Healthcare Environment Analysis and Healthcare Status Analysis of Cambodia

Establishment of ASEAN e-Government Cloud System for Infectious Disease Response(Combodia)
5. Healthcare Environment Analysis
A. Government Organization Analysis
1) Government Organization Structure
o Cambodia has three departments (Inspection, Health, Administration and Finance) under the
Central Health Minister, which governs overall health.
[Figure 22] Cambodian Ministry of Health’s Organization Chart
Source: Kingdom of Cambodia Department of Planning & Health Information, 2016
2) Role and Functions of Government Organizations
o Central Health Bureau: Legislative, Policy, Strategic Planning, Resource Mobilization and
Distribution.
56
Ⅱ. Environmental Analysis
o Provincial Health Bureau: OD connection with the Central Health Department, annual planning of
health policies and strategies with the 3-year Rolling Plan, appropriate allocation of available
resources, coordination and collaboration with external aid.
Ⅰ
o Health Administration Unit (OD): Implementing national policies and provincial health strategies,
providing comprehensive and effective services according to community needs, effective and
equitable distribution of available resources, and mobilizing additional resources for local health
services (NGOs, etc.).
[Figure 23] Cambodian Health and Medical Delivery System

Ⅱ
Source: Korea Health and Medical Foundation, Cambodia's national overview and healthcare ODA status (2016) Re-citation
B. Government Policy Analysis Ⅳ
1) National Development Plan
 National Strategic Development Plan 2019-2023
o Since the announcement of the Rectangular Strategy (RS) in 2004, the Cambodian government
revises and announces it every five years and establishes and discloses the National Strategic
Development Plan (NSDP), a five-year strategic goal to support the implementation of the Ⅴ
Rectangular strategy.
o Since the formation of Cambodia's sixth government in September 2018, the fourth Rectangular
Strategy (RS IV), a new national development strategy, has been announced.
57
[Figure 24] The 4th “Rectangular Strategy Diagram”
o As for the Rectangular strategy IV(RS IV), four key areas (infrastructure, power, water resources,
and human resources) were selected, and only the priority was changed.
<Table 25> Cambodia's Rectangular Strategy (RS Ⅲ~Ⅳ)
Category Phase III Rectangular Strategy (RS III) Phase IV Rectangular Strategy (RS IV)
Agriculture Human Resource Development

1
(Enhancing Agriculture Sector) (HRD)
Infrastructure
2 Economic Diversification
(Development of physical infrastructure)
Private sector development and employment

3 (Development of private sector and Enhancing Private Sector and Employment
Employment)
Human Resource Development and
4 Competency Development Sustainable and Inclusive Development
(Capacity Building and HRD)
Source: ODA Korea, 2016
58
o The Cambodian government prepared and promoted the National Strategic Development Plan
(NSDP) 2014-2018 as a major means of implementation for the implementation of 'Rectangular
Strategy III'.
Ⅰ
- Focusing on four policy priorities out of a total of 10 NSDP health strategies.
 Improvement of reproduction, maternal and child health and nutrition

 Reduction of morbidity and mortality of major infectious diseases
 Reduction of morbidity and mortality due to non-infectious diseases and major public health
problems
 Ensuring Equitable Access to Quality Health Services Ⅱ
<Table 26> Key Goals and Contents of the 2014-2018 National Strategic Development Plan (NSDP) in Cambodia
Goal Main Content
Combating Corruption, Legislative and Judicial Reform,

Governance
Public Administration Reform, and Military Reform
Improve productivity, diversification and commercialization,

Agriculture land reform and mine removal, livestock and aquaculture promotion, Ⅲ
sustainable operation of natural resources
Transportation and urban infrastructure development, water resource

and irrigation system management, electricity production and
Infrastructure
accessibility improvement, information and communication
technology development
Strengthening the private sector, promoting investment and business,

Private Sector Development And
developing industries and SMEs, Ⅳ
Employment
Strengthening the labor market and promoting the financial sector
Peace, political stability, social order promotion,

Building an Environment for
regional/global integration, economic/financial environment,
Rectangular Strategy III
sustainable environment, development partnership
Source: ODA Korea, 2016
59
2) Health Sector Development Plan
 Health Strategic Plan (HSP)
o Cambodia exceeded the MDGs targets in most healthcare sectors through two health strategic plans
and achieved success in provide economic risk protection to low-income families by expanding the
scope of the equity fund 9. However, due to limited resources, the quality of health services does
not meet the expectations and demands of its people. Therefore, it is expected that investing in
more thorough education based on ability and quality management that works well can improve
the quality of healthcare services. HSP 3 aims to expand healthcare service targets, improve service
quality and equity, and the key areas for this are securing health finance, manpower development,
basic support system, health infrastructure expansion, and Health Information System (HIS).
[Figure 25] Strategic Areas for Health System Intervention (HSP3)
Source: Cambodia Ministry of Health, 2016a
9The equity fund is a fund that is used to exempt the poor population (below the international poverty line, currently about 20% of the
population) selected by the community from out-of-pocket expenses when using medical institutions, created with the pool funds of
development partners and the government's response fund. About 90% of the selected beneficiaries are receiving benefits.
60
o HSP3 has the following four specific development goals.
<Table 27> Four Development Goals of HSP 3 in Cambodia
HSP 3 Four Major Development Goals

Ⅰ
1. Promote reproductive health and reduce maternal-neonatal-infant mortality and malnutrition
2. Reduced mortality and prevalence from major infectious diseases
3. Decrease in prevalence and mortality due to non-infectious diseases and other public health problems
4. Establishment of a health system responsible for responding to public health needs

Ⅱ
o There are seven strategic goals to achieve the four major development goals, and measures for each
area have been established to achieve these strategic goals.
<Table 28> HSP 3 Strategic Objectives in Cambodia
Intervention Area For

HSP 3 Strategic Objectives
Each Purpose
Ⅲ
Comprehensive, stable, and effective use of high-quality healthcare services in
Healthcare Delivery
public and private healthcare facilities
Stable and sustainable health finance with enhanced fiscal risk protection Health Finance
Securing an appropriate number of skilled, competent and motivated healthcare Development of Health
personnel with professional and professional ethics Personnel
Appropriate supply of medicines, necessities, and medical materials so that Essential Support
Ⅳ
effective essential medical services can be used in public healthcare facilities. System
Basic infrastructure of public healthcare facilities, latest medical equipment Basic Infrastructure
and technology, and ICT provision Development
Access to reliable, accurate and timely use of high-quality health and related
Health and Medical
data to promote disease monitoring and response systems and health promotion
Information System
research
Strengthen regional responsibility for healthcare, strengthen the capabilities of
Health System
healthcare institutions at all levels, including leadership, management Ⅴ
Management
capabilities, and systems
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o The cost of HSP3 during five-years increased from $592 million (2016) to $753 million, with the
Health Program accounting for more than half of the total cost of seven strategic goals.
<Table 29> HSP 3 Strategy Objectives Cost

(Unit: $ dollars)
SO (Strategic
2016 2017 2018 2019 2020 Total
Objective)
SO 1- Health
331,362,816 328,010,341 352,481,768 365,780,196 386,810,687 1,764,445,808
program
SO 1.1 - SRH 3,381,985 3,528,487 3,777,592 4,005,256 4,244,969 18,938,289
SO 1.2 - MNH
86,390,539 71,091,266 63,635,413 60,463,049 58,199,314 339,779,581
& PMTCT
SO 1.3 - CH &
43,842,987 38,070,559 37,052,062 40,746,058 38,830,696 198,542,363
Immunization
SO 1.4 -
7,073,485 7,521,117 9,191,901 9,735,705 12,898,223 46,420,432
Nutrition
SO 1.5 - HIV 91,711,442 95,149,503 96,669,528 98,210,578 100,652,282 482,393,332
SO 1.6 - TB 27,150,528 26,351,531 26,690,865 29,251,793 28,922,125 138,366,841
SO 1.7 - Malaria
21,657,056 23,037,343 38,653,991 25,356,794 2,665,638 132,370,822
& Dengue
SO 1.8 –
4,770,000 4,962,000 5,228,200 5,631,020 5,843,122 26,434,342
Parasites
Emerging
3,595,217 3,698,980 4,173,730 4,825,165 5,660,498 21,953,590
disease
SO 1.9- NCD
(risk factors, 14,235,507 19,827,423 27,214,108 39,430,895 52,835,276 153,543,209
detections)
SO 1.10 – NCD
- - - - - -
(Acute events)
SO 1.11 -
5,079,176 8,914,655 12,306,525 18,196,893 22,446,240 66,943,490
Mental health
SO 1.12 -
Blindness & 5,239,714 7,009,685 8,092,446 9,146,727 10,525,738 40,014,309
hearing
SO 1.13 –Food
safety, hygiene, - - - - - -
sanitation
SO 1.14 - Drugs,
12,166,564 13,291,872 13,695,628 14,061,136 14,660,394 67,875,594
alcohol, tobacco
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SO (Strategic
2016 2017 2018 2019 2020 Total
Objective)
SO 1.15 -
Injuries & 4,362,681 4,838,376 5,371,433 5,980,870 6,678,823 27,232,183
disabilities Ⅰ
Disaster
705,935 717,545 728,345 738,258 747,349 3,637,432
preparedness
SO 2 - Financial
26,534,636 32,275,716 38,284,038 44,996,620 52,478,538 194,569,548
risk protection
SO 3 - HRH 67,048,305 80,283,956 96,208,220 113,385,742 131,939,823 488,866,045
SO 4 - Supplies
61,938,216 62,365,580 66,175,837 66,674,427 69,814,300 326,968,360
& equipment Ⅱ
SO 5 -
96,493,610 98,418,416 100,343,222 102,300,528 104,228,730 501,784,505
Infrastructure
SO 6 - HIS 3,367,725 4,034,556 2,377,804 2,473,604 2,307,004 14,560,692
SO 7 -
5,296,849 4,917,917 4,837,577 5,316,201 5,397,895 25,766,439
Governance
Total 592,042,157 610,306,482 660,708,465 700,927,318 752,976,976 3,316,961,397
Source: Cambodia Ministry of Health, 2016a Ⅲ
o Health personnel play an important role in achieving development and strategic goals, and health
manpower development strategies are expected to address the lack of structure, size and
composition, remuneration and motivation of future personnel.
<Table 30> Health Workforce Development Strategy of HSP 3 in Cambodia
HSP 3 Health Workforce Development Strategy Ⅳ
1. Adopt an integrated approach to health workforce planning to ensure that health workforce development
can meet population and service needs
2. Improve the quality of education and training to meet human skills and development needs in changing
demographic and epidemiological environments
3. Maintain and secure skills of health personnel to effectively provide healthcare services
Ⅴ
4. Create an environment for optimal employee productivity, motivation and participation
5. Strengthen regulation and management of health personnel to provide safe and high-quality healthcare
services
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o The Ministry of Health drafted the 4th Health Strategic Plan 2021-2030, HSP4, to continue to
develop the National Health Development Agenda with Vision 2030, which includes Cambodia's
sustainable goals for ensuring healthy living and promoting well-being at all ages (UNGM, 2021).
- The plan supports the National Social Protection Policy Framework (NSPPF) 2016-2025, a long-
term plan to reduce and prevent poverty, vulnerability, and inequality, and focuses on strengthening
human resource development (The Royal Government of Cambodia, 2017).
 Health Workforce Development Plan 2016-2020 in Cambodia
o Cambodia has established and implemented three Health Workforce Development Plans (HWDPs)
(Cambodia Ministry of Health, 2016b). The first HWDP 1996-2005 focused on the proper training
and allocation of healthcare personnel under the Health Coverage Plan presented at that time, and
the second HWDP 2006-2015 aimed to enhance and manage the capacity of health personnel.
o The number of health workers increased with the implementation of HWDP twice. The number of
doctors, which was only 50 in the 1980s, is currently more than 2,000 in the public sector alone.
However, as a result of the HWDP's interim evaluation conducted by external experts who have
worked with the Ministry of Health's Medical Personnel Committee in 2011, problems of medical
personnel and quality in sectors inconsistent with national policy were pointed out. If these
problems are neglected, the quality of medical services received by the people will decrease due to
excessive discharge of low-quality medical personnel. In order to prevent this, the need for
certification of educational institutions through the implementation of national examinations for
doctors, dentists, pharmacists, and nurses and the verification of the curriculum has been raised
since 2012. In addition, the Australian Government Department of Foreign Affairs and Trade, 2011
recommended that students be actively engaged in clinical practice by establishing an educational
hospital.
o The third HWDP 2016-2020 is based on the results of this interim evaluation. The goal of HWDP
2016-2020 is to "retain competent and well-motivated health and medical personnel to an
appropriate level by 2020”. Seven areas of activity were presented as a strategic framework for this.
64
[Figure 26] HWDP 2016-2020’s Strategic Framework
Source: Cambodia Ministry of Health, 2016b
o Among them, the education and training of health personnel focuses on preliminary education. The Ⅲ
strategic goals of HWDP 2016-2020 are as follows.
<Table 31> Strategic Interventions Related to Education of Healthcare Personnel during HWDP 2016-2020
The technology and development needs of human resources in changing populations and
Strategic Objective epidemiological environments
Improve the quality of education and training to meet
Introduction of competency-based curriculum for education of all health professionals
Ⅳ
Establish standardized standards for certification of educational institutions
Strengthening monitoring of competency-based curriculum implementation by health
education institutions
Strengthen clinical practice training for all health professionals
Strategic Field training is based on employee development and training requirements identified to
Intervention achieve the goals of the educational institution
Development and reinforcement of coordination systems for field education
Conduct appropriate periodic expert requirements evaluation for graduate students, post
basic education programs, and use them as basic data for admission Ⅴ
Implementation and strengthening of national admissions/graduation examinations
Strengthening teaching competence of health education institutions
Source: Cambodia Ministry of Health, 2016b
65
3) Implementation Plan for Sustainable Development Goals (SDGs)
o The Global Sustainable Development Goals (SDGs) include 17 items to drive action in very
important areas by 2030, and these SDGs are subdivided into 17 goals, 169 detailed goals, and 230
index.
o Cambodia's SDGs are 107th out of 163 countries, ranking in the middle and lower ranks. The SDG
index score is 63.8 and the spillover score is 97.6 (spillover ranking 47/163). It appears that not
only financial problems, but also technology, capacity building, and trade and system problems
need to be solved 10.
[Figure 27] Cambodia SDGs Overall Score
Source: Dashboards, SDG Dashboards and Trends
o According to the "GOOD HEALTH AND WELL-BING" Cambodian SDG 3 dashboard and trend
related to this project, major tasks such as maternal mortality, tuberculosis incidence, traffic
10 https://opendevelopmentmekong.net/topics/sustainable-development-goals/
66
accident mortality, subjective well-being, access to drugs and vaccines remain, some are
appropriately increased but insufficient to achieve the goal.
[Figure 28] SDG Dashboards and Trends

