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 Cambodia High Level Forum on Health, Nutrition and Population MDGs Geneva, 8 January 2004
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.
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.
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.
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;
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
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.
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.
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).
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;
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;
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.