COUNTRY REPORT: CAMBODIA Sophal Oum, MD, MTH, DrPH, Deputy Director-General for Health

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1 COUNTRY REPORT: CAMBODIA Sophal Oum, MD, MTH, DrPH, Deputy Director-General for Health I. ESTABLISHED PROFESSIONAL QUALIFICATIONS IN HEALTH, 2003 Sector Medical Service, Nursing, First Aid Medical Service Clerical Work Clinical Laboratory Dental Service Rehabilitation Medical Doctor (Medical Assistant) Pharmacist (Pharmacist Assistant) Midwife: Secondary (Primary) Nurse: Registered, Secondary (Primary) Lab Technician: Secondary (Primary) Dentist (Dentist Assistant) Physiotherapist Qualification Specialized nurse: Nurse Anesthetist, Mental Health Nurse, Dental Nurse, Basic Eye Nurse etc. Medical Specialist: Internal Medicine, Surgery, Pediatric, Gynecology and Obstetric, Psychiatry, Anesthesia, Pathology, Radiology, Pharmacology etc. TRAINING INSTITUTIONS 1. University of health sciences (UHS): Total number of staff: 186, including Faculty of Medicine (64); Faculty of Pharmacy (18), Faculty of Dentistry (40), and Technical School for Medical Care (64). 2. Regional Training Centers (RTCs): 4 RTCs in the country, with a total 117 staff; established in 1989/91 (upgraded from Provincial Training Centers created in 1980). 1

2 A. Pre-Service Education II. TRAINING PROGRAMS 1. University of Health Science (UHS): Faculty of Medicine, Pharmacy, & Dentistry and Technical School for Medical Care (TSMC) Name of Training Programs Qualification Level Duration of Course Comments (Date) Medical Doctor (1980 Onwards) Diploma (Degree) 7 years (Or Medical Assistant + 4 years) Medical Assistant ( ) Pharmacist Diploma (Degree) 5 years Pharmacist Assistant ( ) (1980 Onwards) Dentist (1982 Onwards) Diploma (Degree) 7 years (or Dental Assistant +4 years) Dentist Assistant ( ) Registered Nurse Diploma (RN) 3 years (1996+) Secondary Nurse Diploma Primary Nurse + 2 years Primary Nurse training ceased in 1987 (1988+) Secondary Midwife Diploma Primary Midwife + 2 years Primary Midwife training ceased in 1998 (1988+) Secondary Lab Technician Diploma 2 years Before 1999: 3 years training Primary Lab Technician ceased in 1989 Physiotherapist Diploma 3 years 2. Regional Training Schools Registered Nurse Diploma (RN) 3 years (1996+) Secondary Nurse Diploma Primary Nurse + 2 years Primary Nurse training ceased in 1988 Secondary Midwife Diploma Primary Midwife + 2 years Primary Midwife training ceased in

3 B. Post-graduate and Post-basic education 1. UHS: Faculty of Medicine, Pharmacy, & Dentistry and TSMC Name of Training Programs Qualification Level Duration of Course Comments (Date) Physician Anesthetist Diploma 2 years Support from Cooperation Francaise Internal Medicine Surgery 3-4 years Commenced in 1998 Obstetric & Gynecology Pediatric 2-3 years training in Cambodia followed by 6 months- 1 Pathology year of training overseas Nurse Anesthetist (ISAR) Diploma (ISAR) 2 years MSF, WB Mental Health Nurse (1999) Certificate 8 months IOM 2. MoH with external provider Psychiatrist (2001) Community mental Health for primary Care Physician Specialist 3 years Support from IOM & U. Norway Certificate 1 year Support from Harvard program for Refugee Trauma, funded by USAID & Nippon Basic Eye Doctor Certificate 2 years Basic Eye Nurse Certificate 8 months Support from Help Age International & CBM/Maryknoll in collaboration with PBL (provincial hospitals) Optometry Technician Certificate 6 months Training Centre COA Optometry Clinic (Phnom Penh) Basic Surgery Certificate 1 year MSF, UNICEF, WB (1999) Dental Nurse Certificate 6 months World Concern 3

