P UBLIC hospitals are as much in need of reform as pharmacies, but improvement may be on the way with large amounts of overseas aid money being pledged for their rehabilitation.
External aid agencies have been concentrating on public hospitals in the last two years, since UNICEF came up with $2.5 million to help import drugs for public hospitals. The entire drug industry in the country collapsed after 1989, when Eastern Bloc drug supplies, which the country was dependent on, stopped flowing in.
For about one year after that, hospitals managed on surplus stocks. But by the end of 1990, most commune level public hospitals, on which the poorest people were dependent, either stopped functioning or ran out of drugs, forcing people to private pharmacies and traditional medicine.
"Private pharmacies, in fact the entire private sector medicine business, sprouted up when public hospitals were in a state of collapse," says one doctor at the PMI hospital on Monivong Boulevard. "Many times we are still out of medicines, and we have to prescribe them for our patients to buy from outside, though we know that very often medicines in pharmacies are not safe."
The situation has improved somewhat with the Unicef aid to the Ministry of Health. A central medical depot has been set up near the ministry to supply basic drugs to provincial hospitals.
"Despite distribution problems, 43 basic drugs now reach all district hospitals except those in Phnom Penh, all provincial hospitals and 75 per cent of commune clinics," says Unicef Project Officer for Health Andrew Morris.
Up to $12 million in aid money has now been pledged by Germany, Britain and the World Bank to import drugs for public hospitals up to 1996. "We hope to cover all hospitals in the country by the end of the year, and to increase the number of drugs supplied to 110," Morris says. "But the question is, what after 1996? They can't depend on imports forever."
But merely supplying hospitals with drugs is not enough. In several hospitals, drugs from the hospital pharmacies are sold by hospital staff on the open market and find their way into private pharmacies, according to doctors and Ministry of Health officials.
"There is no account of how much of the medicine we send to hospitals is lost in this way," admits Morris. "We have to find a system by which properly functioning hospitals are supplied with more drugs."
One hospital which claims to have stopped the practice entirely through good administration is the capital's highly-rated children's hospital, Kantha Bopha. "Our pharmacy is managed by Khmers who keep strict account of the drugs themselves," says Swiss founder Dr Beat Richner.
But even if public hospitals' drugs supplies soon improve they still face image problems. Often, they are not accessible to provincial people. A Unicef study shows that using a government hospital is the last resort for patients, even though their chances of being cured may be as good or better than other alternatives.
The survey, conducted in December 1992, into malaria cases showed people will try drugs at the market, then go to private clinics and only go to district hospitals if they are still ill.
This is despite the obvious difference in cost of malaria treatment. The survey found that private clinics cost 40,000 riel, buying drugs from the market costs 5,000 riel, traditional medicine costs 3,000 riel and the local district hospital costs just 250 riel.
Despite exorbitant costs, private alternatives do not have a better record of curing malaria. The survey shows that medication from the market has a cure rate of 11.7 percent, while private clinics cure the disease 25 percent of the time. Public hospitals do much better, curing the disease 91 per cent of the time.
"People now shop for health care, they have several options," says Morris. "Public hospitals have to convince people to start coming back to them for treatment."