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Opinion: Closing Cambodia’s Health Gap: A Lifeline for Women and People with Disabilities
- Apr 3
- 6 min read
Junior Research Fellow
Future Forum's junior research fellow, Vandeth Ngoun was published in The Cambodianess on April 3rd, 2026. Check out the original article HERE, and read it below!
Cambodia has made impressive strides over the past two decades—cutting poverty and helping people live longer, healthier lives. But as the country looks ahead to becoming a higher-income nation by 2050, one stubborn gap remains: making sure everyone benefits equally from that progress. Expanding access to healthcare, especially for the most vulnerable, will be critical to turning economic gains into real improvements in people’s lives.
Right now, important gaps persist—particularly for women and people with disabilities. This commentary argues that Cambodia can close that gap by putting the “Zone for the Development of the Informal Economy” into action in a more targeted way. The idea is to focus on self-employed women and people with disabilities, linking them to a digitally integrated system of social health protection.
A few practical shifts could make a big difference. Removing means-testing for those with moderate or severe disabilities would eliminate a major barrier to care. At the same time, introducing a phased subsidy for self-employed women would make it easier for them to stay covered. Together, these steps could turn a complex, paperwork-heavy system into something much simpler—an automatic pathway to universal healthcare.
This isn’t just a technical fix. It’s about making sure that women and people with disabilities—many of whom work in the informal sector—are no longer left on the margins as Cambodia continues to grow.
Structural Informality and Gendered Risk
Informality is the dominant condition of the Cambodian labour market, with 88.3 per cent of the total workforce operating outside formal legal and social protection frameworks. In this landscape, women are disproportionately vulnerable, as they constitute 87.6 per cent of the informal workforce and over three-quarters of the labour in the garment subsector, yet often remain classified as “contributing family workers” without independent health security.
The households with persons with disabilities in the informal sector are twice as likely to experience catastrophic health expenditures compared to those without, yet the current targeting systems, like the ID Poor Card, do not fully account for the extra costs of living with a disability.
This policy issue is compounded by a severe lack of awareness: nearly two-thirds of informal workers are unaware of the National Social Security Fund (NSSF) or their potential eligibility for healthcare benefits. Furthermore, women shoulder the bulk of unpaid care work, which limits their ability to pursue rigid formal employment and forces them into precarious informal roles with no safety nets.
Creating the Social Protection Bridge
The core of this proposal is to establish a clear pathway for strengthening access to healthcare, specifically for two distinctly vulnerable groups: women employed in the informal sector and persons with disabilities. This can be done within the "Zone for the Development of the Informal Economy" as envisioned in the National Strategy for Informal Economy Development (NSIED). There are three components that will achieve this goal.
First, the government must automate Health Equity Fund (HEF) coverage for all citizens with a Disability ID Card who are assessed as having moderate or severe levels of disability. This move effectively transforms the disability card into a direct entitlement, bypassing the delays and potential inaccuracies inherent in the current proxy-means test system for IDPoor. This will support all people with moderate or severe disabilities in directly accessing the healthcare that they need.
Second, the Ministry of Labour and Vocational Training (MLVT) should implement a targeted NSSF contribution holiday for self-employed women in priority sectors such as handicrafts and food services. This "holiday" would waive service fees and contributions for a fixed five-year period, allowing women to access formal healthcare while their micro-enterprises grow.
Third, the solution involves the comprehensive integration of rehabilitation services, such as hearing and visual aids, directly into the NSSF and HEF benefit packages to ensure a continuum of care that aligns with the population's actual needs.
Short, Medium, and Long-Term Action
The implementation process will be led by the Ministry of Industry, Science, Technology and Innovation (MISTI), which will act as the executive coordinator to ensure inter-ministerial synchronisation across the health, labour, and finance sectors.
In 2023, the Royal Government of Cambodia (RGC) adopted Sub-Decree No. 280 on Implementing the Voluntary Contribution Health Care Social Security Scheme. In the short term, the MLVT and the NSSF should adopt the sub-decree and increase the registration and volunteer contribution for self-employed individuals to join the healthcare scheme.
Simultaneously, the Ministry of Social Affairs, Veterans, and Youth Rehabilitation (MOSVY) will complete the mass distribution of Disability ID Cards to the 288,000-plus individuals already identified, ensuring each card features a unique QR code linked to the Disability Management Information System (DMIS).
To lock these gains, the National Social Protection Council (NSPC) must issue an inter-ministerial instruction clarifying that this card grants immediate access to HEF services at all public facilities, resolving the administrative gatekeeping currently reported by medical staff.
Moving into the medium term, implementation shifts toward digital integration and proactive outreach. The Ministry of Economy and Finance (MEF) will lead the integration of the NSSF registration system with the Cambodia Data Exchange (CamDX) to apply the "Once-Only Principle," enabling micro-enterprises to register for taxes, business permits, and social security in a single digital transaction.
This period will also see the rollout of an Electronic Medical Record (EMR) system, allowing healthcare providers to scan a patient’s card to instantly verify eligibility and medical history. To ensure these systems reach those they are designed for, MISTI and the NSPC will partner with women-led associations and NGOs to run localised awareness campaigns specifically targeting the 84 per cent of informal workers who are currently "invisible" to the formal system.
In the long term, the focus will evolve toward fiscal sustainability and full formalization. MISTI will establish a monitoring framework using Key Performance Indicators (KPIs) to measure the success of micro-enterprises transitioning from the transitional zone into full formal status.
As these businesses reach stable revenue thresholds, they will transition from fee exemption to a simplified, turnover-based presumptive tax regime, ensuring that the expanded healthcare system is supported by a growing domestic revenue base. This phased approach ensures that the formalization process is viewed by women and vulnerable workers as a pathway to benefits rather than a punitive administrative hurdle.
Counterargument and Cost: Addressing Fiscal Realities
Critics of this plan may point to the significant fiscal risk of extending non-contributory healthcare to a large informal population, arguing that it could strain an already limited national budget.
The NSIED itself cautions that the Royal Government must be careful not to "teach the citizens to be dependent on the government". However, the cost of inaction is far higher, as current informality deprives the state of public revenue and threatens long-term labour productivity.
To finance this expansion without jeopardizing macro-fiscal stability, a World Bank analysis suggests that raising the VAT rate from 10 per cent to 12 per cent and rationalising exemptions could generate revenue gains of up to 1.8 per cent of GDP.
Only 21 per cent of this new revenue would be required to offset the poverty impact of the tax increase through targeted transfers, leaving substantial funds to finance the universal health expansion proposed here.
Furthermore, increasing excise taxes on tobacco and alcohol products that contribute to 26 per cent of deaths in Cambodia could generate an additional 0.5 per cent of GDP while simultaneously reducing the long-term medical burden on the public health system.
Parting Message: The Moral Imperative of Health Equity
The development of the informal economy is not merely a technical challenge of business registration; it is a fundamental imperative to protect the women and vulnerable citizens who drive Cambodia's economic growth.
By creating a clear, digitally enabled path from informality to formal protection, Cambodia can ensure that "no Cambodian citizen will be left behind" on its path to sustainable and inclusive prosperity.
This plan provides the necessary structure to turn the aspirations of the National Strategy into a lived reality for millions of women and disabilities, proving that a healthy workforce is the strongest foundation for a high-income future.
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