Ⅰ
Source: Dashboards, SDG Dashboards and Trends
o At the end of 2018, the Cambodian government approved the Cambodia Sustainable Development
Goals (SDGs) Framework 2016-2030. Of all the goals, CSDG 3 has the highest ratio of goals and
index, with 13 goals and 27 index in the global framework, while CSDG 3 has 11 goals and 21
Ⅲ
index.
o (Contributing to achieving SDGs) This project contributes to achieving SDGs 3 (health and
welfare) and contributes to achieving detailed goals 3.4 and 3.b 11.
- (Detailed goal 3.4) Reduce early death from non-infectious diseases to one-third, aim to promote
mental health and well-being, and these diseases are preventable if they respond more effectively Ⅳ
and fairly through the health system.
- (Detailed goal 3.8) Achieve universal health coverage, including financial risk protection, access to
quality essential medical services, and access to essential medicines and vaccines that are safe,
effective, good quality and affordable for all.
- (Detailed goal 3.b) Provide access to affordable essential medicines and vaccines for all people and Ⅴ
to support research and development of vaccines and drugs for infectious and non-infectious
11 https://impactlibrary.net/entry/UN-SDGs-goal-3
67
diseases. The Trade-Related Intellectual Property Agreement 12 and the Declaration on Public
Health highlights the seriousness of the problems of many developing and poorest countries,
especially those caused by epidemics such as HIV/AIDS, tuberculosis, malaria, etc. It also includes
contributions from developed countries by providing incentives to companies and institutions that
promote technology transfer to the poorest countries.
C. Healthcare General Status
1) Key index of healthcare
o The current status of major health index in Cambodia is as follows.
<Table 32> Status of Major Health Index in Cambodia
Life expectancy 70.1 years old (2020) (Male: 67.7 years old, Female: 72.2)
Birth rate 21.6 (per 1,000 population / 2020)
Crude death rate 6.0 (per 1,000 population / 2020)
Adult mortality rate Male: 194.7 female: 128.0 (per 1,000 gender / 2020)
Fertility rate 2.5 people (2020)
Maternal mortality ratio 160.0 (per 100,000 normal births / 2017)
Infant mortality 22.0 (per 1,000 normal births/2020) (24.6 male and 19.3 female)
Contraceptive rate 56.3% (2014)
Medical expenditure 0.1% of total GDP (2016)
HIV/AIDS prevalence (adult) 0.5% (2020)
Number of HIV/AIDS carriers 72,000 people (2020)
Source: WB, 2022.
2) Major causes of disease and death
o (Partial mortality) In Cambodia, infectious, maternal, perinatal, and nutritional status (26%)
account for the highest proportional mortality rate, followed by cardiovascular disease (24%) and
other non-infectious diseases (20%).
12It is concluded for the purpose of unifying each countries diverse intellectual property rights protection standards and preventing the
overflow of counterfeit products.
68
[Figure 29] Proportional Mortality in Cambodia
Source: WHO Noncommunicable disease country profiles 2018
o (Major cause of death) examine the main causes of death in Cambodia 2009-2019, stroke is the
most prominent, and diseases requiring continuous treatment such as respiratory diseases, heart Ⅲ
disease, and liver cirrhosis are ranked high.
- In order to manage chronic diseases, it is necessary to increase medical accessibility of local

residents, and above all, it is necessary to obtain safe medicines easily and quickly.
[Figure 30] Changes in Cambodia's Main Cause of Death (2019 Compared to 2009)
Source: Cambodia. http://www.healthdata.org/cambodia
69
3) Status of Medical Expenditures
o Cambodia has a medical service delivery system that combines public and private medical service
providers. According to the 2011 Health Account System ("SHA"), public health service providers
include healthcare system management and financial support (government budget for central and
local administration, national programs) and medical facilities (national programs, local hospitals,
county hospitals, military hospital and health centers). And private health care providers consist of
private hospitals, private clinics, pharmacies, NGO hospitals and other private/non-medical service
providers.
 Medical expenditure by provider
o In the case of public medical service providers, medical system management and cost
procurement13 account for the highest percentage of current medical expenses.
- Spending on medical system management and cost procurement services increased from $169
million as of 2012 to $180.4 million in 2016.
- Spending at national hospitals was the second highest expenditure category, increasing from $81.9
million to $191.1 million during the same period (2012-2016).
- Spending on local and county local hospitals varied from $52.2 million to $78.7 million annually, while
spending on health centers increased from $62 million to $74.6 million between 2012 and 2016.
<Table 33> Total Medical Expenditure by Provider (Unit: US$ million)
Public Provider 2012 2013 2014 2015 2016

Provider of health system administration
169.0 197.2 181.5 191.9 180.4
and financing
National Hospital 81.9 88.2 120.4 184.2 191.1
Provincial Hospital 52.2 55.0 77.4 78.7 64.8
District Hospital 48.8 41.5 43.8 64.5 56.5
Health Centre 62.0 67.2 70.2 69.9 74.6
Total 414.0 449.1 493.3 589.1 567.3
* Due to rounding, the numbers shown in the relevant table may not be added up accurately to the sum indicated.
Source: World Health Organization, 2019
13Overall management of the healthcare sector, including regulation of activities and financial management of institutions primarily
provide medical services
70
 Government Medical Expenditure by Provider
o As a result of subdividing government funds spent by public health service providers, it can be seen
that government spending is mainly used to manage and finance medical systems, and most of them
Ⅰ
are concentrated at the central government level, not at medical facilities.
- Government spending on medical system management and cost procurement accounted for more
than $100 million per year from 2012 to 2016. These figures do not include details of expenditure,
but are inferred to include the management and governance of preventive treatment.
- The government has doubled spending over the past five years by further expanding medical
Ⅱ
services provided by national hospitals.
- In the relevant government budget, expenditure on health centers was higher than that of other types
of medical facilities. The expenditure increased from $36.3 million in 2012 to $58.6 million in 2016,
which is due to the increase in the number of health centers over the past five years.
<Table 34> Government Healthcare Expenditure by Provider (Unit: US$ million)
Provider 2012 2013 2014 2015 2016 Ⅲ

Provider of health system administration
109.7 118.0 114.0 128.9 120.1
and financing
Health Centre 36.3 39.7 38.4 44.5 58.6 Ⅳ

