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CONTRIBUTORS |
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CHILD'S RIGHTS | NGO Child's Rights Committee |
EDUCATION | EDUCAM |
ENVIRONMENT | NGO Forum / Environment Working Group |
GENDER & DEVELOPMENT | Gender and Development Network |
HEALTH SECTOR REFORM | MEDICAM |
HIV/AIDS | HIV/AIDS Coordination Committee |
LAND ISSUES | NGO Working Group on the Land Law & NGO Forum / Environment Working Group |
LANDMINES | NGO Forum / Cambodia Campaign to Ban Landmines |
MENTAL HEALTH | Mental Health Working Group |
MICROFINANCE | Credit Working Group |
RULE OF LAW & HUMAN RIGHTS | Human Rights Action Committee |
Almost 3 decades of war and conflict have devastated Cambodia economically and socially. With the GDP per capita income below US$200, the country ranks among the poorest in the word. Although a new Government has been established through democratic elections, and peace seems to have arrived in Cambodia, a large range of socio-economic problems needs to be addressed.
This situation particularly affects the lives of the children who represent more than half of the population of Cambodia, and in the worst cases leads them to be malnourished, child labourers, child prostitutes, street children, disabled children, petty criminals, drug addicts, or infants affected by HIV/AIDS.
The reconstruction and development of the country is still in its early stage and the future of Cambodia rests with its children. On behalf of the NGOs and IOs working for childrens rights and the overall well being of children in Cambodia, the National Coalition of NGOs working on children's issues committee (NGO-CRC) strongly recommends that the following key children issues be addressed in the National Development Plan of Cambodia.
KEY CHILDREN'S ISSUES
Child Development Through Better Education
Many countries have effectively removed child illiteracy by introducing universal primary and lower secondary education, but a poor country ravaged by conflict and war like Cambodia, is far removed from such a desirable situation. According to UNICEF's "State of the World's Children" 1997 report, in Cambodia adult literacy is estimated at 35% of the population, and despite a large increase in school enrolment in recent years, less than 50% of children reach grade 5 and less than 2% graduated from high school. This is due to:
The quality and commitment of teachers being very limited because of their extremely low salary and lack of expertise. Also the methodology and strategy of teaching are not updated.
Schools, especially in the city, have many shifts and children learn only for short hours in large classes.
Parents neglect to send their children to school even if they have sufficient means to do so.
Parents need child labour, and in particular girls, to support the family.
Schools in remote areas lack buildings and teachers.
Child Survival Through Better Health Care
A study of child survival reveals that many children still die of preventable diseases such as diarrhoea, malnutrition, measles, malaria, dengue fever, acute respiratory infection and tuberculosis. Some die at birth or immediately afterward because either the mother is sick, malnourished or too young to be pregnant, or she does not have access to proper health care during pregnancy or delivery.
The number of children affected by HIV/AIDS is rapidly increasing due to the disbelief and the limited capacity of parents to understand the disease. Lack of a training strategy and appropriate methodology that matches the capacity of the rural population is also a problem (lack of trained health workers).
Health services reach only 35% of the population, and only 34% have access to clean water (UNICEF's "State of the World's Children" 1997 report). Furthermore, medicine in rural areas is of very poor quality and parents need to pay for high health care costs.
Protection Of Children Through Better Law Enforcement
The Cambodian legal system is still in the development stage and there are significant gaps in critical areas. Cambodia does not have adequate laws to protect children. Enforcement of laws they do have has been minimal, in part because the mandatory regulations allowing implementation of the laws are lacking.
Poor law enforcement affects childrens lives by failing to protect them from becoming child labourers, child prostitutes, or drug addicts. Many children are abducted and even sold for labour and sexual exploitation. About 30% of female prostitutes are children aged 12-17 years old. Many children are also severely affected by domestic violence.
The dissemination of existing laws is very limited. In rural areas in particular, both officials and parents lack information about laws relating to children. Children accused of having broken the law are kept in prison without any legal representation or other assistance and there is no juvenile justice system.
RECOMMENDATIONS
To improve the situation of children in Cambodia, the following is recommended:
Child's Rights (CR) awareness should be systematically and effectively raised among policy makers, law enforcers, the general public and children themselves through all means: CR training/workshops, CR campaigns, awareness raising through mass media, etc.
Review of existing laws and development of new laws concerning the protection of child's rights. This should be widely disseminated in simple language and effectively enforced.
A juvenile justice system needs to be established and practised throughout the country
The skills of teachers, doctors, nurses to teach and disseminate relevant information must be improved. Their salaries needs to be increased in order to have these professionals act according to childrens needs.
The curriculum for primary and secondary school needs to be modernised for better child learning.
All these important tasks necessarily demand technical and financial support for NGOs and the RGC. The allocations in the National Budget for children programmes must be increased in all sectors.
Nowhere is the need for multiple foci more evident than in the education sector. While few would argue with the priority placed on basic education by the Government and world community, it is also self-evident that the education of tertiary faculty, school teachers, and institutional and school managers plays a large part in the determination of system quality. The flow data presented later suggest that insufficient numbers of professionals are graduating from post-secondary to provide the political leadership, the bureaucratic competencies, and the private sector momentum needed in the medium-term. Moreover, unless professor/ teacher quality is enhanced at each level, graduates will continue to be of poor quality, and undermine human resource development efforts in all sectors. The exclusive priority for basic education proposed in some quarters is self-defeating. The investment proportions proposed in 1994 for the Education Investment Program, 1995-2000 remain sound; basic education 2/3rds; upper and post-secondary 1/3rd.
Within this context and the constrained resource environment that has followed the events of July 1997, EDUCAM has identified the following priority issues.
Strategic Planning
In the interest of sustainable development, greater emphasis needs to be placed on the prioritization of needs, the identification of the source of problems and the resource implications of the reform policies aimed at solving those problems. For example, the promotion and retention benefits of the new policies of smaller Grade 1 classes and automatic promotion are unlikely to be realized unless sufficient places can be found for Grade 1 graduates in Grade 2. At the current time such places simply do not exist. Grade 2 currently accommodates only about 47% of Grade 1 children. Piloting new policies in a small number of schools might also help to refine the problem definition and test "the solution" as well as identify possible unintended effects. Adequate financing, of course, is essential in all phases of planning: prioritization of needs, problem identification, pilot testing of a remedy, and implementation of the new policy.
The Ministry is well-placed to develop a Cambodian led process of sector development. The 1998 restructuring integrated the various planning units into a single Department and its Director was given the status of Deputy Director General of Administration and Finance. At the same time the four year UNESCO HRD (human resource development) capacity building project in education has generated a large number of Ministry personnel trained in planning and management. Provincial and national sector reviews have been instituted with a view toward conducting a Ministry led sector review in 1999 to update the Investment Program. Unfortunately the funding for the UNESCO project has come to an end at this critical point.
Structural Issues
The most pressing structural issues are at the basic education level where high population growth rates combine with under-investment to produce predictably low efficiency and high wastage. For every 1000 children who enter Grade 1 only 69 graduate in 6 years. Forty-one percent repeat Grade 1, while another 12 percent drop out. (While the repetition rates decline substantially as Grade level increases, the dropout rates move in the reverse direction.) The problems of low quality at primary level are compounded by the fact that so few of these children remain in school until the end of the cycle.
Of the original 1000, 48 (or 5%) enter junior secondary school, of which only 12 graduate in 3 years time. About 1/2 of these continue to senior secondary and 2 graduate. A tiny fraction of the initial cohort continues to the tertiary level. These flows suggest that HRD output standards, essential to national development in all sectors, are not likely to be meaningful until there are national standards governing the quality and quantity of school inputs. National budgeting of education to date has given no priority to the quality and quantity of inputs needed to produce the desired amounts of student learning. Effective HRD in Cambodia calls for a shift in the culture of schooling from rote learning of simple skills and facts to learning for application to the real world. Two examples illustrate how under-funding of education reduces the prospect of achieving this transformation.
