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Health reforms see success

Siem Reap district makes progress amid criticism of manager.

A SIEM Reap health official whose management drew a public protest from subordinates last week has achieved resounding success in improving health outcomes and cracking down on unlicenced clinics and pharmacies in recent years, public health experts say.

More than one-third of the 120 staffers who work at Siem Reap’s Angkor Chum district hospital gathered last Thursday to protest against Angkor Chum operational district director Mak Samoeun, accusing him of behaving like a “dictator” and preventing them from offering private health services to supplement their incomes. According to a USAID-funded report released last month, however, Angkor Chum has become one of the most successful operational districts (ODs) in the Kingdom’s health sector, due in part to the forced closure of unlicenced medical facilities.

“The Angkor Chum OD has a reputation among government officials and NGO staff for providing highly successful health-care management and effectively providing health services to the population,” reads the report, written by health professionals Tong Soprach and Peng Vanny.

In 2005 and 2006, the report says, health professionals in Angkor Chum noted several instances in which local residents died because they relied on unlicenced medical practitioners who were siphoning patients and revenue from the district hospital and health centres. Over the next few years, Mak Samoeun led an effort to bring patients back to provincial health facilities, quickly improving maternal and child health indicators and increasing revenue for the health sector.

By 2009, all illegal pharmacies and private practices in Angkor Chum were closed or in the process of being closed, and care was available at local health centres 24 hours a day. In addition, 88 percent of child births were aided by trained health personnel – compared with just 26 percent in 2005 – and the average revenue at health centres in Angkor Chum jumped from 7.5 million riels (US$1,789) per month in 2005 to 38.2 million riels per month in 2009.

Opponents, Mak Samoeun said, hope to oust him not because they are concerned about the district health sector, but because they have lost money since their illegal facilities have been shut down.

“Some of my superiors have urged people to protest because what I have done makes them lose profits,” he said.

Sao Sim, director of the Angkor Chum referral hospital, said all 45 of the protestors had thumbprinted a petition against Mak Samoeun of their own volition, and were waiting for an official solution to the dispute from provincial health officials.

Sieng Kheng, a doctor at Angkor Chum referral hospital, said he had protested because he needed to run an unlicenced clinic out of his home in order to boost his meagre earnings.

“Mak Samoeun exaggerates about how all his staff have high salaries … but in fact, this is not the truth,” Sieng Kheng said.

Although Mak Samoeun has often faced criticism for implementing his reforms, his achievements in improving Angkor Chum’s health outcomes are undeniable, said Tapley Jordanwood, a health financing expert with the Phnom Penh-based Better Health Services project.

“He has a deftness with which he addresses issues in his OD,” Jordanwood said. “He so clearly has the trust of a wide variety of people up there.”

Minister of Health Mam Bunheng referred questions to Dy Bunchhem, director of the Siem Reap Provincial Health Department, who could not be reached for comment on Monday.



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