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A Review of Health Leadership and Management Capacity in Cambodia / [email protected] Augustine Asante, John Hall and Graham Roberts

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A Review of Health Leadership and Management Capacity in Cambodia / Hrhhub@Unsw.Edu.Au Augustine Asante, John Hall and Graham Roberts Leadership and management A REVIEW OF HEALTH LEADERSHIP AND MANAGEMENT CAPACITY IN CAMBODIA Augustine Asante, John Hall and Graham Roberts HUMAN RESOURCES FOR HEALTH KNOWLEDGE HUB www.hrhhub.unsw.edu.au Cambodia The Human Resources for Health Knowledge Hub This technical report series has been produced by the Human Resources for Health Knowledge Hub of the School AcknOwlEDGEMEnts of Public Health and Community Medicine at the University The authors would like to acknowledge David of New South Wales. Taylor (Research Assistant, UNSW) for his Hub publications report on a number of significant issues in human resources for health (HRH), currently under the contribution of drafting this report. We are also following themes: grateful for the comments and feedback from leadership and management issues, especially at Dr John Dewdney (Visiting Fellow, UNSW), Dr district level maternal, neonatal and reproductive health workforce Russell Taylor (Director, Archerfish Consulting) at the community level and Ms Gillian Biscoe (Executive Director intranational and international mobility of health workers of the Bellettes Bay Company Pty Ltd). This HRH issues in public health emergencies. profile was reviewed by Dr Ponndara Ith, a The HRH Hub welcomes your feedback and any questions you may have for its research staff. For further information former Cambodian Ministry of Health official on these topics as well as a list of the latest reports, summaries and current PhD candidate within the School and contact details of our researchers, please visit www.hrhhub.unsw.edu.au or email [email protected] of Public Health and Community Medicine of the University of New South Wales. © 2011 Human Resources for Health Knowledge Hub Published by the Human Resources for Health Knowledge Hub Suggested citation: of the School of Public Health and Community Medicine at the University Asante, A, Hall, J and Roberts, G 2011, A review of health leadership of New South Wales. and management capacity in Cambodia, Human Resources for Health Level 2, Samuels Building, School of Public Health and Community Knowledge Hub, University of New south Wales, Sydney. Medicine, Faculty of Medicine, The University of New South Wales, National Library of Australia Cataloguing-in-Publication entry Sydney, NSW, 2052, Australia Asante, Augustine. Telephone: +61 2 9385 8464 Facsimile: +61 2 9385 1104 A review of health leadership and management capacity in Cambodia / [email protected] Augustine Asante, John Hall and Graham Roberts. www.hrhhub.unsw.edu.au 9780733429620 (pbk.) Please contact us for additional copies of this publication, or send us your Health services administration--Cambodia. email address and be the first to receive copies of our latest publications Public health administration--Cambodia. in Adobe Acrobat PDF. Health services administrators--Rating of--Cambodia. Hall, John Joseph. Roberts, G. (Graham). University of New South Wales. Human Resources for Health Knowledge Hub. 362.109596 Design by Gigglemedia, Sydney, Australia. COntEnts 2 Acronyms 3 Executive summary 4 Snapshot: Cambodia 5 Introduction 6 Purpose and approach 6 Access to health care 7 Financing of the health system 7 Human resources for health 9 Health management structure 11 Number and distribution of managers 12 Competence of local managers 13 Management working environment 13 Functioning of management support systems 14 Socio-cultural context 15 Summary 16 References 18 Appendix LIst OF FIGURES 8 Figure 1. Sources of health finance, 2005 8 Figure 2. GDP per capita and health spending as a proportion of GDP, 2000–2004 10 Figure 3. Organisational and management structure of the health system in Cambodia LIst OF TABLES 11 Table 1. Distribution of health personnel and facilities by province in Cambodia, 2008 A review of health leadership and management capacity in Cambodia Augustine Asante et al. 1 AcrONYMS AIDS acquired immune deficiency syndrome AusAID Australian Agency for International Development GDP gross domestic product GTZ Deutsche Gesellschaft für Technische Zusammenarbeit (German Technical Cooperation) HIV human immunodeficiency virus HRH human resources for health MAKER Managers taking Action based on Knowledge and Effective use of Resources MDG Millennium Development Goals MoH Ministry of Health NIPH National Institute of Public Health NIS National Institute of Statistics UNDP United Nations Development Programme UNSW University of New South Wales USAID United States Agency for International Development USD$ United States dollars WHO World Health Organization WPRO Western Pacific Regional Office (WHO) A note about