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Background: Cambodia developed its public health system along the principles of the district model and geared its services towards managing communicable diseases and maternal and child health issues. In line with other countries in the region, non-communicable diseases have emerged as a leading cause of adult mortality. We assessed the current capacity of the Cambodian district health system to manage hypertension and diabetes, with a focus on access to medicine for these chronic conditions.Methods: A case study whereby in three purposely selected districts in an equal number of provinces a total of 74 informants were interviewed: 27 health care providers and administrators, 30 community representatives and 17 managers of specific non-communicable diseases interventions and social health protection schemes. Questions related to the World Health Organization's health system building blocks. Data analysis involved coding, indexing, charting and mapping the data. Following these exercises all information was analysed by kind of respondent and their respective answer to the question concerned. Responses by respondents of three groups of interviewees were compared when appropriate. At 14 health centres and 3 district hospitals the availability of key medicines for hypertension and diabetes in accordance with the National Essential Drug List was assessed. This was also done for essential tools and equipment to diagnose these two conditions.Results: Although there was agreement amongst nearly all interviewees that non-communicable diseases were prevalent, the district health system, including all health systems building blocks and the referral system, was inadequately developed to effectively deal with these conditions. Medicines supply was erratic and the quantity provided allowed for few patients to be treated, for a short period only, mainly at secondary or tertiary level.Conclusions: Because of the public health, social and economic importance of non-communicable diseases, a rapid response is required. Given the current Cambodian situation, such response may initially be a diagonal approach, with non-communicable diseases services integrated in the National HIV/AIDS Programme. This should happen together with a reorientation of the health system to enable a horizontal approach to non-communicable diseases management in the long term. [ABSTRACT FROM AUTHOR]

Virtuous exemplars embody the virtues of a cultural community, a dynamic, contextual understanding that is best explored by critical hermeneutic analysis. In order to describe their lives and refine the mental-health treatment of Cambodian immigrants, 12 virtuous exemplars from a Cambodian-American Buddhist and 12 from a Cambodian-American Christian population were interviewed. Grounded theory and a mixed-methods analysis were used. Rigor-enhancing strategies include triangulation, collaboration, member checking, and researcher reflexivity, as well as interviewing a comparison group of 12 Euro-American Christians. Cambodian-American Buddhists and Christians take their religion seriously, and it influences their daily lives. These Buddhists focus on perseverence in the present life and gaining merit for the next. The Christians focus on serving God and nurturing relationships in this life. They report that they are more different from the Cambodian-American Buddhists than Latent Semantic Analysis indicates, providing evidence of both religious and cultural distinctives among the subgroups. [ABSTRACT FROM AUTHOR]

Following the destruction of Cambodia's health infrastructure during the Khmer Rouge period (1975-1979) and the subsequent decade of United Nations sanctions, international development assistance has focused on reconstructing the country's health system. The recognition of Cambodia's heavy burden of tuberculosis (TB) and the lapse of TB control strategies during the transition to democracy prompted the national tuberculosis programme's relaunch in the mid-1990s as WHO-backed health sector reforms were introduced. This paper examines the conflicts that arose between health reforms and TB control programmes due to their different operating paradigms. It also discusses how these tensions were resolved during introduction of the DOTS strategy for TB treatment. [ABSTRACT FROM AUTHOR]

Although considerable attention has been given to ethical issues related to clinical research in developing countries, in particular related to HIV therapy, there has been limited focus on health systems research, despite its increasing importance in the light of current trends in development assistance. This paper examines ethical issues related to health systems research in‘post’-conflict situations, addressing both generic issues for developing countries and those issues specific to‘post’-conflict societies, citing examples from the author’s Cambodian experience. It argues that the destruction of health infrastructure results in a loss of structures and processes that would otherwise protect prospective research subjects who are part of vulnerable populations. It identifies the growth of health systems research as part of a trend towards sectoral and programmatic development assistance, the emergence of‘knowledge generation’ as a form of research linked to development, and the potential for conflict where multilateral and bilateral donors are both primary funders and users of health systems research. It also examines the position of the health system researcher in relation to the sponsors of this research, and the health system being analysed. [ABSTRACT FROM AUTHOR]