First, in terms of material inputs, Government statistics indicate that donor-funded primary level textbook and teacher guide coverage is improving. However, only 58 percent of the schools have teacher guides for Grade 1 and there is a near universal cry for on-the-job teacher training in the use of both texts and guides. These resources are considerably scarcer at the higher grades throughout the system. There is a special need for science materials and equipment, beginning in primary but particularly at the secondary level. Second, even where some materials are available, teachers generally do not know how to use them. As a consequence, few students entering the Royal University of Phnom Penh, including science majors, have any laboratory experience. At the University, through the efforts of the NGOs, laboratories have only just begun to be re-established.
Financial Issues
The education share of government expenditures, as opposed to government budget, hovers between 6 and 8 percent. The true expenditures for last year cannot be calculated since teacher salaries are three months in arrears. Donor contributions also are not yet available for 1998 but have declined since the events of July 1997 and are not expected to recover until such time as Government's own investments increase.
Government now recognizes the utility of formal user contributions to education and recognizes non-mandatory contributions at the primary and secondary levels. Concern continues, however, about teacher charges for tuition particularly during school hours and on school property. While such charges help provide city teachers with a living wage, privatization of schooling to the classroom level has a strong negative effect on both equity and efficiency and undoubtedly is one of the factors contributing to the low completion rates of children from poor families.
At the present time, serious consideration is being given to changing public higher education policy to establish tuition fees, while at the same time providing scholarships for able but poor students. This change is widely supported by the donor community and has been repeatedly recommended in both sector and sub-sector studies.
Donor Coordination
The combination of dramatic need for qualitative improvement throughout the system and continued population pressure at the primary level argues for renewed coordination efforts. At a minimum, government and donors need to continue to collaborate on strategies to address the current quality/quantity dilemmas in an era of constrained finances. Optimally, in the interests of efficiency, true partnerships can be established. Again, the latter are dependent on government willingness to invest national wealth in the social sectors.
Figure Progression Rates |
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Primary School | ||||||||
Y e a r |
||||||||
Grade |
||||||||
One |
Two |
Three |
Four |
Five |
Six |
Graduate | ||
1 |
1000 |
|||||||
2 |
412 |
469 |
||||||
3 |
125 |
272 |
||||||
4 |
52 |
180 |
||||||
5 |
23 |
126 |
||||||
6 |
9 |
88 |
69 |
|||||
7 |
4 |
|||||||
Dropouts | 119 |
71 |
41 |
31 |
27 |
15 |
Figure 1 indicates that 69 of the original 1,000 students graduate from grade 6 "on time,"i.e., in six years. For every 1,000 who enter, 469 are promoted to Grade II, 412 are left back and 119 drop out. As the grades go up, the percentage of repeats falls but the % of dropouts increases.
Forestry and Fisheries
NGOs agree with international donors that Cambodias natural resources need to be better managed and that revenues need to be directed to the national budget. However, NGOs bring an additional perspective, focussed on the need to preserve the food security and livelihoods of subsistence-based communities.
The NGO community in Cambodia would like to voice concerns regarding the privatisation of forest and fisheries resources at the expense of local communities who rely on these resources to meet their livelihood requirements. Approximately 85% of Cambodians live in rural areas, relying on agriculture (primarily rain fed rice), fisheries and forest products for subsistence (Associates in Rural Development, 1998). Average rice yields are the lowest in the region largely due to a combination of poor soil fertility and reliance on rainfall (Ministry of Commerce 1998). Most farmers rely on common access to natural resources such as forests and fisheries to breach the gap between shortfalls in rice production (income) and family requirements.
"Forests have always been a defining element of the economy, culture and environment of Cambodia" (Ministry of Commerce 1998). Rural communities commonly harvest building materials (timber, poles, bamboo, rattan etc.), food (honey, fruit, nuts etc.), resins, medicinal plants and other products from local forests. Forests supply 98% of rural and 85% of Phnom Penhs fuel for cooking (ARD 1998). Environmental benefits of forests include water regulation, soil conservation and bio-diversity. For many highland communities, forests are an integral cultural asset, access to the loss of which would be catastrophic. Flooded and mangrove forests also provide critical habitats for Cambodias inland and coastal fisheries. According to official statistics, fish and fish products are estimated to provide 40-60% of Cambodias protein requirements (Ministry of Commerce 1998).
Traditional community access to forest and fisheries resources has been eroded rapidly in recent years through privatisation of these resources to commercial interests. The forest cover of Cambodia has declined from an estimated 73% during the middle of this century to an estimated 58% at present. Most of this forest loss has occurred in the last twenty years. During the last five years, 62% of remaining commercial forest resources have been allocated to foreign companies for exclusive exploitation rights (Ministry of Commerce 1998). In the fisheries sector, most of Cambodias most productive inland fisheries have been allocated as concessions to business interests (Degen and Nao Thuok 1998). There are 164 lake, riverine and river beach lots covering 852,900 hectares (Zalinge et al. 1998). Not surprisingly, conflict between powerful business interests, often linked to local military units, and local communities over access to forest and fisheries resources are common in rural Cambodia.
Ostensibly, the revenue generated by privatisation of forest and fisheries resources is to be used to fuel Cambodias economic development. In reality, little improvement in the livelihoods of the average rural Cambodian has been observed as a result of privatisation and only a fraction of the value of these resources contribute to the National Budget.
NGOs in Cambodia have pioneered institutional support for community forestry and local management of forest resources. Both the Ministry of Agriculture and the Ministry of Environment have taken an interest in these initiatives, creating their own community forestry units. However, these efforts will remain localised unless mainstreamed into the overall forestry policy framework. We therefore ask the international community to encourage and assist the RGC to:
enact an appropriate community forestry policy;
ensure that the draft forestry law recognises community needs and provides for community participation in the management of forest resources;
review existing fisheries policy and legislation to similarly ensure that they recognise community needs and provide for community participation in the management of fishery resources;
ensure that the draft land law also recognises community needs and allows for community participation in the management of forest and fishery resources (see separate section of this report).
The NGO community urges both the RGC and the international community to take steps to ensure that the people of Cambodia are able to capture the full benefit of their rich national forest and fisheries resources. This would require the introduction of sustainable forest and fisheries management systems that meet the needs of local communities as a top priority. Community participation would be an integral component of these management systems. These systems would not conflict with the need for taxation revenue at the national level, but would instead represent an economically efficient investment in both sustainable management of these resources and in Cambodias greatest asset, its people. The NGO community in Cambodia is willing and committed to working with the RGC and the international community to achieve the sustainable management of Cambodias forest and fisheries resources, in order to meet the challenge of eradicating poverty in Cambodia.
Environmental Law Enforcement
The enactment of appropriate legislation for the management of Cambodias natural resources must be supported by appropriate enforcement measures. NGOs recognise the difficulties of law-enforcement in Cambodia and of enforcing forestry legislation in particular.
However, NGOs were most alarmed last year when a World Bank-funded consultant proposed the creation of an expensive new military regiment for the surveillance and apprehension of illegal loggers (DAI 1998). Despite the safeguards mentioned in the consultants report, the potential for both corruption and armed conflict would be great, as would the risk to local communities. Most likely, it would be the local communities living near the forests who would be most vulnerable in the face of armed units - not the city or town based perpetrators of the logging activities.
