title: Managing non-communicable diseases at health district level in Cambodia: a systems analysis and suggestions for improvement.
abstract: BACKGROUND
  Cambodia developed its public health system along the principles of the district model and geared its services towards managing communicable diseases and maternal and child health issues. In line with other countries in the region, non-communicable diseases have emerged as a leading cause of adult mortality. We assessed the current capacity of the Cambodian district health system to manage hypertension and diabetes, with a focus on access to medicine for these chronic conditions.
  
  
  METHODS
  A case study whereby in three purposely selected districts in an equal number of provinces a total of 74 informants were interviewed: 27 health care providers and administrators, 30 community representatives and 17 managers of specific non-communicable diseases interventions and social health protection schemes. Questions related to the World Health Organization's health system building blocks. Data analysis involved coding, indexing, charting and mapping the data. Following these exercises all information was analysed by kind of respondent and their respective answer to the question concerned. Responses by respondents of three groups of interviewees were compared when appropriate. At 14 health centres and 3 district hospitals the availability of key medicines for hypertension and diabetes in accordance with the National Essential Drug List was assessed. This was also done for essential tools and equipment to diagnose these two conditions.
  
  
  RESULTS
  Although there was agreement amongst nearly all interviewees that non-communicable diseases were prevalent, the district health system, including all health systems building blocks and the referral system, was inadequately developed to effectively deal with these conditions. Medicines supply was erratic and the quantity provided allowed for few patients to be treated, for a short period only, mainly at secondary or tertiary level.
  
  
  CONCLUSIONS
  Because of the public health, social and economic importance of non-communicable diseases, a rapid response is required. Given the current Cambodian situation, such response may initially be a diagonal approach, with non-communicable diseases services integrated in the National HIV/AIDS Programme. This should happen together with a reorientation of the health system to enable a horizontal approach to non-communicable diseases management in the long term.
authors.affiliation: Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), c/o NIPH, No.2, Street 289, Khan Toul Kork, P.O. Box 1238, Phnom Penh, Cambodia. bart.jacobs@giz.de.
authors.forename: Bart
authors.initials: B
authors.lastname: Jacobs
authors.affiliation: School of Population Health, The University of Queensland, Herston Road, Herston, 4006, Brisbane, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Hill
authors.affiliation: Alliance for Health Policy and Systems Research (HSR/HIS), World Health Organization, 20 Avenue Appia CH-1211, Geneva 27, Switzerland.
authors.forename: Maryam
authors.initials: M
authors.lastname: Bigdeli
authors.affiliation: Chean & Jaco Consulting Ltd, Street, #457 Group 1, Thnout Chrum Village, Sangkat Beung Tumpoun, Khan Meanchey, Phnom Penh, Cambodia.
authors.forename: Cheanrithy
authors.initials: C
authors.lastname: Men
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000600:supply & distribution; D002160:Cambodia; D002648:Child; D002908:Chronic Disease; D003153:Community Health Services / Q000592:standards*; D003920:Diabetes Mellitus / Q000628:therapy*; D006282:Health Personnel / Q000592:standards; D006304:Health Status; D006767:Hospitals, District / Q000458:organization & administration / Q000592:standards / Q000600:supply & distribution; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D007004:Hypoglycemic Agents / Q000600:supply & distribution; D008297:Male; D011634:Public Health / Q000592:standards; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D013597:Systems Analysis; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents
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