A new study has found that external donors wield outsize influence in determining national health care policies in Cambodia.

The research was published earlier this month in the journal of the London School of Hygiene and Tropical Medicine. The study focused on Cambodia and Pakistan, where researchers interviewed “informants” from each country’s domestic health sector.

Dr Mishal S Khan, one of the authors and an assistant professor at the London School of Hygiene and Tropical Medicine, said these countries were selected given their history of “a fairly high level of dependence on donor funding”.

“External donors can have power to influence health polices in Cambodia because they control the financial resources … but even if the financial resources do not come from external donors, they can influence health polices because domestic policy makers rely on them for technical knowledge and for skills around turning scientific evidence into polices,” she wrote in an email.

The study finds that, overall, policymakers in Cambodia felt that the level and availability of external funding often dictated which issues were placed high on national agendas, as well as the types of interventions chosen to address the health issues.

An interviewee in Cambodia told researchers that targets based on a global HIV/AIDS strategy “have been powerful in influencing programme implementation in the country because of international support”.

Having funding and policy dictated by external agencies “can mean that issues important in the Cambodian context are not given due attention”, the researcher Khan said.

For example, one international NGO representative and policy adviser in Cambodia interviewed for the study used mental health in the Kingdom as an example to show researchers how much dependence on donor funding impacts health policy.

“She explained that even though domestic stakeholders were aware of the urgent need to address mental health issues – owing to the genocide perpetuated in the country – this was not a priority health area until 2016 … because of a lack of donor funding, on which the government is reliant,” the study reads.

Another informant in Cambodia reported that he had seen a sudden increase in NGOs focusing on specific topics, which were often not linked to national priorities or even the NGOs’ own mandates, as “they were dependent on wining grants to continue their operations”.

Chum Sopha, director of NGO Health and Development Alliance, agreed that sometimes NGOs’ work depends on availability of funding.

“Sometimes we don’t want to do this,” he said. “But we try to get grants because it’s better to do something than nothing… We see the problems [internally], but we don’t have the funds.”

He added that, generally, external funding mostly focuses on infectious disease.

“They neglect non-communicable diseases,” he said.

According to Khan, it’s important for policies to be set and owned by Cambodian stakeholders because that makes them more likely to continue without donor support.

“Often if a policy is adopted only because an external agency is pushing it then the domestic stakeholders go along with it, but do not really get behind it with their full effort,” she added.

To address the issue moving forward, Cambodian policymakers can increase collaboration across universities and local technical agencies to come up with a joint list of priorities for the health sector important for the Cambodian context, Khan said.

“This way they do not have to rely so much on technical knowledge and organisation capabilities of external donor agencies,” she said. “It could also be beneficial to invest in capacity building of policymakers in terms of being able to generate and use scientific evidence as this will reduce reliance on external agencies.”