Donors working together for better health in Cambodia
05 September 2007
Related pages:
Cambodia country profile |
Millennium Development Goal 4: Child
Mortality |
Millennium Development Goal 5: Maternal Health |
Millennium Development Goal 6: HIV, AIDS,
malaria & other diseases
With the life expectancy of its people standing at 57 years, and around
two-fifths of its
children stunted through malnutrition, Cambodia's health is
among the poorest in Southeast Asia. And despite some recent progress in
reducing HIV infection rates and infant and child deaths, the country is still a
long way from reaching the Millennium
Development Goals on health.
In 2006, there were 22 donors providing $109 million of support to Cambodia's
health sector, through 109 separate projects. However, if the country's health
system is to meet the needs of its citizens, the Ministry of Health needs to
spend more of its time carrying out real improvements, and less of its time managing
all of these projects. The International Health Partnership (IHP),
launched in September 2007, aims to coordinate the efforts of donors, getting
them behind national priorities and freeing the Ministry of Health to go about
its key business of providing better healthcare to Cambodians. Donor coordination can be a great boost to
development, as the evidence shows.
Coordinated support in action
 In
recent years, the
 Government of Cambodia has worked with four development
partners - the
United Nations Population Fund, the
World Bank, the
Asian
Development Bank and DFID - on a programme designed to address some of the
country's most pressing health problems. The programme hires international
medical groups to help manage health facilities, and sets specific goals to work
towards. Effective donor coordination has meant that its efforts have been
spread widely over the country, covering 12 districts and serving 1.4 million
people - a tenth of the population.
One major achievement of the programme has been to increase the number of
children born either in a clinic, or at home with a professionally trained
midwife. Between 2000 and 2005, the proportion of deliveries attended by skilled
health personnel rose from 31.8 to 43.8%, contributing to a rapid
reduction in infant and child deaths.
Chum Mony's family are among the many who have benefited. While Chum sits in the shade under his house in Preah Sang, a poor village in
rural Cambodia, his neighbours come by to visit to see his two-day-old son.
Unlike his older brothers, as well as his parents and ancestors, the new
addition to the family was born in a clinic, thanks to the joint donor-supported
programme. In the past in Preah Sang, birth has been the business of village
midwives, often with tragic consequences (for years Cambodia had some of Asia’s
highest rates of infant and maternal mortality). But this change to tradition
has been welcomed by the villagers, among them the baby's grandmother. “Having
babies at home means paying the midwife with lots of rice and other presents,”
she explains. At the
clinic, the total charge, including check-ups and injections, was under $4.
“Much cheaper,” she says with a smile.
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How the IHP will make a difference
At present in Cambodia, only four donors are working in a coordinated way,
creating massive complications for the Ministry of Health. With so many separate
projects, review missions, implementation units and technical support
initiatives there is a huge burden on the Ministry and its staff. An entire
floor of the Ministry is set aside for separate donor project offices, and much
time is taken up here, rather than on core jobs elsewhere.
Better coordinated assistance and more support for the health system will
help to improve healthcare for all Cambodians.
The IHP will provide technical support for the development of a new eight-year
health plan for the country, and will ensure that donors follow the priorities
set out in this plan. It will also ensure that more money goes through
Government health systems, which should help to strengthen them over time. If
donors put into practice in Cambodia the commitments they have made globally on
working together, their assistance will be more effective on the ground, and the
Ministry of Health will be able to focus on its major duty: making Cambodia a
healthier, and therefore more productive and better off nation.
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Key Facts
- Cambodia had Asia’s highest HIV infection rates in the 1990s, but
has successfully reduced prevalence rates among the 15-49 age group from
3% in 1997 to 0.9% in 2006. Good progress has also been seen in reducing
infant and child deaths (both down 30% in 2006 from 2000 rates).
However, 37% of children are stunted through malnutrition and the maternal
mortality ratio remains high at 472 maternal deaths per 100,000 live
births.
- Less than 25% of health sector assistance provided by donors in
Cambodia is
classified as supporting a coordinated programme.
- The International Health Partnership (IHP) encompasses all of the
health MDGs. It is a new agreement between donor countries,
international health agencies and foundations, and developing countries
that aims to ensure all partners work better together and that they
direct their support to the priorities identified in the national health
plans of poor countries.
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