Equity differences in the Health Status of the Population



69642

Background report

Cambodian Health System

Health Status of the Cambodian Population

Health Service Delivery

Prepared by

Marie Ryan

Epiconsult Phnom Penh

On behalf of the World Bank office, Phnom Penh.

June 2007

Health Status of the Cambodian Population

|Contents | |Page |

| |Figures & Tables |3 |

| | | |

| |Summary findings |6 |

| | | |

| |Health Status Introduction |8 |

|1 |Child Health |9 |

| |Infant and under-five mortality |9 |

| |Child morbidity |17 |

| |Immunization |20 |

| |Nutrition |22 |

| |Anemia & Micronutrient deficiency / Parasitic Infection |25 |

| | | |

|2 |Maternal Health |27 |

| |ANC / Deliveries |27 |

| |Maternal Mortality |28 |

| |Fertility |30 |

| |Contraception |30 |

| |Women’s Education |32 |

| | | |

|3 |Adult Morbidity |33 |

| |Physical Impairment / Disabilities |33 |

| |Prevalence of Medical Injections |34 |

| |HIV/AIDS |35 |

| |Tuberculosis |35 |

| |Mental Health |36 |

| |Malaria /DHF |36 |

| | | |

|4 |New Challenges |37 |

| |Demography |37 |

| |Chronic Disease |38 |

| |Tobacco and Alcohol |38 |

| |Diabetes |38 |

| |Emerging Diseases |39 |

| |Landmines / UXO |40 |

| |Physical Rehabilitation |41 |

| |Road Accidents |41 |

| | | |

| | | |

| | | |

| | | |

Health Service Delivery

| | | |

|Contents | |Page |

| |Key Points |42 |

| |Summary Findings |43 |

|1 |Distribution of health services |47 |

| | | |

|2 |Performance of Health Service Delivery |48 |

| |Emergency Obstetric Care |48 |

| |Full MPA Status at Health Centers |48 |

| |Integrated Management of Childhood Illnesses (IMCI) |48 |

| |Attendance at Delivery by Trained Health Providers |48 |

| |Birth Spacing Services |49 |

| |Other Indicators |49 |

| |Utilization of public / private sectors |49 |

| |Barriers to Utilization |52 |

| |Referral Systems |56 |

| | | |

|3 |Quality |56 |

| |Patient perceptions CDHS 2005 and CSES 2004 |56 |

| |National Policy for Quality in Health |57 |

| |Empowerment of consumers & Information on quality |59 |

| |Institutional regulation & management |59 |

| |Clinical Practice |60 |

| |Professional Development |60 |

| |Management development |60 |

| |Institutionalization of quality |60 |

| | | |

|4 |Contracting |61 |

| |Background |61 |

| |Contractor Performance |63 |

| | | |

|5 |Private Sector: |64 |

| |Relationship with the public system |64 |

| |Current Status |65 |

| | | |

|6 |Human Resources |67 |

| | | |

|7 |National Programs |72 |

| |Hospitals |72 |

| |Ministry of Health and Provincial Health Departments |73 |

| |Group B summary |75 |

| | | |

|8 |Cross-sector initiatives: |77 |

| |Priority Mission Groups (PMG) |77 |

| |Decentralization |78 |

| |Merit Based Pay Initiative (MBPI) |78 |

| |Priority Action Programs (PAP) / |79 |

| |Accelerated Disbursement District (ADD) | |

| |Program Based Budgeting |79 |

| |References |80 |

| |Abbreviations |81 |

| | | |

Health Status Figures

1. Significant changes in infant mortality

2. Significant changes in under-five mortality

3. Summary Infant and Under-five deaths Urban vs. Rural

4. Regional comparison Infant & Under-five mortality

5. Under-five mortality (per 1000 live births) 1995-2005

6. Health Center Outpatients Children 0-4 years

7. Prevalence and treatment sought for diarrhea in under-fives

8. Annual re-treatment and replacement of bed nets & % Impregnated bed net coverage of the village population

9. Trends in Vaccination

10. Percentage of children not vaccinated

11. Regional comparison vaccinations for measles & DPT

12. Age vs. Percentage Malnourished: Stunting; Wasted; Underweight

13. Trends in Nutritional Status of Children Under-five

14. Stunting : Wasting : Underweight - Children Under-five

15. Exclusive Breastfeeding

16. Regional comparison: % children under-five who are underweight

17. % Moderate & Severe Anemia in Women & Children

18. Vitamin A Supplements, Children 6-59 months

19. Regional Comparison Maternal Mortality Rate (MMR)

20. Regional comparison of births attended by skilled personnel and ANC

21. Regional comparison of fertility rates

22. Modern contraceptive use by married women

23. Unmet need for Family Planning

24. Use of Modern Contraceptives in Lowest Rating Provinces

25. Regional comparison of modern contraceptive use

26. Regional comparison of Life Expectancy at Birth

27. Reported Communicable Disease

28. Reported Heath Problems

29. Estimated Prevalence of HIV

30. Regional comparison for DOTS detection and treatment rates

31. Malaria & Dengue Hemorrhagic Fever Case Fatality Rate (%CFR)

32. Regional comparison: Diabetes prevalence (all ages) % Estimates: Rural vs. Urban

33. Regional comparison: Diabetes prevalence 20yrs+ 2000 and 2030

Health Status Tables

1. Summary Infant mortality & Under-five mortality

2. Infant Mortality compared to the national averages in 2000 and 2005 (p ................
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