Forty years ago, in 1978, as Cambodia was facing its gravest hour, the countries of the world gathered in Alma-Ata in the Soviet Union to recognise health as a human right and agree to bring healthcare close to where communities live, with their full participation, and to work across sectors to achieve health for all.
This approach was called “primary healthcare”.
Subsequently, experiences in many countries have shown that implementing a primary healthcare approach has been both effective in improving health outcomes and cost-effective.
As we celebrated World Health Day this year on Sunday (commemorating the founding of the World Health Organisation), it was timely that its theme was primary healthcare – to remind all countries, including Cambodia, of its continued importance for achieving health for all.
In the 1980s and 1990s, as Cambodia rebuilt its health system, it implemented aspects of the primary health care approach, building health facilities close to communities, and prioritising prevention and care for mothers and children.
These achievements contributed to Cambodia’s impressive progress to achieve most of the Millennium Developments Goals on maternal and child health and tackling HIV, tuberculosis and malaria – one of the few countries in the world to do so.
A majority of the disease burden in Cambodia is now from noncommunicable diseases such as cardiovascular disease, diabetes, cancer and respiratory disease.
There are also increasing challenges with road traffic injury and mental health.
Important progress
And there is still the need to sustain efforts on maternal and child health and communicable diseases.
Recognising these challenges, the Royal Government of Cambodia has committed to achieving universal health coverage – ensuring that quality health services are accessible, affordable and acceptable for all Cambodians – by 2030, as other countries have also done as part of the Sustainable Development Goals.
In recent years, as part of this effort, the Royal Government has made important progress in providing social health protection for more Cambodians.
Building the capacity and quality of the first contact of care and placing these services close to communities – the most important part of primary healthcare – is just as important to prevent and treat diabetes and cancer as it is to address malaria and tuberculosis.
The primary healthcare approach thus remains the foundation of universal health coverage, and of all health services.
International experience shows that it is possible to provide more and more services in facilities like the health centres in Cambodian towns and villages that have contributed so much to the country’s health progress, or even within people’s homes. And doing so is the most cost-effective way to provide services.
Sixty-seven per cent of total health spending in Cambodia is on the first level of care, showing the high demand for primary care by the people of Cambodia.
This care is provided by health centres, but also in hospital out-patient clinics and in private clinics.
But it is 10 times more expensive to provide the same service in a hospital out-patient clinic than in a health centre.
And getting people to access healthcare early, and close to where they live, is also the best way to prevent and treat disease before complications arise.
Cambodia is well poised to build on its existing success with implementing primary healthcare as it strives to achieve universal health coverage.
Further support
Recently, at the National Health Congress, Prime Minister Hun Sen urged the health sector to invest more in health personnel in rural areas.
The recently announced cash transfer scheme for pregnant women and children provides further support and incentives for people to access primary care.
As WHO, we recommit to sustaining our long history of working with the Royal Government and people of Cambodia to improve health and wellbeing, keeping primary healthcare at the centre of these efforts to achieve health for all Cambodians.
Dr Kumanan Rasanathan is the Acting Representative of WHO Cambodia.
