C
ambodia has to tackle a “double epidemiological
burden”. The country faces the typically
characteristic pathologies of developing
countries (tuberculosis, dengue, malaria...),
and also diseases more specific to prosperous
societies (diabetes, cardiovascular diseases, cancer...).
Exacerbating the problem is the fact that Cambodia is
poorly equipped to address these issues.
Self-prescription and self-treatment are common
practice (Poursat, 2004). Members of the population
frequently consult private doctors and traditional therapists
who have had widely varying amounts of training. The
public authorities do not yet have control over this lucrative
private sector. Meanwhile, public facilities go underused
(according to the 2010 Demographic and Health Survey
(DHS) only around 25% of the population sought first treatment
in the public sector (DHS, 2010)). Unofficial payments
often add to the costs of official treatment prices (Meessen et
al., 2008). Public staff are poorly paid, which often encourages
doctors and nurses to look for work in the private
sector. This lack of regulation allows the flagrant abuse of
the price setting of services and of the quality of prescriptions
(Duffau, Diaz Pedregal, 2009).
The Cambodian Government finances only 10% of
national health expenditure, while international donors
contribute more than 20%. The remaining 70% of the total
cost has to be met by the users. This represents a considerable
burden for the average household in Cambodia,
especially in rural zones. Health costs are around 25 USD
per person per year in these zones, which is more or less
a month’s salary for a rural inhabitant.