Total 199.3 216.2 209.0 245.5 268.6
 Health extended by provider from OOP payments
o Most of the medical expenses financed by the out-of-pocket expenses were generally spent on Ⅴ
private hospitals, that Cambodians in need of medical services chose as the top priority. The amount
of out-of-pocket payments to private clinics has increased significantly by more than $100 million
over the past five years.
71
- What this may suggest is that while investment in the private sector has grown, laws and regulations
governing this sector are lacking. Out-of-pocket medical expenditures for other private medical
service providers, mainly defined as "non-medical professionals without formal medical education,"
sharply decreased from $86.3 million in 2012 to $15.6 million in 2016.
o In 2016, the out-of-pocket expenditure on public hospitals accounted for the second largest portion
of the total expenditure, while the out-of-pocket expenditure on hospitals and health centers in the
county decreased.
<Table 35> Medical Expenditure by Provider from Out-Of-Pocket Expenses (Unit: US$ million)
Provider 2012 2013 2014 2015 2016
Health Centre 25.8 27.5 31.8 25.1 17.1
Private Hospital 85.1 90.6 104.1 52.5 74.5
Private Clinic 265.7 282.7 288.8 332.2 376.9
Pharmacy/Drugstore 78.8 83.7 61.5 49.5 95.1
Other Private 86.3 87.3 31.9 17.5 15.6
Total OOP payments 629.8 663.1 664.2 653.3 728.5
 Health expenditure by factor of provision
o The Cambodian National Health Accounts (NHA) collects information on the costs spent on
providing medical services, and there are four main categories of input.
- Employees' compensation: Employee benefits, social contributions, and all other employee-related
expenses
- Drugs: All medicines, such as vaccines and serum, cotton, wound dressing, protective clothing,
uniforms, and other consumables.
72
- Materials and services: Goods and services used in the production aspect of medical services, or
other types of goods and services, such as management offices, kitchens, and transportation, or for
more general purposes such as electricity and water.
Ⅰ
- Consumption of fixed capital: Maintenance of buildings, purchase and maintenance of other capital
goods such as medical devices and vehicles.
o It shows that human resources account for the largest portion of all medical expenditures. As of
2012, it steadily increased from $387.4 million to $457.5 million in 2016, which means 37.9% of
current medical expenditure on providing factors.
Ⅱ
o The second largest portion of medical expenditure was pharmaceutical expenditure, which was
similar to the increase in human resource expenditure. Drug expenditure increased slightly from
$330 million as of 2012 to $391 million in 2016, accounting for 32.4% of ordinary medical
expenditure on input.
o Spending on the fixed capital category increased from $46.4 million in 2012 to $69.3 million in
Ⅲ
2016, accounting for about 6% of input.
[Figure 31] Medical Expenditure by Supply Factor (Unit: US$ million)
73
 Government health expenditure by factor of provision
o Considering government spending on healthcare services, the government paid $86.8 million in
2012 for human resources, health systems, and governance to provide health services. The amount
increased to $11 million in 2016.
o In the case of human resources, it accounts for the largest proportion of the government budget
(37.3%) for healthcare.
o The proportion of drug expenditures increased from 17.1% ($34.2 million) of the government's
healthcare budget to 19.7% ($52.9 million), an increase of $18.7 million.
<Table 36> Government Expenditure on Healthcare by Supply Factor (Unit: US$ million)
Factor of provision 2012 2013 2014 2015 2016
Compensation of employees 86.8 93.8 90.6 107.9 100.1
Pharmaceuticals 34.2 37.5 36.2 42.8 52.9
Materials and services 52.6 55.9 54.1 62.4 76.8
Consumption of fixed capital 25.5 28.0 27.1 30.8 38.6
Others 0.3 1.0 1.0 1.5 0.1

Total 199.3 216.2 209.0 245.5 268.6
[Figure 32] Trends in Government Medical Expenditure by Supply Factor (Unit: US$ million)
74
 Government health expenditures by input at central and provincial levels
o During the five-year period of 2012-2016, local expenditure on healthcare increased significantly
from $ 94 million to $142.5 million.
Ⅰ
<Table 37> Government Spending on Healthcare at Central and Local Levels (Unit: US$ million)
Central Ministry of Health 2012 2013 2014 2015 2016
Pharmaceuticals 3.3 3.6 3.5 4.3 7.7

Ⅱ
Others 0.2 0.9 0.9 1.5 0.1
Total 105.3 113.0 109.3 132.8 126.0
Provincial 2012 2013 2014 2015 2016
Pharmaceuticals 30.9 33.9 32.8 37.1 45.2 Ⅲ
Others 0.0 0.0 0.0 0.0 0.0
Total 94.0 103.2 99.7 112.7 142.5
Ⅳ
o While a higher proportion of government funds' medical expenditure at the central government
level was used for employee compensation and materials/services used, priority of expenditure at
the lower government (local government) level was given to employee compensation and
medicines for basic public health services.
Ⅴ
75
[Figure 33] Percentage of Government Healthcare Expenditure Due to Central and Local Levels of Input (Unit: US$ million)
 Government health expenditure by factor of provision and level of care
o In 2016, the Ministry of Health spent a total of $147.4 million on public medical facilities. As a
result of classifying government expenditures by input and treatment level, health centers
accounted for the highest proportion of those expenditures (US$57.5 million, nearly twice as much
as spending on national, provincial, and municipal hospitals).
o In the case of government expenditure on drugs, expenditure on national hospitals was $7.7 million,
$11.4 million for local hospitals, and $10.2 million for rural hospitals, while $23.7 million for
health centers and public health centers. Human resource-related expenses amounted to $24. 4
million, accounting for 42.5% of the government's current total expenditure on input to health
centers.
76
o The consumption of fixed capital was the smallest proportion of facilities at all levels, from $1.2
million for local hospitals to $2.2 million for health centers.
<Table 38> Government Spending on Healthcare Based On Supply Factors and Healthcare Service Levels (Unit: US$ million)
Ⅰ
Facility
Factor of provision National Provincial Referral
Health center
hospital hospital hospital
Compensation of employees 16.1 13.3 8.0 24.4
Pharmaceuticals 7.7 11.4 10.2 23.7
Materials and services 7.0 6.2 5.4 7.2 Ⅱ

Consumption of fixed capital 1.8 1.2 1.8 2.2
Total 32.5 32.0 25.4 57.5
Ⅲ
4) Status of Medical Expenses
o Cambodia's current medical expenses in 2016 were US$1.27 billion. 22.3% and 16.6% of ordinary
medical expenses correspond to government funds and donor funds, respectively, and household
medical expenses accounted for 60.4%. And less than 1% of the financial resources were private
and social health insurance funds.
<Table 39> Medical Expenditure by Resources (Unit: US$ million) Ⅳ

2012 2013 2014 2015 2016
Source
of fund Amount % Amount % Amount % Amount % Amount %
Government 199.3 19.4% 216.2 20.4% 209.0 19.9% 245.5 22.0% 268.6 22.3%
Donor 199.8 19.4% 180.8 17.1% 176.7 16.8% 210.3 18.8% 200.1 16.6%
PHI - - - - - - 5.4 0.5% 7.5 0.6%

Ⅴ
SHI - - - - - - 1.3 0.1% 2.3 0.2%
Total 1028.9 100% 1060.1 100% 1049.9 100% 1115.8 100% 1207.0 100%
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o Out-of-pocket medical expenses were the main financial resources, accounting for about 60% of
the current medical expenses. Out-of-pocket medical expenditure showed an absolute increase
from $629.8 million in 2012 to $728.5 million in 2016. During the same period, the government's
medical expenditure increased 34% from $199.3 million to $268.6 million.
o External resources, donors, and NGO spending remained relatively constant at about $200 million
during the period. Spending based on private health insurance and social health insurance
accounted for only a small portion of ordinary medical expenses, less than 0.6% and 0.2%,
respectively.
[Figure 34] Medical Expenditure by Resources (Unit: US$ million)
D. Healthcare Institution Status
1) Healthcare Services and Delivery Systems
o Cambodia is a mixed healthcare service delivery system that encompasses the public sector (central
government, province, and operating area level) and the private sector (profit and non-profit
organizations).
78
<Table 40> Healthcare System in Cambodia
Category Type Characteristic

Central/National government level
Provincial level Primary preventive service Ⅰ
Operational District level Inpatient hospitalization service
Public Healthcare System * Ministry of Health, Training A community-based healthcare systems
Institutions, National Center, National approach
Hospital, Referral Hospital, Health Guidance from the Ministry of Health
Center, Health Post
Private-for-profit organization Primary outpatient care services
Private Healthcare System
Private-for-Non-Profit organization Guidance from the Ministry of Health
Source: Korea Health Industry Promotion Agency, 2021
Ⅱ
2) Medical Facilities by Type
o (Status of medical institutions) As of 2018, 15,882 medical institutions nationwide provide medical
services, of which 1,450 are public medical institutions and 14,432 are private medical institutions
(Korea Health Industry Promotion Agency, 2021).
Ⅲ
- Public medical institutions consist of 103 Operational Districts, 34 national/provincial hospitals, 92 local
forwarding hospitals, and 1,221 health centers. Private medical institutions consist of 5,908 nursing
facilities, 4,673 clinical offices, 1,856 pregnancy management offices, 22 hospitals, and 425 clinics.
[Figure 35] Interactive Map of Cambodia Medical Facilities in 2010
Source: open development Cambodia, 2010
79
 Public Medical Institution
o As of 2016, Cambodia has 107 hospitals, 1,164 public health centers and 98 health centers in 98
Operational Districts (ODs).
o Hospitals are divided into 8 national hospitals and 99 referral hospitals, which are classified into
grades 1 to 3 (CPA 1 to CPA 3) 14 according to size, facilities, and function.
<Table 41> Public Health Institutions in Cambodia
Category 2008 2010 2012 2014 2016
1. OD(Operational District) 77 77 79 88 98
2. Hospital 87 89 91 106 107
2.1. National Hospital 8 8 8 8 8
2.2. Referral Hospital 79 81 83 98 99
2.2.1. Referral Hospital (CPA 1) 34 36 51 49
3. Public Health Center 967 997 1,024 1,105 1,164
4. Health Center 107 117 124 106 98
Source: Cambodia Ministry of Health, 2015; Cambodia Ministry of Health, 2017
o National hospitals are usually composed of one ophthalmological hospital, two pediatric hospitals,
one maternity hospital, and four specialized hospitals. Jayavarman VII and Kanta Bopha mainly
treat pediatric patients. Therefore, there are three national hospitals that provide general hospital -
level treatment.
14CPA1: General surgery or blood transfusion not possible, but obstetric services available; CPA2: CPA1 activities + emergency
service, general anesthesia, blood transfusion, ophthalmology, otolaryngology, dental services available; CPA3: CPA2+major surgery
and tertiary service available
80
<Table 42> National Hospital of Cambodia
Hospital Name No. of Beds Location Remarks
Ang Duong Hospital 80 Phnom Penh Ophthalmology hospital

Ⅰ
Calmette Hospital 530 Phnom Penh General hospital
General hospital
Jayavarman VII Hospital 986 CM lip (However, pediatric-oriented
treatment)
Khmer-Soviet Friendship Hospital 550 Phnom Penh General hospital
Preah Kossamak Hospital 250 Phnom Penh General hospital
Kantha Bopha Hospital 1,032 Phnom Penh Pediatric Hospital

Ⅱ
Maternal and Child Health Center 145 Phnom Penh Maternity hospital
National Pediatric Hospital 150 Phnom Penh Pediatric Hospital
Source: Export-Import Bank of Korea, 2018
o Public health facilities such as public health centers and hospitals have increased at a noticeable
rate, especially in urban areas, over the past few decades.
Ⅲ
<Table 43> Number of Health Facilities in Cambodia (2018)
Health Provincial Rural Public

