The views expressed in this paper/presentation are the views of the author and do not necessarily 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 Provincial Health Department OD Operational District

Intermediate level

Peripheral level
-Referral Hospital -Health Centers

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NRIP’s coverage area 

NRIP focuses its efforts on NR56, between Serey Sophoan (Banteay Meanchey province) and Samraong City (Oddar Meanchey province)

4

Service delivery points under NRIP
8 government health centers and 2 referral hospitals are located in the vicinity of NR56.

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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

All construction of the road is being carried out by military personnel. At the time of mapping, all construction camps were located on NR68 and the road to O’Smach (not within NRIP target areas)

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Market places in NRIP target areas
The map shows that at least 6 large market places are situated on or in close proximity to NR56. These market places could in future expand and develop as rest places and overnight stays.

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Where and why do people seek services?

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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 

13

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)

14

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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