Fragmented care pathways for non-communicable disease in Cambodia: implications for people-centred and integrated health systems.
8 affiliations
- 1Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Global Health - Michel Dumas, OmegaHealth, Limoges, France [email protected].
- 2Unit of Clinical Pharmacy, Pharmacy department, Limoges Hospital Center, Limoges, France.
- 3Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Global Health - Michel Dumas, OmegaHealth, Limoges, France.
- 4Pharmacy department, Calmette Hospital, Phnom Penh, Cambodia.
- 5Endocrinology department, Calmette Hospital, Phnom Penh, Cambodia.
- 6Cardiology department, Calmette Hospital, Phnom Penh, Cambodia.
- 7Neurology department, Calmette Hospital, Phnom Penh, Cambodia.
- 8University Department of Nursing Science, Faculty of Medicine, Univ. Limoges, Limoges, France.
Abstract
Introduction Low- and middle-income countries face major challenges in organising longitudinal care for non-communicable diseases (NCDs). In Cambodia, a pluralistic health system, weak primary care and limited coordination across providers contribute to fragmented care pathways. This study explores how patients and healthcare professionals experience NCDs management and how care is organised across public, private and community settings.Methods We conducted an interpretivist qualitative study using 36 semi-structured interviews with adults living with hypertension, type 2 diabetes or epilepsy, and 3 focus group discussions with 24 healthcare professionals across three Cambodian provinces. Data were analysed using a hybrid inductive–deductive thematic approach with triangulation.Results Care pathways were highly fragmented and non-linear, shaped by symptoms, cost, geographical access and social influence rather than structured referral systems. Limited therapeutic literacy, sociocultural beliefs and fear of long-term medication contributed to poor treatment continuity. Communication gaps between hospitals, primary care, private clinics and community pharmacies resulted in patients carrying medical information between providers. Pharmacists were accessible but under-recognised and weakly integrated into chronic care teams. Financial and logistical barriers further undermined follow-up.Conclusion Fragmented service organisation, weak interprofessional coordination and limited patient education hinder effective NCDs management in Cambodia. Strengthening people-centred care models, integrating pharmacists and nurses into multidisciplinary teams and implementing simple interoperable communication tools could improve continuity, medication safety and patient engagement. These findings highlight the need for system-level reforms that strengthen care coordination, formalise the role of pharmacists and enhance therapeutic education within people-centred NCDs care models.
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BibTeX
@article{marcellaud2026fragmented,
title = {{Fragmented care pathways for non-communicable disease in Cambodia: implications for people-centred and integrated health systems.}},
author = {Elodie Marcellaud and Claire Martin and Theanine Sarsrey and Polin Soy and Sotheavy Lach and Tassadit Merabtine and Jeremy Couturas and Sum Satha and Malis Vorn and Chanraksmey Aon and Emilie Auditeau and Sina Ros and Chamroeun Hun and Jean Toniolo and Jeremy Jost},
journal = {BMJ global health},
year = {2026},
month = oct,
doi = {10.1136/bmjgh-2026-023580},
url = {https://europepmc.org/article/MED/42907142},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Fragmented care pathways for non-communicable disease in Cambodia: implications for people-centred and integrated health systems.
AU - Elodie Marcellaud
AU - Claire Martin
AU - Theanine Sarsrey
AU - Polin Soy
AU - Sotheavy Lach
AU - Tassadit Merabtine
AU - Jeremy Couturas
AU - Sum Satha
AU - Malis Vorn
AU - Chanraksmey Aon
AU - Emilie Auditeau
AU - Sina Ros
AU - Chamroeun Hun
AU - Jean Toniolo
AU - Jeremy Jost
PY - 2026
DA - 2026/10/21
JO - BMJ global health
DO - 10.1136/bmjgh-2026-023580
UR - https://europepmc.org/article/MED/42907142
AB - Introduction Low- and middle-income countries face major challenges in organising longitudinal care for non-communicable diseases (NCDs). In Cambodia, a pluralistic health system, weak primary care and limited coordination across providers contribute to fragmented care pathways. This study explores how patients and healthcare professionals experience NCDs management and how care is organised across public, private and community settings.Methods We conducted an interpretivist qualitative study using 36 semi-structured interviews with adults living with hypertension, type 2 diabetes or epilepsy, and 3 focus group discussions with 24 healthcare professionals across three Cambodian provinces. Data were analysed using a hybrid inductive–deductive thematic approach with triangulation.Results Care pathways were highly fragmented and non-linear, shaped by symptoms, cost, geographical access and social influence rather than structured referral systems. Limited therapeutic literacy, sociocultural beliefs and fear of long-term medication contributed to poor treatment continuity. Communication gaps between hospitals, primary care, private clinics and community pharmacies resulted in patients carrying medical information between providers. Pharmacists were accessible but under-recognised and weakly integrated into chronic care teams. Financial and logistical barriers further undermined follow-up.Conclusion Fragmented service organisation, weak interprofessional coordination and limited patient education hinder effective NCDs management in Cambodia. Strengthening people-centred care models, integrating pharmacists and nurses into multidisciplinary teams and implementing simple interoperable communication tools could improve continuity, medication safety and patient engagement. These findings highlight the need for system-level reforms that strengthen care coordination, formalise the role of pharmacists and enhance therapeutic education within people-centred NCDs care models.
SN - 2059-7908
ER -