Cambodia since 1980 has revised and reformed
its health system several times, resulting in the
establishment of the current healthcare system in
1996. This latest reform introduced a three-tier
structure with responsibilities allocated at central,
province and district levels:
1. Central (top) level: consists of the Ministry of
Health, national institutes, national hospitals,
national programmes and national training
institutions, responsible for policies, legislation
formulation and strategic planning.
2. Intermediate level: made up of provincial
health departments and provincial hospitals,
it serves as the linkage between central level
and operational districts and is responsible for
operationalising national policies.
3. Lower level: comprises operational districts
(ODs), referral hospitals (RHs), health centres
(HCs) and health posts (HPs).
Public health services are provided through
a national network comprising eight national
hospitals, 77 ODs, 79 RHs, 1029 HCs and 77 HPs
(Sann and Lo 2006; MOH 2008). Implemented
within the health system are two services delivery
models, each providing a package of health services
through contracting: 1) Complementary Package
of Activities (CPA) provides specialist services
and treatment at RHs; 2) Minimum Package of
Activities (MPA) provides primary healthcare at
HCs and HPs.
As one of the five strategic areas of the Health
Strategic Plan 2008-15 (HSSP2), health system
service delivery “…supports the key output of the
public and private health sector and is the means
through which the ultimate outcomes of the
HSSP2 will be achieved” (MOH 2008: 30). The
goals of the health service delivery strategy are
decentralised service delivery, improved quality
in service delivery and management, promotion
of effective public-private partnerships in service
provision, and greater community engagement.
Core inputs seen as necessary for health service
delivery include financial resources, competent
healthcare staff, adequate physical facilities and
equipment, essential medicines and supplies,
current clinical guidelines, and operational
policies.
This paper focuses on current research and
suggests future directions for research that can
help improve the organisation and quality of
health service delivery in Cambodia.