A study of the Kingdom’s district health system has found it “unable to manage” non-communicable diseases such as diabetes and hypertension, which are estimated to be responsible for more than half of adult deaths.
The paper, published last week by open access publisher Bio Med Central, surveyed health care providers, community representatives and managers of health care initiatives across three of the country’s 81 operational health districts in order to assess the district health system on several indicators that include access, equity and quality of care as well as financing, governance, expertise of staff and the supply and provision of medicines.
While non-communicable diseases (NCDs) were widely considered as prevalent among those interviewed, the study found that the district system “was inadequately developed to effectively deal with these conditions. Medicines supply was erratic and the quantity provided allowed for few patients to be treated.”
“Health centres reported that their available supplies would offer a median of only three days’ medicine to NCD patients,” the study found, adding that none of them were found to have all the required essential drugs available.
Meanwhile, hospitals – a tier above health centres in the district system – could only provide drugs to treat “5 to 7 diabetes patients per quarter”.
The findings also reported chronic shortages of medicine, with new stocks lasting a month on average across health facilities. When medicines ran out, providers would write letters to health administrators less than half the time, and otherwise either referred patients to higher-level facilities or “would propose the patients buy drugs on the market”, when ostensibly such drugs should be provided free of charge.
Outside of hospitals, none of the health centres studied had equipment to conduct the blood or urine tests that are part of NCD screening. What’s more, “few of the facilities examined had an annual government budget for NCD, and those budgets available were minimal”, on the order of a few thousand dollars annually.
Also lacking are qualified professionals, as “nearly half of the health centres (47 per cent) did not have anybody employed who had completed formal NCD management training”.
Reducing the burden of NCD’s was stated as a goal in the Ministry of Health’s second Health Strategic Plan 2008-15, however a lack of financial commitment from the government, as well as a “lack of interest from international donors”, has limited progress.
Dr Khim Sam Ath, a technical officer for NCDs at the World Health Organization in Cambodia, said yesterday that funding to combat such diseases remained minimal, adding that the WHO has lobbied the government to address the issue more substantially.
“Only 6 per cent of the national health budget had been earmarked for NCDs . . . It’s still very low compared to other programs, [ie Malaria or HIV/AIDS],” Sam Ath said. “It’s a matter of several disease burdens.”
A Health Ministry spokesman did not respond to a request for comment as of press time.