The continuing weakness of Cambodia's public health sector has been identified as

a major factor in the growing problem of landlessness in rural Cambodia, an Oxfam

UK-funded report has concluded.

Better medical care is crucial to reducing the growing problem of landlessness, says Oxfam

Landlessness among the report's sample population was overwhelmingly linked to the

need to sell land to pay for costly medical care.

"Expensive private health care was the primary reason for people to sell their

land to finance treatment," said Dr. Seng Bunly, the report's co-author. "And

they approached private doctors mainly due to lack of faith in the government health

care sector."

The report's findings cast doubt on both the utility of the annual $6 million donors

pump into the Cambodian health system as well as the efficacy of the 109 health sector

NGOs at work in the Kingdom.

Oxfam-UK focused on 11 villages in Kampong Cham, Kampong Thom and Battambang, where

loss of land was overwhelmingly linked to the need to derive cash to pay private

medical costs. Approximately 60% of the 250 families interviewed said medical costs

were the sole reason for selling their land.

145 villages across 18 provinces were surveyed to assess the extent and cause of

landlessness in Cambodia, followed by a mini case study Health and Landlessness in

December, 2000 designed to determine how illness was contributing to the problem.

The findings are meant to assist health service providers in preventing landlessness

caused by illness.

"...the high cost of private health care services in the private sector and

the fact that the high premium on land had many people willing to buy land, particularly

during 1992 and 1998," Bunly said. "We are not sure if the health costs

have [since] come down significantly or whether there still exists any demand for

rural land."

Micro credit schemes designed to help the rural poor were identified as the other

significant contributor to landlessness and poverty.

The findings are particularly disturbing considering that the most commonly reported

illnesses that led to landlessness, malaria, dengue, TB and typhoid, are preventable

communicable diseases that both the government and the NGO sectors have mobilized

extensive resources to prevent and control.

The report noted that although the majority of those who later sold their land to

finance private medical care first sought treatment at public hospitals, attitudes

of the hospital staff, lack of medicines and the general perception that 'effective

treatment' required injections and IV infusions prompted them to turn to more expensive

private doctors

"Because people in this study resorted to many sources of treatment and spent

significant amounts of money on treatment that did not even improve their condition,

there is a need for consumer education regarding appropriateness and cost effectiveness

of different treatment options," the report states. "Given the clear link

between illness and destitution, it may be possible for the ministries to launch

broad-based consumer health education campaigns involving mass media, NGOs and other

civil society organizations."