4 C. Job Summary Primary Nurse: Provide nursing care to the patient; take care of infection control; educate the patient/family on disease prevention and health promotion; assist in providing MPA and CPA services; work according to regulation/organization of nursing care; and work as a team member for the hospital under the direction of the unit chief and chief nurse. Secondary/ Registered Nurse: Provide nursing care to the patient; responsible on infection control; educate the patient/family on disease prevention and health promotion; participate in providing MPA and CPA services; perform nursing duties according to rules/regulation; supervise patient management according to the physician s instructions; and provide training to students nurses. Primary Midwife: Assist in promoting women health; provide ante/post natal care and birth spacing services; assist in the promotion of safe motherhood, reproductive health, and birth spacing programs; assist in promoting the growth development and monitoring of child health; and take care of infection control in maternity ward. Secondary Midwife: Antenatal care, delivery, post-natal care, and birth spacing; monitor growth development and child health; participate in the provision of MPA at health centre; assist in the training of primary midwife staff and TBAs. III. GENERAL INFORMATION ON HEALTH SERVICES (OUTLINES) Demographic situation Territory: 181,035 sq km; total population: 13,228,753 in 2003; Average population density: 73 inhabitants/sq km.; 85% living in rural areas; Comprises a total of 24 provinces/municipalities, 182 districts, and 1623 communes. Ministry of Health Mission: Ensure sector wide equitable, quality health care for all people of Cambodia, through targeting resources, especially to the poor and to areas in greatest need. Policy: All people in Cambodia should have (1) equal access to good quality, basic, essential and specialized health services; and (2) information that enable them to make informed choices about matters affecting the health and well-being of themselves & their families. 4

5 Health Workforce: Health Staff actually working by Category, Cambodia 2003* Category Number (%) Population Ratio Remarks Medical Doctor (MD) 1,727 (10.3) 7,660:1 MD Medical Assistant (MA) 1,309 (7.8) 10,015:1 MA Ratio total Nurse to MD+MA: 2.5:1 Nurse: Total 7,686 (46.0) 1,721:1 Nurse Registered/Secondary Nurse 4,231 (25.3) 3,127:1 Secondary/Registered Nurse Ratio total Midwife to MD+MA: 0.9:1 Primary Nurse 3,455 (20.7) 3,829:1 Primary Nurse Midwife: Total Secondary Midwife Primary Midwife 2,710 (16.2) 1,608 (9.6) 1,102 (6.6) Total Health Workforce 16,727 (100.0) * Not included staff on leave without pay and on study leave Current health situation: 4,881:1 Midwife 8,227:1 Secondary Midwife 12,004:1 Primary Midwife Ratio total Nurse to Midwife: 2.8:1 Rise in infant and child mortality including increasing post-neonatal mortality, mortality and morbidity from diarrhea diseases, acute respiratory infections, vaccine-preventable diseases, dengue and malaria; Low immunization coverage (40% fully immunized) due to lack of funding & irregular outreach, especially in remote areas Majority of Cambodian women deliver at home, attended by TBAs. Limited progress in rational use of drugs; need to improve prescription practices & to curb over prescription. High MMR, which is linked to the low coverage of reproductive health services High child & infant mortality, which are linked to low coverage of & poor access to critical child health services High levels of malnutrition & micro-nutrient deficiencies Coverage & utilization health services particularly low for the poor. High disease burden from infectious diseases: therefore continued need for cost effective interventions, both curative & preventative. Irregular outreach results in low immunization coverage & has negative effect on other services provided through outreach, i.e. birth spacing, vitamin A supplementation, de-worming, health education 5

6 Health Service Delivery: Strategies 2003/7 -Further improve coverage and access to health services especially for the poor and other vulnerable groups through planning the location of health facilities and strengthening outreach services; -Strengthening the delivery of quality basic health services through health centers and outreach based upon minimum package of activities; -Strengthen the delivery of quality care, especially obstetric and pediatric care, in all hospitals through measures such as the complementary package of activities (i.e. Clinical care: emergency (different package), internal medicine, surgery, gynecology and obstetric, pediatric, tuberculosis treatment, referral consultation, and addition services such as ophthalmology; and (2) Clinical support services: clinical laboratory (different lab package), blood bank/depot, radiography, echography, and ambulance); -Strengthening the management of cost-effective interventions to control communicable diseases; and -Strengthening the management and coverage of support services such as lab, blood safety, referral, pharmaceuticals, equipment and other medical supplies and maintenance of facilities and transport. Key areas of Work 2003/7 Source: MoH Cambodia, Health Sector Strategic Plan

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