[Back]    [Home Page]

Improving Capabilities


The ability to end cycles of poverty is to a large extent reliant upon development of increased capabilities within the population. The NPRS recognises that this requires a long-term commitment to improved health, education, nutrition, safe water and sanitation.  Investments in these areas also contribute directly to the quality of people’s lives.

Progress

There has been progress in the health sector through the construction and renovation of health facilities, the development of Primary Health Care guidelines, the expansion of the DOTs programme, the development of the Health Sector Strategic Plan, the commencement of the Health Sector Support Project and the development of a provincial annual operational planning process. The Annual Joint Health Sector review is a welcome innovation to improve co-ordination among health sector partners.

The NGO community has consistently applauded progress made by the RGC in relation to education over recent years: infrastructure development, new schools, improved learning conditions for students, and increased enrolments.  The PAP process, while far from perfect, has delivered increased resources to schools.

In order to improve nutrition, a sub-decree concerning universal salt iodination was passed and signed by the Prime Minister in October 2003.  Vitamin A supplements were distributed in 8 provinces.  However, the intake of iodised salt and vitamin A nationwide remains very low.

Despite the above improvements, Cambodia is not on track to achieve the CMDG health targets.  Data from national household surveys suggests that child mortality and infant mortality may have actually increased over the last decade, while other statistics show a slight decline from a higher level.  Education statistics are more promising, with Cambodia well on track to achieve its primary education enrolment CMDG targets, but falling behind its secondary education enrolment targets.[1]

Issues

Within the priority sectors of health and education, the RGC has committed itself to increased budget allocation and a strong emphasis on pro-poor service delivery. This approach is essential for the development and improvement of capabilities and is welcomed by the NGO community. As with all such developments, it is important that those commitments are translated into action at the most fundamental level of service provision and support.

In the health and education sectors the RGC has made commitments to increase budgets and improve support for public health provision. The NGO community has been pleased to see these increases and seeks to work with government to further facilitate improvements within the sector. However, progress remains constrained by a failure to disburse the funds committed to these sectors.

The RGC has made clear it plans to increase salaries in order to address the current weak incentives for effective service delivery.  Whilst these increases are welcome, they will not allow civil servants to receive a living wage from their formal employment alone.  NGOs recommend that, in sectors such as health, part-time work of government officials be recognised and better regulated and that additional incentives provided through donor funding be standardised.  The Ministry of Economy and Finance could be asked to clarify how additional allowances and incentives could be channelled through the PAP system. 

In the health sector, spending needs to be directed to lower operational levels.  Over the past few years, significant resources have gone to higher-level activities such as research and strategy development.  External support to the health sector needs to concentrate less on a few “popular” diseases, and more on disease prevention, nutrition and mother and child health.  Health posts in rural areas and health rooms in urban areas have shown excellent cost effectiveness. 

At the same time, the private health sector, which accounts for a large proportion of medical consultations, particularly in urban areas, is in need of clear and effective regulation to ensure sound medical practices.

NGOs welcome the Ministry of Health’s development of a Strategic Framework for Equity Funds to make health services freely available to the poor.  NGOs look forward to further co-operating with the Ministry in this endeavour.

Strategic commitments to increasing and improving health provision in specific areas are also important. In particular, targets within both the NPRS and the CMDG in relation to infant, under-five and maternal mortality need to be prioritised. This requires both improved reproductive health care and efforts to improve nutrition.

Within the education sector, the improvement in enrolment levels is welcome; but repetition and dropout rates still remain high. Proactive strategies are needed, on both demand and supply sides, to ensure equitable access for girls, who suffer from a low enrolment and low retention rates, and for the inclusion of disabled children and ethnic minorities within the public school system.

There are serious teacher shortages in remote areas of the country, with pupil/teacher ratios of over 70:1 in some provinces.  Redeployment strategies are not working effectively due to inadequate incentives and other constraints.  Greater effort is needed to recruit and train locally residing teachers.

The NGO community welcomed the introduction of the Priority Action Programme (PAP) and the publishing of targets for the disbursement of funds as a significant move towards the development of a system of open and effective funding. In both health and education, the problems surrounding the allocation of funding to the public sector have been, and continue to be, a major factor in the ability of government to provide these services in an equitable and effective way.

While welcoming the PAP system of post-audit programmatic budget allocation, NGOs note, regrettably, that there is little evidence that it has so far had a major impact upon budget operations in the education and health sectors. Cash management problems continue to occur with disbursements being irregular and delays tending to result in budgets being back-loaded.

In education, 80 per cent of the 2002 PAP allocation and none of the 2003 PAP allocation had been disbursed as of October 2003.  This is severely damaging to the ability of the education sector to honour its commitments. Partly as a consequence of this, schools and teachers continue to seek unofficial funding from their students, thus seriously limiting access to education for poor families.

In health, as in other sectors, there continues to be problems with the budget “dry season”, as funding fails to flow efficiently and regularly to the sector. Thus, during the first six months of the year field staff consistently face serious problems in accessing their budgets and are therefore unable to deliver health services effectively. The lack of available money during this period has a devastating impact upon health service delivery.

Recommendations

The NGO community makes the following recommendations in relation to health, education and nutrition:


[1] GSCSD, CMDG Report: Challenges and Framework for Actions, draft, July 2003.

  [Top]     [Back]    [Home Page]