Quality Free Health Care Remains Elusive for Poorest Cambodians

By Sun Narin, VOA Khmer

An Equity Card belonging to Om Samath, a resident of Siem Reap City’s Chreav commune, March 15, 2019. (Sun Narin/VOA Khmer)

Chreav commune, Siem Reap City – When Om Samath arrived at the provincial referral hospital last year to undergo eye surgery, she knew the operation would be performed free of charge.

Two years earlier, her family was identified as one of the poorest in the commune and issued an Equity Card, a perk of the government’s IDPoor program that grants holders access to free treatment at state-run medical facilities.

What the 53-year-old widow didn’t expect was that once the operation was performed, her inability to pay would relegate her to the status of second-class patient for the duration of her two-week recovery. She received a daily food stipend of 5,000 riel, or about $1.25, but no follow-up care.

“They didn’t change the bandage on my eye as it should have been. I noticed that they changed others’,” Samath told VOA in an interview at the small tin-sided house she shares with her daughter, son-in-law and five young grandchildren.

“If I had had money, I would have given it to them so that they would have taken proper care of me,” she added, swinging her 1-year-old granddaughter to sleep in a hammock.

Om Samath, 53, a resident of Siem Reap City’s Chreav commune, looks after her grandchildren while their parents are at work. March 15, 2019. (Sun Narin/VOA Khmer)
Om Samath, 53, a resident of Siem Reap City’s Chreav commune, looks after her grandchildren while their parents are at work. March 15, 2019. (Sun Narin/VOA Khmer)

Frustrated and confused

The IDPoor program was launched by Ministry of Planning in 2006 with the support of the German and Australian governments, which sought to simplify the process for identifying vulnerable households and targeting free health care and other services. With an initial focus on rural Cambodia, the program expanded to urban areas in 2016.

“Before the project began its work, there was no standardized, universally recognized and nationally applied procedure for recognizing poor households in Cambodia,” according to Germany’s aid agency, GIZ. “This meant that poor households were unable to assert their rights to basic social services, such as free medical treatment.”

The Cambodian government claims the IDPoor program has been a success, with more than 600,000 Equity Cards — also known as poverty cards and cards for the poor — having been distributed to households across the country, benefiting an estimated 2 million people.

But more than a decade after the program was launched, recipients and non-recipients alike remain frustrated and confused about the criteria used to allocate the cards and the benefits bestowed on their holders.

“I thought that I would be given donations of rice and other food,” said Pork Kep, who, like Samath and many other grandmothers in rural Cambodia, takes care of her grandchildren while her adult children seek employment in urban areas — or abroad.

Kep, 46, suffers from headaches, high blood pressure and gastrointestinal issues. But instead of seeking treatment at the commune health center or provincial referral hospital, she self-medicates using pills purchased from a local pharmacy. The pills cost about $3 per week — a significant expense.

Pork Kep, a resident of in Siem Reap City’s Chreav commune, was granted an Equity Card but has never used it for health care. March 15, 2019. (Sun Narin/VOA Khmer)
Pork Kep, a resident of in Siem Reap City’s Chreav commune, was granted an Equity Card but has never used it for health care. March 15, 2019. (Sun Narin/VOA Khmer)

Her confusion about the Equity Card is exacerbated by the fact that scores of NGOs have, over the years, used the IDPoor database to deliver non-medical services such as food, clean water, agricultural assistance and educational opportunities.

San Chanbunsorn, 37, received an Equity Card in 2013 and, through a program at his daughter’s school, received a 25-kilogram sack of rice and a bottle of cooking oil every three months while his daughter was a student in grades 1 through 6.

“Now, I don’t get any more because my daughter is studying in Grade 7,” he said.

‘They wear gold’

Resentment is ripest among those without Equity Cards.

“I should be given one because I am so poor. Look at my house,” said Pha Chorvoin, 34, gesturing to her a home, a crude shack constructed of wooden planks and palm fronds.

