In May 2024, with the launch of the “Roadmap for Universal Health Coverage 2024-2035”, Cambodia took a significant step towards enabling citizens to access quality healthcare services without financial hardship.

The roadmap has four key goals: ensuring equitable access to essential health services for all, improving the quality of health services to meet national and international standards, protecting individuals and families from the financial risks associated with healthcare costs and strengthening health system governance, management and accountability.

By the end of 2035, the roadmap aims to create a Cambodian healthcare system that is accessible to all, high-quality, financially protective and well-governed, thereby creating a healthier and more equitable society.

The action plan accompanying the universal health coverage (UHC) roadmap aims to transform the healthcare landscape. It aims to strengthen health systems by enhancing the overall capacity and infrastructure to deliver comprehensive and high-quality services. Additionally, it plans to expand health coverage to ensure all population groups, especially vulnerable and marginalized communities, have access to essential health services and so safeguard them from the financial hardships associated with healthcare costs.

The International Labour Organization (ILO) commends the Government of Cambodia on the launch of the UHC roadmap and its commitment to a comprehensive approach to contributing to the realisation of decent work and human rights through health and social protections.

To achieve universal health coverage, every country has created its own way to achieve the goal, according to its own national context and available resources. Nonetheless, three principles are commonly followed. Countries normally need to increase domestic funding, progressively moving away from external aid; and need to consider mixed financing sources, based on collective financing and pre-payment such as social contributions and general taxes, while avoiding reliance on out-of-pocket spending.

As a trusted partner in policy development, the ILO has been actively supporting the Royal Government in the expansion of social protection coverage through the project “Advancing Social Protection in Cambodia (ASPC)” funded by the EU. Looking ahead, the ILO stands ready to support Cambodia in the implementation of the roadmap, by sharing best practices and providing technical assistance rooted in a human rights framework and in line with international standards.

In 2019 and 2020, 17.9 per cent of Cambodian households faced substantial out-of-pocket health expenses relative to their income, and households pay 60 per cent of the country’s current health expenditure. At present, 41 per cent of the population is covered, with the Health Equity Fund (HEF) granting access to healthcare for 4.3 million Cambodians and the National Social Security Fund (NSSF) having 2.1 million active contributors as of 2022. Although coverage rates are growing, millions of Cambodians, including children and people with disabilities, do not have access to social health protection.

To bridge these gaps, the ILO suggests accelerating the extension of effective coverage to workers with contributory capacity and enforcing mandatory coverage of dependents within the contributory system. This approach will ensure that families of contributors, especially children, are not left behind. 

The government could consider the feasibility of automatically covering the medical care of contributors’ dependents and prioritising children, subject to the affordability of this measure. In this sense, the health contributions for dependents of civil servants who opt in are currently being financially supported by the government, which is leading the way as an employer.

Moreover, the ILO supports the vision of a Cambodian social health protection system with a single-payer funding model aiming for the harmonisation across different schemes which provides the entire population with adequate benefits.

 This approach could streamline administration and ensure consistent protection across the country.

For those without contributory capacity, the ILO recommends state-sponsored membership through tax-financed resources, ensuring that even the most vulnerable populations have access to essential and quality health services comparable to those with contributory capacity.

By adopting these strategies, Cambodia can move closer to achieving UHC, ensuring equitable access to quality healthcare for all its citizens, and establishing sustainable, resilient social health protection for future generations.

International Labour Organisation in Cambodia