevalence rate among 15-49 years* |
2.8% |
| |
*(2000) |
|
Improving these indicators has determined
the range of work for implementation in the strategic plan.
Health improvement will contribute to poverty alleviation
and socio-economic development. Currently, around 36 per
cent of the population live below the poverty line and about
32 per cent of women are illiterate.
Priority
will be given to the following demographic and health
concerns:
• The rise in infant and child mortality including
increasing post-neonatal mortality,
mortality and morbidity from diarrhoeal diseases, acute
respiratory infections, vaccine-preventable diseases, dengue
and malaria
• The high rates of under-nutrition among women and
malnutrition among children
• High maternal mortality ratio, and deaths from obstetric
trauma and septic abortions
• High case fatality from infectious diseases particularly
HIV/AIDS, TB, and malaria
• The high total fertility rate
• Population growth
• Harmful practices among consumers and providers including
unhealthy lifestyles and widespread inappropriate health
seeking behaviour
The population aged 65 years or more is expected to increase
resulting in a number of emerging non-communicable or
chronic diseases such as cardio-vascular disorders, cancer
and diabetes. As commercial and industrial sectors expand,
the health sector will also see increasing numbers of
work-related problems, injuries, and road traffic accidents
unless more attention is given to prevention. Another
concern is that on average, households spend almost US$ 24
per capita on health services. Among those who sought care,
80 per cent had to use savings, or even borrow or sell
assets to pay for health care costs. One or more of the
concerns affect almost every family in the country. The
Ministry of Health has been working on them and there are
some signs of success. But we need to do more.
THE OVERALL GOAL OF THE
STRATEGIC PLAN IS TO:
Enhance health sector development in order to improve the
health of the people of Cambodia, especially mothers and
children, thereby contributing to poverty alleviation and
socio-economic development.
THE RESULTS OR OUTCOMES WE
EXPECT FROM
EFFECTIVE AND EFFICIENT ACHIEVEMENT OF THE GOAL ARE:
• Reduced infant mortality rate
• Reduced child mortality rate
• Reduced maternal mortality ratio
• Improved nutritional status among children and women
• Reduced total fertility rate
• Reduced household health expenditure, especially among the
poor
• More effective and efficient health system
PRIORITY AREAS OF WORK
To get these results the government will, during the period
2003-2007, give priority to six areas of work:
• Health service delivery
• Behavioural change
• Quality improvement
• Human resource development
• Health financing
• Institutional development
• Further improve coverage and access to health services
especially for the poor and other
vulnerable groups through planning the location of health
facilities.
• Strengthen the delivery of quality basic health services
through health centers based
upon minimum package of activities.
• Strengthen the delivery of quality care, especially for
obstetric and paediatric care, in all
hospitals through measures such as the complementary package
of activities.
• Strengthen the management of cost-effective interventions
to control communicable diseases.
• Strengthen the management and coverage of support services
such as laboratory, blood safety, referral pharmaceuticals,
equipment and other medical supplies and maintenance of
facilities and transport.
Behavioural change
• Change for the better the attitudes of health providers
sector wide to effectively communicate with consumers
especially regarding the needs of the poor through
sensitisation and building interpersonal communication
skills.
• Empower consumers, especially women, to interact with
other stakeholders in the development of quality health
services through mass media and inter-personal
communication.
• Promote healthy lifestyles and appropriate health seeking
behavior through advocating for healthy environments and
implementing counselling and behavioural change activities
Quality improvement
• Introduce and develop a culture of quality in public
health, service delivery and their management through the
use of Ministry of Health quality standards.
• Develop and implement minimum and optimum quality
standards for the public and private sectors incorporating
pro-poor and gender issues through the use of appropriate
tools.
Human resource development
• Increase the number of midwives through basic training and
strengthen the capacity and skills of midwives already
trained through continuing education.
• Strengthen human resource planning to reduce
mal-distribution of the numbers and type of workforce
through identification of posts and the reallocation of
staff.
• Enhance the management and technical skills and competence
of all Ministry of Health workforce through quality,
comprehensive training, education, retention and support
measures.
Health financing
• Ensure regular and adequate flow of funds to the health
sector especially for service delivery through advocacy to
increase resources and strengthening financial management.
• Allocate financial resources to improve the accessibility
of health services for the poor through alternative health
financing schemes.
• Ensure transparent, efficient and effective health
expenditures through strengthening resource allocation,
coordination of different sources of funding, and
monitoring.
Institutional development
• Organizational and management reform of structures,
systems and procedures in the
Ministry of Health to respond effectively to change.
• Effective public private partnership to improve
accessibility, quality and affordability though the
promotion of private sector participation and enforcement of
regulations.
• Enhance Ministry of Health capacity to address chronic
diseases and emerging public health problems through raising
awareness and developing comprehensive plans.
• Further develop the health sector to strengthen management
effectiveness throughout the health service by:
a) Enhancing management and leadership culture sector-wide
b) Increasing effective decentralization and
deconcentration
c) Institutionalizing sector wide management
Human resource development
|
Health financing
|
Institutional development
|
SOME STRATEGIC ACTIONS
The Ministry of Health is very supportive of the need for
flexibility. Therefore in the strategic plan only strategic
actions for implementation of the strategies are given
(volume 1, annex B). Each level and also each province and
(operational) district of the health system will develop
detailed actions or activities depending on factors such as
role, needs and problems. Such actions/activities will be
reflected in annual operational plans (volume 4 of the
strategic plan). The actions are also linked to the
direction and scope of the strategic plan (volume 1), the
medium term expenditure framework (volume 2) and the
monitoring and evaluation framework (volume 3).
The following are examples
of some strategic actions for the 8 core strategies:
• Further improve coverage and access to health services
especially for the poor and other
vulnerable group through planning the location of health
facilities.
Finish revision of health coverage plan
• Strengthen the delivery of quality basic health services
through health centers based upon
minimum package of activities. Review and revise the minimum
package of activities to especially target the top priority
diseases and other problems such as malnutrition
• Strengthen the delivery of quality care, especially for
obstetric and paediatric care, in all
hospitals through measures such as the complementary package
of activities.
Finalise and implement the complementary package of
activities according to role of hospitals at district,
provincial, and national levels building upon evidence based
practices
• Change for the better the attitudes of health providers
sector wide to effectively communicate with consumers
especially regarding the needs of the poor through
sensitisation and building interpersonal communication
skills.
Raise awareness among public, private, NGO health providers
about quality health services and professional ethics
(accountability) including inter-personal communication
skills
• Introduce and develop a culture of quality in public
health, service delivery and their management through the
use of Ministry of Health quality standards.
Establish a quality assurance office to support, encourage
and help managers develop quality client/consumer orientated
services
• Increase the number of midwives through basic training and
strengthen the capacity and skills of midwives already
trained through continuing education.
Continue providing 4 month maternal and child health course
for health centre staff
• Ensure regular and adequate flow of funds to the health
sector especially for service delivery through advocacy to
increase resources and strengthening financial management.
Strengthen budgeting and financial planning
• Organizational and management reform of structures,
systems and procedures in the
Ministry of Health to respond effectively to change.
Clarify roles and functions, lines of accountability and
decision-making, delegation of authority at all levels of
the Ministry of Health, including national programmes,
national hospitals and other national health institutions
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