Chorvoin earns $100 per month as a cook at a local restaurant; her husband makes about $6.50 a day as a construction worker. She has two children — a 4-year-old son and 2-year-old daughter — and is pregnant with a third.

“My children often get sick,” she said, suffering from frequent fevers, coughs and headaches as a consequence of poor sanitation.

Yet despite not having an Equity Card, they receive free medical treatment at the commune health center because the staff there know that her family is poor. When she is ready to deliver her baby, Chorvoin said, “they will give me free delivery,” explaining that the service would normally cost about $15.

Pha Chorvoin’s house is located in Siem Reap City’s Chreav commune. She has not been granted an Equity Card. March 15, 2019. (Sun Narin/VOA Khmer)
Pha Chorvoin’s house is located in Siem Reap City’s Chreav commune. She has not been granted an Equity Card. March 15, 2019. (Sun Narin/VOA Khmer)

While Chorvoin does not understand why she has not received an Equity Card, she is equally uncertain about why some other have — though she has some theories.

“Some people have the card, but they wear gold,” she said. “They are not really poor.”

“I think the distribution [of cards] is not fair yet. People who are close to the authorities get the cards,” she added.

“They only give the card to people they know,” agreed Chorvoin’s sister-in-law, Touch Saray, 35, adding that her family, too, has not received a card despite their dire circumstances.

Allegations of bias

Meas Nee, an independent social and political analyst, says such grievances are commonplace, and reinforced by widespread reports of unjust Equity-Card allocation and a two-tiered health care system.

“I think there is still not equal treatment at health centers,” he said. “People who have money get treatment first and the poor get it later.”

A common complaint, Nee added, is that families most in need of free health care — impoverished, indebted and undernourished — are passed over in favor of those with allegiances to the ruling Cambodia People’s Party (CPP) and ties to local officials.

“Some people are not very poor but they still get the card,” he said. “The government must make sure that there is no political bias in this process.”

This suspicion is rooted in decades of CPP rule; at the national and local level, government services are almost always controlled by party affiliates. In the lead-up to the 2018 election, the CPP undertook a nationwide campaign to register entire households as “CPP families.”

Kong Beub, the deputy chief of Chreav commune, denied allegations of bias in the IDPoor program.

“We give them out without considering different political preferences,” he said. “We announce the names publicly and people can complain.”

According to Beub, a little over 200 families in the commune hold Equity Cards, down from about 300 in 2017.

Keo Ouly, director of the Planning Ministry’s IDPoor department, agreed that the procedure for distributing Equity Cards was fair and transparent. “We have our process,” he said.


Poverty and debt

But Kdeub Savath, 33, who helped survey poor families in Chreav commune from 2013 to 2016, said this “process” was flawed, noting that local officials never followed up with families that received Equity Cards during his time as volunteer.

Of the card, he said: “Some people don’t make use of it. Some should get it, but they don’t.” The consequences of the latter, he added, are grave. “Some villagers have land, but they owe the bank. Some get ill, and if their illness gets serious, they can’t go for treatment.”

Indeed, many residents of Chreav commune — just a short drive from the tourist-choked center of Siem Reap City — suffer from severe poverty and paralyzing debt.

Although poverty in Cambodia has fallen sharply in recent years, 4.5 million citizens teeter just above the global poverty line, according to the World Bank. “The loss of just 1,200 riel (about $0.30) per day in income would throw an estimated 3 million Cambodians back into poverty, doubling the poverty rate to 40 percent,” Neak Samsen, a Bank analyst, wrote in 2014.

Boeung Bora, director of the Chreav health center, said that more than 100 families with Equity Cards — half of all card holders in the commune — seek free treatment at his facility each month.

“Mostly children with the flu and respiratory problems, and pregnant women,” Bora said. “We treat only minor problems. If it’s a serious problem, we send them to the provincial referral hospital.”

And when an obviously destitute patient show up without an Equity Card? “We also give them free treatment,” he said.