NGOs were therefore most pleased to receive assurances that the World Bank does not support the DAI proposal. Other international donors and lending institutions should take note of the World Banks own conclusions. The introduction of yet another armed force (in addition to the military, the police and the militia) into the forests of Cambodia, should not be encouraged through international funding support, nor should it be imposed through the conditions placed on international aid. Equally worrying, would be any proposal to place more guns into the hands of untrained personnel or ministry staff. NGO studies have shown widespread support in Cambodia for efforts to reduce the number of weapons and practice of using weapons in Cambodian society (Neb & Ashby 1998).
Nevertheless, NGOs recognise that the RGC must take decisive action to better manage and enforce sustainable forestry practices in Cambodia. While NGOs do not pretend to have any hard and fast solutions, we believe a number of points should be considered.
The first is that illegal forestry activities should be seen as part of a wider problem, which includes the trafficking of women and children, the smuggling of drugs, and even the import of toxic wastes. Many of these activities are perpetrated with apparent impunity. While the international community has focussed its attention on the issue of illegal logging, there is a need to address the wider context.
Secondly, it is interesting to note that many of the groups involved in illegal logging activities have official papers from higher authorities permitting the activity. The only people who do not have papers seem to be the local communities who have been using the forest lands for generations. Strong political will from the highest levels is needed to stop the practice of issuing permits for illegal and unsustainable logging activities.
Thirdly, NGOs, through their experience in supporting community forestry activities, believe that giving local communities a greater role in the management and use of forests, with appropriate technical support, will lead to better forest management.
Fourthly, the RGC and international community should take note of the additional recommendations contained in the DAI report (Chapter 6), which we believe are most essential in reducing the incidence of illegal logging. These recommendations include demobilisation of the military, demobilisation of village militias, maintenance of the log export ban, elimination of log collection permits, increased penalties for corruption, and the drafting and enactment of a new forestry law. Also commendable are the recommendations to strengthen data collection, public education and the management of revenue collection within the forestry sector.
NGOs welcome the efforts taken by the RGC, immediately prior to the CG meeting, to cancel logging concessions and to give the Ministry of Environment greater watchdog powers. NGOs also welcome the stated resolve of the RGC to bring to justice the perpetrators of the recent toxic waste incident in Sihanoukville, to clear up the waste, and to enact a sub-decree and sign an international convention which will discourage further such imports. It is hoped that these efforts will continue, in order that future generations may also receive the benefit of Cambodias abundant natural resources.
Public Participation in Environmental Impact Assessment and Hydro-power Planning
Over the past few years, the Ministry of Environment has been building a capacity for environment impact assessment (EIA) review and creating the related legal framework. The international community should continue to support the role and importance of this Ministry in the RGCs project approval process. Donors should ensure that proper EIA procedures are followed in any projects they fund. In addition, industrial developments need to meet acceptable pollution control standards.
NGOs are aware that the RGC is currently considering a number of hydo-power projects, in particular the proposed Prek Thnaot hydroelectric dam in Kompong Speu province, which is intended to provide 18 MW of electricity and irrigation to 70,000 hectares of land. NGOs in Cambodia believe that proper consultation with local communities in the development of large-scale projects such as hydroelectric dams is essential. Active local community participation in decision making is an important step in the EIA process.
A Ministry of Environment report (1997) notes that
"EIA legal instruments such as a draft 1997 EIA sub-decree and EIA guidelines will serve as a legal framework for public participation. The implementation of EIA for development projects will provide an excellent opportunity for local communities to participate in project planning and project implementation from the earlier stage (p.6)."
This is particularly true for the Prek Thnaot project. An environmental study completed in 1994 (Nippon Koei 1994) estimated that over 17,000 people would be displaced from the dam site. Resettlement areas were located in the province; however, these would require a substantial reduction in the average area of farming land per household. It is not known whether these relocation sites are still available. The Ministry of Environment report (1997) notes that while surveyed villagers professed a readiness to be relocated, they lacked the information necessary to make reasoned decisions.
A study carried out by the NGO Forum on Cambodia in four provinces in 1997 found that rural people
"can understand and participate in dialogue on complex issues like hydropower development if provided with appropriate information in the right context. Local peoples knowledge of their history, culture, livelihoods and resource use is invaluable to the planning process, in particular the prediction of social and environmental impacts (Uy & Emerson 1997, p.24)."
The study outlines a number of strategies for effective dialogue with local communities. To be genuine, the process must begin before a construction contract has been signed. Issues such as relocation, compensation and environmental protection need to be worked out in advance.
Public participation is important if Cambodia hopes to avoid a polarisation of opinions between groups over hydropower, as has been evident in neighbouring countries. Public participation will help to ensure transparency and accountability, and to ensure that community needs are properly addressed. The Prek Thnaot project has the potential to become a model for future EIAs and relocation plans in Cambodia. The support of the international community and the active collaboration of the RGC are needed to ensure a positive outcome.
While taking into account local community needs and perspectives, it is imperative that hydropower planning in Cambodia also take into account regional effects. The RGC needs to take into account the impact of dam development in Cambodia on the Mekong Delta in Vietnam, in the same way as those upstream should be concerned about their downstream neighbours. To this end, donor agencies and the RGC should work with the Mekong River Commission to make sure that it reverts and adheres to its original mandate of ensuring a regional approach is taken to the development of the Mekong. This includes taking account of cumulative impacts, sustainability and participation of local and wider community interests.
References Cited:
GENDER AND DEVELOPMENT This paper summarizes the result of a consultation of the Gender and Development Network in Cambodia held 22 January 1999 on emerging issues and challenges that women and their families would likely face in view of the current rapid socio-economic change in Cambodia. In particular, it identifies the potential effects of the continued lack of public attention and priorities given to social needs and services that have significant implications for women and their ability to provide care and subsistence to their families.ARD 1998, "Forest Policy Transition Paper For Cambodia" Executive Secretariat to Manage and Execute Forest Management Policy and Associates in Rural Development Inc.
DAI 1998, "Forest Law Enforcement Program: Draft Final Report, June 1998" Log Monitoring and Logging Control Project, Development Alternatives Inc.
Degen, P. and Nao Thuok 1998, "Inland Fishery Management in Cambodia : Is the fishing lot system the basis for improved management or should it be abolished?" Mekong River Commission/DANIDA: Project for Management of the Freshwater Capture Fisheries of Cambodia.
Ministry of Commerce 1998, "Cambodia : The Remergence of New Opportunities, Business and Investment Handbook" Ministry of Commerce, 1997-1998.
Ministry of Environment 1997, "Public Participation and Socio-Economic Impact Assessment: Cambodias Country Report for the UNDP/UNESCAP Workshop and Executive Seminar on Environmental/Social Impact Assessment and Public Participation for Electricity Generation Projects."
Neb Sinthay & Ashby, J. 1998, "Possibilities to Reduce the Number of Weapons and the Practice of Using Weapons to Solve Problems in Cambodia" Peace Partnership: Dhammayietra Centre for Peace and Non-violence, American Friends Service Committee & Mennonite Central Committee.
Nippon Koei 1994, "Prek Thnot Multipurpose Project: Environment Study Report" Nippon Koei Co. Ltd in association with Snowy Mountains Engineering Corporation for the Cambodia National Mekong Committee.
Uy Khema & Emerson, B. 1997, "Mekong People: The Role of Local Communities in Hydro-planning Towards Public Participation in S/EIA, Cambodia" NGO Forum on Cambodia.
Zalinge van, N., Nao Thuok and Touch Seang Tana 1998, "Where There is Water, There is Fish? Fisheries Issues in the Lower Mekong Basin From a Cambodian Perspective" Mekong River Commission/DANIDA: Project for Management of the Freshwater Capture Fisheries of Cambodia.
Addressing women/gender issues in development processes in Cambodia is becoming an increasingly important concern for NGOs. There is a growing concern that a combination of constraining factors may result in serious gender disparities in access to health services, education and economic opportunities. These factors include: the low priority given to public investments on social development; the lack of safety net measures against the economic regional crisis; and the weak enforcement of laws and policies that determine womens welfare and rights.
