COUNCIL FOR THE DEVELOPMENT OF CAMBODIA (CDC)


4.3 SOCIAL SECTORS

4.3.1 EDUCATION 222. The Government’s policy priorities for the education sector are laid out in its Interim Poverty Reduction Strategy Paper of 2000. These include: equitable access and quality improvements in the provision and delivery of basic education (the first 9 years of schooling) by around 2010. For post basic education Government’s priority is to enable more equitable access for the poorest, alongside a growing public/private partnership in financing and management. A cross cutting priority is to strengthen legislative and regulatory frameworks for quality assurance and sector performance monitoring across all sub sectors. It is recognized that total public expenditure has been below what is necessary to achieve these policy objectives. As set out in the Public Expenditure 2002/4, the Government intention is to more than double the education recurrent budget over the next 3 years as an initial step to strengthen policy implementation. Increased public spending on education will adopt clearly defined pro-poor policies and strategies, and to significantly increase school operating budgets that will be managed at the provincial/district and school levels. A key strategic priority of the RGC is to reduce direct and indirect costs to parents (the major access barrier) through a significant increase in performance based teacher salaries. The PAP for 2002 for education sector is designed to secure implementation of these policies. These initiatives will be underpinned by development of new legislation and regulations, covering all levels including higher education, and a draft education act that is planned to be prepared by early 2003. 223. The MoEYS PAP proposals for 2002 are designed to move policy implementation forward. They will assure financial sustainability of the quality and efficiency improvement programs that are being implemented through PAP supported initiatives covering instructional materials, continuous teacher development, expansion of literacy and non formal education and introduction of HIV/AIDS awareness programs. The PAP 2002 proposals for higher education and technical vocational education and training (TVET) are consistent with these policies and strategic directions. In addition, MoEYS has prepared plans for expansion of targeted food and cash/ in kind incentives for upper primary and lower secondary students from poor families to secure attendance and progression into secondary schooling. These revised incentive programs will be introduced in mid to late 2002. 224. Improving Efficiency and Productivity: The Government's strategic priority is to achieve significant improvement in the teaching and learning process through the provision of textbooks, increased school operating budgets and additional resources for professional development. A second priority is to make substantial efficiency gains in the use of classrooms through formalized double-shifting and multi-grade teaching. A key measure will be to secure substantial improvements in efficient staff deployment through rigorous monitoring of staffing norms and use of these norms in forward budget preparation. This MoEYS policy and strategic framework recognizes the fundamental importance of improved living conditions for teachers. Within the overall resource allocations, there is provision for a doubling of teacher salaries in the next 5 years. Government is determined to ensure that teacher pay increases are linked to performance improvements (e.g. regulation of attendance) and efficiency gains. Consistent with NPAR proposals, the strategy is to provide graduated across-the-board increase for all staff, alongside larger pay increases for core groups, who will make the greatest impact on policy implementation (e.g. head-teachers, teachers in remote areas, etc.). In particular, the proposals emphasize the importance of the classroom teacher, alongside more efficient and scaled down administrative support. Quality improvements to basic education will be based on curriculum reform. Students will be assessed regularly for learning through a national public examination linked to the regular monitoring of standards set at the end of grade 9 – the final level of basic education 225. Equitable Access: Scheduled quality and efficiency improvements to basic education will be complemented by prioritized rehabilitation and expansion of classrooms for primary and secondary schools. Cost effective models for delivery of schooling will be developed. Measures will be taken to reduce costs for poor families linked to targeted scholarships. Pre-entry reception classes will be expanded nationwide to regulate age of entry and secure school readiness. Within this framework, the emphasis will be on achieving better literacy and numerate skills with a view to meeting the Government’s target of 90 percent of 12 year olds completing Grade 6 and becoming functionally literate and numerate by the year 2005. The target is to ensure an enrolment of 2.4 million in primary, 0.8 million in lower secondary and 0.3 million in upper secondary schools by 2005. A high priority will be to expand access for the poor and females as well as under-served and low enrolment areas. The reform programs are already showing success and will be expanded to incorporate a broader coverage incentives programs for the poor and acceleration of primary and secondary school building program in currently underserved areas in 2002 and 2003. 