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ACHIEVING THE CAMBODIA MILLENNIUM DEVELOPMENT GOALSExtracts from 2005 Update 1. The Cambodia Millennium Development Goals (CMDGs) have 9 goals, 25 overall targets, and 106 specific targets covering (i) extreme poverty and hunger; (ii) universal nine-year basic education; (iii) gender equality and women’s empowerment; (iv) child mortality; (v) maternal health; (vi) HIV/AIDS, malaria and other diseases; (vii) environmental sustainability; (viii) global partnership for development; and (ix) de-mining, UXO and victim assistance. For each specific localized indicator of the CMDGs, short, medium and long-term target values to be achieved during 2005, 2010 and 2015 have been specified. 2. While there has been significant progress over the last decade in implementing pro-poor policies and wide-ranging reforms aimed at strengthening democracy, rule of law and good governance, the most formidable development challenge faced by the Royal Government of Cambodia (RGC) today is to meet the targets set under the CMDGs. Eradicate extreme poverty and hunger 3. Measuring progress against this goal is somewhat constrained by the scope of baseline data in 1993/94, which could not cover the entire country due to security problems at the time. Nevertheless, available estimates show that poverty rates have fallen significantly in the urban and more accessible rural areas which were covered by the 1993/94 survey, but that poverty rates are now much higher in the remaining mostly rural and relatively less accessible areas. 4. According to estimates using recall data on consumption, the proportion of total population below the poverty line in Cambodia was 34.7% in 2004. As there is no comparable estimate for the total population in 1993/94, it is difficult to assess the changes in poverty for the entire country. The changes in poverty rate for the people living in the same geographical areas that were included in the 1993/94 Socio-Economic Survey of Cambodia (SESC) can, however, be estimated. This covered only 59% of geographical area and 68% of households, excluding many poor and inaccessible rural areas due to security problems at the time. The estimates, based on the truncated and comparable sample, show a strong decline in the poverty rate from 39% in 1993/94 to 28% in 2004 in areas covered in 1993/94 survey. 5. Similarly, the percentage of people living below the food poverty line for the entire country was 19.7% in 2004, but earlier country-wide figures are not available. However, estimates from the same comparable sample show that the proportion of people below the food poverty line also fell substantially from 20% in 1993/94 to 14.2% in 2004 for the areas covered by 1993/94 survey. 6. The incidence of poverty in the excluded areas from the 1993/94 survey can be calculated from the available data which comes to 45.6% in 2004, much higher than the 28% in the included areas. Similarly, the food poverty index in 2004 is estimated at 28.7% in the excluded areas, more than double the 14.2% for the included areas. 7. While Cambodia’s success in reducing poverty in urban and more accessible rural areas is commendable, a major challenge over the next decade is to reduce poverty in the remaining rural areas from their existing high levels. For this, and for meeting the CMDG target of halving the poverty rates for the entire country from the available benchmarks of 1993/94, Cambodia requires faster economic growth and its much better pro-poor distribution over the next ten years. A major requisite for achieving this is to adopt deliberate, focused and targeted strategies and actions to accelerate poverty reduction in the rural areas, especially in those high poverty-stricken areas that were excluded from the 1993/94 SESC. 8. While there is evidence of progress in reducing poverty, it seems to have been at the cost of increased hardship amongst segments of the population, especially children and women. As well as the rural issue, there are also issues of increasing inequality and its impact on working children, vital to the development of Cambodia’s next generation of human resources. Achieve universal primary education 9. Cambodia has made progress in increasing access to basic education, but the country has a long way to go to reach the targets set under the CMDGs. One of the ten estimates of performance shows that the situation has worsened, while another four show only minimal progress. Of the remaining five indicators, four do not show enough progress to reach the 2005 targets while one indicator--the proportion of 6-14 year olds out of school--shows improvement that exceeds the 2005 target. 10. The net admission rate, which compares actual to potential admissions in grade 1, remained the same at 81% in both 2001 and 2005, against a target of 95% in 2005. The survival rate (the proportion of students who stay in education) from grade 1 to grade 9 has actually fallen from 33% in 2001 to 30.18% in 2005 as against a target of 52%. Other survival rates – from grade 1 to grade 5 and to grade 6 - have shown only marginal improvement. These and other results leave a big gap to the targets set for realising the goal of universal nine-year basic education. The estimates imply a persistent low level of efficiency in the education system in Cambodia. 11. In 2005, 18.7% of 6-14 year olds remained out of school, better than the 2005 target of 22%, and the 35% out of school in 1999. However, the figure needs to be treated with caution in view of the increasing proportion of working children aged 5-17. Reports indicate that there are many over-aged children stuck at the primary level, which creates disincentives for parents to send their children to school. Other disincentives obviously include poor quality education, lack of trained teachers and educational materials, as well as poverty itself. Measures such as paying teachers a living wage and possible redeployment of more qualified teachers to rural areas should be considered. 