Facts and Figures

Cambodia is located in south east Asia and borders Thailand in the west and north west, Vietnam in the east and Lao PDR in the north east. Cambodia’s south westerly coast runs along the Gulf of Thailand.

Cambodia’s land area covers around 181,000 square kilometres of which only 21% is cultivated (the majority of this is located along the Mekong River).

Despite Cambodia being one of the most densely forested countries in the region - with more than half of its land area covered by forests - resources are rapidly depleting due to poorly managed mining, logging and hunting activities.

Cambodia’s capital city, Phnom Penh, is located inland in the south east of the country. Cambodia has an estimated population of 13.8 million with a projected annual growth rate of 1.9% to 2015.   

While the population density is low around 90% of Cambodia’s population live in the central lowlands region. Many younger people are now beginning to move to urban areas, which is in turn increasing pressure on urban facilities. Approximately 60% of Cambodia's population is literate.

Approximately 16% of the population live in urban areas and the common language is Khmer. The ethnic composition of Cambodia is Khmer (90%), Vietnamese (5%), Chinese (1%) and other (4%). Approximately 95% of the population are Buddhist.

Provinces

Administratively Cambodia is divided into 21 provinces and 3 municipalities, including
the capital of Phnom Penh.

The Fred Hollows Foundation currently works in the provinces of Kampong Chhnang, Kampong Thom, Kampong Speu, Prey Veng and Kandal, as well Phnom Penh.

Political History

Cambodia’s history of internal conflict has devastated the country’s economy and scarred its people. After more than a century of French rule Cambodia gained independence in 1954.

The country then suffered internal conflict in the late 1960s, which was further exacerbated
by the war in Vietnam. With growing support from the rural population, a pro-military coup was staged in 1970.

This was followed by years of civil war resulting in another coup in 1975 when the notorious Khmer Rouge (under the leadership of Pol Pot) took control of the country.

During the next four years, the Cambodian people suffered terrible atrocities at the hands of the Khmer Rouge. Nearly three million people died from starvation, disease or execution as a result of the regime.

Within weeks of taking power the Khmer Rouge had forcibly relocated the population of Phnom Penh and other urban areas into the countryside of Cambodia.  As a result of the regime, all national infrastructures were dismantled, currency was abolished and the country was renamed Democratic Kampuchea.

In early 1979, Vietnamese military forces entered Phnom Penh, defeated the Khmer Rouge and installed the People’s Republic of Kampuchea. The Khmer Rouge continued its insurgent activities over the next decade throughout Cambodia.

In 1989 the country’s name was returned to the State of Cambodia and Vietnam withdrew
its troops in response to international pressure. Democratic elections were held in 1993 and
the Kingdom of Cambodia was again proclaimed a constitutional monarchy. 

Since 1993 Cambodia has been relatively peaceful, however political instability continued to affect economic development in the late 1990s.

In 2003, Cambodia’s third national elections were held, resulting in a 'power-sharing' between the ruling Cambodian People’s Party and the Royalist Party (United Front for an Independent, Neutral, Peaceful and Cooperative Cambodia).  

King Norodom Sihamoni is the Head of State but does not have executive power over the kingdom. H.E Samdech Hun Sen remains the Prime Minister after being first appointed in 1985 and being re-elected in 1998 and 2003.  

Economy

Cambodia is one of the poorest countries in the world. In 2004, the Gross Domestic Product (GDP) per capita was US$354 compared to US$550 in Vietnam and US$2,539 in Thailand. Approximately 30% of the Cambodian population live on or below the poverty line. 

Cambodia’s manufacturing, transport and social infrastructure has deteriorated from decades
of civil war and from the direct actions of the Khmer Rouge between 1975 and 1979. The economy grew a little in the late 1980s and early 1990s, however, subsequent internal conflict caused it to slow again. 
 
Since 2000 the World Bank, the International Monetary Fund, the United Nations and several international donors have been providing assistance to the Cambodian Government to help turn the economy around. An estimated 90% of all public investment in Cambodia is funded by international donations.

