A new study examining the development of health care in post-conflict societies suggests that the influx of NGOs in Cambodia may have weakened the government health sector.

The report, published last week by BioMed Central, compares Cambodia’s health care development after the fall of the Khmer Rouge to post-conflict health care development in Uganda, Sierra Leone and Zimbabwe.

The study concludes that Cambodia has been more dependent on health NGOs for a longer period of time than the other case studies. While it does acknowledge that “international aid was critical to support the country’s reconstruction”, the study also claims that conflicting agendas “did not help strengthening government stewardship and ownership of health sector development in the post-conflict period”.

According to the report, the loss of health care professionals was “most extreme” in Cambodia compared to the other case studies, resulting in a more urgent need for external assistance. “The influx of external actors to support the reconstruction and development of the health sector led to a brain drain from public to NGO sector,” the study reads.

At this point, Cambodia developed a dependence on non-governmental actors, while the government struggled to coordinate with these organisations. “Development and management were pulled into different directions by conflicting agendas . . . and lack of coordination,” the paper claims.

The study reports that efforts to harmonise have increased in recent years, with the Ministry of Health also seeing an increase in employees.

Chum Sopha, director of the Health and Development Alliance, took issue with the insinuation that NGO participation had weakened the sector, saying that his NGOs and others simply helped shore up an already weak government health care sector.

“We fill in the gaps in government health care,” said Sopha, who has worked in Cambodian healthcare since 1992.

“NGOs came to train government staff and help build better facilities,” he added.

In 2015, WHO released a report condemning Cambodia’s public health care system for lack of access to services, comparatively high costs, and low coverage of government-funded care.

The study does recognise the positive effects NGOs have had on the development of healthcare in Cambodia, asserting that international aid has made Cambodia more open to innovation and experimentation than the other case studies.

“Changes in policy seem at least in part derived from evidence feedback loops, maybe because of the more operational presence of NGOs and long term engagement by development partners,” the study reads.

Despite some progress, the report concludes that certain fundamental issues – such as adequate pay and distribution of health care workers – remain “unresolved”.