Joint Annual Performance Review 2007 - Ministry of Health

Ministry of Health
Joint Annual
Performance Review
2007
Department of Planning and
Health Information
5-7 March 2007
1

TABLE OF CONTENTS
Foreword
Acknowledgements......................................................................................................................i
Executive Summary....................................................................................................................ii
Priorities 2007-2008....................................................................................................................4
Working Group Reports
Health Service Delivery..................................................................................................5
Behavior Change and Communication.........................................................................13
Quality Improvement....................................................................................................28
Human Resource Development....................................................................................35
Health Financing...........................................................................................................45
Institutional Development.............................................................................................56
Welcome address by H.E. DR. Nuth Sokhom, Minister of Health...........................................81
Report on Health achievement 2006 by HE. Prof. Eng Huot, Secretary of State……….……83
Opening remark by DR. Michael J. O' Leary ..........................................................................86
Opening speech by H.E. DR. Nuth Sokhom, Minister of Health.............................................87
Closing remark by DR. Michael J. O' Leary .............................................................................93
Wrap-up of JAPR 2007 by H.E. DR. Nuth Sokhom, Minister of Health.................................95
Annex: Presentations................................................................................................................. 97
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FOREWORD
The Joint Annual Performance Review (JAPR) 2007 was held at the Cambodiana Hotel in
Phnom Penh, on 5-7 March 2007. This was the third JAPR, combining the 5 th Joint Annual
Health Sector Review and the 28 th National Health Congress, with more than 400 participants
contributing to this crucial event.
The JAPR serves as the forum to assess achievements of the previous year, to examine the
constraints in implementation of the Health Strategic Plan 2003-2007, and to identify
priorities for the coming year. The JAPR 2007 brings together, in an inclusive and
harmonized manner, the main stakeholders in the health sector, from the central officials to
provincial health staff, representatives of commune council, as well as health partners – the
donors and NGO community. The six Working Groups of the HSP contributed to the
assessment of the health situation from the perspective of the different key areas of work.
More significantly, this year, the priority actions for the AOP 2008 were identified to serve as
the focus of effort to make a significant impact in saving the lives of mothers, newborns and
young children in Cambodia, especially the poor.
Based on the results of the review, we are confident that with support and determined effort
from everyone, from health officials at all levels, commune councils and all the health
partners, including NGOs, we will continue to make significant progress toward the goals laid
out in the Health Strategic Plan 2003-2007 and the National Strategic Development Plan
2007-2010.
HE. Dr. Nuth Sokhom
Minister for Health
Dr. Michael J. O' Leary,
WHO Representative
Lead Donor Coordinator
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ACKNOWLEDGEMENTS
This document serves as the final report to the Joint Annual Performance Review (JAPR)
2007 conducted on 5-7 March 2007.
This document is produced by the Department of Health Planning & Information, with
Dr. Char Meng Chuor
Deputy Director General for Health
Dr. Lo Veasna Kiry
Director, DPHI
Dr. Sao Sovanratnak
Deputy Director, DPHI
Team Leader
Dr. Khol Khemrary
Chief, Health Information Bureau
Program Coordinator
Working Groups led by:
HSD- Prof. Sann Chan Soeung, Deputy Director General;
BCC – Dr. Lim Thai Pheang and Dr. Sin Sovann, NCHP;
QI – Prof. Koum Kanal, NCMCH and Dr. Sok Po, QA Office, DHS;
HRD – Ms. Keat Phuong & Dr. Phom Sim Song – DHR;
HF – Mr. Chea Kim Long, DBF, Dr. Sok Kanha, DPHI, and Mrs. Khuot Thavary;
ID – Prof. Koet Meach and Dr. Mey Sambo, DP
Technical Staff:
Mr. But Saben, Dr. York Dararith and
Mr. Sek Sokna
Technical Consultant:
Dr. Benjamin D. Lane
Financial Support to the event provided by: HSSP, and the WHO.
Disclaimer. The proceedings and documents prepared in Khmer were translated into English.
Any errors in translation are not the responsibility of authors and presenters.
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SUMMARY REPORT ON
2006 HEALTH SECTOR PERFORMANCE
The year 2006 was the fourth year of implementation of the Health Sector Strategic Plan
(HSP) 2003-2007. In HSP 2003-2007, six Key Areas of Work were laid out, in which
strategies for strengthening Cambodia’s health sector are to be implemented. These are: (1)
Health Service Delivery; (2) Behavioral Change and Communication; (3) Quality
Improvement; (4) Human Resources Development; (5) Health Financing; and (6) Institutional
Development.
