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HEALTH

 (i) Introduction

 

The good health of a nation’s population is important for that nation’s security, prosperity, and economic development and as such it is within the responsibility of governments to promote it to the best of their ability. The Royal Government of Cambodia (RGC) in general and the Ministry of Health in particular recognize this responsibility and the past several years have seen much effort to promote a healthier population. Yet, the responsibility for health promotion does not rest with governments alone, and the goal of a healthy nation is shared by the NGO community in the health sector as well as other stakeholders. MEDICAM, as a membership organization of more than 100 NGOs working in Cambodia’s health sector, is pleased to have participated in this effort.

 

The last several years have seen progress in a number of areas. Some achievements worth highlighting include: 1) Increased budget and spending by the RGC in the health sector reflecting the priority given to health issues within the government. 2) The development of new healthcare policies, strategies and guidelines are a welcome addition and represent the continuing effort to rebuild Cambodia’s public health infrastructure. 3) An increase in coordination is seen in many areas. An example is the improvement in the annual operational planning process with decentralization and the inclusion of different stakeholders. 4) An increase in functionality of some of the structures within the Ministry of Health such as the Technical Working Group on Health (TWGH). 5) Progress in the implementation along with positive outcomes are seen in a number of areas of the Health Sector Strategic Plan (HSSP). Improved immunization rates and a decrease in HIV prevalence are notable examples. Lastly, 6) Cambodia’s successful proposals to the Global Fund to fight AIDS TB and Malaria (GFATM) in rounds 1,2,4 and 5 makes it one of the more successful countries in the region to obtain additional funding to fight these three important diseases. It reflects a relatively good collaboration between stakeholders in this innovative public-private partnership

 

Both health NGOs and civil society acknowledge and appreciate the efforts of the RGC to include them in the policy and planning dialogues and as partners in their implementation. As partners in health with the MoH, NGOs have contributed significant resources in the planning and implementation of health sector projects and as such share in the successes noted. But as partners and implementers, NGOs are likewise in a good position to note the difficult challenges that lie ahead. Thus, MEDiCAM allows itself periodically to summarize in the form of this position paper some of the main issues that it sees facing the development of the health sector in Cambodia. The issues and recommendations below are not intended to be comprehensive, nor are they able to be detailed. It is hoped they will articulate the NGO perspective on important selected topics in health.

 

 (ii) Key Issues and Recommendations

 

While some progress in the health sector has been made over the past several years much more remains to be done. Achievement of critical outcomes such as the Millennium Development Goals (MDGs) as well as the successful implementation of the Ministry of Health’s Strategic Plan (HSSP 2003-2007) will require sustained effort, increased leadership and coordination, an application of additional resources in some areas and a more efficient utilization of resources already at hand throughout the health sector. Examples include:

 

1) Budget “dry season”: Most of the issues raised in MEDICAM’s last position paper remain relevant but will not be explicitly repeated to avoid redundancy. Nevertheless, the issue of regular and timely cash disbursements to the implementers of health policy at the operational level is important enough to bear repeating.

 

MEDICAM again calls on the RGC to show transparency and accountability for policies designed to reduce delays in budget disbursement during the first part of the year.

2) Promote equal access to quality medical services throughout Cambodia: This shared goal requires a multifaceted response. Improvements in equity, access and quality are all interrelated. A number of studies continue to suggest that the poorest segment of Cambodia’s population benefit the least from improvements in the health system. Distance and long travel times to facilities remain a barrier, particularly in rural areas where the majority of Cambodia’s poor live. A maldistribution of trained providers often results in understaffing and absenteeism at health facilities once they are reached. Even when health services are available and staffed, the poor are often forgotten due to concerns that they can not afford it. Lastly, concerns about perceived low quality, poor staff attitudes and unavailability also contribute to the poor shunning the public health system. Unavailability is usually because of the dual roles public providers have in both public facilities and their own private practices.

Thus, solutions must include overcoming distance and travel obstacles, creating effective policies and incentives for providers to work in remote health posts, health financing and insurance schemes that provide the poor with affordable care, and improvements in quality of services and provider attitudes and behaviors. Specifically, MEDICAM encourages:

A) The RGC along with donors and other stakeholders develop a clear policy and strategic plan that addresses recruitment, training and adequate salary of health providers in such a way as to ensure a more equal distribution in the rural health posts. This need is felt most acutely with trained health providers (THPs) in maternal health. Significant increases will be necessary if Cambodia is to meet MDG #5 regarding maternal survival and other goals.

B) Promote the MoH policy on Quality Assurance and solicit the NGO community in its implementation and in the effort to develop a method of accreditation.

C) Invest in the ongoing training in quality as well as in behavior change to health care providers at all levels of the health care system.

3) Health System Strengthening: Health system development is a complex issue which necessarily varies from country to country. Nevertheless certain necessary components are well established and include government stewardship, stable health financing mechanisms for essential health services, and competent human resources appropriately deployed to implement health service delivery. In addition to the recommendations in section 2, MEDICAM encourages policymakers to:

A) Focus on improving effective public sector management of health through building capacity in health data collection and information systems, procurement and logistical systems, decentralized management and mechanisms to enhance central-provincial communication.

B) Engage the private sector. MEDiCAM recognizes the need for regulation and Quality Improvement within this sector yet private providers are often the point of first contact and deliver the majority of health services in Cambodia. Properly utilized, the private sector can extend the coverage of interventions and improve health system performance. Innovative ways to create effective public-private partnerships should continue to be explored.

C)  Involve communities and civil society as an ally to the public health sector to aid in communication and intervention at a grassroots level. 

4) The Way Forward: MEDICAM believes the needs and challenges facing the health care system in Cambodia can only be met through a unified approach which involves all the stakeholders working together in a coordinated and cooperative manner. In pointing out needs and opportunities for improvement in the health sector, the NGO community recognizes that it too has many areas needing improvement. MEDICAM will call on the health NGO Community in health to promote increased collaboration, coherence and accountability by joining with all stakeholders and the RGC to develop a strong health care system and to improve the health of the population with all stakeholders and the RGC. It will encourage NGOs to work in harmonization with the Ministry of Health’s strategic goals in a way that makes the NGO community more effective partners with other stakeholders in the health sector.

MEDICAM remains convinced that NGOs are a vital and necessary partner for achieving the RGC’s health objectives. A huge amount of field experience, technical expertise, technology, human resources and financial resources resides collectively within the NGO community. MEDICAM believes that these resources could be more fully and effectively utilized in an environment of increased cooperation and understanding. Thus MEDICAM encourages:

A) The Ministry of Health, NGOs, civil society and their multilateral and bilateral donors to agree on a broad framework for the roles of NGOs that maximizes partnership and minimizes misunderstanding, competition and mistrust.

Many specific health issues remain to be addressed in Cambodia. Meeting MDGs such as reducing child mortality; improving maternal health; combating HIV/AIDS, TB, malaria and other infections; preparing to meet emerging threats such as avian influenza; and dealing with the increasing burden of chronic non-infectious disease are but a few examples. MEDICAM believes that the recommendations outlined above will contribute to successfully meeting these challenges and help provide better health and enhanced lives for the people of Cambodia.

 

For more information on the issues raised in this paper, please contact:

MEDiCAM, Tel: 023 211-486, Email: medicam@online.com.kh

 

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