A situational analysis to improve health systems in Cambodia

MOH departments including the Department of Hospital Services (NIPH) and the Health Systems Support Unit, WaterAid, WHO, UNICEF, and LSHTM.

Trigger: In 2015, when developing its National Health Strategic Plan 3 (HSP3), the Ministry of Health (MOH) saw an opportunity to achieve Cambodia’s national vision on quality of care by investing in WASH in health care facilities. A range of organizations recognized WASH in health care facilities as a priority and agreed to act.

What: To align WASH partner activities with MOH priorities, the Health Systems Support Unit of the National Institute of Public Health (NIPH) conducted a systems analysis. The NIPH identified existing data, policies, standards, and targets, elaborated government and partner roles and responsibilities, and identified opportunities for strengthening policies and programming. The analysis also included a detailed investigation of the government’s readiness to engage in health policy reform, taking into account the service-delivery profile of its health care facilities, the history of Cambodia’s health system reform, and a map of health donors and partners in Cambodia.


  • Baseline assessment completed. NIPH conducted an assessment of WASH conditions in 117 health facilities in five provinces to form a baseline for HSP3.
  • WASH in health care facilities included as an indicator of quality care. Targets for WASH in health care facilities are now included in the HSP3 and account for 15% of the facility score for quality of care, which is linked to performance-based financing.
  • New standards adopted. The system analysis was the impetus for new WASH in health care facilities guidelines and the inclusion of WASH practices in the curriculum for National Health Centre Manager Leadership and Management Training.
  • Monitoring completed for continuous improvements. The WASH FIT tool was contextualized and tested in four provinces and will be used to support improvements of WASH services.
  • Operational research underway. Research focusing on hygiene behavior and IPC practices during birthing is underway, led by LSHTM, NIPH, and WaterAid through the Water for Women Fund.

 Challenges and Opportunities: Systems analysis are not static activities. Because health systems change over time, methods for analysing health systems must be continually updated and refined. Updated methodologies for analyses (2015, 2017 and 2019 [planned]) continue to inform MOH and partner policy and programming activities. However, efforts to influence policy during policy reform have required flexible funds and strong coordination. Establishing a multi-stakeholder coordination mechanism with the MOH has helped align approaches, fostered open dialogue, and ensured that evidence-based actions are taken to scale.

Who: MOH departments including the Department of Hospital Services (NIPH) and the Health Systems Support Unit, WaterAid, WHO, UNICEF, and LSHTM.