Most people in Cambodia are engaged in subsistence agriculture. Although the agricultural industry accounts for around 40% of the country’s GDP and more than 70% of the workforce is employed in the sector the growth rate is now slowing. At the same time, employment is increasing in other industries, such as garment manufacturing and tourism.

Sources: Cambodia Government, DFAT, Human Development Report 2006, National Institure of Statistics, SBS World Guide, UNDP, World Health Organization

Population: 13.8 million
Urban population: 16%
Life expectancy: 56.5 years
Literacy rate: 73.6%
Percentage of population living on less than $2 a day:  77.7%
Infant mortality rate (per 1,000 births): 97
Percentage of population which is undernourished: 33%
Number of doctors (per 100,000 people): 16

The health status of Cambodia’s population is very poor and amongst the lowest in Asia. In 2004, life expectancy at birth was just 56.5 years compared with 70 years in neighbouring Vietnam and Thailand. 

In 2004 the infant mortality rate was 97 deaths per 1,000 live births, which is three times the average rate for the east asia and pacific region.

Widespread poverty, inadequate health services and poor sanitation has taken its toll on Cambodia’s people. The main causes of death are currently malaria, acute respiratory infections, road accidents, tuberculosis and meningitis.

Dengue fever, diarrhoea and malnutrition are also significant causes of death and sickness, particularly amongst children. Around 50% of children aged 3 to 5 years also have stunted growth due to chronic malnutrition and around 1 in 8 Cambodian children will die before the age of five years old.

The health services of Cambodia were decimated during the 1970s, during the Khmer Rouge’s regime. In 1979 there were only 50 doctors left in the country.

Another sinister legacy from the decades of conflict is the estimated 4-6 million unexploded landmines which still exist in Cambodia. As a result, Cambodia has the highest rate of amputations due to landmine injury in the world at one amputee per 236 persons. 
 
In the 1990s the Cambodian Government set about to reform and re-establish the infrastructure of its health system, particularly at the primary health care level. In 2004, spending on health equated to 2.1% of the country’s GDP.

The Cambodian Ministry of Health’s (MoH) priorities for developing its health system include:

• Improving the coverage and access to health services, particularly for the poor
• Strengthening the quality of care especially in obstetric and paediatric care
• Increasing funding for health services

Sources: Cambodian Ministry of Planning, Human Development Report 2006, National Institure of Statistics, UNDP, World Health Organization (WHO).

Number of blind people: 166,577
National blindness prevalence: 1.2%
Main causes of blindness: Cataract (65%), uncorrected refractive error, glaucoma, corneal scarring and pterygium.
Number of people with cataract blindness (backlog and annual incidence): 108,275
backlog cases and an annual incidence of 20,436 cases
Number of cataract operations performed annually: 11,835 (2006)
Reasons for low cataract surgical rates and backlog:  Limited awareness, lack of access to eye care services, cost of surgery, shortage of human resources and poor infrastructure
Percentage of blind population with uncorrected refractive error: 10%
Percentage of blind population with glaucoma: 8%
Percentage of blind population with corneal scarring: 5%
Percentage of blind population with childhood blindness: 6-7%

While the number of cataract operations performed each year has increased from 500 in 1992 to
approximately 11,835 in 2006, there still remains a large and growing number of people affected by cataract blindness.

A Rapid Assessment of Avoidable Blindness survey will be undertaken, with the support of The Foundation, in October 2007 to obtain more accurate data on the prevalence and main causes of blindness in Cambodia.

One of the major barriers to eye health services in Cambodia is the cost of cataract surgery, which ranges from US$150 - $500 in a private facility compared to US$20 - $80 in a public hospital. This cost is very prohibitive to most of Cambodia’s population who live on incomes of less than US$5 per month.

The ability for remote populations to travel to a health facility for treatment is also often difficult due to the cost of transport and the time required away from their employment. People are also often not aware that the majority of blindness is treatable or that eye health services are available in parts of Cambodia.

