Cambodia’s economy has grown rapidly in the past decade, which has resulted in increased spending to improve health care in the Southeast Asian country.
The government is committed to offering universal health coverage for all of its citizens by 2030. (Currently, 60% of Cambodians have no form of health insurance.) Other goals include strengthening efforts to control infectious diseases such as hepatitis C and malaria and managing the growing burden of non-communicable diseases like diabetes and hypertension.
The country was also ill-prepared to deal with Covid-19, and now realizes that its ability to get ready for and respond to future pandemics needs to be built up with stronger planning, budgeting, and management of disease surveillance, laboratories, and countermeasures like protective equipment, testing, drugs, and vaccines.
Cambodia faces a major challenge in realizing these initiatives, however, due to a lack of personnel trained in health policy analysis, health economics, and financing.
“The big economic questions for a country like Cambodia are how much money do we need to spend to improve the health programs and the health conditions of the population?” said Robert Hecht, BA ’76, professor of epidemiology (microbial diseases) at the Yale School of Public Health (YSPH). “How do we figure out how to set priorities and where to begin? For Cambodia, the national health budget and what's available to spend don’t come close to what they would like to have to accomplish all of their goals.”
To address these gaps, Hecht is collaborating with colleagues at Cambodia’s National Institute of Public Health (NIPH) to establish a Master of Public Health in Health Economics and Financing (MPH-HEF) program. Hecht and Dr. Chhea Chhorvann, MD, director of the NIPH, and dean of the School of Public Health in Cambodia, are co-leading the project.
Defining Cambodia’s Challenges
“Health economics is all about making smart choices that will get the most bang for the buck and save the most lives with the limited funding available,” said Hecht. “One of the big challenges for the government is how to reach everybody with an insurance scheme that protects them, so they don't have to pay a lot of money out-of-pocket when they need health care.”
Cambodia also seeks to reduce its dependence on outside organizations and institutions that are currently helping them finance child vaccination programs and efforts to combat tuberculosis and HIV.
“Outside funders are going to be reducing their financial support in the coming years as Cambodia gets richer and is in a better position to pay for these things on its own,” Hecht said. “We want to achieve a smooth handover from these outside donor organizations to government funding so that these very important services don't go downhill when the outside money finishes.”
Another priority is to keep the supply chain running efficiently to avoid overstocking or understocking vaccines, essential medicines, and diagnostic tests. “From a financing point of view, they want to make sure that they forecast how much they need and that they're in a position to order and pay for these commodities in a timely way,” Hecht said.
Enrolling the First Students
The first phase of the partnership was made possible in 2023, when Hecht received a $38,000 Kempf Award and Faculty Research Grant from the Whitney and Betty MacMillan Center for International and Area Studies at Yale to design the curriculum. Hecht and his Cambodian collaborators have since raised an additional $350,000 from the China Medical Board and are actively seeking more funds.
The first students are currently enrolling in the two-year degree program and are expected to graduate in 2026. Classes will be taught by faculty from Yale as well as faculty from schools of public health in Singapore and Hong Kong. “We are working with some of the leading organizations in Asia,” Hecht said. “I think this is a really notable feature of what we’re trying to do.”
Most of the students are health care professionals, such as doctors, nurses, pharmacists, and lab technicians, and are already working in government or with private organizations. “These are early career or mid-career professionals who want to shift into health economics and financing or want to use these new skills in economics in their current jobs,” Hecht said. “Given how Cambodia is changing, there should be ample opportunities for employment at the other end of the pipeline.”
On a recent visit to Cambodia, Hecht and Chhorvann met with representatives from the Ministry of Health and the World Bank, the latter of which is involved in mother and child nutrition programs to try to reduce the number of malnourished babies and mothers in the country.
Hecht pointed out that YSPH’s involvement will be temporary. “The idea behind this is not that Yale faculty continue to teach and run this program forever,” he said. “We will play a big role over the first three years, but then we will phase down in years four and five and will hand over the primary teaching and mentoring to our Cambodian faculty colleagues. We want them to be self-sufficient, and we're there as a catalyst to help them get there and build up their ability to run this thing as quickly as possible.”
Chhorvann said the collaboration has been very responsive to the needs of the NIPH. “Yale University has been playing a critical role in supporting NIPH on all fronts,” Chhorvann said. He noted that the collaborative model was unique in that it leveraged existing connections between Hetch and his Cambodian colleagues that were formed during Hecht’s prior work in Cambodia.