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(12).
Health and Nutrition
In Section 3.1.2. (Lack of
Capabilities), the NPRS states that “”Poor health is the major cause of
impoverishment and other forms of social deprivation (e.g., loss of education
and employment opportunities). The
NPRS discusses the high cost of health care among the poor, and observes that
40% of new landlessness is related to ill health. The NPRS also states that
“The poor always tend to have worse health.” Health related issues are also
discussed in separate sections dealing with Nutrition, Gender Disparities, and
HIV/AIDS.
In Section 4.3.1., the NPRS
discusses strategies “aimed at reducing financial barriers to access
among the poor and improving management capacity within the public sector.”
These strategies include:
- “Regulatory mechanisms for price
control through official user fee schemes with community participation in
setting prices, identifying the poor for exemptions and monitoring
quality;”
- “Equity Funds to promote access to
priority services (e.g., emergency obstetric care, catastrophic expenditures
at referral hospitals);”
- “NGOs will be contracted to provide
primary and secondary care services for poor, remote areas,” and
“support from NGOs will be mobilized for other non-contracted areas … to
extend services to poor and marginalized communities;”
- “Incentives to staff working in
remote areas will be effectuated through performance based measures.”
- “The MOH will also “explore the feasibility of piloting
community-based health insurance and pre-payment schemes in partnership with
NGOs;” and
- “…the health sector will focus on mobilizing
resources available among the poor, enabling informed
choices to take appropriate actions for their health and well-being and
promoting their participation in decisions on health and
health-related services.”
The NPRS also discusses at some
length its efforts to set up community/village health support groups, provide
health and nutrition related information, promoting the use of public sector
health services, promote local participation at the Commune Council level, and
promote participatory research at the grassroots level.
In the Annex 3 Matrix, the
strategic objectives also refer to:
- Piloting health insurance as a way to “enhance
accessibility and affordability of key essential services,” and;
- “Improving community-based health care (both
physical and mental health issues) by providing: basic health
education, including mental health activities; HIV/AIDS awareness education,
and promoting household hygienic latrine construction.”
The indicators and targets
listed in 6.1/ refer to:
- infant mortality rates and infant mortality rates
among the poor;
- under five and maternal mortality rates;
- percentage of children under 1 year who are fully
immunized (from 40% to 60%);
- reduced proportions of underweight children;
- percentage of births attended by skilled health
personnel (from 32% to 46%);
- high expenditures among poor/vulnerable households
as % of household income.
- Fertility rates and contraceptive prevalence;
- HIV/AIDs prevalence rate (age 15-49, from 2.6% to
2.3% in 2005).
Additional indicators and
targets are found in the Annex 3 Matrix (3.1.), including:
- Health coverage plan increased from 80% to 100% by
2005;
- Malaria incidence reduced to 7% and mortality to 7%;
- Dengue case fatality rate reduced to 1% nationwide;
- Household expenditures reduced by 50% among poor and
vulnerable groups;
- Contract rates at public sector facilities increased
from 38% to 50%;
- Contracting expended from 5 to 121 ODs in poor
remote areas.
The NPRS also observes that
health is a cross-cutting theme and that “pro-poor efforts will be connected
with inter-ministerial initiatives …” The NPRS refers to the National
Commission on Macroeconomics and Health, a joint initiative between the MOH and
the MEF, which is “to be formed in 2003 and will focus on investment
in the health sector.” Sub-themes include “the analysis of public policies
affecting poverty and health and the effects of government-wide reforms and
public financing on health sector performance. The national commission will lead
advocacy on increasing priority and investment to health as the centre stage of
Cambodia’s social and economic development.”
Nutrition:
Section 3.1.2.. (Lack of
Capabilities) refers to Mortality and Malnutrition, and discusses infant, under
five and maternal mortality, protein energy malnutrition , Vitamine A Deficiency
(VAD), Iron Deficiency Anaemia (IDA) and Iodine Deficiency, with attention to
effects o girls and women of child-bearing age.
In Section 4.3.2., the NPRS
observes that “Among the general population, especially children and women,
the main underlying causes of malnutrition are not primarily related to food
availability, but rather to poor feeding and caring practices and low access to
health and environmental sanitation. Women therefore will be the key target
group for nutrition programme.”
“The focus
will be on prevention of malnutrition at the early years of life, with
interventions starting before birth and focus on the first two years in life
when about 50 percent of children become malnourished. It is also necessary to
improve nutritional status of women in childbearing age and pregnant women for
their health and in relation to prevent intra-uterine growth retardation.”
The NPRS outlines the following
strategic objectives for improving nutrition:
- Priority emphasis to improving infant and young
child feeding practices;
- Active promotion to increase iodized salt production
- Strengthen the Vitamin A capsule distribution in
outreach services (to eliminate Vitamin A deficiencies over five years)
- Develop and implement policy on control of IDA to
cover children and women of child-bearing age;
- Promote use of AN Care by pregnant mother and
provide education for adequate weight gain in pregnancy and reduction of
IDA;
- Explore possibility of food fortification with
micronutrients (Iron and Vit A;
- Establish nutrition information systems;
- Improve family behaviour and care [practices for
young children and pregnant mothers, including health seeking behaviour;
The NPRS in both Sections 6.1
and the Annex 3 Matrix provide an extensive roster of measurable indicators and
targets for monitoring and evaluation. In Section 6/1 the indicators include:
- Percentage of children under 5 moderately/severely
stunted (35.5% by 2005; from 44% in 2000);
- Protein energy malnutrition in children under 5 (31%
by 2005, from 45% in 2000);
- Malnutrition among women of reproductive age (15% by
2005; from 21% in 2000).
Additional indicators and
targets from Annex 3 Matrix include:
- Number of mothers giving colostrums increased from
11% to 35%;
- IDA among childbearing age women reduced from 58% to
40%;
- IDA among pregnant women reduced from 65% to 43%;
- Number of exclusively breast-feeding mothers for
five months increased from 5% to 25%;
- Household use of iodized salt from 12% to 80% by
2007;
- Coverage of VitA supplements for children under 5
increased from 29% to 80%;
- Increase in percentage of children with access to
(and consuming) locally produced low-cost iron and VitA fortified foods;
- Coverage of Antenatal Care increased to 50%.
NGO Action:
The NGO CG Statement observes
that “Improving the population’s health status is a necessary pre-requisite
to other poverty reduction and human development objectives.”
- Monitor public sector and donor budget allocations
for the health sector, as well timely disbursements of such funds (ref: National
Commission on Macroeconomics and Health, a joint initiative between the MOH
and the MEF, which is referred to in the PRSP….)
- Monitor the introduction of equity funds, expansion
of insurance coverage, and the distribution of fee exemptions.
- Monitor the implementation and coverage of health
coverage plan according to 2005 targets;
- Monitor salary levels and disbursements for health
worker salaries (including incentive measures for those working in remote
areas);
- Monitor ongoing progress of health and nutrition
indicators/targets, particularly as they concern the poor (re. Section
6.1.).
- Continue monitoring accessibility and affordability
of health care for the poor, with special attention on women and children;
- Promote mental health awareness and services,
including the concept of primary mental health, in the context of the APRI.
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