For each of these, well-defined strategies were developed, with clear indicators and ambitious
targets. In this Joint Annual Performance Review 2007, it can be seen that the significant
health investments of the Royal Government and its partners continue to show important
results in terms of health sector performance.
The Health Sector Priorities 2006-2007
Last year, the Joint Annual Performance Review 2006 extended and refined the five Health
Sector Priorities from the previous year. The Health Sector Priorities for 2006-2007 have been
to develop linked Child Survival and Reproductive Health interventions, including HIV/AIDS
through focusing activities and resources throughout the health sector on:
• Emergency Obstetric Care
• Attendance at Delivery by Trained Health Providers
• Implementation of the 11 Child Survival Scorecard Interventions
• Reproductive Health including Birth Spacing Services
The 2006-2007 Priorities represent a continuation of the 2005-2006 Priorities, with the IMCI
priority expanded to include all Child Survival Strategy interventions from the Child Survival
Scorecard. Thus, nutrition, ITBN and tetanus interventions are now included in addition to
IMCI. Indeed, because of the integrated nature of the Child Survival Strategy, its
interventions overlap with both IMCI and the other 4 Health Sector Priorities Interventions.
Child Survival Strategy Interventions
2005-2006 HS Priority
Infant and Young Child Feeding
Initiation of Breastfeeding
Exclusive Breastfeeding
Complimentary Feeding
Oral Rehydration Therapy
IMCI; Full MPA
Antibiotic for Pneumonia
IMCI; Full MPA
Insecticide Treated Bednets
Malaria Treatment
IMCI
Vitamin A
IMCI
Measles Vaccine
IMCI
Tetanus Toxoid
Skilled Birth Attendance
Attendance at Delivery
Progress towards the 2006-2007 priorities marks an essential step toward the strategic goals
for the health sector set forward in the Health Sector Strategic Plan 2003-2007 and the four
health related strategic goals of the National Strategic Development Plan 2006-2010 (infant
and child mortality, maternal mortality, tackling communicable diseases, and an effective
health system).
Each of the 5 priorities have been supported by activities within each of the 6 Key Areas of
Work (Health Services Delivery, Behavior Change and Communication, Quality
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Improvement, Human Resource Development, Health Financing, and Institutional
Development), either directly, or through health sector strengthening activities. This
Summary Report is therefore organized around the 5 priorities, in order to demonstrate the
integrated nature of the 6 Key Areas of Work.
Emergency Obstetric Care
The Guidelines for the Complimentary Package of Activities (CPA) have now been
completed and disseminated to hospitals across the country. These guidelines provide the
framework for ensuring standards of quality for hospital care across the public sector.
Together with the Guidelines for Referral completed in 2005, this represents a significant step
in improving the quality of Emergency Obstetric Care. In 2006 a further 16 surgeons from 14
RHs have been trained with the Basic Surgical Training (BST) course, and 25 nurses from 16
RH’s have completed the ISAR anesthesiology course in March 2006. In partnership with
RACHA and BTC, 84 HC staff were trained in the 4-month midwifery course including basic
EOC , and Life Saving Skills (LSS) courses have been provided to 117 staff from 91 Health
Centers. To improve blood safety, the National Institute of Public Health supervised 93% of
provincial labs and blood banks.
Attendance at Delivery by Trained Health Providers
In 2006, the percentage of deliveries attended by trained health staff in public facilities
remained stable at 34%, with CDHS 2005 reporting 43.8% for public and private sectors
combined. Nevertheless, important steps were taken to ensure improved performance in this
area.
The training and deployment of midwives is a key element for this priority area, as is antenatal
care, an effective referral system, and improved community awareness of the importance
of seeking proper care. There were 88 new entrants to the Post-Basic Midwifery Training and
85 graduates are expected in the coming year. For Primary Midwifery Training, 398 Primary
Nurse Midwives were graduated, among whom 192 graduated as Primary Midwives..