226. Higher Education and TVET: The framework for strengthening the relevance of higher education and TVET to changing economic needs is provided by the ongoing implementation of strategic plans. These plans specify training delivery systems and roles and responsibilities of a reformed TVET system as well as identification of targeted groups. The Departments of Higher Education and TVET and National Training Board are the main institutions supervising and monitoring the implementation of these plans. In addition to reform of these systems, the Government will strengthen its investment appraisal mechanisms with a view to ensuring that instance external assistance programs as well as foreign direct investment incorporate structured training modules for transfer of technical specialization’s to national staff. The Government recognizes that provision of TVET services is a rapidly growing segment of the education and training sector. As most of these services are increasingly being provided by the private sector the Government will play a supporting role rather than establishing competitive organizations at ministry level. The Government has an important role to play in complementing the emergence of vocational and technical training by modernizing curricula and upgrading teacher’s skills in core science and technology areas, business studies and languages in secondary schools. Schools science will be strengthened and courses on self-employment, income generating activities and small business management will be developed and introduced into secondary schools and higher education curricula. Emerging entrepreneurs will be trained in finance and investment analysis, business management and accounting through closer links to the technical and vocational programs of business and non-government organizations. The private sector and NGOs will take the lead role in service provision in entrepreneur enterprise and development training. 227. Youth and Sports: The Government is committed to facilitating the emergence of sports facilities and youth associations, so as to increase individual responsibility for health and civil capacity for community initiated self-help development. A key priority is to establish a policy and planning environment conducive to the participation of the private sector in the direct provision of recreational and specialist sports facilities and sponsorship of sporting events. The role of the Government will be essentially that of a facilitator given the fiscal limits of public provision of recreational and specialist sports facilities. However, the Government will in the near term play a more direct role in the provision of school sports facilities as part of the process of rehabilitation and expansion, wherever feasible, of educational facilities. 228. Resource Mobilization and Financing Options: The Government is committed to devoting a greater share of national resources to education. Mobilization of additional resources from the budget and external assistance will be complemented by the opportunity to develop alternative financing options from revised private sector/community participation in the development of education. The Government will explore the feasibility of tax incentives to encourage individuals and private business to provide financial support to educational institutions. Schools will be encouraged to provide part of their own financing by developing financing mechanisms with the communities that they serve, linked to better financial regulations. However, Government is determined to reduce the share of non-public spending for basic education to ensure equitable access for the children from poor families. The expenditure composition of education will be further reviewed with a view to increasing the incentive framework for recruitment and retention of teachers and to ensure allocation of expenditures to their highest rate of return. The Government will focus on improving cost efficiency by reducing the number of non-instructional staff to a ratio of 5 to 8 percent of total staff by not replacing those non-instructional staff who leave or retire and by re-deploying non teaching staff who hold teacher qualifications. The Government will explore with donors the scope for moving towards a mixture of recurrent and capital budget support through appropriate modalities, alongside well planned capacity building technical assistance. 229. The Government recognizes that, in common with other sectors, many of the proposed education policy priorities are not easily implemented through traditional project funding alone. This situation applies particularly to many of the proposed institutional reforms. The education MTEF will be revised on an annual basis, taking account of PEP, PIP and PAP allocations for the sector. The MoEYS financing framework 2002/6 will also be revised annually, taking account of the outcomes of an annual Government/ MoEYS/donor/NGO annual performance review mechanism, which began in 2001. In late 2001, the development partners have produced an ESSP appraisal report and an action plan. The Government anticipates that the PIP for education will increasingly consist of a mix of recurrent and capital budget support. Early in 2002, the Government has secured support for this kind of mixed modality through an education sector development loan from ADB, and support for a substantial program from Sida for capacity building. 4.3.2 HEALTH SECTOR 230. The updated Health Sector Policy for 2002-2007 is based on a set of values and principles. The *values* underlying the policy put emphasis on the provision of high quality health services, with equity, and without discrimination by gender, age, place of residence, or ability to pay, that are pro-poor, and are based on trust between providers and users. The *working principles* for the implementation of these policies emphasize social protection for vulnerable groups, listening to what people want, a sustainable cost structure, focus on rural areas, capacity building and human resource development, and partnerships. 