Research Site Manager: Dr Peter Annear

Once known as Krong Chaktomuk, meaning 'City of Four Faces', Phnom Penh is located at the junction of four large rivers where the Mekong flows in from the north and away toward the delta, the Tonle Sap flows in opposite directions in wet and dry seasons taking overflow from the flooded Mekong, and the Bassac breaks from the Mekong and flows south to the coast. These rivers provide potential freshwater, fish, transport, trade routes and other resources.

Phnom Penh is the commercial, political and cultural hub of Cambodia, of which it is the capital city. Located at about 11° N and 105° E it covers an area of 375 square kilometers and is home to about two million of Cambodia's population of more than 13 million. The city is known for its traditional Khmer and French influenced architecture and was considered the Pearl of Asia in the 1920s.

Phnom Penh, which lies on a river flood plane, takes its name from the Wat Phnom Daun Penh (or the Hill Temple of Grandma Penh, a wealthy widow). Wat Phnom (as it is now known) was built in 1373 to house five statues of Buddha on a purpose-made hill 27 metres (89 ft) high. The city first became the capital of Cambodia after Ponhea Yat, king of the Khmer Empire, moved the capital from Angkor Thom (at Siem Reap in the north-west) after it was captured by Siam a few years earlier. But it was not until 1866, during the reign of King Norodom I, that Phnom Penh became the permanent seat of government under French colonization.

Completely abandoned during the 1975-79 reign of the Khmer Rouge, Phnom Penh is now a rapidly growing urban centre. Showing the fruits of political stability and double digit economic growth that have characterized the country in the last decade, the city is being transformed from a relatively dilapidated colonial town to a new and rapidly modernizing city. With new offices, hotels, restaurants, bars and residential buildings springing up around the city it nonetheless retains its traditional Khmer and colonial charm. Phnom Penh is home to the Royal Palace, the National Assembly (parliament), the National Museum, the Toul Sleng Khmer Rouge Genocide Museum, the Royal University of Phnom Penh, the University of Fine Arts and other national institutions.

The French ruled over Cambodia from 1865 to 1954. From 1954 to 1970 Cambodia was an independent Constitutional Monarchy under the mercurial King Norodom Sihanouk (who abdicated the throne to become Prime Minister). A coup in 1970 put General Lon Nol into power at the head of the US-supported Khmer Republic until the isolation and collapse of his regime paved the way for the entry of the Khmer Rouge and the instigation of the 'Democratic' Kampuchea dictatorship. Vietnamese troops and Cambodian dissidents overthrew the Khmer Rouge in 1979 to establish the socialist-inclined People's Republic of Kampuchea. Reflecting reforms in the economic and political system, the PRK was re-named the State of Cambodia in 1989, opening the period of transition to a market economy. After the UN-sponsored national elections of 1993 and the reinstatement of Norodom Sihanouk as the figurehead king in a constitutional monarchy, the country was again renamed as the Royal Government of the Kingdom of Cambodia, a title which is retains today.

Today Phnom Penh is a busy and vibrant city with a strong cultural life. It is also a city of contrasts where the emerging elite is rapidly accumulating wealth from government, business and property speculation, a new middle class is starting to feel a sense of self-confidence and poverty is still widespread in urban neighbourhoods and numerous squatter settlements. As income differentiation increases with economic growth, the exclusion of the poor from many of the social facilities of the capital becomes more apparent. This is no-where more evident than in the country's health system, where public national hospitals in Phnom Penh operate largely on a user-pays basis, private medical providers are proliferating and the very poor are often excluded from services through prohibitive costs.

How are each of these communities responding to the massive changes that are both occurring in Dili and across the country? The trend towards believing that social problems can be best handled at a community level sits awkwardly in East Timor. On the one hand, many international organisations seem to stress market solutions to many of the problems in East Timor. Yet, on the other hand, from a community level the nation-state is seen to be the appropriate political structure to give shape to and regulate East Timorese society. Hence, the wide variety of social problems facing East Timor-high unemployment, domestic violence, maternal health, crime rates, literacy levels, general health care-are typically seen to be able to be solved by either the market or by the nation-state. Cutting across this however are a range of community centred and grass root approaches that work extensively from personal networks, both genealogical and geographic, or through very particular institutional processes, such as the church. This analysis will consider the role of institutional formations in that locality, both those that run specific programs that are targeted in that area, or are part of a broader program across many locations.

In many poor countries today up to three-quarters of the national cost of providing health services are paid for out-of-pocket by patients themselves. The widespread introduction of user charges for public health services—a result of structural adjustment and declining government budgets—has caused the exclusion of many poor people from the health care they need, often including a third of the population. Now, innovative and locally based strategies to break down these financial barriers are emerging in Phnom Penh and in Cambodia more broadly and in other poor countries. Dr Peter Annear has spent the last two years researching these issues and advising the Cambodian Ministry of Health on procedures to meet the health needs of the poor. Under the title of Health Equity Funding, new schemes—which pay the costs of health care for those who are pre-identified as poor—first mushroomed in Cambodia and are being taken up in other places, effectively providing free access to health care for all those living below the poverty line.

The reports, references and other materials in this database—which is a part of the Community Sustainability Project—have been prepared by Dr Annear to provide background materials and up-to-date information on these issues. The Community Sustainability Project is a global research network dedicated to providing a better understanding of the nature of community from the local to the global. Co-ordinated from the Globalism Institute at RMIT University in Melbourne, the Community Sustainability Project is a truly international activity that aims to make a difference to living more sustainably in the world today. Achieving sustainable access to health services in countries such as Cambodia is a critical part of adequately sustaining communities more broadly.

Peter Annear