Continuing education for midwives was provided for a total of 170 Health Centers (including
4 month MCH course, Life Saving Skills, post basic midwifery and primary nurse and
midwife). However only 51% of midwifery posts were filled, due to insufficient applicants at
HC level. ANC consultations rose to 60% of pregnant women receiving at least 2
consultations. The proportion of health facilities (ODs) deliveries covered through Equity
Funds has increase 28% to 39% (30 ODs). As part of the Health Sector Plan Mid-Term
Review, a Midwifery Review has been completed, and implementation of its
recommendations will begin in 2007.
Implementation of the 11 Child Survival Scorecard Interventions (including IMCI)
The Cambodia Child Survival Strategy has now been translated and will be disseminated
officially in March 2007, and a major costing exercise for the Strategy is underway, which
will strengthen MoH and it’s partners’ ability to focus resources effectively on scorecard
interventions.
The health system reached more children in 2006, and 456 health centers were implementing
IMCI, up from 322 in 2005. New case consultations for per child under 5 rose further to 1.0
per year, and hospital discharges for children under 5 rose to 64 per 1000 population in 2006,
up from 57.6 in the previous year. Antenatal care consultations also rose, with 59% of
pregnant women receiving at least 2 ANC consultations, up from 53.8%. 86% of pregnant
women received 60 iron/folate supplements during their first visit, either at a health center or
during outreach, far surpassing the target of 60%. Tetanus toxoid coverage however remained
stable at 50%, partly due to the budgetary restrictions for outreach under 10 km. For similar
reasons, DPT3 coverage for children under 1 year was down to 81% from 85%, and the
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percentage of women receiving 1 capsule of Vitamin A within 8 weeks of delivery fell to 50%
from 52% in 2005. However, Vitamin A coverage for children 6-59 months improved, with
77% receiving capsules in Round 1 and 78% in Round 2. This was under target but
nevertheless a marked improvement for R1. The percentage of children aged 12– 59 months
who received mebendazole rose to 56.7%, well above the target 40% and last year’s 35%,
Initiatives to support breastfeeding continued, with 7 hospitals now implementing the baby
friendly hospital initiative and 1999 villages implementing baby friendly communities.
Although implementation of the Sub-Decree on Infant and Young Child Feeding was delayed,
awareness of colostrums, exclusive breastfeeding in the first 6 months, and supplementary
food was raised through a series of television spots. The results of the Cambodia
Demographic and Health Survey 2005 indicate that 60% of children exclusively breastfed
during their first six months.
Full MPA Status at Health Centers
All health centers are now equipped with refrigerators, although gas supplies and technical
support for maintenance continue to pose challenges at some facilities. All health centers are
continuing to implement DOTS for TB. The 2006 target of 470 Health Centers providing Full
MPA Coverage was missed, however progress was made in 2006, with Full MPA now at 447
out of a total of 967 Health Centers. To improve the quality of service at health centers,
important steps were taken to extend the implementation of Priority Mission Groups in
Kampong Trach Distrct, Takeo and the North-West region.
Birth Spacing Services
The percentage of married women using modern contraceptive methods supplied by the
public health service rose further to over 27%, and many women are also seeking these
services from the MoH’s partners in the private sector.
Cross-cutting Performance
Program Based Budgeting and Planning was piloted throughout the MOH, thereby
strengthening the Ministry’s ability to link resources to performance. Annual Operational
Plans for 2007 by institution were successfully completed and the consolidated sector AOP
for 2007 was approved and is being implemented. Contracting is ongoing 11 Operational
Districts, and a review of the contracting strategy will soon be completed as a contribution to
the HSP Mid-Term Review. The Human Resources database was maintained throughout the
year, and the performance management system (PMS) was successfully adopted by central
departments. 69% medical doctors were registered with the Medical Council, and the
Membership of the Dental Council has been approved by sub-degree.
Progress continued on the complicated but essential task of improving staff remuneration and
linking it to performance through ongoing work on the development of a merit-based
component as part of the performance management approach in the MoH. The scheme is
intended to cover 160 positions at the central MoH during 2007 and based on the lessons
learnt and experience gained the scheme would be extended to cover 2 PHDs and 2 National
Programs. Important progress was made in enabling the health system to expand access to the
poor. Equity Funds expanded to cover 30 Operational Districts, with 89,320 poor people
benefiting from them in 2006. 86,483 poor households were pre-identified for Equity Fund
eligibility, and 8 Community Based Health Insurance Schemes have been implemented.
