Foreign Intervention Measures and the Rural Poor in Cambodia: the Question of Effectiveness?

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At a nation-level, foreign aid for health care is assumed to have beneficial consequences for every individual in the country. However, if we categorise the population into urban and rural groups and re-evaluate the impacts of these foreign aid for health care, one will realise that there is actually limited improvement in the standard of living of the local people in the rural areas. Due to uneven distribution of medical resources throughout a country, the provision of health care services to those in the remote parts of Cambodia still encounters multiple challenges. As such, the people are deprived of the basic needs of health care and they are likely to suffer from poor health. According to a study done by the Cambodia Socio-Economic Survey in 2004, it is affirmed that less than 60% of the rural poor had access to any form of health care services. This reflects that Cambodia’s public health sector still has low overall utilisation, especially in the rural areas (Lane, 2007).

The failure of making health care services more readily available to a larger population of the rural poor can be attributed to several fundamental reasons, with the most significant being monetary difficulties.

Firstly, financial barriers are the most common factor cited in preventing the rural poor from accessing health care facilities in the country. Whenever health treatment seekers make their way to public hospitals or health centres, they are expected to deal with a myriad of problems which include regular treatment fees, hiding exemption schemes and unexpected costs of receiving health care treatments (Annear, 2009). The sum of these fees can add up to an average health expenditure of 52 US dollar per capita per year, which is 15.9% of the average income generated by a rural poor adult per year. This is a considerable amount for them and in order to cope with the health care burden, some households have to turn to extreme measures like borrowing money from lenders or even selling household properties. With reference to an article published by The Lancet Publishing Group in 2002, 46% of people who had recently lost their land in Cambodia had sold it to pay for their health care expenditures. Therefore, high spending on healthcare prevents savings, retards capital growth, hinders productivity growth, and keeps income low (Bura, 2012). Inevitably, the rural poor find themselves trapped in a vicious poverty cycle due to these inescapable circumstances.

Secondly, challenging geographical issues are major constraints for people in the rural areas to access adequate health care amenities in the country. Cambodia’s rural poor live in remote villages, far isolated from any basic health care services and facilities. As such, transportation means are of huge concerns to them. Many of them have to walk more than 10 km to reach the nearest medical clinic, and many others have to travel a greater distance just to reach the nearest road out of their village (IFAD, 2011). Due to the poor infrastructure in the country, there is no public transportation system in the rural areas and there are also no plans to make one available anytime in the near future. Therefore, due to the geographical distance and lack of transportation means, many rural poor people are unable to access existing medical facilities.

Policymakers might argue that health care services are still somewhat available to the rural poor through outreach programmes conducted by non-governmental organisations (NGOs) in Cambodia. However, I feel that these initiatives are too small-scale and are unable to make significant impacts in providing adequate medical assistance to their target audience. Moreover, these outreach programmes are also limited due to difficulties like the lack of quality equipment, donor fatigue and disillusionment of humanitarian workers.

Lastly, a major deterrent to accessing health care treatment in the country is that the rural people believe that medical care is not guaranteed for the patient, even if they have managed to make the journey to the public hospitals or health centres. Due to the manpower crunch in the medical facilities, there are a limited number of patients that can be treated each day. Take the example of Center of Hope, a hospital offering free surgical services to patients. The centre only has 11 medical beds, 13 surgical beds, eight surgeons, and 70 nurses. However, on certain days, the place might be flooded with as many as 300 people, both from urban and rural areas of Cambodia, arriving to seek treatment. In this scenario, the staff will have to pick out the ten most obviously sick patients from the bunch of patients and allocate the rest into a “lottery draw”. 20 numbers are then drawn from a cardboard box to indicate the patients who will be able to seek treatment that day while the rest will be told to go back home. Therefore, such uncertainty in getting guaranteed health care treatment discourages the rural poor from actively seeking health care services.

Due to the amalgamation of the above mentioned reasons, the rural poor in Cambodia do not have access to health care facilities in the country as much as they are supposed to. Therefore, while the amount of foreign aid for health care initiatives in Cambodia has been increasing over the years, the direct benefits of higher life expectancy and decreasing infant mortality rate might not be applicable to every social group in the country, especially to those living in the rural and remote areas.

Increased Political Involvement

As it stands, it seems like the effectiveness of foreign investments and aid measures is limited to the urban areas. Considering the large amounts of money pumped into these two aspects, reaching out effectively to benefit the whole country ought to be an area of concern for policymakers.

While it may currently seem almost impossible to improve the standard of living of the rural poor in Cambodia, I believe that there might be a chance to change for the better. This is due to the increased political involvement of the rural poor people in recent years. If this political trend gains enough momentum through the next few decades, it will be able to serve as a catalyst to help boost the effectiveness of these foreign initiatives in reaching out to the rural poor people.

In 1992, the United Nations Transitional Authority in Cambodia (UNTAC) was established as part of the United Nations peacekeeping operations to supervise the administration of a free and fair election in Cambodia the following year. It was the first national election to be held in Cambodia and it signified the beginning of a historic new chapter in Cambodia’s political development. For the first time, the citizens were the ones to choose