Cambodia, Laos Agree to Withdraw Troops From Border-Dispute Zone

By Sun Narin, VOA Khmer

Cambodian Prime Minister Hun Sen, second from right, talks with his government offers as he arrives from Laos, at the airport in Phnom Penh, Cambodia, Saturday, Aug. 12, 2017. Hun Sen, who threatened Friday to use force over a border crisis with neighboring Laos, has announced less than 24 hours later that he has peacefully resolved it. (AP Photo/Heng Sinith)

Prime Minister Hun Sen on Saturday came to an agreement with his Laos counterpart Thongloun Sisoulith to withdraw troops from the border region in northern Stung Treng province where tensions have escalated in recent weeks. Continue reading “Cambodia, Laos Agree to Withdraw Troops From Border-Dispute Zone”

As N. Korea Threats Loom Large, Cambodia Joins Asean Seeking Scaling Down of Hostilities

As U.S. President Donald Trump issued a threat of war against North Korea, Cambodian Foreign Minister Prak Sokhon this week said that Asean countries had sent a “strong message” to the reclusive state expressing “grave concerns” over its nuclear weapons program. Continue reading “As N. Korea Threats Loom Large, Cambodia Joins Asean Seeking Scaling Down of Hostilities”

In Siem Reap, Villagers Hope for Cheaper Electricity

The electricity grid is seen on a road in Siem Reap, Cambodia, July 10, 2017. (Sun Narin/VOA Khmer)

Like many villagers in Siem Reap, Khun Ma seeks shade in his home to avoid the mid-afternoon heat. The 32-year-old tuk tuk driver cannot afford the high rates charged by private electricity companies in the city. Continue reading “In Siem Reap, Villagers Hope for Cheaper Electricity”

កម្ពុជា​ត្រូវ​ការ​ពេល​បន្ថែម មុន​ស្នើ​ដាក់​បញ្ចូល​ទីក្រុង​៣​ទៀត​ជា​បេតិកភណ្ឌ​ពិភពលោក

By Sun Narin, VOA Khmer

សំណង់​ផ្ទះ​ប្រវត្តិសាស្រ្ត​នៅ​ក្នុង​ក្រុង​បាត់ដំបង ខេត្តបាត់ដំបង ដែល​បន្សល់​ទុក​តាំងពី​សម័យ​អាណានិគម​បារាំង ហើយ​រដ្ឋាភិបាល​គ្រោង​នឹង​ស្នើ​សុំ​ដាក់​បញ្ចូល​ជា​បេតិកភណ្ឌ​ពិភព​លោក​របស់​អង្គការ​យូណេស្កូ។ (ស៊ុន ណារិន/VOA)

មន្ត្រី​ក្រសួង​វប្បធម៌ និង​វិចិត្រ​សិល្បៈ​ បាន​លើក​ឡើង​ថា កម្ពុជា​កំពុង​សិក្សា និង​ត្រូវ​ការ​ពេល​វេលា​បន្ថែម​ទៀត​ក្នុង​ការ​ស្រាវជ្រាវ មុន​នឹង​ដាក់​សំណើ​ទៅ​អង្គការ​យូណេស្កូ ដើម្បី​បញ្ចូល​ទីក្រុង​ចំនួន​៣ ក្នុង​ខេត្ត​៣​ផ្សេង​គ្នា រួម​មាន​ខេត្ត​បាត់ដំបង កំពត និង​ក្រចេះ ជា​ទីក្រុង​បេតិកភណ្ឌ​ពិភពលោក។ Continue reading “កម្ពុជា​ត្រូវ​ការ​ពេល​បន្ថែម មុន​ស្នើ​ដាក់​បញ្ចូល​ទីក្រុង​៣​ទៀត​ជា​បេតិកភណ្ឌ​ពិភពលោក”