This situation may in turn lead to a worsening of problems such as the sexual and economic exploitation of women and children as well as abuse and violence against women. It is expected that the economic downturn will result in a significant increase in the poverty of women, in abuses against women and the exploitation of women. As key providers of food and care, women will experience severe difficulties in carrying out their family responsibilities. NGOs are concerned that these social costs will remain unaddressed, and women and children may end up paying the cost.
The following interrelated issues are identified as priorities that require coordinated action:
Reproductive Health Problems
An important concern in Cambodia is that women's health faces great risks from reproductive health problems. The main problem is the very high maternal mortality rate in Cambodia, arising from poor access to and utilization of maternal care services, low-quality health facilities, and insufficient access to birth spacing information, supplies and services. UNFPA has estimated the current maternal mortality rate at about 500 deaths per 100,000, with about 2,000 Cambodian women dying each year of childbirth-related causes (UNFPA 1996). In addition, a large number of women experience adverse health problems due to pregnancy and delivery-related complications, many of them resulting in lifelong disability.
The most important causes of maternal deaths are hemorrhage, induced abortion, obstructed labor, hypertension, and sepsis. Malaria and tuberculosis, both common illnesses in Cambodia, can further increase the risk of maternal death. One study showed that women were 44 times more likely to die from a malaria infection than men because their general health and nutritional status is poorer, and they are less likely to have access to health care (UNICEF 1996).
Cambodia has one of the highest fertility rates in the region - estimated in 1996 at 5.2 children per woman. There is evidence of a large unmet need for contraception in Cambodia, with an estimated 78% of couples of reproductive age interested in birth spacing but unable to access contraceptives. This unmet need is well above the levels observed in most other Asian countries. Since pregnancies spaced too closely together expose women to health risks, the poor availability of contraceptives in the country imposes a much larger burden on Cambodian women than on Cambodian men.
Sexually transmitted diseases (STDs) pose another health risk that affects women. The incidence of STDs has been growing in Cambodia, and the rate of HIV infection has been increasing at an alarming rate. Sero-prevalence testing among commercial sex workers has showed an increase in infection from 9% in 1992 to 40% in 1996. In 1996, 1.7% of pregnant women tested were HIV positive - the second highest rate in the region after Thailand (MOH 1997).
Prostitution and Trafficking
Prostitution and trafficking are two social problems that have become very serious in Cambodia. With the rapid spread of HIV/AIDS, women and children involved in commercial sex risk a life of suffering and early death. The greatest part of the trafficking takes place inside the country, but a large number of Cambodian children are also trafficked to Thailand and many Vietnamese girls are trafficked into Cambodia.
The number of commercial sex workers (CSWs) has increased dramatically in the last 8 years. According to NGOs working with CSWs, there were only 1,500 CSWs in Phnom Penh in 1990. By late 1994, the number had increased to 17,000 (UNICEF 1996). It is likely that this has increased by five-fold now.
Surveys show that 35% of CSWs in Phnom Penh are under the age of 18, with some as young as 10 or 12 (UNICEF 1996). A rapid appraisal of 11 provinces and Phnom Penh in 1995 identified minors aged 12-17 years of age constituting 31% of CSWs. Even these large numbers are likely to be underestimated, as child sex workers are often hidden by brothel owners because of their illegal status and their high value. A young virgin can fetch a price of US$300-700 for a week, while an experienced CSW earns only about US $2 per client (UNICEF 1996).
Unfortunately, eliminating prostitution is an extremely challenging and difficult task as poverty is an important factor. As long as poverty is widespread in Cambodia, there will be a strong incentive for impoverished women and children to enter into prostitution and for destitute parents to sell their daughters and sons into prostitution.
Violence Against Women
Violence against women within the household is a serious problem in Cambodia. A household survey conducted in Phnom Penh and six provinces in 1995-1996 found that 16% of all women surveyed - about one out of every 6 women - reported being physically abused by their husbands. The survey also indicated that the education of a woman beyond the primary level was observed to significantly reduce the probability of being abused by her husband.
Lack of Schooling and Education
Another area in which women are significantly at a disadvantage with respect to men is literacy. Adult literacy rates are significantly higher for men (79%) than for women (55%). About 42% of Cambodian women above the age of 15 years have never attended school, while the ratio is only half as low for men (21%). The large differences in adult literacy and completed schooling are mainly due to lower school enrolment rates for girls. The female-male enrolment gap is wider in rural areas than in urban areas. (Table 1)
Table 1: Gross enrolment rates by gender and urban/rural residence, 1997- 1998 School Year
Sector | Sex | Primary | Lower Secondary | Upper Secondary |
Rural |
Male |
100.16 |
25.04 |
4.19 |
Female |
85.36 |
12.01 |
1.73 |
|
Urban |
Male |
102.84 |
56.90 |
28.28 |
|
Female |
88.51 |
35.59 |
16.44 |
Source: MoEYS, 1998 |
Dropout rates are higher for girls than for boys. A survey of 1,530 households in 5 provinces indicated that housework and minding siblings were the most important reason for girls' dropout and non-enrolment. Parents are also concerned for their daughters security when travelling to school, especially in areas where there is a considerable distance between home and school and the risk of abduction for prostitution is higher. (MoEYS and CARE, 1998)
Conclusion
NGOs are actively cooperating with the government through community action and capacity building programs to address gender concerns in all aspects of development. They have made significant contributions to the progress made in recent years in translating into practice Cambodias legal and policy frameworks to promote womens rights and equality. These important efforts would not have been possible without the continued commitment and support of bilateral and multilateral agencies.
The NGO community and the government both recognize that investing in womens education and health is an investment in the countrys future. As Cambodia develops, NGOs are concerned that the gender dimension of change and its socio-economic and political implications might be set aside in an attempt to achieve perceived economic gains. It should be recognized that society consists of women and men. It is only when equal opportunity and partnership between the genders exists that sustainable development can occur. It is only when women find themselves on equal footing with men that a nation can effectively plan for its future.
HEALTH
SECTOR REFORM
HIGHLIGHTS
In the health sector, the insistence on the rule of law as a prerequisite is widely justified by the lessons learned over the past recent years: the difficulties encountered in the development of the health sector are many (as exposed in MEDiCAM 1997 Position Paper), but the main root causes could be summarized as the lack of financial resources, and the poor skills and education level of health staff.
Although most observers may agree on this diagnosis, the reasons invoked for the lack of resources may vary (see National Health Budget below). The low skill and educational level of health staff and managers is the legacy of genocide and war, and this now requires financial support, technical assistance and time.
FOCUS
This paper is not intended as a review of what has been achieved in the health sector in 1998, but rather as a focus on a few specific issues considered to be of importance by NGOs.
THE NATIONAL HEALTH BUDGET
The lack of financial resources -- or difficult access to them -- results in low salaries, low motivation, low quality of work, and very poor working conditions. The main reasons generally cited are the lack of national revenues, notably due to the war, the political turmoil, and now the Asian economic crisis. Yet, those explanations may be insufficient. Three other causes also exist: 1. Too much of the few government sources of revenues are channeled to the security sector rather than the social sector, notably the health sector - (6% of the 1998 national budget was allocated to the health sector compared to 40% to the defense sector). 2. The Ministry of Health (MOH) has such difficult access to its own budget that the Ministry could not even access the 6% it was allocated. 3. With the exception of funds for drug supplies, two thirds of the funds allocated to the MOH do not transit through the MOH but instead through the Provincial Governors Treasuries. This cumbersome and non-transparent circuit results in partial disbursement of funds to Provincial and Districts health facilities. These budget and access-to-budget obstacles render MOH planning and management extremely difficult, and hamper the health reform. Good laws and regulations, such as a better health financing circuit, and efficient enforcement of these laws and regulations -notably through greater transparency - are what is needed.