Health National
Capital/Region Administrativ Hospital Hospital Health
Clinic Hospital
e Region (OD) (PRH) (PH) Center
Banteay
6 1 8 66 10 -
Meanchey
Battambang 5 1 5 77 6 -
Ⅳ
Kampong Cham 9 1 8 88 0 -
Kampong
3 1 2 42 2 -
Chhnang
Kampong Speu 4 1 3 55 4 -
Kampong Thom 3 1 2 53 4 -
Kampot 4 1 4 64 0 -
Ⅴ
Kandal 10 1 10 99 2 -
Koh Kong 2 1 1 13 10 -
Kratie 2 1 2 31 16 -
81
Health Provincial Rural Public

Health National
Capital/Region Administrativ Hospital Hospital Health
Clinic Hospital
e Region (OD) (PRH) (PH) Center
Mondul Kiri 1 1 1 11 16 -
Phnom Penh 7 1 7 43 7 9
Preah Vihear 1 1 1 27 17 -
Prey Veng 12 1 11 113 6 -
Pursat 4 1 3 40 4 -
Rattanak Kiri 2 1 1 27 8 -
Siem Reap 4 1 4 91 3 -
Preah Sihanouk 1 1 0 14 2 -
Stung Treng 1 1 0 14 1 -
Svay Rieng 4 1 4 43 2 -
Takeo 6 1 6 78 4 -
Oddar Meanchey 2 1 1 37 1 -
Kep 1 1 0 5 0 -
Pailin 1 1 0 6 0 -
Tboung Khmum 7 1 5 68 4 -
Total 102 25 89 1,205 129 9
Source: Open Development, Statistical Yearbook of Cambodia (2021)
 Private Medical Institution
o Private medical facilities generally provide outpatient treatment services and are operated as
various types of facilities. The Ministry of Health grants permission after registering and reviewing
of private medical facilities.
o As of the end of 2015, there are 8,488 licensed private medical facilities. However, there are many
non-medical suppliers (traditional pharmacies, traditional therapists, midwives, magicians, etc.) in
rural areas, and reached about half of all suppliers (World Bank, 2013). However, the proportion
of people receiving treatment from non-medical providers gradually decreased to about 2% in 2014
(Cambodia Ministry of Health, 2014).
82
<Table 44> Private Medical Institutions in Cambodia
Category 2009 2010 2011 2012 2013 2014 2015
Nursing care room 758 1,252 1,505 1,733 1,630 1,754 3,392
Ⅰ
Pregnancy care room 242 331 427 485 520 506 1,030
Physiotherapy room 5 12 19 21 22 20 13
Consultation cabinet 2,268 2,516 2,473 2,640 2,768 2,732 2,891
Dental consultation 284 313 318 368 411 419 758
Dental clinic 29 26 33 36 39 38 41
Esthetic/Beauty center 2 6 6 8 10 12
Ⅱ
Medical laboratory 29 25 20 23 27 27 38
Maternity 8 7 7 7 7 8 11
Clinic 95 102 110 130 156 181 244
Polyclinic 37 36 41 48 48 51 47
Hospital 4 8 11 11
Total 3,755 4,622 4,970 5,501 5,644 5,757 8,488 Ⅲ

Source: Cambodia Ministry of Health, 2017
 Number of Hospital Beds
o The total number of hospital beds in Cambodia increased from 8,968 in 2008 to 12,651 in 2012,
but gradually decreased since then to 10,870 in 2016. The reason for the decrease in the number of
hospital beds seems to be due to management problems such as remodeling of some hospitals or Ⅳ
lack of medical personnel. Compared to the number of hospital beds per 10,000 people in 2015,
Cambodia has 8, which is less than half of Laos (15), Thailand (21), and Vietnam (26), requiring
additional hospital beds (UNDP, 2019).
<Table 45> Number of Hospital Beds in Cambodia (2008–2016)
Category 2008 2010 2012 2014 2016

Ⅴ
Total Number of Hospital Beds 8,968 11,587 12,651 12,249 10,870
Source: Cambodia Ministry of Health, 2015
83
E. Healthcare Personnel Status
 Status of Healthcare Personnel
o The number of medical personnel working in the private and non-governmental sectors is not
identified, and the current status of public health and medical personnel in Cambodia is as follows.
- The largest number of public healthcare personnel are nurses with 42.6% (secondary nurse +
primary nurse) followed by midwives (25.8%). This is seen as a result of the emphasis on Fast Track
Initiative 2010-2015 to reduce maternal and neonatal mortality, and unlike doctors, nurses and
midwives mostly work in provincial areas.
- The number of pharmacists increased by about 13% from 464 as of 2010 to 525 as of 2015. In recent
years, the number of pharmacists has rapidly increased to 3,000, and it is believed that professionals
for drug supply and medical services are being strengthened.
- There are 2,346 doctors, accounting for 11.2% of the total workforce, and 80% of specialists are
placed in the center.
- Due to the low remuneration of public hospitals, doctors often work at private hospitals or
concurrently as practitioners, which is not illegal. Although the scale of concurrent occupations has
not been accurately investigated, it is estimated that about 2/3 of all doctors do (World Bank, 2012).
- The number of doctors and nurses per 1,000 people is 0.169 and 0.791, respectively, which is a
small number compared to neighboring countries Thailand and Vietnam. Doctors account for 1/3
of Thailand, which is 15% of Vietnam level, and nurses account for about half of Thailand and
Vietnam (World Bank, 2012).
84
<Table 46> Status of Medical Personnel in Public Health and Medical Institutions in Cambodia 2010-2015
Category 2010 2011 2012 2013 2014 2015
Medical Doctor* 2,139 2,180 2,178 2,021 2,347 2,346

Ⅰ
Medical Assistant 1,087 1,052 1,018 962 906 863
Dentist 189 212 214 226 243 250
Pharmacist 464 474 486 529 526 525
Secondary Midwife 1,863 1,994 2,432 2,734 2,963 3,130
Secondary Nurse 5,155 5,366 5,662 5,534 5,700 5,745
Primary Midwife 1,815 1,997 2,164 2,332 2,327 2,282

Ⅱ
Primary Nurse 3,359 3,381 3,366 3,387 3,299 3,173
Secondary Laboratory Technician 424 442 454 460 484 506
Others 1,807 1,716 1,747 2,483 2,179 2,134
Total 18,302 18,814 19,721 20,668 20,974 20,954
* including doctors, professors, specialists

Source: Cambodia Ministry of Health, 2016c
Ⅲ
o (Status of Medical Personnel) As of 2020, Cambodia had 82,043 doctors and 3,131 pharmacists,
and as of 2017, 684 dentists,17,306 nurses, and 5,142 midwives, respectively.
<Table 47> Number of License Registrations by Occupation in Cambodia
Occupation Number Of License Registrations
Medical Council (Doctor) 10,407 (2020)

Ⅳ
Dental Council of Cambodia (Dentist) 684 (2017)
Cambodian Council of Nurses (Nurse) 17,306( 2017)
Cambodian Midwives Council (Midwife) 5,142 (2013)
Pharmacy Council of Cambodia (Pharmacist) 3,131 (2020)

Source: Korea Health Industry Promotion Agency, 2021
 Types of Medical Personnel Training Institutions Ⅴ
o University of Health Science: A fee-based medical training program for general public people who
do not serve in the military after completion of the training.
85
o Although the number of private institutions providing pre-job training and education is increasing,
details on the number of students and other information are private.
<Table 48> Number of Medical Personnel Training Institutions (2011)
Number And Type Of Ownership

Type Of Training Organization Total
Public Organization Individual
Medical Science 2 2 4
Dentistry 1 1 2
Pharmaceutical Science 1 2 3
Nursing Science 6 5 11
Midwifery 6 5 11
Experimental Technology 1 1 2
Radiology 1 0 1
Physical Therapy 1 0 1
Public Health Science 1 0 1
Source: Human Resources for Health Country Profiles CAMBODIA (2014)
o The Cabinet has the final authority to manage and regulate medical personnel education institutions,
and two ministers from the Ministry of Health and the Ministry of Education, Youth and Sports are
making key decisions related to the establishment of training institutions with direct responsibility.
o The Ministry of Human Resources Development is in charge of providing pre-job training,

additional training for government agencies' employment and health personnel, and monitoring and
coordinating related activities. Private medical institutions, which are increasing in recent years in
cities, are under the jurisdiction of the Ministry of Health, and management and reporting are under
the jurisdiction of the Ministry of Education, Youth and Sports. Currently, there are a total of 36
medical personnel training institutions (20 publics and 16 private) nationwide.
o Due to the lack of the absolute number of healthcare workers, as of 2012, there were 2.3 doctors
and 7.9 nurses per 10,000 populations, far below the Southeast Asian average of 15.3 and 25.1,
respectively. Since most of the manpower is concentrated in Phnom Penh, the capital, it is not easy
to solve the problem of manpower supply and demand issue in a short period of time in the outskirts.
86
<Table 49> Status of Medical Personnel in Public Health Facilities in Cambodia

Employee Category 2013 2014 2015 2016 2017 2018
Doctor 2,021 2,347 2,346 3,129 3,130 3,432
Doctor's Aid 962 906 863 866 839 613
Ⅰ
Pharmacist/Pharmacist
529 526 525 759 769 745
Assistance
Dentist 226 243 250 476 500 497
Second-Degree Midwife 2,734 2,963 3,130 4,022 4,178 4,279
Second-Degree Nurse 5,534 5,700 5,745 7,897 7,850 7,912
Midwife Level 1 2,332 2,327 2,282 2,364 2,320 2,256
Nurse Level 1st 3,387 3,299 3,173 3,193 3,060 2,864
Laboratory Technician Level
460 484 506 833 775 797 Ⅱ
1 And 2
Others 2,483 2,179 2,134 1,633 1,744 729
Total 20,668 20,974 20,954 25,261 25,310 24,545
Source: OpenDevelopment (2022), Statistical Yearbook of Cambodia 2021
F. Comprehensive Healthcare Environment Implications

