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The views expressed in this paper/presentation are the views of the author and do not necessarily

reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the
governments they represent. ADB does not guarantee the accuracy of the data included in this paper
and accepts no responsibility for any consequence of their use. Terminology used may not necessarily
be consistent with ADB official terms.
Cambodia’s health delivery service structure

MOH

Central level
National hospital
National Program
Institutional

PHD
Intermediate level
Provincial Health Department

OD
Operational District

Peripheral level

-Referral Hospital
-Health Centers

NRIP’s coverage area 

NRIP focuses its


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

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Service delivery points under NRIP

8 government health centers


and 2 referral hospitals are
located in the vicinity of
NR56.

Entertainment establishments on NR56

Entertainment
establishments are
concentrated in Samraong
City and O’Smach (the
latter not included under
NRIP) and there were no
entertainment workers
reported in any of the
smaller communes.
There are 16 entertainment
venues in Samraong City,
and 12 in O’Smach.

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Construction camps in NRIP target areas

All construction of the


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

Market places in NRIP target areas

The map shows that at


least 6 large market
places are situated on or
in close proximity to
NR56.
These market places
could in future expand
and develop as rest
places and overnight
stays.

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Where and why do people seek services?

Gaps in service delivery
• Most  health  care  providers  identified  gaps  in  human  capital, especially  in 
adequate  technical  knowledge  and  the  absence  of  staff  and  were  concerned  of 
the additional strain that existing facilities could face once the NR56 is completed.  
• Almost  all  health  care  providers  were  concerned  with  sanitation,  re‐infection  of 
women  and  the  refusal  of  diagnosis  and  treatment of  males  in  STI  clinics 
(according to the baseline report 90% of patients are female). 
• Many  clients  on  the  other  hand  thought  that  health  centers  are  providing  good 
quality  and  affordable  care  and  the  majority  of  patients  saw  gaps  in  physical 
distance and time spent on seeking care. 
• The  health  centers  could  cope  with  a  few  extra  patients,  but  a  doubling  of 
patients  would  not  be  feasible. The  HC  chief  in  Banteay Chmar said  a  new 
building would enable better patient care there.  Another HC chief said equipment 
would need to be replaced more regularly.
• Health service providers recognize a need for further training in SRH.  This training 
should  focus  on  diagnosis,  treatment  and  possibly  include  the  importance  of 
accurate  record  keeping  for  report  writing.  Medication  supplies  need  to  be 
improved so good quality drugs are available consistently. It is not clear whether 
this  is  a  logistical  issue  which  will  improve  as  the  road  condition  improves,  or 
whether it is financial. 

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NRIP strategies and activities
• (1)  Identify  relevant  stakeholders, including  the  National  Center  for 
HIV/AIDS, Dermatology and STI Control (NCHADS); the National Maternal 
Child  Health  Center  (NMCH)  and  the  local  health  authorities.  Encourage 
their involvement in the project from the beginning. 
• (2)  Conduct  GIS  mapping in  the  target  areas  before  starting  project 
implementation  (e.g.  mapping  health  services,  entertainment 
establishments, markets, etc.)
• (3)  Conduct  baseline  assessment, including  questionnaire  on  service 
delivery among health center staff and the community
• (4) Discuss issues of service delivery with NCHADS and NMCH, and through 
regular meetings with the TWG on Mobility and HIV, Pro‐TWG on Health 
and Technical Advisory Committee on Workplace
• (5) Support NCHADS and NMCH in conducting trainings on SRH in selected 
health centers and referral hospitals

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Improving client uptake of services in CRIP/NRIP target 
areas
• (1) Knowing what services are available 
in your area – CRIP/NRIP have developed 
take home service directories and hotline 
cards; services are also promoted through 
the weekly one hour radio broadcasts 
• (2) Knowing what to expect and what 
should happen in a consultation – the 
“What to expect” tools help to promote 
consumer awareness of what individuals 
should receive during STI or VCCT 
consultations and help to dispel fears and 
misconceptions
• (3) Strengthening of referral networks 
and mechanisms – all partners identify 
relevant private, public and NGO service 
providers (if available) in their target 
areas and establish network agreements; 
services promoted at every outreach 
contact

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CRIP’s health referral strategy continues to improve 

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Coordination and Partnerships

• The use of existing agreements and collaboration with 
Provincial Heath Departments for the referral of individuals to 
health services
• NCHADS for STI, VCCT, OI/ART services; NMCH for RH/FP 
services
• Coordination with local authorities and structures for the 
delivery of targeted SRH capacity building support 
(forthcoming)

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Facilitating and limiting Factors

• The main limiting factor remains the vertical nature of health 
services/programs within the Cambodian health system
• Also limiting, is the fact that many issues recognized as gaps 
in health delivery are beyond the scope of NRIP (e.g. drug 
availability; health infrastructure strengthening; etc)

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Sustainability

• Difficult to talk about sustainability as capacity building 
support does not guarantee that SRH services will be 
strengthened in the long run
• That said, working with health care providers and local 
authorities to anticipate possible impacts of the road 
development may foster better long‐term planning for service 
needs, quality assurance and uptake facilitation

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