Even if recommendations include an increased share of the National Budget for the health sector which would certainly be in better accordance with development objectives and good governance principles caution is still needed. Slashing the security sector too fast however desirable that may be could lead to serious disturbances. Greater investment in the health sector, and direct support to a very carefully prepared demobilization and disarming process is needed first. Future allocation of the budget should ensure an increase in the amount rather than simply the proportion that is allocated to health.
Institutional changes are also necessary, notably with regard to relations and communication between the Ministry of Finance (MOF) and the MOH, so that the latter gets better control of its own budget. At the provincial level, more transparency throughout the financing circuit is essential to improvement of the fund allocation system. For Provincial and District Health Directors as well as for Health Centers Managers, the current ongoing financial uncertainty renders planning and management extremely difficult and the set up of a cost-recovery scheme almost impossible. A good demonstration of good governance at the highest level would require a better compliance of governments expenditures with the National Budget approved by the National Assembly.
THE NEED FOR TRANSPARENCY
As stated earlier, one of the major difficulties that the MOH is facing in the implementation of the health reform is access to its budget from the MOFE, both at central and at provincial levels. In 1998, NGOs (notably through a MEDiCAM Working Group), in close co-operation with the MOH and some Provincial Governors have demonstrated that transparency can considerably assist the transfer process and allow a much better disbursement of funds to the Provincial Health Departments. Some simple and practical recommendations can therefore be made such as to ensure that the MOH be regularly sent the formal MOFE monthly declaration ("Prakas") of how funds will be disbursed to the health sector in each province. Currently this decree is sent directly to the Provincial Governors treasury but not to the MOH.
Greater transparency throughout the financing circuit will also allow more accurate evaluation of the financial needs of health facilities that NGOs are willing to support, hence ensuring that NGOs will complement rather than substitute the State; another guaranty of sustainability. In the meantime, owing to this lack of transparency and to the poor communication between the MOFE and the MOH, the latter has set up its own financial monitoring and reporting system (P1/P2 and D1/D2) from district and provincial level to central level. Although this certainly greatly facilitates the financial control at the central level, another observation in the field is that too strict reporting requirements have pushed local managers to resort to disguising expenditures necessary to the facilities but not authorized so that they would fit in the reporting format. The strict reporting format has reportedly also rendered innovative approaches such as pilot projects more difficult to implement. Recommendations include giving more flexibility to managers to manage their budget. To that effect, reviewing the National Health Budget, setting budget lines per facilities rather than per chapters would provide the flexibility required at the local level without jeopardizing accountability and monitoring.
An issue directly related to the above is that of "leakage" of government resources. Much has been written on the "poor ethics" of public health staff and of their corrupt practices. If little can be justified on an ethical stance, much could be explained by the very poor salaries that civil servants are paid - this is "survival corruption" at health facility level. It is believed that there is also corruption at a much higher level and at a much larger scale across the civil service. It would be worth studying to what extent reduced corruption would save government resources and permit the salaries of civil servants to be increased, putting an end to survival-level corruption.
USERS FEE SCHEME A DOUBLE-EDGE SWORD
Recent studies have shown that the average expenditure in health care is approximately 20-33US$ per capita/per year. Most Cambodians are paying far more than they can afford for generally poor quality, ineffective care. Instead of being a factor of poverty alleviation, health care is a serious impoverishing factor in Cambodia.
Although the users fee scheme often misleadingly called the "cost-recovery" scheme is an important part of the Health Reform, in the opinion of many NGOs, too much emphasis has been put on it at the expense of the quality of care. NGOs warn that to base the feasibility of a users fee scheme on the sole findings of household expenditures in health services surveys is hazardous. The recommendation would be to take more consideration of the level of indebtedness people get into to pay for health services. In brief, if to treat a sick family member the family has to resort to selling, for example, its sole buffalo or rice field its main capital the consequences are far-reaching, and almost irreversible.
The reality is also that too many users fee schemes have been put in place in disregard of the formal and official procedure set up by the MOH, resulting in wide spread schemes that exclude the poorest. The exemption of those who cannot pay represents the most difficult challenge to the system: - How to evaluate who is poor? What about seasonal poverty? Chronic diseases? etc. Many health professional can now see the personal interest of having paid patients and are not so inclined to exempt. Moreover the poverty level in Cambodia is such that it would not be wise to expect too much from the users fee system, at least at the primary level (Health Centers). Without cautious implementation, the users fee may bring little benefit for the suppliers, but big problems to the poor. It should be kept in mind that wherever the rich, or those who can pay, have the option to go to the private sector, only the poor frequent the public facilities. The MOH-recommended -- and NGO-supported -- community participation in the setting of the users fee system is certainly the most appropriate way to respond. However it is precisely those who should be consulted who cannot attend Community Participation meetings because they are busy trying to meet their basic survival need, such as adequate housing, food, water, and security.
Some interesting and successful users fee schemes experiments, for example at Takeo Hospital and other central facilities in Phnom Penh, are starting to emerge. The MOH and other health actors are trying to learn the lessons, but these remain experimental and so far involve only tertiary level of care (hospitals). Extreme caution is needed before these schemes are replicated at the secondary and primary health care levels.
The widely spread assumption that the users fee will provide better motivation of health staff, hence better care to the patients, still remains to be proven. In the meantime, the examples tend to show that users fee schemes, particularly those set up without official approval, may exclude the poorest from access to health care even further.
Efforts to direct Health Financing better should first ascertain whether the new system gives better equity and quality services (including the "perceived" elements of quality), rather than just seek more income for the suppliers.
Finally, it should remain clear that the introduction of the users fee is not the solution to low salaries. In that regard the Public Administration Reform remains the priority.
THE LOW SALARIES OF CIVIL SERVANTS IN THE HEALTH SECTOR
As in 1997, low salaries as well as the low skill and education level of the civil servants are still the main obstacles to health reform. The consequences of the low salaries are now well known: absenteeism, survival corruption, and low motivation. It also predisposes the very prejudicial brain drain of the most competent civil servants leaving their post for better-paid jobs in International Organizations or NGOs. Finally low staff salaries render supervision more difficult as managers are reluctant to demand too much from under-paid staff, hence jeopardizing strict respect for the professional code of conduct, the enforcement of new regulations, and the implementation of the Health Reform as a whole.
Nevertheless, it should not be expected that salary increases alone will re-motivate staff. The work environment, the leadership, the extent to which staff are involved in management, the training offered, etc, will have equal weight in ensuring staff motivation. In other words, a holistic approach to the management of the staff is needed.
THE REFORM
Although the Health Sector Reform was launched from within the overall Public Administration Reform, the former is now very much ahead of the latter.
A lot of progress was observed in the health sector: infrastructure, institutional strengthening and management training. New organizational structures have been set up, co-management teams of Health Centers and hospitals have been institutionalized, management courses were given, a Health Information System was introduced, etc. There is now a regular supply of medicines from the Central Medical Store. There is enough staff (actually too many) with at least the basic skills to operate the system although the better skilled are too concentrated in the urbanized area. However, all this progress has failed to draw more patients to the public facilities. And public health staff continue to re-channel patients to their private clinics.
The reality is that at present, both for financial and human resource reasons, only government health facilities that are supported by International organizations or NGOs can afford the implementation of the new system. There is also a need to link with, and regulate, the other parts of the health sector (including traditional and private for profit). This is needed to prevent patients from spending too much money on ineffective care and arriving at public health facilities when it is too late and all their money has been spent.