Ⅲ
o Since the Cambodian health government is largely composed of the Central Health Bureau, the
Provincial Health Bureau, and the OD (Health Administration Unit), it is judged that the formation
of a cooperative system of stakeholders will play a very important role in establishing a
Pharmaceutical Information system.
o The goals and strategies of HSP 3 and the SDGs of the UN, which are directly related to this project,
Ⅳ
are reinforced and promoted as the core of the Cambodia SDGs Implementation Strategy (CSDGs).
- In particular, SDGs implementation strategy 3.b "Aiming to support research and development of vaccines
and drugs for infectious and non-infectious diseases, supporting access to essential drugs and vaccines at
reasonable prices for all people”. Is a strategy that meets the vision and purpose of the project.
o Cambodia promotes the establishment of health policies led by the Ministry of Health and the Ⅴ
training of healthcare professionals, and in particular, it is in charge of policy support and
implementation in cooperation with the Ministry of Education and Youth. However, there is a
shortage of professionals in public health centers, clinics, and pharmacies, which are actually the
first level (district level) service delivery channels in charge of providing medical services.
87
- However, it seems appropriate to proceed with the policy, organization, and digitalization of drug
supply management at national level under the Ministry of Health, and it is necessary to consider
the environment of public health centers, clinics, and pharmacies.
o Based on SDGs 3. b’s strategy, the project is judged to improve access to affordable essential
medicines for all local residents through "establishment of a Pharmaceutical Information System
and capacity building”, and achieve the vision of governmental and national development strategy,
which is ‘improving citizens’ quality of life through the establishment of a digital government and
building trust and providing better public services."
- It is very consistent with the purpose of this project, such as expanding health systems and
infrastructure, responding to infectious diseases, strengthening health capabilities, and creating a
health system for the people, which are the main detailed strategies of the Cambodian government.
o According to Cambodia's major causes of death, deaths from chronic diseases account for a large
proportion of the total mortality rate. In order to manage chronic diseases, it is expected that the
project will have a positive effect on reducing Cambodian mortality by solving the problems o f
Cambodian drug distribution and management. Especially it is expected to improve local residents'
access to medical care and the supply (accessibility) of essential medicines, and to be able to obtain
safe medicines at the right time and in the right place.
o Cambodia has about 15,000 medical institutions nationwide to provide medical services. The
Pharmaceutical Information Pharmaceutical Information Service Center in this project needs to be
established in consideration of the fact that it should be utilized and used in various medical service
sites such as general hospitals, public health centers, and pharmacies.
- In addition, it is necessary to consider Cambodia's lack of financial resources, unstable human

resources for medical personnel, cooperation with provincial units, and the budget for this project.
o It is judged that strengthening services in the public medical sector will have a high effect in terms
of improving the accessibility and quality of medical services for the vulnerable people in
Cambodia.
88
3. Healthcare Status Analysis
A. Pharmaceutical Distribution and Management System Related Status
1) Pharmaceutical-Related Organizations Analysis
 DDF (Department of Drug and Food)
o DDF consists of a total of five departments under the supervision of Director "Heng BUN KIET",
and there are three major departments related to this project: DRB, TB, and RB.
- Established in 1994, it is a major agency that regulates all pharmaceuticals.
- It has full discretion to grant or reject all pharmaceuticals, including permission and rejection of
medical services and drug-related advertising.
- Drug Regulation Bureau: Management, Regulation, Inspection and Advertising
- Pharmaceutical Trade Bureau: Import/Export Pharmaceuticals, Cosmetics, Materials, Chemicals,

Narcotics, Psychotropic Drugs Import/Export Control, Pharmaceutical Companies, Cosmetics
Companies, Cosmetics Centers Establishment/Closing Management, and Psychotropic Cosmetics
Monitoring Training
- Registration Bureau: Manufacturer Registration, Pharmaceutical Registration, Traditional Drugs

and Health Supplement Included Product Registration and Medical Devices, Reagents and
Cosmetics Support
- Essential Drugs Bureau: Supervision Department, Planning and Coordination Department, Supply
Department, Information, Rational Drug Utilization Department and Drug Surveillance Department
Management and Responsibility
- Food Safety Responsible: Food Regulation, Food Inspection and Consumer Protection
146
Ⅲ. Status Analysis
[Figure 59] DDF Organizational Charts and Departmental Roles
Source: Provided by Cambodia DDF
 CMS(Central Medical Stores)
o CMS consists of three major departments under the director's supervision.

Ⅲ
o CMS is the department in charge of pharmaceutical distribution in public medical facilities in
Cambodia and is in charge of managing the overall medical supply chain of medical facilities to
public general hospitals, local hospitals, and health centers.
[Figure 60] CMS Organizational Charts
Source: CMS from Cambodia
147
o CMS stakeholders related to this project are as follows.
[Figure 61] CMS Key Stakeholders
Source: CMS from Cambodia
2) Pharmaceuticals political, economic, legal and sociocultural analysis
 Politic
o Cambodia does not have a government-controlled Reimbursement System 16.
- Drug prices are determined on the market17.
- First introduced in 2010, the Pharmaceutical Strategic Plan of Action for Implementation of
Medicine Policy established that one of the nation's long-term goals is to develop guidelines for the
import, distribution and pricing of medicines in the private sector18.
o Pharmaceuticals provided through the public sector healthcare system are provided to Cambodian
citizens at no personal cost. The Ministry of Health uses the National Social Security Fund (NSSF)
and/or Health Equity Funds (HEF) to pay for the pharmaceuticals 19.
- Details on whether the method of payment by the Ministry of Health to the pharmacy is prepaid or
in the form of repayment are not disclosed.
16 https://2016.export.gov/industry/health/healthcareresourceguide/eg_main_108570.asp#P69_9477
17 Bureau-Point et al. (2020). Self-medication and the pharmaceutical system in Cambodia. Medical Anthropology, 39(8), 765-781.
18 https://uk.practicallaw.thomsonreuters.com/w-016-6538?transitionType=Default&contextData=(sc.Default)&firstPage=true
19 Ibid.
148
- There is no law that provides a standard for the period of time the government should repay
pharmacies or other medical providers for medical products and services provided through the
public health system.
Ⅰ
o The total number of registered pharmaceuticals and medical devices registered from 1994 to 2018
was 22,328, and 20,823 cases or 93.3% of the total, were imported products.
<Table 68> Registration Status of Pharmaceuticals and Medical Devices (1994-2018)

Modern Traditional Health
Type Medical Device Reagent
Medicine Medicine Functional Food
Number Of
16,941 537 1,400 2,590 860 Ⅱ
Registrations
Source: Ministry of Health, KOTRA Recited from Cambodian Drug Market Trends (2019 .11.8.)
 Economy
o As Cambodia's economy grows and access to medical services improves, the pharmaceutical
market is expected to continue to grow 20.
Ⅲ
- Raising awareness of diseases, increasing chronic diseases, high preference for imported
pharmaceuticals, and support from various international organizations and NGOs can be seen as
growth factors in the pharmaceutical market.
- Apart from the people's high preference for imported pharmaceuticals, it shows the lowest level of
drug expenditure in Asia along with Laos and Myanmar, and the demand for inexpensive generic
pharmaceuticals is high. Ⅳ
20 KOTRA. Cambodia Pharmaceutical Market Trends (2019.11.8.;
https://dream.kotra.or.kr/kotranews/cms/news/actionKotraBoardDetail.do?SITE_NO=3&MENU_ID=430&CONTENTS_NO=1&bbsGbn=254&bbsSn=254&p
NttSn=178573)
149
<Table 69> Cambodian Pharmaceutical Market Size and Trend
Category 2018 2019 2020 2021 2022F 2023F
Pharmaceutical Sales
291 333 351 611 538 417
($mln)
Per Capita Drug Sales

17.9 20.2 21.0 36.1 31.3 24.0
($)
Total Medical
Expenditure 1,510 1,872 2,044 2,284 2,469 2,663
($mln)
Per Capita Medical

92.9 113.6 122.2 134.8 143.8 153.2
Expenditure ($)
Sales of
Pharmaceuticals as A 1.19 1.23 1.30 2.10 1.69 1.19
Percentage of GDP
Sales of
Pharmaceuticals
19.3 17.8 17.2 26.8 21.8 15.6
Compared to Medical
Expenses (%)
Source: Fitch Solutions; KOTRA Cambodia Pharmaceutical Market Trends (September 20, 2022) Recited
2022 Statistics for 2022 and 2023 are expected
o HS Code is divided into HS 3003 (medicaments) and HS 3004 (medicaments), and HS 3003 is a
mixture of two or more ingredients for treatment or prevention, and is limited to 3002, 3005, or
3006, excluding retail shapes or packaging. HS 3004 is limited to a certain dose (including those
in the form of disseminated administration) or retail shape or packaging, excluding items 3002,
3005, or 3006, regardless of whether it is mixed or not.
150
<Table 70> HS Code 3003: Top Countries in Cumulative Income for the Last Five Years
(Unit: thousand dollars)
Country 2014 2015 2016 2017 2018 5 Year Total
India 2027 444 183 152 226 3,032 Ⅰ
Thailand 219 211 206 498 1,576 2,710
Indonesia 2,397 34 55 80 0 2,566
Vietnam 360 292 98 774 331 1,855
China 287 276 559 214 386 1,722
Malaysia 170 145 160 276 156 907
Pakistan 167 72 205 184 212 840
Taiwan 160 150 112 143 37 602
Korea 35 25 3 100 42 205 Ⅱ
Total 6,102 2,655 1,945 2,475 3,339 16,516
Source: ICT Trademap
o In terms of cumulative imports over the past five years, Korea occupies the position of one of the
top five exporters after Thailand, India, France, and Vietnam.
- It is speculated that the high volume of pharmaceutical imports from France is due to the fact that
Ⅲ
Cambodia used to be a French colony and that there are many doctors who studied abroad in France.
- Except for France and Korea, most of the top importers of Cambodian drugs are ASEAN countries
and China, which can be seen as having a great influence on price factors.
<Table 71> HS Code 3004 : Top Countries in Cumulative Income for the Last Five Years
(Unit: thousand dollars)

5 Year
Country 2014 2015 2016 2017 2018 Ⅳ
Total
Thailand 28,338 30,476 29,565 36,162 43,990 168,531
India 30,279 32,853 29,152 33,554 39,039 164,877
France 32,194 29,666 28,827 32,069 31,409 154,165
Vietnam 8,510 10,767 11,319 12,423 13,834 56,853
Korea 8,510 9,239 9,540 10,515 11,264 48,339
China 7,781 9,192 9,283 8,042 12,290 47,638
Indonesia 8,831 8,331 8,160 9,496 9,197 39,300 Ⅴ
Singapore 4,116 5,314 3,117 4,206 5,858 25,441
Pakistan 6,946 3,558 4,813 5,728 8,103 25,183
Malaysia 2,981 4,221 4,577 4,589 6,509 24,561
Total 164,108 174,402 163,880 185,569 208,466 896,425
Source: ICT Trademap
151
o The expenditure on pharmaceutical is the second largest after expenditure on manpower in ordinary
medical expenses, accounting for 30.4-33.1% of total ordinary medical expenses.
[Figure 62] Percentage of Healthcare Expenditure by Supply Factor (ln USD)
Source: World Health Organization. (2019). Cambodia national health accounts (2012-2016): health expenditure report
 Law
o The regulatory framework for governance, accountability and legal enforcement of pharmaceutical
supply was adopted in 1996 21 and included in the Law of the Management of Pharmaceutical
Affairs (Pharmaceutical Law) revised in 2007 and 2018 2223.
- This Act deals with the definition of drugs, the management of toxic substances, the production,
trade, import and export of drugs, management and supervision authority, and punishment.
o The Law of the Management of Pharmacological examines the provisions related to this project.
- Article 1: The purpose of this law is to regulate all medicines in the Kingdom of Cambodia.
21 https://niph.org.kh/niph/uploads/library/pdf/LD149__mgt_of_Pharmaceutical_(1996)_Eng.pdf
22 https://niph.org.kh/niph/uploads/library/pdf/LD153_Law_on_Pharmaceutical_Management_Eng.pdf
23 https://www.ddfcambodia.com/images/stories/Naran/Law%20on%20The%20Amendment%20of%20Law%20on%20Management%20of%20Pharmaceutical
.pdf (Khmer)
152
- Article 8:1: The following require the approval of the Ministry of Health.
 opening, closing, or re-location of pharmacies, pharmaceutical import and export-related

companies or pharmaceutical manufacturing facilities
Ⅰ
 pharmaceutical import and export-related businesses
 Import, export and storage of pharmaceutical and pharmaceutical raw materials
 pharmaceutical advertising
- Article 8: The production, import, export and trade of medicines for veterinarians are determined
by the Joint Declaration of the Ministry of Health and the Ministry of Agriculture, Forestry and
Fisheries. Ⅱ
- Article 9: The supervision and control of pharmaceutical activities is the authority of the Ministry
of Health, and the supervision and control of medicines for veterinarians is the jurisdiction of the
Ministry of Agriculture, Forestry and Fisheries.
- Article 10: The following persons are subject to one of two punishments except for punishment for
other crimes. 1. 1 ,000,000 (million)~a fine of 10,000,000 (million) lire, 2. 1 to 3 months suspension Ⅲ
of the production or importation, export or transaction of drugs
 advertising drugs without the approval of the Ministry of Health