12. The literacy rate for 15-24 year olds has remained largely unchanged in recent years. In 2005, the rate was 83% compared with 82% in 1999. The target was to increase it to 90% in 2005. Another major concern is the issue of bridging the gender gap in basic education. Performance in 2005 shows large shortfalls, especially in lower secondary education. Promote gender equality and empower women 13. Cambodia has made significant progress in promoting gender equality and most of the indicators are close to targets. However, there are major problems, especially in the area of domestic violence, which have only recently begun to be addressed. Further, some apparent gains mask underlying problems. 14. Over the years, gender disparity at upper secondary and tertiary education has been declining and in 2005, the ratios of females to males in both upper secondary and tertiary education are close to their targets. 15. The ratio of literate females to males in the age group 15-24 years is below its target for 2005. The estimate is 90% for 2005 while the target was 95% as against a benchmark of 87% in 1998. Similarly, the ratio of literate females to males 25-44 years old has increased marginally to 80% in 2005 compared with a target of 85%. 16. The most noteworthy feature of women’s empowerment is the increase in women’s share of wage employment in all three broad sectors, with targets achieved in both agriculture and industry. Only in the services sector has progress not met the target. Women’s share of wage employment in services is estimated at 27% in 2005, compared with the target of 30%. However, it must be remembered that most women by far work in the informal sector and as unpaid family labour. 17. Changes in the status of women in the political sphere have been slow. Women still have little representation in political, administrative and other areas. A notable exception is in some senior public service jobs such as under secretaries of state for which women’s share has surpassed the 2005 target, albeit to less than 12%. 18. There is evidence of high levels of violence against women, and gender equality overall remains a major issue in Cambodia. The recent enactment of the new law on domestic violence is evidence of the Royal Government’s commitment to improving the situation, but the challenges in this area are substantial. Reduce child mortality 19. Estimates of child mortality show significant improvement in all available target areas. The present estimates, however, should be treated with caution due to differences in survey methodologies and techniques in data collection. The under-five mortality rate is estimated at 82 per 1,000 live births in 2005 compared with 124 in 1998. The target for 2005 was 105. Similarly, the infant mortality rate is estimated at 66 per 1,000 live births in 2005 compared with its target of 75 and a benchmark value of 95 in 1998. Such indicative trends are consistent with the rapid decline in total fertility rate and the reported increase in immunization – both for DPT3 and for measles. For example, the proportion of children under one year immunized against DPT3 increased from 43% in 2000 to 83% in 2005, surpassing the target of 80%. For immunization against measles, the target was also achieved, with the coverage increasing from 41% in 2000 to 80% in 2005. 20. The proportion of mothers who start breast-feeding their newborn child within one hour of birth increased to more than 29% in 2005, surpassing the target. Nevertheless, the major causes of child mortality in Cambodia remain acute respiratory infection and diarrhoea for which effective measures are needed. 21. A rapid initial fall in child mortality due to fertility decline and other factors, however, is unlikely to be sustained unless the underlying causal factors that result in high child mortality in Cambodia are addressed, such as poverty, malnutrition and food insecurity; lack of access to safe water and improved sanitation; poor housing; limited knowledge of personal hygiene; unsafe health practices; inadequate health care system and disease control programmes. A central message that emerges is that child mortality in Cambodia remains among one of the highest in the region; that the potential of vertical disease control programmes are rapidly approaching their limits; and that further progress will increasingly depend on success in establishing functional health services where current progress is unsatisfactory. Improve maternal health 22. Recent information on the status of maternal health is scanty. Data is available on only four of the nine indicators. In particular, data is not available on the most important indicator, maternal mortality ratio. However, where information is available the picture is mixed. 23. The total fertility rate has declined from 4.0 in 1998 to 3.3 in 2005, surpassing the target of 3.8. The proportion of married women using modern birth spacing methods through the public sector has increased to 20.1% in 2005. However, considerably more married women access the services through social marketing systems and the private sector and, considering the total number, the overall result will probably be close to the 2005 target of 30%. Similarly, the share of pregnant women with two or more ante-natal care (ANC) consultations from skilled health personnel in the public sector increased from 25.4% to 47% over the same period. The overall rate including non-public facilities would be close to the target of 60% in 2005. Analysis of inter-censal population survey (CIPS) 2004 data suggests that more than one-fifth of the illness-related causes of death of women in 15-44 years age group are due to pregnancy-related complications including during deliveries. Such alarmingly high figures call for careful assessment of the situation, and review of interventions. Combat HIV/ AIDS, malaria and other diseases 24. Cambodia has made significant progress in meeting 2005 targets under the goal through effective measures to combat HIV/AIDS, the incidence of malaria, dengue and other major diseases such as tuberculosis. While data on only 12 of the 19 indicators under this goal is available for 2005, many of these results exceed targets. 