In another area, there is a serious lack of ethics in the government health facilities that goes beyond the survival corruption mentioned above, and cases of poor people refused access to care even in emergencies are not uncommon. Promotion of the professional code of conduct (or code of deontology) is much needed.
Human resource development (HRD) through continuing education is essential. After a good start, the end of the Asian Development Bank-supported project, the departure of its foreign experts, as well of the chief of the MOH Human Resources Department for further studies, have caused an unfortunate halt to the process. It is of utmost importance that the Human Resources Department be given more means and leverage within the MOH so that HRD is given more attention.
In addition to the need to improve all health related skills, the new Operational Health Districts plan also gives new responsibilities to managers who often do not have yet the skills to implement them. Yet, the District and/or Provincial managers skill and motivation is paramount to the success of the reform implementation. Staff, including managers, should be recruited and promoted based on competencies rather than political loyalty, as seen in the past
Finally, the establishment by the MOH of a Health Sector Reform Indicator Framework is an essential step to better evaluate the progress of the reform. Some of these indicators are rather constraining (such as the Human Development Index) and their adoption demonstrates the good commitment of the MOH.
"QUALITY" CARE VERSUS "PERCEIVED QUALITY" CARE
The quality of services is central to health reform. First, because most reform is based on the assumption that once good quality care is provided in public health facilities, those facilities will be more frequented. Second, because the question of quality is said to be linked directly to the successful implementation of users fee schemes. However, there are different perceptions of quality care. Quality care, as broadly understood by policy makers, is effective care care that gives the best treatment and has the greater chance to heal. It also includes the notion of best value for money. For the population, quality care relates more to the satisfaction they draw from it, that is, the extent to which it responds to their expectations. It encompasses a wide range of factors, among which medicines play a key role (see Drugs below). Generally, it is perceived that the more drugs prescribed the better the care. The private for-profit sector has quickly understood how to exploit this perceived quality for lucrative purposes, and going to a private practitioner is often a sophisticated variant to self-medication. The reason the public sector is not learning appropriate lessons is because the doctors practicing in private clinics are the very same as those in the public facilities. They have an interest in playing on the dissatisfaction the public sector conveys to attract patients to their private clinics.
As stated earlier, quality of care must remain the goal of the reform, but public services will also have to take into serious consideration patient perception of quality and seek to give them personal satisfaction, not only good treatment. This is paramount to any set up of users fee scheme.
THE PRIVATE FOR-PROFIT SECTOR
The private sector is without doubt the fastest growing sector in the field of health. This is most likely due to the fact, discussed above, that the private sector responds more skillfully to what people perceive as quality care. This expansion of the private sector goes largely unregulated and uncontrolled leaving the door open to irregularities and serious abuse. More State regulation of the private sector is in order and logical, but it must be acknowledged that implementation would be very difficult because the public and private doctors are the same people. Given the current situation with regard to law enforcement, the establishment of a self-regulatory "Ordre des Médecins" as in many other countries would be a good first step. Success of such an initiative would come from the qualified health professionals who would be more inclined to protect themselves from illegal practice than the many unqualified individuals who open private clinics. At present, doctors with the most clients are not necessarily the best clinicians but rather those who satisfy best their clients (see above).
DRUGS
Drugs are a centerpiece of the health system. One major progress made in 1998 by the RGC was the great improvement in the drugs distribution plan, as well as in their actual regular delivery to the public health facilities throughout the country (from the MOH Central Medical Store). This is a major achievement even if, in some instances, confronted with a serious shortages of funds, officials in charge of health facilities resorted to selling some State-supplied drugs to secure the cash needed to run their facilities. The ever-growing official list of Essential Drugs was a matter of concern, until the MOH recently undertook a thorough review with the assistance from UNICEF.
On a less positive note, the dramatic increase in the prices of the drugs procured for, and charged to, the RGC by the monopolistic private contractor is a matter of growing concern. Some items reportedly cost up to 50% more than their average cost in the international market. Although this may not put in question the procurement contracting principle, it does however raise the question of the cost-effectiveness of the current contractor.
Other concerns related to drugs are the continued and dangerous wide practice of self-medication, over-prescription of drugs in the private sector, general lack of rational use of drugs, low prescription skill of health professionals, and the ever-flourishing business of illegal pharmacies run by unqualified vendors.
THE HEALTH SITUATION
The health situation remains one of the poorest in the world with still the highest Infant and Maternal Mortality rates, chronic malnutrition, Malaria, Tuberculosis, and HIV/AIDS. In addition, 1998 saw a peak epidemic of Dengue Haemorrhagic Fever, several cholera outbreaks, and a massive intoxication by methanol (in home-made wine). Tobacco, alcohol abuse and traffic accidents remain public health issues requiring more attention, though the government is making progress in these matters.
The spread of the HIV/AIDS epidemic remains by far the main and most serious concern (see the HIV/AIDS attachment), with an estimated 150,000 HIV infected people, and more importantly now the fast-growing number of full-blown AIDS cases. Projects must increasingly address treatment of those already infected, and all the related socio-economic consequences, while continuing prevention work as the priority.
To this bleak situation the MOH always responds to the utmost of its capacity within its limited means, often to be confronted by difficulties that are beyond its control. Too many MOH decisions rest with the MOFE or with the Provincial Governors. NGOs therefore renew their support to all efforts of the MOH to provide equal quality health services to all, and they welcome the new Governments statements on this issue. They now await the implementation of this declared commitment.
In 1991 the Ministry of Health initiated a plan to control HIV/AIDS. The National AIDS Center Program works closely with NGOs and UN organizations and endeavors to involve these organizations at the national level. Issues central to the improvement of HIV/AIDS programs in Cambodia in which donors can make a difference include:
FOCUS ON CARE
There is currently a funding gap for the care of HIV/AIDS patients. According to Ministry of Health figures, less than 3% of the $5.5 million dollars allocated for all HIV/AIDS programs in Cambodia in 1998 was for care. As the number of affected individuals and families increases, more care, counseling and social services are needed.
HIV/AIDS counseling is needed in order to be able to provide patients with AZT treatment, instruct them in coping mechanisms, and provide referrals for support services. This is especially relevant for rural areas as counseling and testing are currently only available in 6 provinces. By the year 2,000 it is estimated that 25,000 people will need care. Total hospital capacity is currently only 7,000, so resources need to concentrate on making community and home-based care available.
As family members become infected, the fate of the entire family is put at risk as scarce resources are spent on health care expenses, children are withdrawn from school to care for siblings or very simply to go and work, for example recycling garbage, to help with some income for the family. At worst, family members resort to the sex trade, reinforcing the cycle of poverty.
The Phnom Penh Home Care Projects a joint project between the Ministry of Health and an NGO -- now visits 540 patients, around 60% are known to be positive, many more may be. The number of patients is rising by approximately 50 patients a month. Eighty percent of people the team sends for testing are positive and 122 deaths have occurred in 8 months.
Currently most donor funding of government HIV/AIDS programs focus on the Ministries of Health and Education. As the need for additional patient care grows, donors need to focus attention on social service ministries which can provide services to HIV/AIDS patients and their families such as the Ministries of Social Action and Vocational Training (MOSA) and of Womens and Veterans' Affairs. With its extensive provincial networks and staffing MOSA is particularly well-placed to take a larger role in this effort.
Welfare support will need to be developed to cope with the additional burden of HIV/AIDS patients. Prime recipients for such assistance are orphans. The number of orphaned children is currently estimated at 5,505 and no provisions are being made for them. This type of assistance requires a long-term framework to support the children until they are fully grown. As part of a support program, vocational training of HIV/AIDS patients and orphaned children will play an important role in assuring the well being of these individuals and their families.