By Sun Narin, VOA Khmer

លោក ព្រែង គឹមសឿន ជំទប់​ទី​២​មកពី​គណបក្ស​សង្រ្គោះជាតិ អង្គុយ​នៅ​តុ​កន្លែង​លោក​ធ្វើ​ការ​ នៅ​ក្នុង​ផ្ទះដែល​ជួល​ធ្វើ​សាលាឃុំ កាល​ពីថ្ងៃ​ទី១៣ ខែកក្កដា ឆ្នាំ២០១៧។ (ស៊ុន ណារិន/VOA)

អស់​រយៈ​ពេល​ជាង​១៥​ឆ្នាំ​មក​ហើយ ដែល​ឃុំ​ស្វាយភ្លើង​ក្នុង​ស្រុក​បារាយណ៍ ខេត្ត​កំពង់ធំ មាន​តែ​ឈ្មោះ តែ​មិន​មាន​សាលា​ឃុំ​នោះ​ទេ។ ប្រជាពលរដ្ឋ​និង​សមាជិក​ក្រុមប្រឹក្សា​ឃុំ បាន​ត្អូញត្អែរ​ថា ការ​មិន​មាន​សាលា​ឃុំ​នេះ​បាន​ធ្វើ​ឲ្យ​ប៉ះពាល់​ការងារ​ផ្តល់​សេវា​ជូន​ប្រជាពលរដ្ឋ​នា​ពេល​បច្ចុប្បន្ន​នេះ។ Continue reading “អ្នក​ភូមិ​និង​ក្រុមប្រឹក្សា​ឃុំ​នៅ​ខេត្ត​កំពង់ធំ​ត្អូញត្អែរ​រឿង​មិន​មាន​សាលា​ឃុំ​ធ្វើ​ការ”

As Battambang Closes Famous Bamboo Railway, Locals Fear Lost Income

A bamboo train railroad over a bridge passing a pond, in Battambang, on July 21, 2017. The railroad will be repaired in the upcoming months. (Sun Narin/VOA Khmer)

For nearly two decades Ngul Nguon has relied on the trade brought by tourists visiting Battambang’s bamboo railway. But his life is about to change as the famous railroad looks set to be closed as the government moves ahead with plans to refurbish the country’s railways. Continue reading “As Battambang Closes Famous Bamboo Railway, Locals Fear Lost Income”

Cambodians at New World Heritage Site Hope for Better Income, But Fear Rules

By Sun Narin, VOA Khmer

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Tourists visit Sambor Prei Kuk temple complex, Kampong Thom, Cambodia, July 13, 2017. (Sun Narin/VOA Khmer)

When Phal Mao heard recently that the Sambor Prei Kuk temple complex near her village had been listed as Cambodia’s third Unesco World Heritage site, she felt happy, and she realized the fortune’s of her community had suddenly changed. Continue reading “Cambodians at New World Heritage Site Hope for Better Income, But Fear Rules”

As Children Returned to Families From ‘Residential Centers’, Mixed Experiences Reported

By Sun Narin, VOA Khmer

Chheum Sokhoch, middle, is pictured with his father Plung Bunkhiem, 40, and his mother, Voeun Ya, 36, at their home in Krobey Riel commune, Siem Reap, Cambodia, July 13, 2017. (Sun Narin/VOA Khmer)

Wearing a long-sleeved school uniform and jeans and a satchel on his back, Chheum Sokhoch, 14, says he has lived in a residential care center in Siem Reap province for about three years. Continue reading “As Children Returned to Families From ‘Residential Centers’, Mixed Experiences Reported”

Land titles help to prevent conflict

By Sun Narin

This informal settlement in Cambodia’s capital Phnom Penh was evicted in 2006 (Photo from http://www.dandc.eu)

The Khmer Rouge ended private ownership of land and real estate in Cambodia. Its genocidal rule claimed an estimated 1.7 million lives from 1975 to 1979.

When the regime collapsed, most Cambodians were living in rural communities. Many had fled their homes, and no one wanted to settle in Phnom Penh, the capital, which was called “a ghost city”. In the acute crisis, people obviously did not worry much about formal land titles. Continue reading “Land titles help to prevent conflict”