 A person who violates the procedures and conditions for the production, import, export, and
transaction of pharmaceuticals.
 Business related to drug import and export without opening or changing pharmacies or proper
approval from the Ministry of Health or manufacturing drugs Ⅳ
 The act of producing, importing, exporting, or storing medicines or pharmaceutical raw
materials without proper approval from the Ministry of Health.
 Selling drugs, keeping diaries, or selling drugs prohibited by the Ministry of Health without
permission.
* If the violation is repeated, the violator will be punished twice the fine, and the
production, import and export activities will be suspended, or one of the two penalties may Ⅴ
be punished.
153
* The Ministry of Health has the right to temporarily suspend the advertising, production,
import and export of the drug in question and must prepare a judicial case to be referred to
the court.
- Article 12: A person who intentionally participated in the following acts is 20,000,000-20,000,000
-Will be fined 50,000,000 (50 million) or sentenced to 5-10 years in prison or both.
 The act of producing, importing, exporting or trading drugs containing addictive substances,
counterfeit drugs, quality drugs, or expired drugs that affect the health or life of consumers
without permission.
o Law on Drug Control, adopted in 1997 24, mainly deals with narcotic-related matters and examines
the provisions related to this business.
 Article 3: Production, distribution, sale, wholesale, retail, transportation, storage, procurement,

free distribution, purchase, use, import, export, or transit of narcotic plants, substances or
ingredients as specified in Table I above are prohibited in the territory of Cambodia.
 Article 15: Any person, individual or national enterprise, medical or scientific facility carrying
out activities or operations related to narcotic plants, substances, ingredients or medicines
specified in this Act shall be controlled and monitored by the Minister of Health. A
pharmacological inspector is designated to conduct regular inspections at least once a year, and
inspections of facilities, locations, inventory, and diary records at any time on a regular basis.
The health inspector can ask for help as needed during the examination.
o Cambodia recently adopted guidelines to strictly enforce existing laws to eradicate illegal drug
activities (November 2020).
o Cambodian law defines pharmaceutical products, substandard and counterfeit drugs 25.
- Pharmaceuticals are defined primarily as one or more types of substances extracted from chemicals,
biological products, microorganisms or plants, and are used to prevent or treat human or animal
24 https://niph.org.kh/niph/uploads/library/pdf/LD153_Law_on_Pharmaceutical_Management_Eng.pdf
154
diseases, to study or diagnose medical or pharmaceutical diseases, and to alter or assist the function
of body organs.
- "substandard”pharmaceuticals are defined as registered products that deviate from pharmaceuticals

Ⅰ
gor which specifications are defined.
- "Counterfeit” pharmaceuticals are defined as unregistered products intentionally produced with

incorrect amounts or incorrect active ingredients, not containing active ingredients, intentionally
labeled incorrectly for fraud, or repackaged or produced by unauthorized subjects.
 Social Culture Ⅱ
o Special attention is required as counterfeit pharmaceuticals are widely spread in Cambodia and
marketing is carried out through indiscriminate false exaggeration advertisements through social
media26.
- The Cambodian government is continuously strengthening its management by supervising and

detecting the distribution of counterfeit and unregistered illegal pharmaceuticals, but it is confirmed Ⅲ
that a considerable amount of counterfeit pharmaceuticals is still in circulation on the market, and
measures against intellectual property rights infringement are insufficient.
o The high demand for pharmacies and Depots is due to “thnam psoam” 27.
- Pills and blister packs (PTP packaging) are rarely sold in their original packaging, and they are more
often sold in large quantities by putting various drugs in transparent plastic bags and sealing them
Ⅳ
with rubber bands.
 These plastic bags are called "thnam psoam" in Khmer.
- This is done not only by non-professional retailers but also by experts.
- Mainly, one dose is packaged in one bag, and 3-8 different drugs are mixed and packaged.
26 KOTRA. Cambodia Pharmaceutical Market Trend(2019.11.8.;
NttSn=178573)
27 Bureau-Point et al. (2020). Self-medication and the pharmaceutical system in Cambodia. Medical Anthropology, 39(8), 765-781.
155
- There is no way for consumers to know the contraindications or to check the expiration date for
these pharmaceuticals.
[Figure 63] Thnam Psoam Form
Source: Bureau-Point et al. (2020). Self-medication and the pharmaceutical system in Cambodia. Medical Anthropology, 39(8), 765-781.
- There is one tendency that is not limited to Cambodia, and consumers (patients) often determine the
duration of treatment. In general, when consumers purchase medicine, they want to test the medice
themselves before purchasing the entire treatment, take it for a day or two, and then purchase
additional drugs if they feel any improvement.
 They usually have a preferred distributor based on previous experience, where they build trust
relationship with sellers.
 Consumers' trust in pharmaceutical distributors is based on interpersonal relationships and the
perceived efficacy of the provided treatment, not on the authority of experts.
3) Current Status of Pharmaceutical-Related Companies
o In Cambodia, there is a small number of pharmaceutical and medical device manufacturers so most
of them are relying mostly on imports 28.
28 KOTRA. Cambodia Pharmaceutical Market Trend(2019.11.8.;
NttSn=178573)
156
- Representative producers include Pharma Product Manufacturing (PPM), Ephac, and Medical
Supply Pharmaceutical Enterprise, mainly producing painkillers, antibiotics, anti-inflammatory,
vitamins, etc.
Ⅰ
- As global companies, Bayer, Sanofi, GSK, Zuelig, Pfizer, etc. are directly and indirectly operating
with local partners such as DKSH.
<Table 72> Pharmaceutical-Related Company Statistics
Type Year 2015 Year 2016 Year 2017. Year 2018.

Pharmaceutical And Medical
14 18 19 18
Device Manufacturers Ⅱ
Pharmaceutical Import And Export
308 337 371 395
Company
Pharmaceutical Import And Export
26 30 31 31
Company Branch
* Pharmacy
2,156 2,234 2,450 2,649
(Pharmacy, Depot A, B)
Source: ICT Trademap; August 2022 Current Status cited in KOTRA Cambodia Pharmaceutical Market Trends (2022.9.20)
Ⅲ
o There are about 400 pharmaceutical importers, and competition is fierce. Too many products are
distributed without control, and many drugs with the same effect are on the market 29.
4) Related Organizations Work Process and Work Authority Analysis
 Pharmaceutical Registration Ⅳ
o Regarding drug registration, DDF managed drug registration through CamPORS, which was
supported and established by WHO, but due to insufficient maintenance, the drug division system
was discontinued, and currently works using the existing Pharmaceutical Registration System.
o Pharmaceutical registration process involves pharmaceutical manufacturers and importers filling

out a manual application form and submitting it offline to the DDF department. DDF inputs drug Ⅴ
29 Bureau-Point. (2021). From depharmaceuticalization to drug abundance: a social history of pharmaceutic regulations in Cambodia. Carine Baxerres; Maurice
Cassier. Understanding Drugs Markets. An Analysis of Medicines, Regulations and Pharmaceutical Systems in the Global South, Taylor & Francis, pp.94-116,
157
information to the Pharmaceutical Registration System used internally, and approval and
permission process is carried out through internal meetings.
- Due to the inefficient drug registration process, the DDF in charge of drug registration and the drug
manufacturing and importing companies are experiencing inconvenience.
[Figure 64] Cambodia Pharmaceutical Registration Process
 Distribution of Pharmaceuticals
o Pharmaceutical distribution management is generally managed with authority by CMS, and a DID
system is installed for each medical facility to manage distribution. Drug inventory information or
drug requests are entered through DIDs (HosDID, ODDID, etc.) for each facility, reviewed and re-
entered at a higher level facility, and finally comprehensively by CMS and reported to the
Cambodian Ministry of Health.
- Well-equipped public hospitals in the metropolitan area seem to be using the system and performing
tasks without major problems, but local or poor medical facilities still use paper reporting and
request methods, resulting in inefficient work and omission of some data.
158
[Figure 65] Cambodia Pharmaceutical Distribution Process
5) Current Status of Pharmaceutical Management
o The distribution structure of pharmaceuticals in Cambodia is as follows.

Ⅲ
[Figure 66] Distribution Structure of Pharmaceuticals and Medical Devices in Cambodia
Source: KOTRA Cambodia Pharmaceutical Market Trends (November 8, 2019)
o Retail distribution of drugs was regulated in the 1990s by enacting four licenses for resale of
Ⅴ
pharmaceuticals.
159
- Pharmacist licenses to open pharmacies and licenses for assistant pharmacists (Depot A) and retired
health professionals (Depot B) were issued to solve the problem of pharmacist’s shortage, and
licenses for the sale of traditional medicines were also issued.
- Officially, the list of pharmaceuticals that Depot can sell is limited, but these restrictions are not
actually observed.
- Consumers can obtain most of their medicines without a prescription at pharmacies and Depots, and
these retailers (private pharmacies, Depots, and informal retailers) are widespread and accessible.
o Similar systems that manage pharmaceutical distribution, such as Korea Pharmaceutical

Information System (KPIS), are found to be LMIS (called DID) used by CMS
6) Cambodian Pharmaceutical-Related Administrative Forms
 Pharmaceutical Registration
o Cambodian pharmaceutical registration is managed using the Pharmaceutical Registration System

used inside DDF, and related forms are downloaded from the DDF website, handwritten, and
submitted offline.
160
[Figure 67] DDF Homepage Pharmaceutical Registration Form Location
Source: Cambodia DDF website

