Cambodia successfully achieved most of the Millennium Development Goal (MDG) health targets and is now actively working towards achievement of the Sustainable Development Goal (SDG) 3 health targets to ensure healthy lives and promote wellbeing for all at all ages. [1-3] This calls for a transformation in the way knowledge is produced and applied, with greater domestic production of research and multisectoral collaboration. This builds on and contrasts with the MDG experience where development programmes were often guided by research and evidence from outside Cambodia with strong influence by external partners.
There is a nascent research culture on health systems and multisectoral collaboration in Cambodia but relatively low levels of utilization of research for policy and practice. There is scope to both build the capacity of research institutions to engage in multisectoral research, and the involvement and understanding of policymakers, implementers and communities bridging different sectors. Increasing the relevance and use of research outputs needs policy-makers, implementers and communities (including patients and caregivers) to be embedded throughout the research process. Engaging stakeholders in the research process can increase the understanding, motivation and ownership of these stakeholders for both undertaking and applying research. [4-6] At the same time, the policy development process needs to be more receptive to research input. Beyond these linked endeavours, the more fundamental question is what model of research and collaboration is most likely to contribute to the production and utilization of knowledge that genuinely contributes to overcoming multisectoral development challenges to achieve the SDGs?
Cambodia now has an increasing number of multisectoral bodies and institutions explicitly tasked with overseeing the development and implementation of policy across different sectors. For example, the General Secretariat of the National Social Protection Council is actively involved in research on social protection, including on mechanisms to move towards universal health coverage in Cambodia. The Ministry of Planning coordinates the overall monitoring of the Cambodia SDGs, and there is scope to integrate necessary and related research with this function. The Ministry of Health coordinates an interministerial group to support the implementation of the Multisectoral Action Plan for the Prevention and Control of Non-Communicable Diseases 2018-2027, and there is a similar group to support the Multisectoral Action Plan on Antimicrobial Resistance 2019-2023. But there remains much to do to increase the understanding of senior policy-makers in these governmental bodies on the use of research, let alone increase their appetite to be part of the research process and co-produce knowledge.
The University of Health Sciences (UHS) and the National Institute of Public Health (NIPH) are both major research institutions with experience in research on multisectoral health issues such as antimicrobial resistance and noncommunicable diseases. They are led by senior researchers who are often consulted by senior policy-makers. NIPH is the home of the National Ethics Committee for Health Research and a health policy and systems research unit with a mandated role in health research coordination. It has mobilized resources and experts to develop a draft health system research agenda and a health research database for monitoring and evaluation. There are also existing initiatives in Cambodia involving research to build new models for noncommunicable disease service delivery and to strengthen antimicrobial stewardship in health facilities, some of which directly engage patient and community perspectives and involvement. Lessons from these existing activities in health sector research can be applied to the more challenging task of research collaboration between sectors.
The Cambodia context is marked by rapidly maturing research institutions, social and economic progress, a commitment to the SDG goals with targets customized to the country’s situation, and existing multisectoral policy mechanisms. Cambodia’s research institutions also already play a role in policy-making due to their leaderships’ participation in relevant policy processes. These present an important opportunity to build a collaborative research culture to inform policy-making for the SDGs, including SDG 3.
Yet significant challenges remain. While there is a strong cadre of health research leaders, more remains to be done to build the capacity of a community of researchers with funding to expand the portfolio of research, and to expand institutional processes to facilitate research input into policy development. Currently, both NIPH and UHS have multiple demands on their time and can only undertake a proportion of the potential research activities which are proposed, or even funded. Understanding about the importance of multisectoral governance and how research can assist both governance and multisectoral implementation is not well developed. The capacity to translate research from other countries into the Cambodian context also requires strengthening. This has been seen during the covid-19 pandemic with numerous instances where uncertainties about evidence at the global level have presented difficulties in implementation across sectors in Cambodia.
To take advantage of these opportunities and overcome the challenges identified above, three key enablers are required to build a more collaborative and multisectoral research culture in Cambodia. First, there is a need for more support from high level leaders in the country to encourage greater engagement between sectors and with researchers on policy and implementation. This should also include linking research production to the enterprise sector early in the process to promote innovation and subsequent utilization. Second, development partners can play a greater role in providing “joined-up” support for the major development challenges that are the focus of the SDGs such as health in SDG 3, including multisectoral financing, and explicit budget lines and technical assistance for policy and implementation research, with a specific focus on building the capacity of emerging researchers to undertake “embedded” and policy-relevant research. Third, there is scope to expand the involvement of patients, caregivers and communities in the production of knowledge to solve multisectoral health problems. In all of these enabling domains, there have been recent signs of encouragement, including the establishment of the new Ministry of Industry, Science, Technology and Innovation that will provide science and research stewardship. The time is ripe to expand these supports, even more given the challenges that the covid-19 pandemic poses for Cambodia in terms of health, social and economic impacts, to build a collaborative research culture to enable multisectoral policy and implementation in Cambodia.
Kumanan Rasanathan is a public health physician based in Phnom Penh, Cambodia.
Chhorvann Chea is the director of the National Institute of Public Health in Phnom Penh, Cambodia.
Por Ir is the deputy director of the National Institute of Public Health in Phnom Penh, Cambodia.
Vonthanak Saphonn is the rector of University of Health Sciences in Phnom Penh, Cambodia.
Sreytouch Vong is policy manager at FHI360 in Phnom Penh, Cambodia. First published in thebmjopinion