25. For HIV/AIDS, the prevalence rate among adults aged 15-49 has sharply declined from 3.0% in 1997 to 1.9% in 2005, surpassing the target of 2.3% set for the year. The HIV prevalence rate among pregnant women aged 15-24 visiting ANC centres has also declined to 2.1% in 2005 from 2.5% in 1998, ahead of the 2005 target of 2.4%. Condom use rate by sex workers is close to its target of 98% in 2005, increasing from 91% in 2001. The percentage of people receiving anti-retroviral combination therapy is 45%, well above the target of 25%, up from only 3% in 2002. Over 9,000 people were receiving this treatment as at the third quarter of 2005. 26. The malaria case fatality rate reported by public health sector declined from 0.4% in 2000 to 0.36% in 2005 although the target was to reduce it to 0.3%. In the case of dengue, the fatality rate has significantly declined -- from 1.5% in 2000 to 0.74% in 2005, better than the target of 1%. 27. While many of these results are encouraging, complacency cannot be entertained for such deadly diseases as HIV/AIDS and tuberculosis. These diseases are significant causes of deaths across all groups of population. Moreover, new areas of concern need to be addressed for HIV/AIDS, such as increasing parent-to-child and husband-to-wife transmissions. The quiet spill over of HIV/AIDS into the rural areas is also a major concern. The conventional intervention strategy to combat the disease by focusing on urban and high-risk groups needs to be complemented by approaches that address vulnerability in a wider range of settings and populations. Ensure environmental sustainability 28. While there are major gaps in the information available in this area, much of the data that can be analysed is positive. Recent information on the key issue of environmental sustainability in Cambodia – the issue of forest coverage and management - is not available. However, it is commonly acknowledged that the pace of forest depletion has not been reduced as planned. The forest depletion process is partly reflected in the high incidence of fuel wood dependency. In 1993, 92% of households were dependent on fuel wood. This declined slightly to around 84% in 2005, while the target was to reduce it to 70%. These targets will remain elusive unless serious efforts are taken in both forestry and energy sectors. 29. Access to safe water sources amongst rural and urban populations has increased to around 42% and 76% respectively in 2005. Safe water access exceeds the rural target of 30% and the urban target of 68%. Similarly, access to improved sanitation amongst the rural population has increased to 16%, well ahead of the 2005 target of 12%. In the case of urban populations, access to improved sanitation is at 55%, close to but below the 2005 target of 59%. Compared with other successes, this relatively poor performance in realising the target is partly explained by the large influx of the rural poor into urban areas. As such, future efforts will need to focus on improving agricultural productivity to reduce the pace of rural-urban migration, and to improve the living conditions of the urban poor. De-mining, UXO and victim assistance 30. As one of the worst landmine and unexploded ordnance (UXO) affected countries in the world, Cambodia adopted the target of completing the de-mining of contaminated areas by 2012. Although significant progress has been made, this target is unlikely to be achieved. The Cambodian Mine Action and Victim Assistance Authority (CMAA) has re-set the completion year at 2015. 31. The major gap, however, lies in reducing the number of civilian casualties each year. The number of such deaths is nearly 800 for 2005 compared with a benchmark of 1,691 in 1993, while the target was to reduce it to 500 per year in 2005 and 200 per year in 2010. This high death rate has occurred despite the clearing of more than 50% of contaminated areas, as compared to only 10% in 1995. Part of the reason for this is that as land is cleared, human habitat approaches the more densely contaminated areas, which keeps the death rate high. The other main reason is the dismantling of UXOs for scrap metal by scavengers. This latter issue also needs urgent attention. Achieving the CMDGs: future challenges 32. Although Cambodia is on track to achieve several CMDG targets, it is not on track in many critical areas related to food security, poverty reduction, education and sustainable social and economic development. Major achievements and critical shortfalls in achieving the CMDGs are summarized in Table 1. Table 1: Major achievements and critical shortfalls in meeting CMDG targets, 2005
33. Cambodia’s present performance in relation to the CMDGs is mixed and uneven. It is likely that Cambodia will not be able to meet all the CMDGs by 2015 unless its national efforts are further strengthened and are supplemented and reinforced through global support. Without such support, Cambodia will fall further behind other developing countries in Asia-Pacific, thereby widening regional economic and social disparities. 34. Cambodia’s progress towards the CMDGs is constrained by many impediments, of which two critical ones are the chronic shortage of investment funds and poor access to international markets, especially in developed countries despite its entry into the WTO. The resource gap needs to be resolved through greater aid inflows, reduced debt servicing and increased current account inflows, as outlined in MDG8. Cambodia’s success in making trade work for development and towards achieving the CMDGs would require its more commercially meaningful access to international markets through granting preferential market access to its export products, such as quota-free and duty-free schemes for all its dutiable products in developed country markets. Cambodia can achieve the CMDGs provided bold initiatives are taken by the external development partners and the global community to strengthen and complement its pro-CMDG national strategies. |
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