The Challenge of Maintaining a System of Primary and Preventative Health Care in Rural Areas.
Moderator: Nina McCoy, Country Director, Australian Red Cross – Vietnam
Panelists:
Dr. Mam Bun Heng, Secretary of State, Cambodia Ministry of Health
Dr. Southsavienne Vilay, Chief of Administration and Secretary Hygiene Department, Lao Ministry of Public Health
Dr. Tran Trong Hai, Deputy Director, International Relations Department, Vietnam Ministry of Health
Barbara Lewis, War Victims Assistance Program, Consortium Laos
Stephane Rousseau, Executive Director, MediCam
Mam Bun Hong, Cambodia
Cambodia remains one of the poorest countries, per capita income estimated at around $300 US dollars, 39% of the population under poverty line. Right now, health care is in a period of relative stability and donor support, but the government has substantial health care challenges ahead. They want to reduce the infant mortality rate through maternal and child health care, but that priority is secondary to controlling communicable diseases (malaria, TB, others), controlling STDs, especially AIDS.
Demographic indicators lay out the demands of Cambodia’s health care system. 52% of the population is male, and the country has a young population with an unusually high fatality rate. The rural population makes up 82% of the country and the mortality rate is one of the highest in the region. GDP growth is 6.5%, and the government spends per capita just a few dollars in US currency on health care.
The key aim of the HCP is to work towards:
¨ equity in access to and utilization of basic quality health services by disadvantaged groups and those living in remote areas.
¨ efficacy and cost effectiveness of healthcare system delivery
¨ financial and functional sustainability of health care system deliver
Progress of Health Care in Cambodia:
• Coordinating Committee established
• Financial and budget reform
• Human Resource Development, ranging from formal education to management training
• Infrastructure—construction and renovation
• Services
Lessons from the Cambodian process:
The primary strengths of the process were political support from the government and intersectoral collaboration. The most notable constraints in the Cambodian process have been the difficulty of maintaining qualified staff in remote areas and the limitations of collaboration. The real challenges for the future of Cambodia’s health care system will be improving the technical capacity of staff and continued monitoring and assessment.
The process must be dynamic and effective providers must be qualified an motivated and working in a well organized financial system.
Southsavienne Vilay, Chief of Administration and Secretary Hygiene Department, Lao Ministry of Public Health Health Policy of Laos:
• health and well being is a primary interest of the government.
• People should receive health care in their own community
• the Delivery system must be effectively implemented.
In Laos, health care providers are plentiful per capita, but they are concentrated in cities and scarce in rural areas. The main problems faced by the Lao health care system are organization and planning, financing and resources (2-3% of GDP goes to health), and integration and coordination of outside resources. In addition, to increase capacity, Laos needs to educate health personnel both in Laos and abroad, and study abroad requires foreign language fluency, usually English, so English proficiency is the first step health care training.
The first priority of the health system is to bring health care to the villages—right now only 17% have reliable access to a health
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