CAPACITY BUILDING
Although there is enough general health care personnel in Cambodia, they are not adequately trained or paid, and often no drugs or equipment are available in the hospitals for them to use. Also, most of the health care staff are located in Phnom Penh or provincial towns. There is a lack of motivation and attention paid to people suffering not only from HIV/AIDS but from other illnesses as well. In order for adequate health services to be provided, it is vital for a stable and realistic government salary system to be put into effect as soon as possible.
The number of HIV/AIDS patients presenting themselves to hospitals is already larger than can be accommodated as in the case of Sihanouk Hospital Center of Hope described below.
Funding alone is still not enough. All funding needs to be accompanied by technical support in all aspects of HIV/AIDS program development including monitoring and evaluation.
COLLABORATIVE STRATEGIES
Government-NGO collaboration in HIV/AIDS in Cambodia is high. At present, NGOs are still in a better position to work in rural areas and do outreach activities. It makes sense for donor agencies to support additional government-NGO collaborative efforts, such as government sub-contracting to NGOs in regions where the NGOs are more strategically positioned. This type of collaboration will allow the Ministry of Health to effectively target remote or under-served areas by putting out requests for proposals for those areas.
DONOR RESPONSIVENESS
Many donor agency HIV/AIDS programs have limited budget flexibility, making it difficult for implementing agencies to be responsive as the in-country environment changes. Five-year programs that were written four years ago for Cambodia simply no longer reflect the real needs of the country, especially with regards to the distinction between prevention and patient care. When preparing or providing oversight for an HIV/AIDS program, donor agencies need to keep the changing nature of the situation in Cambodia in mind and build in budget flexibility that will allow them to be more responsive. When the donor agencies themselves are limited by such conditions, they need to take up the issue with their head offices.
Finally, given the scope and nature of the HIV/AIDS problem in Cambodia, donor-funded NGO projects should be two-to-three years long at minimum, while government-implemented programs need to be at least five years long.
FOCUS ON RURAL AREAS
Many people in rural areas do not have access to HIV/AIDS education. It is important to avoid concentrating resources in urban areas at the expense of the majority of the population that lives in rural areas. Media programs and additional outreach in rural areas are important, especially below the district administrative level.
Access to services in rural areas is equally limited. Health Centers should be supported to include all services, including STD treatment.
SIHANOUK HOSPITAL CENTER FOR HOPE
Sihanouk Hospital Center for Hope is a privately-funded hospital staffed by HOPE Worldwide, an international NGO, to train Cambodian staff and provide quality free health care for the poor. It was opened in December 1996 and began to collect data on HIV/AIDS in January 1997. In 1997 52% of people tested were positive for HIV. In 1998, the figure was 64%.
Aside from newly-diagnosed cases, people already known to be HIV positive attend the out-patient department. Only about 52% of the HIV positive patients are from Phnom Penh, the rest are from different provinces. Most are very poor, uneducated and many are too afraid to tell their families and friends for fear of rejection. Many have already been abandoned.
Due to the huge number of patients attending the hospital every day, it is simply not possible to see them all. Many are turned away and asked to return the next day. On average, 300- 350 patients are seen and treated a day. The purpose of the visits involve general medical/surgical problems. Many people have AIDS-related diseases. About 150 are turned away each day. There is no way of knowing how many of these have attended with an HIV/AIDS-related disorder.
Hospital staff receive a good regular monthly salary. As a result, they are motivated to work hard, are rarely absent from their work, enjoy learning and applying good medical practice. The patients therefore receive a high standard of care. In comparison, many hospitals in the city have insufficient resources and staff fail to receive salaries. This leads to poor motivation, staff demanding money from poor patients, corruption, high absenteeism as staff pursue their own private practice outside of the hospital.
The traditional Cambodian social safety net relies on most people having almost enough land to grow almost enough food to feed their families. In the absence of any formal social security services or other income support mechanisms, equitable distribution of land is all that stands between most Cambodians and starvation.
EMERGING LANDLESSNESS
Most Cambodians survive by seasonally switching between different modes of production - farming, fishing and foraging. Restricting public access to any of these domains - farmlands, wetlands or forest - could suddenly end this diversified, mobility-dependent survival strategy with devastating consequences for many rural people. There are signs that this is already happening.
CAUSES OF LANDLESSNESS
Cambodians are losing their land because of the combined effects of:
In its six years of operation, the vagaries and limitations of the Land Law 1992 has caused many difficulties for judges, land title officials, landowners, investors and, most commonly, for the rural poor and other vulnerable groups.
Some provincial courts are hearing as many as 30 land disputes per month. Inadequate administration of land rights registration;Administrative land titling work has been poorly resourced and inadequately executed in Cambodia. Investment in capital infrastructure, technical capacity and trained professional staff has been very low.
Less than 10% of occupied land has even the weakest form of tenure. Expropriation by force and the abuse of power.For the first time in its history, Cambodia is experiencing a shortage of unused, arable land for its burgeoning population. The emergence of a growing class of landless people is placing unmanageable demands on scant public services.
The population of Cambodia will double in the next 20 years.
LANDLESSNESS IMPACT ON DONORS
The likely outcome of landlessness continuing to increase at its current rate, will be an escalation of the demand for assistance from the international community to feed ordinary Cambodians thus perpetuating Cambodia' s dependence on that help.
The World Food Program reached 1.7 million Cambodians in 1998 supporting almost 15% of the population for an average of 45 days. DONOR IMPACT ON LANDLESSNESSA Revised Land Law adopted by the Council of Ministers of the RGC as a Final Draft on 28 October 1998 is being fast tracked through the National Assembly because of pressure to comply with the terms of a loan agreement with an international bank.
WILL THE REVISED LAND LAW WORK?
Rather than fix current land access and titling problems, or better equip Cambodia to deal with its looming scarcity of unoccupied arable land, the Revised Land Law makes these problems and difficulties worse.
The draft revised land law as it stands
a. fails to protect public land from privatization for personal profit.
CAMBODIA NEEDS INCLUSIVE GOVERNANCE
In a functioning, pluralist democracy, legislation is an instrument of the public policy that emerges from public debate between competing interests. In this instance though a Final Draft Revised Land Law has been produced without any public discussion or any clear policy for allocating rights on, or apportioning access to immovable property in Cambodia.
No public debate about land policy = no national land policy for Cambodia.
The Final Draft Revised Land Law could be vastly improved with additional input to its formulation from non-government organizations and individuals with expertise in this area.
HOW CAN GOVENMENT, NGOS AND DONORS MITIGATE LANDLESSNESS?
We are happy to note that the RGC was among the nations who signed the Mine Ban Treaty in Ottawa in December 1997. We are grateful to the Prime Minister, Samdech Hun Sen, for his pledge given at a recent Cambodian Mine Action Center-organized conference that legislation for ratification of the treaty will be passed to the National Assembly for approval as soon as possible after the formation of the new government. As a demonstration of their commitment to the de-mining process, the government needs to ratify the treaty and to begin destroying stockpiles of mines without delay.
Since the signing of the Mine Ban Treaty in December 1997, an additional 1,600* or more people in Cambodia have fallen victim to landmines and unexploded ordnance. The ratification of the Mine Ban Treaty will mark not the end, but a new beginning in the battle against the scourge of landmines, and donor assistance will be needed for some period of time to come.
While continuing funding for de-mining activities, donor agencies need also to continue and strengthen monitoring of the de-mining process so as to ensure that key objectives are met. The de-mining process does not end with the removal of mines from the ground, but only when the land is returned to the displaced and landless. The government needs to ensure that displaced people can return to their houses and farmland and be given secure title. In this way, those who were formerly landless and vulnerable may again be able to care for themselves and contribute to the economy of Cambodia.
