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
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
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
"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."