231. The updated health Policy will focus on the following twelve priorities: Provision of basic health services to the people of Cambodia with the full involvement of the community. Provision of essential specialized services as appropriate and within the available resources. Decentralization and de-concentration of financial, planning and administrative functions within the health sector. Optimization of human resources through appropriate planning, management, including deployment, and capacity development within the health sector. Priority emphasis on prevention and control of communicable and selected non-communicable diseases and injury. Priority emphasis on provision of good quality care to mother and child. Enforcement and further development of appropriate health legislation to protect the health of the population. Active promotion of appropriate health and health-seeking behaviours among the population. Emphasis on the quality, effective and efficient provision of health services by all health providers. Increased promotion of effective public and private partnerships for the efficient health sector. Effective use of the health information system for evidence-based planning, implementation, monitoring and evaluation in the health sector. Promotion of equitable access to priority services, especially by the poor. 232. The Ministry of Health’s operational objectives for 2002 include: Developing a framework for Sector Wide Management that includes (a) long-term policy and strategy; (b) a master plan for the development of the health sector from 2001 to 2007; and (c) a framework for medium-term (3 year) health sector expenditures. Operationalizing the Boosting of Health Care Services through continuing discussion with relevant institutions and partners for development of technical and other essential conditions for implementation. Strengthening the capacity of provinces and ODs in developing integrated annual plans for construction of health facilities, and supporting the medium-term development plans of the provinces Strengthening quarterly supervision, control, and monitoring systems and annual evaluation of all levels, in conjunction with strengthening communicable disease control systems to support the development of action plans, management, and interventions in the case of outbreaks of disease. Utilizing computerized information management systems for updating health information at provinces and ODs and encouraging the central level to provide feedback. Capacity building to prepare the budgets and plans, and strengthen the budget management efficiency through Operational District Training in the priority programs. Extend computerized accounting management to all entities and provinces/towns that implement the priority activities, and train OD and health centre staff in accounting techniques over the whole country. Strengthening the mechanism for exemption of fees for the poor when using consultation and treatment services, especially in referral hospitals and the national hospitals. This will assure that the poorest among the population that can not effort to pay for health services are not denied the services which they require. Improving the management and the use of income gained from user fees with efficiency and transparency by following the policy and financial regulations. This will improve the quality of health services and encourage staff to carry out their responsibly and respect their own professional ethics. Improving the management, distribution, and the use of drugs to properly conform to the guidelines and methods of treatment. This will reduce minimum stock shortages and over stocking. Carrying out the pilot strategy of Integrated Management of Childhood Illness (IMCI) in Kampong Tralach OD in Kampong Chhnang Province, and in Romeas Hek OD in Svay Rieng province. Increasing the coverage rate of expanded program of immunization for children under 1 year to 80% for 50 ODs and 50% for the other 23 ODs. At the same time, strengthen the system of integrated research on measles, and childhood tetanus. Increasing the campaign providing additional measles vaccines for children from 9 months to 14 years of age in Phnom Penh, Kandal, Kampong Speu, Takeo, Kampong Chhnang, Pursat, Battambang, Svay Rieng, Kampot, Kampong Cham, and Sihanouk Ville. Carrying out the campaign of providing additional tetanus vaccine for the second and third time to women from 15 to 44 years of age at the provinces/towns and ODs where the rate of tetanus vaccine injections is low. Increasing the rate of the second antenatal consultation for pregnant women to 40%, and the rate of tetanus injection for pregnant women to 50%, of all pregnant women. Increasing the rate of birth spacing to 30% and the rate of delivery by trained health staff to 70% of all deliveries. Reducing the rate of HIV/AIDS transmission by: increasing general awareness IEC for HIV/AIDS prevention; expanding and extending testing and counseling services; expanding the activities of 100% condom use; and promoting the continuum of care for HIV/AIDS. Expand Tuberculosis Care with the treatment of DOTS at 180 new health centres; at the same time increase the new case finding rate to 58%, and maintain a recovery rate higher than 85%. Reduce the rate of malaria incidence to 10 per 1,000 population, and the death rate to under 0.10%. Promote voluntary blood donation to ensure both the quality and quantity of blood collected. Open for service 5 blood banks at referral hospitals at OD level. Construct and expand 100 new health centres. Develop a teaching hospital in order to improve the quality of pre and post service training for health professional. Improve, step by step with the existing resources, the technical skills at referral hospitals, especially at provincial and OD level, by providing CPA and strengthening the referral system between health centres and referral hospitals. Increase the training in clinical techniques and management for health centre staff, referral hospitals, and management officers. In response to the lack of midwives at health centres, provide in-service, refresher training for health staff at health centres in the skills of maternal and child health care. Strengthen the on going training through decentralization of the development and use of the health human resource data system and expand the data management to included students who finish their studies, and the private health services. Promote the implementation of other public health programs to response to the needs for health education and promotion, oral and dental health, mental health, eye care, and food safety and