During the course of 1998, non-government organizations working in heavily mined provinces became aware that, in some cases, land which had been de-mined had not been returned to those people for whom it had been intended - that is, refugees, internally displaced people (IDPs) and the landless poor.
Several key problems were identified:
It is difficult to estimate the total proportion of de- mined land under dispute. The Cambodia Mine Action Center (CMAC) Socio-economic Unit report of 1998, stated "the proportion of land under dispute is quite limited. In the areas assessed, it amounted to only 4%." This information was drawn from an assessment of 20% of the total surface area cleared by CMAC to date, in land that is easily accessible. NGOs working in heavily mined provinces believe the proportion of disputed land to be much higher. NGOs agree with CMAC's assessment, given in the same report, that without proper co-ordination and co-operation there is much potential for land disputes, especially in areas previously administered by the army and from which the civilian population had been displaced.
It is critical that the process of land use planning be improved. Land allocation and ownership issues need to be resolved before mine clearance begins. This step needs to be supplemented with adequate monitoring of land use after de-mining, ensuring that the actual target beneficiaries receive the land. There is also a need for greater communication and co-operation between de-mining, advocacy and development agencies over the issue of de-mined land.
The problem of de-mined land allocation is part of the larger land ownership problem existing in Cambodia today. The need for a more effective Land Law is addressed elsewhere in this paper.
The 20 years of conflict in Cambodia, especially the period 1974-1979, have had a profound impact on the mental health of the population. The experience of trauma, especially when severe and persistent, diminishes people's ability to cope with the problems of daily life. While there are no quantitative measures of the incidence of such distress within Cambodia, it is widely noted by mental health observers that the traumatic experience of the period has affected a significant proportion of the population. In addition, chronic mental illnesses, such as schizophrenia, are found in Cambodia at approximately the same rate as the rest of the world.
There are insufficient resources - human, technical or financial - devoted to addressing this problem. Needed are culturally relevant and accessible services, research, and a comprehensive system to address the long-term mental health needs of the nation, and thus to increase the capacity of citizens to take full advantage of development programs and strategies.
CURRENT SITUATION
ISSUES
SUGGESTIONS TO DONORS
To fill this gap, NGO micro-credit programs have expanded rapidly since 1991. Today, the most recent reports indicate the total amount of loans outstanding is approximately $15.3 million serving 215,000 borrowers. This represents approximately 11 percent of the rural population. It is estimated that a further $10 million in credit is supplied through friends, relatives and moneylenders. Demand for rural credit is estimated to be in the range of $100-$150 million resulting in a credit gap of $67-$117 million3. Therefore, the current supply of rural credit is considered woefully inadequate.
With limited access to financial services other than family and friends, people have relied on moneylenders and traders for investment capital to finance essential inputs for agricultural production or micro enterprises. With nominal interest rates ranging from 10 to 30 percent per month, this has seriously constrained rural economic growth as the extremely high interest rates have undermined the borrowers ability to achieve an adequate return on his/her investments. Furthermore, with such high rates of interest, borrowers run the risk of entering a perpetual cycle of indebtedness
The RGC and donors are currently seeking to further develop the rural (micro) financial system to address this critical constraint to development. Outlined below are NGO recommendations relating to development of the rural (micro) financial sector.
Royal Cambodian Government
Donors
Reducing Impunity
Accountability is one of the first and fundamental steps in the process of building the nation, as it supports the rule of law and protection of human rights. Cambodia has a constitution and legal system which upholds human rights, democratic principles and due process of law; however, the constitution and legal system have yet to become the paramount instruments of state.
Impunity constitutes one of the main causes of human rights violations throughout the world. Impunity in the Cambodian context means that civil servants, police, military and armed groups are often protected from prosecution. Impunity is prevalent in all phases of the legal process, hampering both the thorough investigation of crimes by police and prosecutors and the rendering of justice by judges. Another cause for impunity is the lack of material resources available to the police and prosecutors to carry out a thorough investigation of crimes and human rights abuses.
Accountability is also hindered by the existence of Article 51 of the Law on Civil Servants. This article requires the prior permission from the Head of the Ministry to prosecute a low-ranking civil servant and the prior permission from the Council of Ministers to prosecute higher-ranking civil servants. It is the experience of human rights workers in Cambodia that this authorization is rarely given and that government personnel are placed above the principle of equality before the law.
NGOs recommend that donors allocate funds and technical assistance in a manner aimed at solving the problem of impunity. In particular:
Efforts to reduce impunity would be greatly enhanced by bringing to justice the former leaders of the Khmer Rouge, who were responsible for the death of an estimated 1.7 million people between 1975 and 1979. We call on the international community to:
Strengthening the Judiciary
Even though progress has been achieved in recent years with regard to the strengthening of the judiciary as one of the main pillars of the rule of law, the NGO community in Cambodia is still concerned about judicial independence, training and corruption. Nevertheless, the NGO community is pleased to note that the Appeals Court overruled a provincial (Kompong Som) court ruling in a case concerning pre-trial detention of two human rights workers who were detained for their alleged involvement in riots and demonstrations in late December 1998. The decision is welcomed as a sign of the maturity of the emerging legal profession and assertiveness of the higher judiciary.
An independent judiciary is essential to ensuring accountability. However, the judiciary in Cambodia suffers from a lack of independence from the Ministry of Justice, for example in the practice of issuing Ministerial circulars which have the effect of law. This violates the principle that only the legislative branch has the power to make laws.
Further contributing to the inappropriate link between the judicial and executive branches of government is the fact that representatives of the Ministry of Justice are permitted to be members of the Supreme Council of Magistracy, which appoints, supervises and disciplines judges. There is also a need for judicial appointments to be made independently of political parties, in order to avoid any risks to judicial neutrality.
In addition, judges, many of whom were never trained as lawyers, often lack basic knowledge related to justice in a constitutional democracy and many courts in the country do not have the necessary equipment or resources to render justice.
NGOs recommend that donors allocate funding to strengthen the judiciary. In particular:
Neutral and Effective Police and Military
Neutral and effective police and military forces are essential to ending Cambodia's climate of impunity and to establishing the rule of law. The legacy of war, in which military units served particular political factions, needs to be superceded by a neutral and effective military focussed on protection of the Cambodian people as a whole.
Police lack basic training on law and techniques, including criminal investigation, and lack an understanding of and respect for human rights and neutrality of the police. They also lack rules of procedure which leads to a failure to respect human rights and to effectively enforce the law.
Military officers also lack training fundamental to the protection of the Cambodian people and international law. Many do not understand or respect human rights and the international conventions of war, which often leads them to violate, rather than protect, people's rights. Also, the continued existence of large "bodyguard" units accentuates the possibility of military clashes.
As in other ministries, nepotism in recruitment and promotion and the existence of "ghost" staff on the payroll detracts from the efficiency of the police force and military.
In order to develop and rebuild itself under the newly-formed government, Cambodia will require police and military forces which ensure the rule of law and accountability. Therefore, NGOs call on the donors to direct funds toward promoting professional and neutral armed forces, well-trained to understand and respect the rule of law, human rights and the principle of neutrality. In particular:
Civil Society
The emergence of civil society is a key to developing the nation and protecting individuals, providing an important contribution to public debate. A civil society can provide assistance in cases where the government is unable or unwilling to address particular problems.
In Cambodia, civil society is still in its infancy and there is a need to protect and nurture the democracy which now exists. Recent threats to democracy have included the harassment and arrest of human rights workers, newspaper attacks on the work of NGOs, and the use of excessive force against demonstrators.
NGOs recommend that donors allocate funds and technical assistance aimed at strengthening and protecting civil society. In particular:
We call upon the donor countries and agencies to encourage and assist the RGC to bring about the suggested recommendations by investing in the implementation of legal reforms in order to guarantee the rule of law and respect for human rights in Cambodia.