Cambodia is instructing doctors to practice without regard to socioeconomic status, according to the country’s top health official, amidst reports that women have been left to die during childbirth and other patients have been refused treatment because they did not have the money to pay for services.
Minister of Health Mam Bunheng said Friday that improvements in healthcare quality and service have over the past two years substantially decreased the number of maternal and child fatalities across Cambodia, which has the highest infant mortality rate in the Southeast Asia.
He said that since 2010 the ministry has worked to teach doctors not to differentiate between the rich and the poor—a practice which has led to some doctors refusing to admit pregnant women and other patients who could not cover certain medical fees.
“We are working on a process to improve maternal and child health,” Mam Bunheng said, adding that the ministry is also in the process of drafting a code of conduct for midwives.
“We are also working to improve our midwives in health centers and referral hospitals,” he said. “We are working to train midwives to work in communities.”
Mam Bunheng said that doctors have been instructed to admit poor patients and that the Ministry of Health has allocated equity fund reserves for providing treatment and food to the underprivileged.
He said that the government has helped about two million poor patients nationwide through the equity fund foundation.
Expensive fees
But the health minister’s statement runs contrary to reports that have recently surfaced in Cambodia about discriminatory practices against the poor in hospitals around the country, particularly in rural areas.
Nob Mean, a farmer from northwestern Cambodia’s Banteay Meanchey province, told RFA that he had been referred to a hospital that had charged him a number of fees for medical services.
“The referral hospital has asked me for money to pay for my bed. It’s expensive,” he said.
“The hospital charged me 81,500 riels [U.S. $20]. It’s a lot of money for the poor,” he said, adding that he considers service in the country’s health industry to be about 60 percent positive, but that he would like the government to bring the standard closer to 100 percent.
Lor Vannthary, a physician who works for a domestic health nongovernmental organization, said that while the government has paid more attention to health issues in recent years, a number of problems remain in the industry.
“Referral hospitals have been built, but they lack a sufficient number of doctors. Young graduating doctors are refusing to work in remote areas of the country and instead prefer the city,” he said.
“Also, some doctors don’t pay close enough attention to patients staying in state hospitals because they have their own private hospitals—the doctors are not being paid enough to work.”
Heng Tai Kry, a secretary of state with the Ministry of Health, acknowledged that some doctors are unable to pay enough attention to their patients, adding that this is largely due to working long hours with many different patients.
He denied the claim that negligence on the part of doctors is a result of low pay.
“Doctors are paid enough to live, but sometimes the demand is too great and we can’t please everybody,” he said.
“The same problem exists even in places like the U.S. and Singapore.”
‘Desperately poor’
Cambodia’s Ministry of Health oversees more than 1,000 hospitals and 5,000 doctors across the country.
According to the London-based nongovernmental organization Health Poverty Action (HPA), some 78 percent of Cambodians live in “deep poverty,” with four of out five living on less than U.S. $2 a day. The group calls healthcare provision in the country “desperately poor.”
Some 58 percent of people in mountainous areas were living below the poverty line in 2004, it says, up from 40 percent ten years earlier.
“While poverty has decreased overall in recent years, the health of indigenous people living in mountain areas has declined dramatically, along with the quality of health services available to them,” the group said.
HPA says that with 98 deaths per 1,000 live births, Cambodia has the highest infant mortality rate in Southeast Asia.
Reported by Tin Zakariya and Sok Serey for RFA’s Khmer service. Translated by Samean Yun. Written in English by Joshua Lipes.