Research for stronger health systems during and after crisis


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ReBUILD's work in Cambodia is being led by the Cambodia Development Resource Institute.

Background: Cambodia, conflict and health

Cambodia has been recovering from conflict since the early 1990s, is no longer recognised as a 'post-conflict' country by some development agencies and is well advanced in health system building. This potentially provides some interesting opportunities for learning for other countries recovering from conflict.

The country still faces challenges. There is poor distribution of health staff between urban and rural areas and an overall shortfall in numbers. In principle, a system bonds those trained in the public sector to a term of rural practice, but this contract is not effectively enforced.

Significant involvement of international non governmental organisations in some districts of Cambodia is a legacy of the post-conflict period. Alongside this there have been a number of innovations in the health system for example, contracting out to the non-state sector and payment for performance. Contracting is now institutionalized within the Special Operations Agencies. These innovative mechanisms and their evolution will be objectively examined by ReBUILD and their impact will be assessed.

68% of health expenditure in Cambodia is out-of-pocket and a third of the population is considered too poor to pay for health care. Historically, use of the public system has been low, and this has been attributed to poor quality of care, although this has been increasing. The Government has called for the expansion of pro-poor health financing and improved service delivery. ReBUILD's research will support this call by generating relevant research and ensuring that it is accessible to decision makers.

ReBUILD's work on health financing policy and on poor households' expenditure on health in Cambodia 

ReBUILD's work on understanding the development and evolution of health workforce policies in Cambodia 

ReBUILD's work on understanding contracting models and their impacts on performance