the use of acronyms in this publication Acronyms are used in both the singular and the plural, e.g. MDG (singular) and MDGs (plural). Acronyms are also used throughout the references and citations to shorten some organisations with long names. A review of health leadership and management capacity in Cambodia Augustine Asante et al. 2 EXECUTIVE SUMMARY This review describes the current situation of health leadership and consumables as well as budget supplements for staff and management capacity in Cambodia. Cambodia has made incentives and operating expenses. Finally, in the Government tremendous efforts to rebuild its health system following years Model, management and service delivery responsibilities rest of conflict that decimated the country’s health infrastructure. with government district health management teams. The introduction of health sector reforms in the 1990s has The actual number of managers and management support seen the health status of the population improve markedly personnel in the Cambodian health system could not be with life expectancy at birth raised from 49.7 years in 1990 to established in this review. However, with 76 operational 62.2 years in 2010. Infant mortality has fallen to 69 per 1,000 districts and each a district health management team of about live births in 2008 from 97 per 1,000 in 2003. The proportion five or six members, it is estimated that between 380 and of the population with access to an improved water source 456 middle managers and management support personnel has increased from 30% in 2000 to 61% in 2008. work at the operational district level although some remote districts may have fewer team members. The majority of the Despite these achievements, the Cambodian health system district level managers appear to have clinical backgrounds still faces serious challenges. Maternal mortality, for example, as medical doctors, nurses or midwives. The Cambodian appears to have worsened slightly with the ratio deteriorating National Institute of Public Health with support from GTZ1 has from 440 per 100,000 live births in 1985–2003 to 460 per been providing management training for district managers to 100,000 in 2005–2009. improve their managerial capacity and performance. To enhance sustainable development of the health sector, The working environment of district managers has reportedly the Ministry of Health has developed a Health Strategic Plan improved significantly following the development of the 1996 2008–2015, which identifies three priority areas – reduce Health Coverage Plan and Guidelines for Operational Health newborn, child and maternal morbidity and mortality with Districts have provided district managers with some sense increased reproductive health; reduce morbidity and mortality of direction in terms of planning. However, the legislative of HIV/AIDS, malaria, tuberculosis, and other communicable environment remains restrictive with middle managers having diseases; and reduce the burden of non-communicable limited influence on human resource management practices. diseases and other health problems. Overall, human resource planning and personnel The Ministry of Health (MoH) recognises the need to management are not aligned with health sector planning scale-up service delivery at the operational district level in and the Health Coverage Plan; there are no human resource order to achieve these goals. It also acknowledges the crucial policies to support staff deployment in underserved role that strong management and leadership capacity and areas; and financial flows are not aligned with managerial performance play in scaling-up service delivery. authority and with accountability for outcomes. Additionally, no effective system of supportive supervision for district WHO estimates that about 4,300 doctors and 14,800 managers exists and key management support systems nurses worked in Cambodia around 2007 with the MoH such as the health information management system do not alone employing over 15,000 staff. Although the size of function adequately to enhance district management. the workforce appears small in relation to the population, compared to similar developing countries, Cambodia’s While the Cambodian MoH has developed strategies to health workforce density is higher than that of about 30 address these and other issues confronting the health system low- and middle- income countries. in the second Health Strategic Plan 2008–2015, the key challenge remains implementation of the plan, particularly, Management structures and responsibilities within the health the capacity of the MoH to monitor and evaluate progress and sector differ in accordance with the different health service impact on health outcomes. delivery models in Cambodia. In the Contracting-out Model, contractors have complete management responsibility for services that have been contracted to them, including hiring and firing of staff and setting of wages.
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