Human Resources

Eye health personnel in Cambodia includes:

• Local ophthalmologists: 8
• Basic eye doctors: 25
• Eye doctors: 15
• Ophthalmic nurses: 86
• Refractionists: 15
  

The ophthalmic community in Cambodia is new and emerging. In 2001 there were just
two trained local ophthalmologists (excluding expatriates) and 14 Basic Eye Doctors (BEDs), who have not undertaken full ophthalmic training but can perform cataract surgery. In 2006, there are just eight trained local ophthalmologists and 25 BEDs. 

Clearly there is a need to increase the number of ophthalmologists working in public health care in Cambodia. ViISION 2020 states that for every one million people, there should be four ophthalmologists. This equates to the need for 55 ophthalmologists in Cambodia.

A significant challenge for human resource development in Cambodia is the recruitment and retention of personnel in the rural areas of Cambodia, where the majority of the population live.

Eye Health Infrastructure

The current health system in Cambodia is structured into the three levels of central (tertiary health care), provincial (secondary health care) and operational districts (primary health care).

At the central tertiary level, the National Ang Doung Hospital in Phnom Penh is the highest referral hospital for complex cases. The hospital has approximately 40 beds and has a separate ward for higher fee paying patients.

The hospital’s eye department is staffed by four ophthalmologists, 11 eye doctors and 21 ophthalmic support personnel. There are personnel with specialist expertise in paediatric eye care and retina services.

Courses for training of trainers in primary eye care (PEC) are conducted at the Ang Doung Hospital. An Information Resource Centre is available for all local eye health personnel and students to access current ophthalmic journals and publications.

At the provincial or secondary level, there are three eye units in Phnom Penh and 16 eye units located in various provinces throughout Cambodia. In general, eye units are staffed by at least one Basic Eye Doctor and two Basic Eye Nurses. The number of beds at eye units can vary from 5-20 and an eye unit may not always have its own operating theatre (operations are instead performed in an operating theatre shared by all hospital departments).

The standard of infrastructure and equipment at eye units is variable. Eye units do not always meet with hygiene or hospital design construction standards. Furthermore, eye units are not always adequately equipped to perform cataract surgery and to treat common eye problems such as glaucoma, corneal scarring and refractive error.

At the primary level, eye care services are delivered through district health centres as well as through the village health volunteers (VHVs) network. Where training in PEC has been delivered at the primary level, health centre staff and VHVs are able to identify common eye diseases, treat minor eye problems and refer complex cases upwards in the health system.

PEC services also involve assistance with outreach patient screening campaigns and with post-operative care for patients who have returned to their village after surgery.

Eye Health Planning and Coordination

While Cambodia suffers from inadequate health facilities and resources, it is unique in having a well coordinated national program which exists to help improve the eye health of its population and to prevent further blindness. 

Established in 1994 by the Ministry of Health, the National Sub Committee for the Prevention of Blindness (now called the National Program for Eye Health) is responsible for developing and implementing a ‘National Eye Care Action Plan’ to assist in coordinating all eye care activities in Cambodia. 

The National Program for Eye Health (NPEH) works closely with non-government organisations (NGOs) to ensure that programs address national priorities and to avoid duplication of NGO activities.

It does this through an Eye Health International NGO Forum which identifies specific objectives within the national plan and tasks these to relevant NGOs. Each NGO program essentially stands alone and is distinct in its geographical location, but all programs contribute substantially to the national goals for eye care.

The primary priorities for Cambodia’s NPEH include the development of human resources, infrastructure and appropriate technology, resource mobilisation and strategies for disease control.

In 2003 the NPEH revised its five year plan and released a new 2003-2007 National Eye Care Action Plan. The treatment and prevention of cataract blindness remains a priority of the plan and a minimum target of 300 operations per annum has been set for each of the 16 provincial eye units. A mid-term review of the current five year national plan was undertaken in 2006.

A Prevention of Blindness (PBL) meeting is held every two months in Phnom Penh with the participation of MoH, NPEH, WHO and eye health NGOs. PBL meetings are held to discuss the planning, management and development of the eye care sector in Cambodia.

The NPEH monitors and evaluates PBL activities at both national and provincial levels.

Sources: DFAT, VISION 2020