Dear Editor,

In Cambodia at the moment, there are still many problems with the public and private healthcare sector.

These include low standards of pharmaceutical manufacturing and drug wholesalers, poorly equipped clinics, the prevalence of counterfeit drugs and a lack of properly trained healthcare workers.

Quality healthcare must be a priority, especially for women and children, and I strongly support efforts by the Ministry of Health to crack down on unregistered pharmacies and clinics, and to remove unsafe products such as condoms, sexual-enhancement drugs and other items sold by retailers on the streets of Phnom Penh (The Phnom Penh Post,

“Condom crackdown continues”, January 25).

According to Article 3 of the 1996 Law on Pharmaceuticals and Medical Management, all owners of pharmacies and other medical-related businesses must obtain proper credentials from the Ministry of Health in order to operate.

Moreover, Article 6 of the law states that properly educated medical professionals must be employed by these businesses, while Article 10 lays out clearly defined punishments for any failure to comply with the law.

Based on my observations and experience, I have noted violations of several articles of the law.

Many pharmacies that possess proper licences nonetheless do not employ no properly educated pharmacists, instead relying on family members or others with no medical background. This is both dangerous and illegal.

Offices approved only for consultation frequently contain medical equipment for testing blood and urine, and they also sell pharmaceutical products, which is also against the law.

In addition, these consultation offices often provide prescription drugs in intravenous form, as many patients trust that IV drugs will more effectively heal their illnesses.

However, these are often administered unsafely, as anyone who has seen people with a serum drip attached to their arms while driving home on the back of a motorbike taxi can attest.

Consultants can also take advantage of patients who trust them by prescribing remedies without warning them of possible side effects, or basing their pricing on how wealthy the consultant thinks the patient might be.

Patients who have died at consulting offices have sometimes been put in an ambulance and sent to a referral hospital, after which the consultant records that they died on the way to hospital, rather than in a consulting clinic.

The government needs to create a body that can provide adequate oversight of the medical community to ensure that patients have access to safe and qualified healthcare.

In rural villages in Cambodia, residents only have access to a limited range of medicines sold by untrained retailers who have no knowledge of the drugs they sell, except for some of the symptoms they are designed to treat.

They also often sell homemade remedies that have no medicinal value at all.

In a related development, the announcement that the government is planning to revise salary supplements could have a severe impact on the healthcare industry.

While the government’s decision to maintain fairness in compensation and spur broader public administration reform might be laudable, I think the termination of incentives should be postponed.

Huge sums of money have been spent on technical assistance, including technical advisers and consultants, based on ActionAid’s calculation of overseas development assistance in 2004, which stood at 15 percent of international funding to Cambodia.

I think instead of cancelling pay incentives, it would be better if the government and the development community could meet and decide to remove all technical assistance expenditures from the government budget, while also strengthening management, monitoring and evaluation systems.

This way, support would remain for incentives to civil servants, especially healthcare workers and teachers who can barely support themselves on their government salaries.

However, it remains vital that the government’s health authorities continue to crack down effectively on all retailers, clinics and pharmacies that employ unqualified workers or deal in illegal goods, and that the Law on Pharmaceuticals and Medical Management be strictly enforced to safeguard the public health sector and, ultimately, to achieve the Millennium Development Goals in 2015.

Tong Soprach

Public Health Consultant

Phnom Penh

Send letters to: [email protected] or PO?Box 146, Phnom Penh, Cambodia. The Post reserves the right to edit letters to a shorter length.

The views expressed above are solely the author’s and do not reflect any positions taken by The Phnom Penh Post.