Reclaiming Lived Space through CLM: Health Inequities and Civic Accountability in Cambodia toward the 2030 SDG Agenda

Abstract Community participation is increasingly recognised as essential to sustainable health systems, particularly in responses to chronic infectious diseases such as HIV and tuberculosis (TB). In Cambodia, the HIV epidemic has transitioned to a concentrated stage. Yet, incidence remains disproportionately high among key populations (KPs), including female entertainment workers, men who have sex with men, transgender women, and people who inject drugs. TB also poses a persistent challenge, with Cambodia ranked among the 30 countries with the highest TB and TB/HIV burdens globally. In response, national strategies have integrated rights-based frameworks and community-led monitoring (CLM) to improve health service quality and accountability. Formally endorsed by UNAIDS and the Global Fund, CLM enables people living with HIV, key populations, and civil society organisations to systematically assess the availability, accessibility, acceptability, and Quality (AAAQ) of health services. Nevertheless, in practice, CLM often becomes constrained by donor-defined metrics, hierarchical governance, and shrinking civic space. This study critically analyses the implementation of CLM in Cambodia's HIV and TB responses, using Henri Lefebvre's theory of the production of space and the AAAQ framework. Drawing on policy documents, national CLM reports (2022–2024), and participatory health data from operational districts, the findings reveal that while CLM has contributed to service-level improvements and formal recognition, it remains structurally disconnected from national agenda-setting and policy decision-making processes. We argue for a reframing of CLM as civic infrastructure, a participatory platform for rights claiming, structural accountability, and inclusive governance in health. Cambodia's experience highlights the potential and limitations of CLM under conditions of constrained civic space and declining donor support, providing timely lessons for global health actors seeking to sustain people-centered, rights-based health governance across low- and middle-income settings.