THE CHALLENGES AND CONSTRAINTS

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THE CHALLENGES AND CONSTRAINTS
FOR ACHIEVING MDGS FOR HEALTH IN CAMBODIA Hang
Chuon Naron Deputy Secretary General Ministry
of Economy and Finance Royal Government of Cambo
dia
High Level Forum on Health, Nutrition and
Population MDGs
Geneva, 8 January 2004
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Main Massages

• First, Close correlation between Health MDGs and
  others, such as Education, Poverty, Gender etc.
  
• Second, Lacking of estimated resources required
  for reaching goals.
  
• Third, Monitoring is a problem and the need for a
  sound system for policy actions.
  
• Fourth, a comprehensive approach is needed to
  achieve the Health MDGs.

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Achievements

• Polio has been eradicated and the levels of other
  communicable diseases, while still high, have
  shown significant decline.
  
• Number of malaria-related deaths has fallen
• Numbers of people (15 to 49) living with HIV has
  declined for the last three years from a peak of
  4 percent to the current estimate of 2.6 percent.
  
• Physical coverage of the population by the public
  health system has also expanded, but the quality
  and utilization still low.

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Status of Health MDGs

• Under-five mortality rates have likely increased
  slightly over the last decade. Cambodia is
  unlikely to meet its target of reducing
  under-five mortality rate to 55 per 1,000 by
  2015
• Cambodia has made limited progress in recent
  years in improving maternal mortality.
  Considerable gap between 450 now and CMDG target,
  which aims at reducing the maternal mortality
  rate to 140 per 100,000 live births by 2015.

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Status of Health MDGs

• The HIV prevalence rate Cambodia would meet its
  CMDG target of 1.8 in 2015
  
• There is significant variation among provinces in
  terms of progress toward MDGs and remote
  provinces tend to be worse off
  

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Overall assessment

• Major challenges to be overcome over the next
  decade,
  
• But prospects for Cambodia to achieve some of its
  Health MDG targets are good.
  
• Return of full peace, security and the
  restoration of macroeconomic stability,
  
• Opportunity to make far-reaching reform
• Some increase in funding and attention in some
  areas
  
• Strong commitment to work in a coordinated way

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Health sector strategy

• Health Strategic Plan for 2003-2007 seeks to
  provide high quality, health services, with
  equity, that are pro-poor and focuses on
  
• Reduced infant mortality rate
• Reduced child mortality rate
• Reduced maternal mortality ratio
• Improved nutritional status among children and
  women
  
• Reduced total fertility rate
• Reduced household health expenditure, especially
  among the poor
  
• More effective and efficient health system.

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Focus of donor spending on health

• HIV/AIDS
• Immunization
• Malaria (12.5 of population at risk)
• Reproductive health (mainly birth spacing)
• TB
• However, to reduce IMR/CMR and MMR spending
  should focus on basic services and causes of
  death, such as Acute respiratory infection,
  diarrhea, malnutrition, obstetric emergency and
  effective birth spacing.

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Health sector financing

• Health sector is financed from government
  revenue (7), donors (18) and private (75)
  
• Government increased health budget from 1995 to
  2002 by 450 increase (280 in real terms).
  
• However, lower than projected allocation for
  health and problems with timely disbursement.
  
• And health sector continues to be seriously
  under-financed only 4 dollars per capita are
  spent by government and donors for basic health
  services (MPA for health centers/Complementary PA
  for hospital).

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Constraints and challenges

• User fees improve services, but restrict access,
  therefore the need for Equity Fund and pre-paid
  health insurance schemes
  
• Improved costing, budgeting and performance
  management of projects and programs
  
• Decentralization of sector management
• Increased participation of stakeholders in
  decision-making process

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Improvement measures

• Better health services requires significant
  improvement in human resources
  
• Performance management
• Incentives, especially for working in remote
  areas
  
• Donors priorities are driven by global
  initiatives, rather than local needs, thus
  rethinking is required

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Lower economic growth (1998 2007)
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Conclusion

• Overall MDGs are not going to be achieved, unless
  more investments are made to reduce IMR and MMR.
  
• Donor-government alignment/coordination needs to
  improve to ensure equitable financing of defined
  priorities
  
• Public sector and fiscal reforms are critical to
  improved service delivery
  
• Measuring progress towards CMDGs requires
  effective and shared system of monitoring and
  evaluation embedded in sound institutional
  framework.

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THANK YOU !!!