This paper examines 116 articles related to sexual and reproductive health translated into English from the Khmer press from April 1997 to February 2004. These excerpts were found in The Mirror, a publication of the non-governmental organisation Open Forum of Cambodia, which collates and reviews all issues of the Khmer press on a weekly basis. Five major themes were identified: the politics of women's health, government regulation and control, the sex industry in Cambodia, rape, and the HIV epidemic. Discourse analysis of these articles in the context of other sources and experience allows a gendered exploration of the reporting of sexual and reproductive health and rights issues in Cambodia by the Khmer print media. The reports explore the contested political empowerment of women in this strongly hierarchical society, and the mechanisms used to regulate and control sexual activity. The expanding sex industry and associated sexual trafficking are reported, together with the corruption of legal structures designed to regulate health systems and protect women and children from sexual exploitation and rape. The growing problem of AIDS and successes in reducing HIV transmission through the collaboration of sex workers in the 100% condom use policy is documented, and the tensions implicit in a cultural representation of women that both protects and constrains women are explored. L'auteur examine 116 articles sur la santé génésique traduits en anglais, parus dans la presse khmère d'avril 1997 à février 2004. Ils proviennent de The Mirror, une publication de I'ONG cambodgienne Open Forum, qui recueille et analyse chaque semaine toutes les questions abordées par la presse khmère. Cing thèmes principaux ont été identifiés : les politiques de santé des femmes , la réglementation et le contrôle de l'État ; l'industrie du sexe au Cambodge ; le viol; et l'épidémie de VIH. L'analyse du discours de ces articles dans le contexte d'autres sources et expériences permet de montrer comment les thèmes de santé génésique sont rapportés par la presse khmère. Les articles abordent l'autonomisation politique contestée des femmes dans cette société fortement hiérarchisée, et les mécanismés utilisés pour réglementer et contrôler l'activité sexuelle. La presse informe de l'expansion de l'industrie du sexe et son corollaire, le trafic sexuel, avec la corruption des structures juridiques destinées à réguler les systèmes de santé et protéger les femmes et les enfants de l'exploitation sexuelle et du viol. Elle aborde le problème croissant du VIH et relate les succès de la réduction de la transmission du virus grâce à la collaboration des professionnelles du sexe à la politique d'utilisation à 100% du préservatif ; elle étudie les tensions implicites dans une représentation culturelle des femmes qui tout à la fois les protège et leur impose des limites. Se examinan aquı́ 116 artı́culos sobre la salud sexual y reproductiva, traducidos al inglés de la prensa Khmer entre abril de 1997 y febrero de 2004. Estos extractos se encontraron en The Mirror, una publicación de la ONG Open Forum, la cual revisa toda la prensa Khmer semanalmente. Se destacaron cinco temas : la polı́tica de salud de la mujer, la regulación y el control del gobierno, la industria del sexo en Camboya, la violación y le epidemia del VIH, El anàlisis del discurso de estos artı́culos en el contexto de otras fuentes y la experiencia permiten una exploración basada en género del reportaje de la prensa Khmer sobre la salud y los derechos sexuales y reproductivos en Camboya. En los informes se exploran el disputado empoderamiento polı́tico de las mujeres en esta sociedad rı́gidamente jeràrquica, y los mecanismos utilizados para regular y controlar la actividad sexual. Se informa de la creciente industria del sexo y la trata sexual asociada, de la corrupción de las estructuras jurı́dicas destinadas a regular los sistemas de salud y a proteger a las mujeres y la infancia de la explotación sexual y la violación.Se documenta el creciente problema del SIDA y los logros en disminuir su transmisión por la colaboracı́ón de las trabajadoras sexuales con el cumplimiento del uso del condón en un 100%, y se exploran las tensiones implicitas en una representación cultural de las mujeres que las protege pero también las limita. [ABSTRACT FROM AUTHOR]

Addresses the appropriateness of highly structured strategic planning approaches in situations of complexity and change, using the Cambodian-German Health Project as a case study. Rhetoric of values, objectives an strategies outlined in original project documents; Changes the shift the focus away from planning towards informed strategic management.

In this article the authors discuss the underreporting of land mines and other explosive remnants of war (ERW) injuries in Cambodia, the Lao People’s Democratic Republic and Viet Nam. They are critical of the underreporting and are supportive of having revisions of the International Classification of Diseases provide opportunities to generate more accurate estimates of the current burden of injury from land mines and ERW.

Background: From 2006, the Association of South East Asian Nations (ASEAN) has been developing Mutual Recognition Arrangements (MRAs) across key professions, including medicine, dentistry and nursing, that would facilitate the development of an ASEAN Economic Community, with shared regional standards and easier mobility of the workforce. This paper examines the interface between those agreements and the registration, professional education and mobility of health personnel in Cambodia.Methods: This qualitative health policy analysis combined documentary and policy review with key informant interviews with 16 representatives of agencies relevant to the development and implementation of the MRAs in health. Thematic analysis identified three themes: registration, education and mobility.Results: Cambodia is an active participant in the ASEAN MRA processes for doctors, dentists and nurses reporting progress annually. Education of health professionals has been increasingly formalised in the past 25 years, with nursing moving towards a 4-year bachelor degree. The private university sector has substantially increased, with English increasingly used as a language of instruction. Recent legislation provides for enforcement through fines and/or imprisonment to ensure all practising health professionals hold initial registration as a health professional and a renewable licence to practise as a health practitioner. Continuing Professional Development is a mandatory requirement for licence renewal. This is consistent with the MRA guidelines, though the capacity for enforcement appears limited. The Medical Council of Cambodia (MCC), and more recently, the Dental and Nursing Councils, have introduced continuing professional development initiatives, using them strategically as a positive reinforcer of registration. Midwifery education and registration in Cambodia does not conform with ASEAN guidelines. In education, course durations in medicine and dentistry are longer than regional counterparts, though anxiety around maintaining clinical standards has resulted in the introduction of a National Exit Examination and reluctance to abbreviate courses. The introduction of reforms appears to reference regional standards, though parity is still some way off. Mobility at present is infrequent and more likely to result from informal mechanisms than through the MRA mechanisms.Conclusion: The Royal Government of Cambodia is committed to the ASEAN MRA process. Developments in registration appear to use regional standards as benchmarks, as do reforms in the education of health professionals, though domestic factors appear to more directly impact on developments. Informal mechanisms facilitate the limited mobility currently occurring, with little formal application of the MRA provisions evident at this point. [ABSTRACT FROM AUTHOR]