AFTER more than a decade of assistance from 109 health sector NGOs administering
annual injections of $6 million of donor funding, the health of Cambodians is as
bad or worse than it was in the late 1980s.
That's the message of the new Cambodian Demographic and Health Survey (DHS) 2000,
a comprehensive report on the state of the Kingdom's health , the release of which
has been delayed by the government due to its "embarrassing" findings.
Based on interviews with more than 15,000 respondents in over 12,000 households,
the DHS is designed to give policy makers an accurate, up-to-the-minute picture of
Cambodian health issues
"They should release it... they spent enough money on it" said Helen Keller
International's Dora Panagides of the $700,000 report.
The UNFPA, UNICEF and USAID-funded report covered 23 provinces and includes data
on topics ranging from infant feeding practices to domestic violence and HIV/AIDS
But the report's grim portrait of a nation fighting an uphill battle against infant
mortality and vaccine coverage has caused the report's release to be delayed for
months due to what sources say is "embarrassment" in the Ministry of Health
That embarrassment is apparently justified with health indicators stalled and minimal
progress on infant mortality since it reached its best point around 1987.
The DHS concludes that the most vulnerable segment of Cambodia society, the young,
are now dying in greater numbers than just two years ago.
According to the report, one in eight Cambodian children will die before their fifth
birthday, an increase in the figure of one in nine infant mortality deaths noted
in the 1998 National Health Survey and more than twice the regional average.
While the report suggests that discrepancy is due to a "...level of mortality
underestimated in the NHS survey" rather than a sudden upswing in child mortality,
other report indicators are equally bleak.
Post-neo natal mortality - between the first month and first year of life - was described
in the report as "...much higher than expected" at 58 deaths per 1000 and
accounting for 61% of overall infant mortality.
MOH officials deny that the DHS's delayed release is in any way related to concern
about its contents, citing instead "technical reasons" for the delay.
"There were discrepancies in the figures," Acting Survey Director Dr Mao
Tang Eang said.
Tang Eang said the MOH was particularly concerned about the DHS statistics on infant
mortality, post-neo natal mortality and the overall mortality rate stated in the
report. The time delay was caused by the MOH's request for clarifications from the
report's sponsors and consultancy firm ORC Macro, which compiled the report.
"The MOH wanted to have some explanation or some justification [for the discrepancies],
so we had to work for a number of months to resolve this problem," Tang Eang
explained. "...so this might be the reason for the delay of the [report's] release."
However this is not the first time the Ministry has objected to independently produced
health research. The release of the previous health survey was delayed by several
months when the MOH objected to data on child immunization. An impasse that was overcome
when the MOH included their own figures in an appendix.
Kees Goudswaard of UNICEF, one of the DHS report's three sponsors, called for caution
in interpreting the results of the report.
Goudswaard emphasized that the report's results are only estimates of actual figures
based on the survey's random sample and "...do not confirm a downward trend"
in infant mortality.
But Goudswaard conceded that the report was anything but good news.
"[A] reduction in mortality is not obvious and we would have hoped that the
work of the MOH and of donors [devoted to Cambodia's health sector] would be reflected
in the results," he said.
One of the key factors hampering a reduction in Cambodia's infant mortality rate
is Cambodia's low vaccination rate, which at 40% remains stalled at 1998 levels.
The poor vaccination coverage is attributed to difficulties in transporting and administering
vaccines in remote areas of the provinces.
While the vaccination rates for expectant mothers in Phnom Penh against neonatal
tetanus - a major cause of death for Cambodian infants - stand at 79%, in Prey Veng
the vaccines reached only 17% of the target population.
Henk Bekedam of the WHO's immunization program suggested that the figures don't yet
reflect the quality of work done since health reforms were initiated in earnest in
"I'm the last person to say that everything is open and transparent but for
the first time districts are receiving the money and while some don't do so well,
others are doing a great job with it" he said.
Francois Frys of the NGO Medicam suggested that health NGOs working in the field
had to deal with issues of poor management, a lack of motivation and corruption but
agreed that slow progress is being made in the Cambodian health sector.
"There are many problems within the MOH and there are many problems within the
health system here in Cambodia but you cannot change the situation within a few years"
Major structural reform is needed to address Cambodia's health emergency, Frys says
"[The problem] is linked to the whole health sector reform," he said. "Before
there were no plans, now at least there are plans and the big challenge is the [implementation]
of those reforms" he said.
Dr Marc Herment of MSF Belgium-Holland-Suisse agreed, citing health sector corruption
as a major challenge to reducing child and infant mortality
"The [national health] budget on paper and the reality of the money that is
directed to beneficiaries is certainly different" he said adding that patient
treatment is not a priority to underpaid health workers.
In child immunization this includes the allocation of almost $26 million over the
next 5 years for the National Strategy on Immunization, (NSI).
Despite the low figures of neo-natal tetanus inoculation reported in the DHS Tang
Eang expressed confidence that the NSI's goal of its eradication by 2005 could still
The planned date for the official release of the DHS however remains ambiguous.
"We are not sure yet when it will be released but we expect it to be in the
third quarter of this year," he said.