HEALTH SECTOR REFORM AND HEALTH INFORMATION SYSTEM IN CAMBODIAAbstract Paper I. HEALTH SECTOR REFORM The rehabilitation of the health sector, as Cambodia enters a period of relative stability and donor support, has created an opportunity, despite an absolute resource constraint, for MoH to develop a more effective role for the state in the regulation of the better access to better quality services. The Ministry of Health is putting in place a process of reform of the sector. Reform consists of a process of carefully managed change, in part as a pilot Ministry. The overall public administrative reform program guides this. The health care system reform focuses on three main components: organizational structure, human resource development and finance. Prior to 1995 the Government Policy was for one infirmary to serve one administrative commune and one hospital to serve every district and every province. The allocation of health facilities, staff, medicines and budget was therefore determined by administrative criteria. In 1995 the MoH approved a new health system for the organization of provincial health services based upon a redefinition of the criteria for location of health facilities together with a definition of a basic minimum services package to be offered at each level. For health center the package is called Minimum Package of Activities (MPA), as for the referral hospital it is Complementary Package of Activities (CPA). The system supported by a Plan entitled the health coverage plan is based upon an equitable geographical access to basic health and referral services for the population in order to optimize the allocation of scarce health resources. Nationwide, it was planned to have 73 operational districts with 67 referral hospitals (excluding national tertiary hospitals) and 929 health centers. In low population density provinces health posts are added to health centers. As of September 2000, at central level there were the MoH Headquarters with nine departments; two training institutions; two institutes, seven national centers, and eight national hospitals with 1890 beds. The provincial level consisted of 24 provincial health departments and four regional training schools. The district level consisted of 73 operational district with 66 referral hospitals encompassing 24 provincial hospital; 113 former district hospitals, 565 health centers and 433 commune clinics. II. HEALTH INFORMATION SYSTEM IN CAMBODIA A. Introduction The redefinition of a National Health Information System (NHIS) in Cambodia was a big task of the Ministry of Health. The Ministry started reviewing the system in 1992. It took the Ministry about two years to design a new health information system (HIS). B. Objectives and Principles The general objective of the HIS is to provide the Ministry of Health and different levels of the health system with reliable information on health problems and health service activities for planning and management of health services. The development process of HIS, with the involvement from different partners, was based a number of principles including reality of Cambodia health system and existing policies. C. Design steps In the design process of the new HIS, certain steps have been followed:
D. Main Characteristics of New HIS The new HIS is characterized by five characteristics: integration, standardization, simplicity, reliability and computerization. E. Components of HIS The new HIS consists of five main components: Monthly routine reports, Alert system (zero reporting), Annual inventory reports, Quarterly reports, and Register forms. F. Implementation, Monitoring and Evaluation The implementation of the new HIS started in March 1994. Before introducing the system to each province, training workshops at provincial and district levels were conducted.To facilitate the implementation process, instruction manual for filling up the forms with case definitions was developed. The computerized system was also set up with HIS software using an application called Episurv. The first HIS evaluation was conducted in 1995 with a positive result "the health information system has been functioning." However there were some constraints such as software problems ,slow process of capacity building, and irregularity of funding support, etc. In late 1996 HIS was revised so as to be in line with the new health system and put in place nationwide in January 1997. In late 1999 HIS was revised again and the revised system has been put to use since 2000. G. Use of Health Information The health information has been used since the first result produced in 1994. It has been mainly used: for control of epidemics; planning and management at all levels of the health care system including allocation of budget, allocation of drugs and consumables, formulation of work plan, monitoring and evaluation of health facilities performance, and monitoring and evaluation of health system performance. H. Constraints Overall, the Health Information System has been functioning, however, it has been facing a number of problems, which has slowed down the level of the development of the system. The constraints include:
I. Conclusion and Recommendations In conclusion, although the system is functioning and the capacity has been built at central level, the HIS staff both at central and provincial level don't yet have the full capacity to manage the system particularly in data analysis/interpretation as well as use of the information. Therefore, more assistance is needed not only on the capacity building through transferring of skills to local staff by consultancy but also on formal staff training, capital and running cost of the project including training, supervision. This will contribute to the sustainability of the system so that it will be able to support and contribute to the development of the whole national health care system. |