Ⅳ
o The Cambodian Pharmaceutical Registration Administration Form is as follows.
- This form is submitted offline by Cambodian pharmaceutical manufacturers to DDF and the
relevant information is entered into the Pharmaceutical Registration System within DDF.
161
[Figure 68] Administrative Form for Pharmaceutical Registration (example)
162
 Distribution of Pharmaceuticals
o Cambodia manages pharmaceuticals using the Drugs Inventory Database (DID) system, manages
and uses a separate database for each medical facility, and the administrative forms used for each
Ⅰ
medical facility are as follows. (Details of the system are covered in the system status.)
- HosDID: Hospital Drug Inventory Database (used by National, Professional and Referral Hospitals)
[Figure 69] HosDID Product Distribution Administrative Form
[Figure 70] HosDID Product Request Administrative Form
163
[Figure 71] Additional Request Administrative Form
[Figure 72] Product Inventory Status Administrative Form
164
<Table 73> Product Inventory Status
Potential Satisfactory Over

Review Period N/A Stock Out
Stock Out Stock Stock
3 SOH >0 & AMC=0 MOS <= 0 0<MOS <1.5 1.5<MOS<6 6 < MOS Ⅰ
1 SOH >0 & AMC=0 MOS <= 0 0<MOS <0.5 0.5<MOS<3 3 < MOS
[Figure 73] Annual Estimate Administrative Form
Ⅲ
- ODDID:Operational District Drug Inventory Database (used in Operational Districts)
[Figure 74] ODDID Administrative Form 1
165
166

Ⅲ
167
168
Ⅲ
7) Drug Codes and Standardization Status
 Drug Registration Code30
o The registration code includes the serial number of applications allocated in order to confirm
submission in the registration process, and the registration code is assigned in the form of
CAMNXXXXIP-YYY upon new registration and CAMR1XXXXXXIP-YYY upon re-registration.
Ⅳ
- CAM means Cambodia.
- N means new number, and R1(R2) means first(second) re-registration.
- XXXX means the serial number of the application form.
- IP means Import Pharmaceutical, LP means Local Pharmaceutical.

Ⅴ
- YY means the year of registration (e.g., 19 means 2019).
30 https://ddf.moh.gov.kh/public/1637580331_Therapeutic%20Product%20in%20Cambodia_01%20August%202019.pdf
169
 Packaging, Labelling and Historical Tracking Regulations31
o Prakas No. 364 regulates packaging and labeling of medical products.
- DDF-critical regulatory body
- The packaging should contain the following information:
- (International name/treatment level/subsidiary and quality/ contraindications/dosages/license

number/lot number/expiration date)
- There must be an explanation and expiration date of the drug written in Khmer language inside the
package.
- Pharmaceuticals containing toxic substances must have a label "Only prescription sales" on them.
- The applicant for permission is not required to link the above printed information with electronic
information.
o Serialization
- Under the current law, there is no obligation to provide history tracking information. However, if
the applicant for permission wishes, it must be approved by the DDF or the Ministry of Health prior
to permission.
- A lot number must be included to track the batch in problem.
- For prescription pharmaceuticals, the Pharmaceutical Law stipulates that the following packaging
and labeling requirements should be met:
- Drugs must be individually packaged or packed in boxes, the names of drugs and substances must
be written, sealed during transportation, and packaged with paint and safety belts.
- External packaging may contain only the names and addresses of the shipper and the recipient and
must be sealed with the shipper's mark.
170
- Labels should provide precautions and warnings necessary for the user's safety, and instructions on
how to use the drug.
- Additional packaging and label requirements may be added at the discretion of the Ministry of Ⅰ
Health.
 Drug distribution Standard Code
o Cambodia's pharmaceutical distribution code consists of a total of 6 digits, 2 alphabetic digits, and
4 number digits.
Ⅱ
- ex) Para 250mg : AA0010
- The first two digits are assigned a code classified by disease type.
171
[Figure 82] Assign Criteria for the First Two-Digits of Cambodia Distribution Code (example)
- Next, the middle two digits are arbitrarily assigned inside the CMS according to the name of the
drug.
- Finally, the last two digits are given according to the strength of the pharmaceutical.
172
[Figure 83] Cambodian Code System (example)
o Unlike Korea, Cambodia does not follow the international standard system (GTIN-13) stipulated
by GS1, an international standard organization. Ⅱ
B. Status of the Pharmaceutical Information System
1) Status of Cambodia's Healthcare Information System
 Status of Cambodia's overall healthcare information system

Ⅲ
o Cambodia's Ministry of Health (MOH) aims to ensure the availability of high-quality health and
health-related information for policy, decision-making, planning and budget, performance
monitoring, evaluation and research. To achieve this goal, many health and medical information
systems have been installed in various departments and program areas of the Ministry of Health,
and the Department of Planning and Health and Information (DPHI) has a duty to support the
implementation of the National Health Strategy Plan (2016-2020).
Ⅳ
- Under this authority, the HIS Secretariat currently develops and manages a database of Health
Management Information System (HMIS) and Patient Management Registration System (PMRS)
to monitor the health status of Cambodian citizens. In addition to these two databases, several other
database systems are developed and managed by the Ministry of Health and other departments and
vertical programs. Some of the institutions hosting the Healthcare Management Information System
and database are listed below. Ⅴ
 DPHI: HMIS, PMRS
173
 Other MOH Departments: Department of Preventive Medicine(DPM), Communicable Disease

Control Department(CDCD), Department of Hospital Services(DHS), Department of Drug and
Food(DDF), Department of Human Resource(HRD), etc.
 National Centers/Programs: CNM, NCHADS, CENAT, NMCHC…
 National Social Security Fund (NSSF): Health – Social Protection Information System (H-
SPIS)
 Other Ministries: MOI, MOP, MOND, etc.
 Private Sector/NGOs
[Figure 84] Major Health and Medical Information System Operating in Cambodia
Source: Department of Planning and Health Information (2017), Health Information System Master Plan 2016-2020
o The ability to integrate and comprehensively analyze health-related systems and databases is
limited for a variety of reasons, including the unavailability of unique identifiers for health facilities,
patient identification codes, and lack of guidance for developing and implementing database
systems.
o In addition, there is a lack of coordination between DPHI and national programs, resulting in
inconsistencies regarding the definition of common index and the number of reporting sites.
174
 Health Management Information System(HMIS)
o HMIS is one of the essential components of strengthening the health system and is a data collection
system specifically designed to support Cambodia's ministry of Health's priority work areas, Ⅰ
healthcare activities, medical facilities and organizations in planning, management, and d ecision
making.
o The main purpose is to share the latest data, efficiency of services, reliable information necessary
for health, healthcare and planning by trusting each other, including MoH, related institutions,
entrusted hospitals, and health centers. Ⅱ
[Figure 85] HMIS Information Flowchart
Ⅴ
Source: Department of Planning and Health Information (2017), Health Information System Master Plan 2016-2020
o Data collection starts at the health center level using a daily record book for treatment, and on-site
facilities and volunteer activities such as outpatient care, prenatal care, vaccination, childbirth price,
and delivery are all recorded in the daily record book.
175
o There is one register for each medical ward, including pediatrics, obstetrics and gynecology,
surgery, pharmacy, laboratory, and record in the register the health center and hospital, date,
patient's name, gender, age, address, treatment date, hospitalization and discharge. The main
components are front-end web application-MySQL DB and DB Tables are HC1, HO2, HCP,
PMTCT, TB-MIS.
 Disease Surveillance Systems in Cambodia
o The Communicable Disease Control Department (CDCD) has established an early warning and
response system known as CamEWARN (Cambodia Early Warning and Response Network).
- CamEWARN is a case-based monitoring system dealing with seven epidemic diseases and
syndromes.
2) Pharmaceutical-Related Information Systems Status
 (Pharmaceutical Registration) CamPORS (Cambodia Pharmaceutical Online Registration)
o Cambodia's Pharmaceutical Online Registration System (CamPORS) was launched by Cambodia

Health on August 1, 2019, supported by the WHO, and issued Prakas 2387 on cosmetic reporting.
o CamPORS is a digital innovation initiative aimed at providing fast, transparent, and easy
registration of therapeutic pharmaceuticals, cosmetics, health supplements, healthcare devices,
traditional medicine and brands.
o CamPORS provides a paperless registration process that submits and evaluates all documents and
documents in digital format.
o To ensure that all medicines manufactured, imported, exported, distributed, and sold in Cambodia
have acceptable quality, safety and efficacy, it aims to provide a paperless registration process in
which all documents are submitted and evaluated in digital form.
176
o The step-by-step process checks the original document by DDF department when registration is
completed. It grant accecc to companies to apply for product registration, renewal, modification,
and other approvals. In addition, the payment for the application is made at the bank, and the
application evaluation begins when the receipt is uploaded to the portal and confirmed. Ⅰ
[Figure 86] CamPORS Step-by-Step Guide
Source: Provided by Cambodia DDF Ⅲ
o CamPORS aims to be fully implemented on April 1, 2020, and has since announced that it will not
accept submissions on paper or in formats such as CD, DVD, or USB drives.
- However, after the WHO's development project was completed, due to non-maintenance,
CamPORS is currently registering online only cosmetics.
Ⅳ
- Therefore, CamPORS is not used for pharmaceutical registration in Cambodia DDF, and is using
the existing (old) system, the “Drug Registration System”.
 Drug Registration System
o The Drug Registration System is a pharmaceutical registration system used prior to CamPORS
development, which is not an online electronic system, but only used inside DDF. Ⅴ
o According to the pharmaceutical registration form, the DDF representative enters the information
entered by the local pharmaceutical company into the Drug Registration System.
- The screen of the Drug Registration System is as below.
177
[Figure 87] Drug Registration System Screen
 (Pharmaceutical distribution) LMIS/DID (Logistics Management Information

System/Drug Inventory Database)
o The system responsible for the distribution and management of Cambodian pharmaceuticals is
LMIS. However, in Cambodia, it is called the LMIS system DID (the two systems are the same
system).
o Cambodia's logistics management information system (LMIS) for health products has been
implemented since the 1990s based on paper.
o In 1998, along with the development of the Essential Drug Bureau (EDB) supply system by the
Ministry of Health, the initial development of the Logistics Management Information System
(LMIS) was carried out as a pilot in three ODs.
178
o A nationwide study of inventory management at Health Centers (HCs), Referral Hospitals (RHs),
and Operational District (ODs) pharmacies was conducted, and a logistics management manual
was developed.
Ⅰ
o The Logistics Management Information System (LMIS) ensures the appropriate amount and
quality of logistics, and vaccines, essential medicines, and consumables meet the patient's needs as
follows.
- Accurate day-to-day management, distribution, and data capture
- Real-time, end-to-end logistics data from origin to service delivery. Ⅱ
- Consumption-based demand forecasting, capacity improvement, and modeling
[Figure 88] Cambodia Domestic Supply Chain Information and Product Flowchart
Source: Functional users and system requirements, 2017