nutrition, etc. Strengthen the mechanism for control of the private sector practice and conditions, and assure the quality of services as mandated by law. Promote coordination and collaboration with international and non governmental organizations and other partners through the use of computer information systems, and strengthen the leadership of the Coordination Committee (Cocom) of the Ministry of Health and the role of Prococom at provincial level. Public Investment Plan for the Health Sector 233. Purpose, Approach, Methodologies, and Scope: The proposed MOH’s Public Investment Plan (PIP) 2002-2004 is an integral part of the RGC’s three-year rolling plan, which has been designed to help attain the Government’s health sector objectives through financial and technical support. Several key strategic choices have been agreed on and identified in order to attain the best fit and maximize the sustainability and impact of the investments. Along with the health sector reforms, the PIP will ensure the success of both the public health programs and the rehabilitation of basic health services. The PIP also takes into account emerging priorities and development of medical technology. 234. Goal and Objectives of Health Sector Development: The overall goal of the Ministry of Health is to promote good health, that will enable the people to participate fully in the socio-economic development of Cambodia and thus contribute to the national goal of poverty reduction. The objective is to improve equity and accessibility of basic health services of good quality health service, efficiently and at the lowest sustainable cost. 235. Investment Components: The investments will be focused in the following four areas: *Strengthening the Health System* by supporting strengthening of health sector management, strengthening basic health services, human resource development, and reform of pharmaceutical management. Priority Health Program will focus on: tuberculosis and leprosy control, control of malaria, dengue hemorrhagic fever and schistosomiasis, control of HIV/AIDS and STDs; and women and child health programs. *Strengthening Hospital and Laboratory Services* through three projects: Rehabilitation and upgrading the capacity of technology at national and provincial hospitals; expansion of blood transfusion services at referral hospitals throughout the country; and strengthening the National Laboratory for Drug Control. Preparedness and response to *Emerging Priorities:* will focus on strengthening medical specialty for ENT and oral and mental health, development of health education, primary health care, and mental health. 236. Monitoring and Evaluation: In addition to the overall health indicators, specific performance goals and objectives have been defined and will be used for monitoring and evaluation. Selected indicators for monitoring and evaluating the overall program implementation progress and results have been developed. 237. Next Steps: Development of the Health Sector Strategic Plan: A number of tasks in the development of a Strategic Plan for Cambodia’s Health Sector have already been completed. These include: the institutionalization of organizational and financial reforms, significant achievements in polio eradication, control of TB, malaria, HIV/AIDS, and expanding birth spacing; and piloting of some innovative strategies i.e. contracting, and community involvement mechanisms. The steps to develop the Health Sector Strategy now being undertaken that will lead to, over the coming 10 months, the preparation of a Health Sector Strategic Plan for 2003-2007, include: *Updating the Health Policy:* already completed. *Identifying appropriate strategies to achieve the policy goals:* this will involve consolidation and scaling up of successful strategies, formation of a partners’ circle to discuss the process of sector strategy design, the joint health sector review with partners (already completed), the development of effective partnerships between public, private and NGO sectors based on comparative advantages. *Preparation of the Strategic Plan 2003-2007: this will involve an institutional review of MOH key departments to strengthen SWM capacity, and the facilitation of clear decisions on leadership responsibilities for sector-wide management. Preparation of a Medium-Term Expenditure Framework: this will involve the compilation of information on donor support to enable strategic decisions on resource allocation, coordination of MOH and donor inputs to reduce gaps and duplication, and facilitation and strengthening of the donor coordination framework. 238. CONCLUSIONS:* Cambodia's health sector faces a high burden of disease, and a weak health infrastructure to cope with this burden. Although significant progress has been made in strengthening and maintaining the public health system, much remains to be done. As in the rest of developing world, the primary constraints to strengthening and maintaining the health system is shortage of funding and the lack of legislative environment that supports its implementation. The health sector in Cambodia has gained strong support and political commitment from the Royal Government of Cambodia through increased budget allocations and investments in the social sector. The Ministry of Health, in collaboration with local and external partners, is taking concrete steps to reconstruct and revitalize the public health system with special emphasis on undertaking organizational, financial and budgetary reforms. The Ministry has developed and is implementing a three-year rolling plan of investment, in which most of the allocations are for the basic health services and essential public health interventions. In addition, the MOH is also making efforts to improve health-related regulations, and considering options for working with the private sector. These policies/plans can only be implemented if sufficient resources are made available from both the government and the donors within a collaborative framework for long-term sustainable development. \| Content \| Back \| Top \| Next \|