Cambodia is a developing nation in ASEAN with a recent history of political stability. Cambodia gained independence from France in 1953 but was devastated by a war with Vietnam. The Cambodian-Vietnamese War ended in 1991, but the country only achieved political stability in 1997 when the Cambodian People’s Party gained power in a coup. The Cambodian People’s Party has been in power ever since.
With strong garment production and tourism industries, Cambodia’s 2017 GDP growth rate is predicted to be over 7%. Cambodia has a young population of 15 million, with a third of its citizens under the age of 15. However, falling fertility rates will limit population growth in the future. Between 2004 and 2015, poverty rates decreased from 50% to under 20%, but the availability of quality healthcare remains low.
Healthcare Environment in Cambodia
In Cambodia, the Ministry of Health is responsible for all healthcare matters. Starting in the 1990s, the Ministry of Health worked with several international development agencies to reform the country’s healthcare system. In the early stages, the Cambodian government implemented social health programs such as Health Equity Funds, voucher schemes, voluntary community-based health insurance, and private insurance. These programs were well-received by the public and yielded positive results. Since then, the Ministry of Health has continued to invest in these healthcare programs and is now focused on improving Cambodia’s healthcare system.
Total healthcare expenditures account for approximately 6% of Cambodia’s GDP and is increasing in the country’s high-growth economy. Healthcare spending in Cambodia is divided between the public and private sectors. Public health service is provided through 24 provincial health departments and 81 health Operational Districts. Each provincial health department operates a provincial hospital and governs several health Operational Districts. These health Operational Districts each serve approximately 200,000 people with secondary care and manage Health Centers that provide basic primary care. Currently, over half of the government’s healthcare expenditures is spent on medical supplies, and there are only 0.7 hospital beds per 1000 people compared to 2.2 hospital beds per 1000 people in Thailand. The effort to decentralize public health service has not been satisfactory, and the remuneration of government healthcare workers and overall lack of healthcare professionals remain major problems. In Cambodia, government employees are only paid $100 to $150 a month, which is below the estimated living wage of $350 a month. As such, many government healthcare employees work both for the public and private sectors. Over 70% of public health workers in Cambodia are nurses and midwives, but they are still unable to serve the entire population.
While the public sector is dominant in health promotion, preventative activities such as essential reproductive, maternal, neonatal and child care health, and major communicable diseases control, the private sector is responsible for the majority of curative care in Cambodia. Additionally, due to inadequate public healthcare services, private healthcare spending in Cambodia has grown significantly in recent years. In 2015, approximately 60% of patients sought care at private providers and out-of-pocket payments accounted for over half of total healthcare spending. Due to the growth of the private healthcare sector, the Ministry of Health now aims to regulate the private sector more effectively by implementing required licensing and increasing enforcement.
Government Regulations in Cambodia
Medical equipment and drugs are regulated by the Department of Drugs and Food in the Ministry of Health under the PRAKAS 1258 law (passed in 2012). Medical devices in Cambodia are classified by risk, in accordance with ASEAN guidelines. There are four classes of medical devices, A, B, C and D, with A being the lowest risk and D being the highest risk. Drug registrations also follow ASEAN requirements and take approximately a year to process.
Approximately half of Cambodians rely on traditional medicine, but the rapidly growing pharmaceutical industry indicates a trend away from such treatments. In 2015, the pharmaceutical market in Cambodia was valued at $255 million compared to $215 million in 2011. In Cambodia, there are about 2,000 registered pharmacies and 10 medical equipment and/or pharmaceutical manufacturers, so there is large number of unmet medical needs. Imported drugs account for over 60% of the pharmaceutical market, and locals highly prefer Western drugs and devices due to their higher quality. Currently, the Ministry of Health is the largest purchaser of medical supplies.
As Cambodia continues to grow and develop, the local healthcare industry should interest Western medical companies. Global players like Merck are already looking to the Cambodian medical market with interest, stating that the unmet medical needs in Cambodia present numerous opportunities.