Ⅴ
179
o Users, clients, patients, and customers receive or use goods through the logistics system (LMIS)
such as pharmaceuticals, drugs, consumables, products, materials, products and inventory items.
[Figure 89] Logistics Management and Stakeholder Mapping
Source: Functional users and system requirements, 2017
o LMIS was updated and intended to distribute it (to five provinces Phnom Penh (the Department of
Drugs and Food and Central Medical Store), Kampong Cham, Kampong Speu, Siem Reap,
Batambang) but failed due to data migration and server problems.
o The electronic system, known as the Drug Inventory Database (DID), was introduced in 2000 and
includes inventory management capabilities and key elements of the LMIS.
- The goal of the system is to computerize and enhance paper-based systems in Referral Hospitals
(RHs), ODs, PHDs and Central Medical Stores (CMSs). This ensures data input and record
improvement, minimization of paperwork, time saving, and quality of pharmaceutical management.
- In the early days of system introduction, it was implemented at regional level and expanded to cover
hospitals, PHDs and CMS between 2006 and 2008.
o The DID system is an offline system that must be installed before the user can use it, and the DID
system uses different databases on different sides of the installed system.
180
- The DID system includes the follow:
[Figure 90] DID System Classification
[Figure 91] DID System Flow
o HosDID (Hospital Drug List Database)

Ⅳ
- HosDID is a system used to manage product inventory in hospital pharmacies.
- HosDID is funded by USAID and developed by RACHA in cooperation with CMS and one of
DDF's office EDB (Essential Drugs Bureau).
- HosDID V1.0 was first developed in 2008, HosDID 2011 was developed in 2011, and the latest
version is HosDID 2014 modified to meet new requirements. Ⅴ
181
[Figure 92] HosDID System Flow
[Figure 93] HosDID System Features
182
[Figure 94] Period Request Flow
o ODDID (OD Drug List Database)

Ⅲ
- OD refers to rural hospitals and public health centers in Cambodia's healthcare system.
[Figure 95] ODDID System Features
183
[Figure 96] ODDID System Flow
o Function of LMIS/DID (Legacy)
- The National Drug Inventory Database is used by the Central Medical Store to process orders from
operating areas, provincial hospitals, and national hospitals.
- The Provincial Drug Inventory Database is designed to help local health departments review and
approve reports and request forms before sending them to the Central Medical Store for order
processing.
- The ODDID (Operational District Drug Inventory Database) is used in the operating district to
process reports and request forms from health centers and referral hospitals.
- Hospital Drug Inventory Database (HOSDID) is used in referral hospitals, provincial hospitals and
national hospitals.
o LMIS/DID differs in functions and processes assigned to DIDs used by medical facilities.
184
[Figure 97] LMIS/DID Features
185
o Since the functions provided by the LMIS/DID system are limited, there are many difficulties in
pharmaceutical distribution management in Cambodian healthcare facilities.
- As a result of investigating the areas that needs improvement in the LMIS/DID system, is as follows.
 Central Data Storage and New Methods for Data Exchange

 Electronic workflow-based approach to approval
 Data visibility tool for repository viewing (for authenticated users),
 Early warning system for imminent expiration and imminent out-of-stock
 Add PRODID and HCDID(Health Centers)functions
 Additional functions such as distribution at the facility level
o LMIS Business Architecture
[Figure 98] LMIS Business Architecture
Unique Prerequisites Option Four

Capabilities Replace DID System With Networked Custom System
MOH custom builds LMIS on a modern technology platform
Summary Description
resuing existing DID components where possible
Capabilities
Inventory Management Enhanced
Stock Retrieval Enhanced
Order Retrieval/Fulfillment Enhanced
Invoicing Enhanced
Stock Management Reporting Enhanced
Country-wide Stock Status Enhanced
Reports and Requests Import/Export Added
Requests Approvals Added
HC Level Data Visibility Added
Early Warning Added
Dispensing Added
Authentication, Account Management,
Added
and Role Based Access Controls
Basic Offline Forms Entry Capability Added
Global Inventory Views Added
Extensibility Added
Usability Added
186
o LMIS System Architecture
[Figure 99] LMIS System Architecture
Ⅲ
o LMIS Data Architecture
- Distribution stage data is managed for each level of four healthcare facilities.
- Purchasing and supply details, consumer (patient) information, etc. are managed by medical facility.
Ⅳ
- It was found that there is no inventory management DB for each type and type of drug.
- It is found that there is no DB for monitoring prices.
- It was found that there is no inventory management DB by region and by medical facility.
187
[Figure 100] LMIS Data Architecture 1
188
189
190
191
192
193
C. Comprehensive Implications for Healthcare Status
1) Pharmaceutical Distribution and Management System
o The Department of Drugs and Food (DDF) plays an overall role in drug-related matters such as
pharmaceutical management, import and export, registration, and regulation, while the Central
Medical Stores (CMS) manages pharmaceutical distribution and reporting in the public sector.
- In order to successfully carry out this project, it is necessary to form a joint project promotion system
with a key organization in charge of drugs in Cambodia's Ministry of Health.
o The Cambodian government does not control the prices of pharmaceutical and drugs provided by
the public health sector and pharmaceuticals provided by the public health is provided by the state
without any cost issues.
- However, the distribution and inventory management of medicines in medical facilities in

Cambodia’s provincial or underprivileged areas are not properly carried out, making it very difficult
for residents to access to essential medical services. Therefore, it is judged that the establishment of
a Pharmaceutical Information System through this project will greatly contribute to the universal
medical security of residents in underprivileged areas.
o The Cambodian government has various laws related to drugs such as Law of the Management of
Pharmaceuticals and Law on Drug Control, but there are no regulations or laws in terms of
pharmaceutical distribution, supply management, or reporting, mainly focusing on illegal,
counterfeit, and narcotic control.
o The Cambodian government is continuously strengthening its management by supervising and

detecting illegal and counterfeit pharmaceutical distribution, but it is difficult to manage
pharmaceuticals safely due to socio-cultural drug use at the end of distribution and supply.
- Through the establishment of a Pharmaceutical Information System, it is expected to contribute high

to the core goals of the Cambodian government through management from the stage of
manufacturing and production to the final distribution and supply end.
194
o (Pharmaceutical Registration) The pharmaceutical registration process involves the process of

submitting an item license application form offline after completing it manually, resulting in
missing information and unnecessary work.
Ⅰ
- Therefore, it is essential to establish a Pharmaceutical Information System to enable efficient
management and rapid business processing through electronic processes.
o (Pharmaceutical Distribution) The pharmaceutical distribution process has a procedure for

inputting and processing different systems for each medical facility. The vertical reporting system
causes the omission of some data, and unnecessary procedures are being made to re-enter
Ⅱ
information in high-level medical facilities.
o The Cambodian drug distribution standard code is managed by CMS itself, but it is essential to
establish a drug standard code system using the international standard as a basis for improving the
efficiency of drug logistics management and expanding data sharing and linkage in all fields of the
medical industry.
Ⅲ
2) Pharmaceutical Management System
o CamPORS, operated by DDF, is a system that submits and evaluates pharmaceuticals and
cosmetics registration in digital format, but currently not available for pharmaceutical registratio n
due to non-maintenance.
Ⅳ
- Currently, DDF is inconvenient because it manages data manually while using the existing Drug
Registration System. Therefore, it is necessary to reflect the electronical registration function in the
Pharmaceutical Management System.
- In addition, it is judged that it is essential to strengthen the capabilities of IT managers, system

managers, and operation control departments in order to prevent repeating the problem of non-
maintenance after the system is established. Ⅴ
o CMS operates LMIS/DID for pharmaceutical distribution and inventory management. However,
different DBs (DIDs) are used for each medical facility level, and each medical facility has a
195
method of transmitting data to higher-level facilities, synthesizing them, and transmitting them to
the final MOH.
- In addition, all processes are operated in a way that combines electronic and manual (TXT or Excel)
methods and integrated into higher-level medical facilities.
o The systems used by the Cambodian Ministry of Health for pharmaceutical management are too
old, and it is impossible to systematically manage pharmaceuticals due to the lack of necessary
functions.
- It is judged that it is necessary to completely rebuild the infrastructure environment due to increased
instability of aging systems.
o Considering the function, purpose, scope, and development environment of the system currently
operated in relation to pharmaceuticals in Cambodia, it is necessary to reflect properly the
Pharmaceutical Information System.
196

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5. Healthcare Environment Analysis

A. Government Organization Analysis

1) Government Organization Structure

[Figure 22] Cambodian Ministry of Health’s Organization Chart

Source: Kingdom of Cambodia Department of Planning & Health Information, 2016

2) Role and Functions of Government Organizations

[Figure 23] Cambodian Health and Medical Delivery System

B. Government Policy Analysis Ⅳ

1) National Development Plan

 National Strategic Development Plan 2019-2023

[Figure 24] The 4th “Rectangular Strategy Diagram”

<Table 25> Cambodia's Rectangular Strategy (RS Ⅲ~Ⅳ)

Agriculture Human Resource Development

Private sector development and employment

Source: ODA Korea, 2016

 Improvement of reproduction, maternal and child health and nutrition

Goal Main Content

Combating Corruption, Legislative and Judicial Reform,

Improve productivity, diversification and commercialization,

Transportation and urban infrastructure development, water resource

Strengthening the private sector, promoting investment and business,

Peace, political stability, social order promotion,

Source: ODA Korea, 2016

2) Health Sector Development Plan

 Health Strategic Plan (HSP)

[Figure 25] Strategic Areas for Health System Intervention (HSP3)

Source: Cambodia Ministry of Health, 2016a

o HSP3 has the following four specific development goals.

<Table 27> Four Development Goals of HSP 3 in Cambodia

HSP 3 Four Major Development Goals

2. Reduced mortality and prevalence from major infectious diseases

4. Establishment of a health system responsible for responding to public health needs

Source: Cambodia Ministry of Health, 2016a

<Table 28> HSP 3 Strategic Objectives in Cambodia

Intervention Area For

<Table 29> HSP 3 Strategy Objectives Cost

<Table 30> Health Workforce Development Strategy of HSP 3 in Cambodia

HSP 3 Health Workforce Development Strategy Ⅳ

Source: Cambodia Ministry of Health, 2016a

 Health Workforce Development Plan 2016-2020 in Cambodia

[Figure 26] HWDP 2016-2020’s Strategic Framework

Source: Cambodia Ministry of Health, 2016b

3) Implementation Plan for Sustainable Development Goals (SDGs)

[Figure 27] Cambodia SDGs Overall Score

Source: Dashboards, SDG Dashboards and Trends

[Figure 28] SDG Dashboards and Trends

Source: Dashboards, SDG Dashboards and Trends

C. Healthcare General Status

1) Key index of healthcare

o The current status of major health index in Cambodia is as follows.

<Table 32> Status of Major Health Index in Cambodia

2) Major causes of disease and death

[Figure 29] Proportional Mortality in Cambodia

Source: WHO Noncommunicable disease country profiles 2018

- In order to manage chronic diseases, it is necessary to increase medical accessibility of local

Source: Cambodia. http://www.healthdata.org/cambodia

3) Status of Medical Expenditures

 Medical expenditure by provider

<Table 33> Total Medical Expenditure by Provider (Unit: US$ million)

Public Provider 2012 2013 2014 2015 2016

 Government Medical Expenditure by Provider

<Table 34> Government Healthcare Expenditure by Provider (Unit: US$ million)

Provider 2012 2013 2014 2015 2016 Ⅲ