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reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the
governments they represent. ADB does not guarantee the accuracy of the data included in this paper
and accepts no responsibility for any consequence of their use. Terminology used may not necessarily
be consistent with ADB official terms.
Cambodia’s health delivery service structure
MOH
Central level
National hospital
National Program
Institutional
PHD
Intermediate level
Provincial Health Department
OD
Operational District
Peripheral level
-Referral Hospital
-Health Centers
NRIP’s coverage area
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Service delivery points under NRIP
Entertainment establishments on NR56
Entertainment
establishments are
concentrated in Samraong
City and O’Smach (the
latter not included under
NRIP) and there were no
entertainment workers
reported in any of the
smaller communes.
There are 16 entertainment
venues in Samraong City,
and 12 in O’Smach.
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Construction camps in NRIP target areas
Market places in NRIP target areas
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Where and why do people seek services?
Gaps in service delivery
• Most health care providers identified gaps in human capital, especially in
adequate technical knowledge and the absence of staff and were concerned of
the additional strain that existing facilities could face once the NR56 is completed.
• Almost all health care providers were concerned with sanitation, re‐infection of
women and the refusal of diagnosis and treatment of males in STI clinics
(according to the baseline report 90% of patients are female).
• Many clients on the other hand thought that health centers are providing good
quality and affordable care and the majority of patients saw gaps in physical
distance and time spent on seeking care.
• The health centers could cope with a few extra patients, but a doubling of
patients would not be feasible. The HC chief in Banteay Chmar said a new
building would enable better patient care there. Another HC chief said equipment
would need to be replaced more regularly.
• Health service providers recognize a need for further training in SRH. This training
should focus on diagnosis, treatment and possibly include the importance of
accurate record keeping for report writing. Medication supplies need to be
improved so good quality drugs are available consistently. It is not clear whether
this is a logistical issue which will improve as the road condition improves, or
whether it is financial.
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NRIP strategies and activities
• (1) Identify relevant stakeholders, including the National Center for
HIV/AIDS, Dermatology and STI Control (NCHADS); the National Maternal
Child Health Center (NMCH) and the local health authorities. Encourage
their involvement in the project from the beginning.
• (2) Conduct GIS mapping in the target areas before starting project
implementation (e.g. mapping health services, entertainment
establishments, markets, etc.)
• (3) Conduct baseline assessment, including questionnaire on service
delivery among health center staff and the community
• (4) Discuss issues of service delivery with NCHADS and NMCH, and through
regular meetings with the TWG on Mobility and HIV, Pro‐TWG on Health
and Technical Advisory Committee on Workplace
• (5) Support NCHADS and NMCH in conducting trainings on SRH in selected
health centers and referral hospitals
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Improving client uptake of services in CRIP/NRIP target
areas
• (1) Knowing what services are available
in your area – CRIP/NRIP have developed
take home service directories and hotline
cards; services are also promoted through
the weekly one hour radio broadcasts
• (2) Knowing what to expect and what
should happen in a consultation – the
“What to expect” tools help to promote
consumer awareness of what individuals
should receive during STI or VCCT
consultations and help to dispel fears and
misconceptions
• (3) Strengthening of referral networks
and mechanisms – all partners identify
relevant private, public and NGO service
providers (if available) in their target
areas and establish network agreements;
services promoted at every outreach
contact
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CRIP’s health referral strategy continues to improve
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Coordination and Partnerships
• The use of existing agreements and collaboration with
Provincial Heath Departments for the referral of individuals to
health services
• NCHADS for STI, VCCT, OI/ART services; NMCH for RH/FP
services
• Coordination with local authorities and structures for the
delivery of targeted SRH capacity building support
(forthcoming)
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Facilitating and limiting Factors
• The main limiting factor remains the vertical nature of health
services/programs within the Cambodian health system
• Also limiting, is the fact that many issues recognized as gaps
in health delivery are beyond the scope of NRIP (e.g. drug
availability; health infrastructure strengthening; etc)
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Sustainability
• Difficult to talk about sustainability as capacity building
support does not guarantee that SRH services will be
strengthened in the long run
• That said, working with health care providers and local
authorities to anticipate possible impacts of the road
development may foster better long‐term planning for service
needs, quality assurance and uptake facilitation
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