Improvements in health services for the poor
Challenge: Cambodia’s health system has improved over the past decade resulting in significant reduction of child mortality, reduction of mortality and morbidity due to communicable diseases such as HIV/ AIDS, TB and malaria, vaccine preventable diseases, and improvement in fertility rate and life expectancy.
Despite these improvements, Cambodia still faces challenges. There has been no improvement in maternal mortality (472 maternal deaths per 100,000 live births in 2005); the lack of sanitation and access to clean water are continuing problems; the level of malnutrition is high (stunting at 37% among children under 5); chronic non-communicable diseases and injuries from road traffic accidents are on the increase; and significant inequalities in health outcomes between the rich and the poor, and urban and rural.
High level of out-of-pocket expenditure leads to problems of affordability in accessing services. In addition there are physical constraints to access for remote, and rural populations.
Approach: Supporting the Government’s Health Strategic Plan 2003-2007, the World Bank’s Health Sector Support Project (HSSP) is implemented jointly with the Asian Development Bank, the UK’s Department for International Development (DFID) and the United Nations Population Fund (UNFPA). The project aims to improve the health of people, particularly poor women and children – predominantly in rural areas through (i) developing affordably and accessible basic curative and preventive health services of appropriate quality; (ii) strengthening institutional capacity to plan, manage, finance and implement the health sector strategic policies and manage resources effectively; (iii) increasing utilization of health services, especially for women and the poor; and (iv) controlling and mitigating the effects of infectious disease epidemics and of malnutrition, with an emphasis on the poor.
HSSP Results:
- In 2008, an estimated 2.3 million poor people were covered by Health Equity Fund (HEF) schemes, which paid for the health care of 227,457 cases. Financing was provided by HSSP, United States Agency for International Development (USAID), UNFPA, other donor partners, and RGC.
- 18 health centers have been constructed and 6 health centers renovated.
- HSSP contributed significantly to the lowering of dengue outbreaks and reduction of dengue case fatality rate, lowering TB and malaria case morbidity and mortality, strengthening the Ministry of Health (MOH) nutrition program and non communicable diseases, and improvement of health system as general.
- Several major studies have been undertaken that provided new baselines for health policy development: General Population Census of Cambodia (2008), Anthropometric Survey (2008), Equity and Development Report (2007), Health Expenditure Tracking Survey (2007), Poverty Assessment (2006), and a report on the 2005 Demographic and Health Survey.
- An ongoing study, the Cambodia Health Sector 2015, is looking at both demand- and supply-side financing, as well as policy options to integrate private providers better into the health system.
Second Health Support Program 2009-2013 (HSSP2): The World Bank, together with Australia Agency for International Development (AusAID), DFID, Agence Française Développment (AFD), the Belgian Technical Cooperation (BTC), United Nations Children’s Fund (UNICEF) and UNFPA, is continuing support to Cambodia’s health sector through HSSP2. The objective of HSSP2 is to support the implementation of Cambodia’s Health Strategic Plan 2008-2015 that aims to ensure improved and equitable access to, and utilization of, essential quality health care and preventive services with particular emphasis on women, children and the poor.
IDA/World Bank Contribution: The World Bank is managing US$ 82 million grant project, of which US$ 30 million is financed by IDA Credit (World Bank) and US$ 52 million by the Multi-Donor Trust Fund (DFID and AusAID). Together with other development partners, the World Bank provided the Royal Government of Cambodia (RGC) with financial and technical assistance in designing Cambodia’s Health Strategic Plan (2008 – 2015).
HSSP2 support includes the following: (i) the construction and renovation of health centers and referral hospitals in line with the MOH’s Health Coverage Plan; (ii) finance innovative sub-national funding arrangements in line with the RGC policy on Public Service Delivery and Decentralization and Deconcentration, such as Special Operating Agencies,; (iii) strengthen health finance management with a particular emphasis on social health protection, which will have direct positive effects on the health of poor populations in remote areas by increasing their access to public health care services and protecting people from catastrophic out-of-pocket health costs; (iv) strengthen human resources in health and human resource planning and management in the public health system; and (v) help to improve the Government’s governance and stewardship of the sector.
(Source: The World Bank Newsletter, Volume 8, January-February 2010)
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