ADVOCACY

As a membership organisation of NGOs, MEDiCAM considers its advocacy role as an essential one. Trying to defend values and causes that are dear to the NGO community, the association fulfilled this role through both formal and informal means. Thanks to the openness of the Ministry of Health, NGOs are invited -- through the MEDiCAM Representatives - to actively take part in most health related official venues. In a more formal way, MEDiCAM also address letters to the highest officials of the Ministry on issues considered of a particular importance. Finally MEDiCAM is also writing a Position Paper every year that is widely distributed to all health actors and major donors to the Cambodia health system. Given the excellent cooperation MEDiCAM enjoys with the MoH -- and while remaining fully independent and outspoken - MEDiCAM feels that there is currently for confrontational approaches to advocacy. On the contrary, MEDiCAM favours the most constructive advocacy approaches.

The 2001 MEDiCAM Position Paper on the Health Reform in Cambodia

Some other issues MEDiCAM raises:

• Better access to quality health care by the poor and vulnerable.

At present, access to quality health care by those-who-cannot-pay is extremely difficult if at all in Cambodia. Free cares to the poor are provided almost exclusively in NGO-supported and monitored facilities. Cases of people refused health care in pubic facilities -- including in emergency situations -- and resulting sometimes in the death of the patient are not uncommon and remain so far totally unpunished. There are a number of factors that renders the access difficult or impossible to the poor (as developed in Medicam Position Papers of 1998 and 1999); most are listed also in the advocacy points below.

• More financial autonomy /better access to budget by health managers.

Health managers in Cambodia are working in a quasi-permanent financial uncertainty. They never know when they will receive funds and how much. This renders any proper financial management impossible and hampers the entire functioning of health facilities, from the provincial and district level down to the Health Centre level. After joint and lasting advocacy actions, some concrete steps were taken by the Royal Cambodian Goverenemet to address this problem, but close monitoring will be strongly needed to ensure that remains a political statement without

• Better use of the health budget (accountability of health managers, rationalisation of the expenses)
• Better transparency in the health financing circuit.
• Transparent and cost-effective procurement of the national drug supply. Notably scrutinise the current monopoly system where the contractor makes up to 60% benefit on State and donors' funds.
• Regulation of the private sector
• Better control of the user's fee/cost recovery schemes
• For the promotion of medical ethics and professional codes of conduct.
• Setting a good rewarding policy in exchange for better services by public health staff
• Enforcement of the law, notably with regard to the criminal sale of fake drugs.

Get to your pen! ...and enter the debate!

If you have issues you wish to raise, or you wish MEDiCAM to raise for you, please, write to us NOW at medicam@bigpond.com.kh