Academic journal article Journal of Health Population and Nutrition

Evaluation of Immunization Knowledge, Practices, and Service-Delivery in the Private Sector in Cambodia

Academic journal article Journal of Health Population and Nutrition

Evaluation of Immunization Knowledge, Practices, and Service-Delivery in the Private Sector in Cambodia

Article excerpt


In 1993, Cambodia (population 14 million) emerged from a lengthy period of civil conflict that ended when United Nations-sponsored general elections were held. Since then, the country has entered an era of economic and social development. Significant developments occurred within the two main social sectors of health and education. Health-sector reform, begun in 1996, led to the establishment of national health institutions, 24 provincial health departments, 76 operational health districts, and more than 930 health centres, most of which serve the rural communities that comprise 80% of the country's total population. As a result of the developing market economy and rapid urbanization, a professional private health sector emerged in the middle of the 1990s with a range of studies indicating that it is expanding at a rapid rate (1,2). Today, two-thirds of the population turn first to the private sector or non-medical sector for medical care (3).

Established in 1986 with the technical assistance of the United Nations Children's Fund (UNICEF), the National Immunization Program (NIP) manages the immunization of an annual cohort of 372,000 infants aged less than one year (2006) against seven diseases and also against tetanus for women of childbearing age. Demographic health surveys conducted in 2000 and 2005 have seen a rise in immunization coverage rate of diphtheria, pertussis and tetanus vaccine (DPT3) in children aged 12 months. The rates of coverage have increased from 43% in 2000 to 76% in 2005, with associated sharp declines in reported vaccine-preventable diseases (3). Cases of neonatal tetanus have reduced from 169 in 2002 to 68 in 2005 (decline in incidence from 0.05 to 0.02 per 1,000 births). Suspected cases of measles have been reduced from 3,640 in 2001 to 264 in 2005 (decline in incidence from 289 to 19 per million population), and the coverage of measles immunization has increased from 41% in 2000 to 70% in 2005. This programme is administered through the state health system, with most service-delivery taking place at the primary-level health centres through outreach services to the 13,000 villages of Cambodia.

A wide definition of the private sector can be des- cribed as "comprising all providers who exist outside the public sector, whether their aim is philanthropic or commercial" (4). For the purpose of the collaboration discussed in this paper, the private sector is referred to as the private, for-profit medical and professional health sector.

Results of recent research in Cambodia have indicated a high prevalence of private, for-profit provision of medical care, some of which has been reported to be of dubious quality. A survey of 198 private doctors in Phnom Penh indicated that more than half of all consultations resulted in the inappropriate prescription of drugs (2). Results of a different study indicated that case management by 108 private doctors included high rates of incorrect diagnoses and improper treatment of acute respiratory infections and diarrhoea in children (1).

Evidence suggests that the private professional healthcare sector is now larger than the public healthcare sector. The province of Kampong Cham with a population of 1.7 million, for example, maintains a base of 153 private facilities, half of which are licensed. Public-sector services in the province are provided from 141 facilities (130 public-health centres and 10 referral hospitals). Therefore, more private-sector than public-sector healthcare outlets exist in this province. This is of particular significance because the province has the largest population base in the country.

To build on experience in both public-sector and private-sector healthcare settings, some national programmes, such as those for tuberculosis and reproductive health, have recently developed collaboration models. Furthermore, the Ministry of Health (MoH) identified public-private collaboration as a key strategy in its Health Sector Strategic Plan (5). …

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