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Health care reform urgently needed, study finds

A nurse supervises a patient using exercise equipment at Phnom Penh’s Khmer-Soviet Friendship Hospital last year.
A nurse supervises a patient using exercise equipment at Phnom Penh’s Khmer-Soviet Friendship Hospital last year. Heng Chivoan

Health care reform urgently needed, study finds

Cambodia’s health regulation system is in need of deep reform, not just minor adjustments, as it is failing to meet its national needs and ASEAN obligations, according to a new report.

The study – published on March 10 in Human Resources for Health, a journal published in collaboration with the WHO – found that “many key functions for health professional regulation are not being performed in Cambodia”.

The review drew on self-assessments by the five regulatory councils – medical, dental, nursing, pharmacy and midwifery – and found the system plagued by potential conflicts of interest, weak complaints mechanisms and laws that did not give the councils a mandate to implement or assess standards.

Researchers found more than half of the Kingdom’s physicians are unregistered, and only two-thirds of dentists and nurses were registered. Four of the five councils rated the majority of organisational and internal governance elements as “weak” or “absent”, with three out of five also describing external governance and public accountability in the same terms.

“[T]here are no effective mechanisms to assure safety and quality of the care that patients receive from all health professionals in Cambodia,” the study’s authors reported.

“We also found that there is no current scope for licensure or renewal of registration of health professionals as a way to ensure their continued competence to practice after initial registration.”

Virya Koy, president of the Cambodian Council of Nurses, agreed that Cambodia was poised to fall short in its obligations to achieve ASEAN standards, saying that shortcomings in funding and human resources were to blame.

“We are not ready yet to open the market; we are so far behind other [ASEAN] countries,” he said.

“There is a lack of financial support . . . We need more resources and more experts.”

Koy said there was no conflict of interest as the council was responsible for observing the professional competency of nurses, while the Cambodia Nurses Association represented their interests.

He said “in the very near future” the council hopes to require nurses to complete 300 hours of credits every three years to keep their medical licence.

Despite the report highlighting poor complaints processes within councils and the Ministry of Health to discipline errant health professionals, government spokesperson Phay Siphan urged the people to address their grievances to the regulatory councils and the courts, not on social media.

“Have a good lawyer and take them to the court . . . not to the NGOs or to the media,” he said.

“This has nothing to do with the government . . . They have their own professional board, they abide by their own ethics.”

Multiple calls to Ministry of Health spokesperson Ly Sovann and opposition lawmaker Ke Sovannaroth – head of the National Assembly’s health commission – went unanswered yesterday.

The Medical Council of Cambodia and the councils for dentistry, midwifery and pharmacy did not respond to requests for comment as of press time.

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