GLOBAL HEALTH PERSPECTIVES
Health System
ECONOMICS, EDUCATION & HEALTH SYSTEMS
Cambodia
Health and Education
(Source: CIA, 2018)
Health Care Services
(Source: IHME, 2018)
Cambodia utilizes an educational model wherein children complete primary general education from grades 1 through 6, then progress to secondary general education from grades 7 through 12. Most children between 3 and 6 years old complete at least one year of pre-school education. University education is an option for children who complete all 12 years of general education, and completion of an university degree usually takes from 4 to 5 years. The educational system is run by the Cambodian state, but private education is an option at all levels; usually, private school are run by ethnic and religious minorities, such as Chinese, Muslim, and Vietnamese (Bookbridge, 2016). The literacy rate of the total population is 77.2%; the rate is 84.7% for males, and for females, the rate is 70.5% (CIA, 2018). According to UNICEF (2013), the primary school net enrollment ratio is 98%. While the total primary school enrollment is rather high, this number is a bit deceiving. There is a lack of quality in education, as there is a need for more teachers and higher pay, so students often have to repeat grades, particularly at the primary school level (UNICEF, 2013). The school life expectancy rate, or how many years of education a child would receive during his or her lifetime, is 11 years for males and 10 years for females (CIA, 2018).
The link between health and the education system in Cambodia relates to the quality of education and the fact that many students drop out of school to enter the labor force, often in order to help support their families. Due to the lack of quality in Cambodia’s education system, many children end up repeating grade levels or dropping out of school, never reaching the university level where they would have the option to train as health care professionals, which would enable them to contribute to the health of the country. Furthermore, when children drop out of school to enter the labor force, they are often making inadequate wages and are unable to afford to care for their health.
Health, Economic Status, and Poverty
(Source: CIA, 2018)
(Source: CIA, 2018)
Industrial Overview
In 2017, the gross domestic product (GDP) in Cambodia was $64.21 billion, and 5.7% of this was spent on health care as of 2014. In the United States, the GDP in 2017 was $19.36 trillion and 17.7% of it was spent on health care as of 2014. Income per person in Cambodia in 2017 was $4,000 compared to $59,500 in the United States. The unemployment rate in Cambodia was 0.3% in 2017 and the population below the poverty line in 2012 was 17.7%; however in the United States, the unemployment rate in 2017 was 4.4% and the population below the poverty line in 2010 was 15.1% (CIA, 2018).
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Health and productivity are closely linked, in that when a person is not healthy, he or she cannot go to work and does not earn a wage, which only continues the cycle of the individual’s inability to afford healthcare. Furthermore, health is a necessary factor for an individual’s success to learn new knowledge, skills, and to be productive (Skolnik, 2016). In Cambodia, undernutrition as a result of poverty is a large problem that results in decreased productivity. Chronic malnutrition is experienced by around 37% of Cambodian children under the age of 5, which continues to be a problem throughout the individual’s lifetime (CIA, 2018). UNICEF notes that “poverty and undernutrition are locked in a vicious cycle of increased mortality, poor health, and retarded cognitive and physical growth, diminished learning capacity and ultimately lower work performance, productivity, and earnings” (2013, p. 7).
(Source: IHME, 2018)
The relationship between health and health expenditure depends on a number of factors, such as where money is being invested in the health care sector. In 2014, 5.7% of Cambodia’s GDP was spent on health, with $3.2 billion coming from out-of-pocket expenses (CIA, 2018; IHME, 2018). In comparison, in 2014, 17.7% of the United States’ GDP was spent on health, with 2.1 billion of that coming from out-of-pocket-expenses (CIA, 2018; IHME, 2018). Large out-of-pocket expenses can have a detrimental effect on the financial status of individuals, as they often have to spend much of their income on treatment or medications (Skolnik, 2016). The average life expectancy in Cambodia is 68 years old, and in the United States it is 78 years old (Health Grove, 2018; Skolnik, 2016). The United States is a high-income country that spends a large amount on health care, but has a lower life expectancy than many other countries that spend less on health. While Cambodia still has a lower life expectancy than the United States, it has a substantially smaller health expenditure. Despite the differences in health expenditure, the health status of a country depends on a number of other circumstances, including genetic, social, and economic elements (Skolnik, 2016).
In Cambodia, theoretically, health care is free for each citizen; however, as previously noted, there are a large amount of out-of-pocket expenses. For example, when supplies are unavailable at a hospital, the patient is forced to buy them on the open market (World Health Organization [WHO], 2012). Each province receives different amounts of humanitarian aid and also has a separate budget from the others. Health centers and health posts are where primary health services are offered and are mainly utilized by rural populations. As of 2012, around 1,049 facilities were expected to cover 10,000-20,000 individuals each (WHO, 2012). In these facilities, NGOs sometimes carry out health promotion and disease prevention programs (WHO, 2012). Referral hospitals are categorized as either national, provincial, or district facilities. They are further categorized by levels of operation: a level one hospital has a basic obstetric service, but no general anesthesia, blood banks, or blood deposits; a level two hospital has all of the features of a level one hospital with other services, such as ICU, general anesthesia, blood blanks, orthodontics, and ophthalmology; a level three hospital has all of the features of a level two hospital with the addition of a larger number of patients and specialized services. In 2011, there were 33 level one hospitals, 31 level two hospitals, and 26 level three hospitals (WHO, 2012). The use of traditional medicine is strong in Cambodia, as many rural populations still utilize the Kru Khmer, or traditional healers (McGrew, 1990).
(Source: WHO, 2012)
In Cambodia, physical access to health care is limited in poor, particularly rural, areas due to distance and transport. While referral hospitals are typically located within the most populated cities, the inability to pay for out-of-pocket expenses is one of the largest barriers to health care. Other barriers to health care include: socio-cultural practices, lack of trust in public health care facilities, lack of expertise and numbers of health care professionals, lack of monitoring and regulation of the private sector, and difficulty accessing medications when using the public sector (WHO, 2012).
In 2010, only 43% of health centers and health posts offered expected basic services, such as emergency first aid, primary diagnosis, immunization, health education, and maternal and child care. Constraints to delivering appropriate care included inadequate essential medications, the absence of key personnel, and an overall absence of operational guideline requirements (WHO, 2012). The Red Cross, UN agencies, and NGOs continue to coordinate their services in order to improve access to care (WHO, 2012). Over the years, humanitarian aid and other efforts have helped to slowly improve health care access and quality (HAQ); in 2015, Cambodia's HAQ index was 50.7% out of a best possible score of 62.3%, meaning that the country is still experiencing a 11.6 gap (IHME, 2018).