Total public health expenditure from both Government and Partner sources continued to rise
rapidly. Government financed planned public health expenditure per capita rose to USD 4.64
in 2006, and the 2007 approved Government recurrent budget for health rose to 80.2 Million
Dollars, which is nearly $6 per capita. Total planned public health expenditure has risen from
7

$10.7 per capita in 2006 to well over $12 for the coming year. At the same time, budget
execution has continued to improve for the system as a whole, with 99.4% of Chapter 11
budget and 97.5% of Chapter 13 budget disbursed by December 2006. At the provincial level
however, Chapter 11 disbursement continued to lag at 82%. The proportion of budget
allocated to the provincial level remained below target at 51%, however many central
institution budgets provide essential services to the provincial level and below.
A National Strategy for the Prevention and Control of Non-Communicable Disease 2007-
2010 was developed and finalized. The Ministry of Health and its partners continued to
achieve notable success in the fight against HIV/AIDS, with Voluntary and Confidential
Counseling and Testing now available at 150 sites covering all Operational Districts. A
current HIV prevalence among adults aged 15-49 years old both male and female is 0.6%
according to the CDHS 2005 results, and targets were met or surpassed for both Dengue and
Malaria case fatality rates.
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Priority Interventions for Health Sector AOP 2008:
Maternal, Newborn and Child Health
On 19 Feb 2007, a technical workshop was hosted by the MoH Department of Planning and
Health Information at the Phnom Penh Hotel, under the chairmanship of H.E. Professor Eng
Hout, in order to identify, prioritize and cost feasible interventions for health sector priorities
for the coming year.
For the past 3 years the JAPR has set priorities for the next AOP. These priorities have helped
the health sector focus its objectives and activities on Maternal, Child, and Reproductive
Health. The current HS Priorities are: Emergency Obstetric Care, Attendance at Delivery by
Trained Health Providers, Implementation of the 12 Child Survival Scorecard Interventions,
Full MPA Status at Health Centers, Reproductive Health including Birth Spacing Services.
These require implementation of many different kinds of interventions, some of which may be
especially useful in solving important bottlenecks to improving performance. Participants
were asked to identify: (1) bottlenecks in improving maternal, child and reproductive health;
and (2) interventions that could solve some of these bottlenecks in one year; and (3) costing
and funding information for these interventions. A matrix detailing the results of these
consultations follows at the end of this document.
Based on examination of key bottlenecks, the following interventions were identified for
recommendation to the 2007 Joint Annual Performance Review (JAPR). Several of these
interventions are already funded and in implementation, several others link closely to ongoing
projects, others however represent gaps that may be of special interest to health partners.
1. Recommended Interventions: System-Wide
• Strengthen the implementation of CPA Guidelines, including HR, supplies and
equipment as well as development of clinical management guidelines for maternal and
reproductive health, newborn care and child health.
• Commence implementation of Midwifery Review recommendations: pre and inservice
training, midwife coverage, staff competency
• Scale up implementation of the 12 Child Survival Score Card interventions, with
special attention to IMCI, Nutrition and training for Paediatric Care (including neonatal)
at Referral Hospitals. (Community, HC, RH. Funding needed for scale-up and
training).
• Expand BCC activities for exclusive and complimentary feeding, increase the number
of Baby Friendly Hospital and Communities and re-enforce Sub-decree of marketing
on IYCF products.
• Expand of CBD and long term method to reduce unwanted pregnancy, and promotion
of safe abortion through training, equipment and supplies (DfID supported
implementation commencing)
2. Recommended Interventions: Districts with special needs
• Strengthen MCH continuum of care (ANC, delivery, new born care and post partum
care) at community, and Health Center Level and RHs (CPA2 strengthening, with
emphasis on improving quality of EOC and pediatric care), in districts where birth
assisted by trained health personnel is low. (10 GAVI/HSS supported ODs. CPA
strengthening still needs funding).
• Establish maternity waiting house with benefits (food, travel cost) at RH’s in remote
districts.(UNFPA currently supporting Stung Treng.)
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• Extend equity fund supported safe motherhood in districts where birth assisted by
trained health personnel is low. (MoH/HSSP expansion of HEF planned)
• Prioritize remote facilities for PMG/Performance based incentives expansion
(expected 2008-09)
3. Funding/Implentation Gaps Identified
• CPA strengthening system-wide, as well as for EOC and pediatric care focus of the
the 10 RH’s serving the GAVI/HSS supported districts for MCH Continuum of Care.
• IMCI, Nutrition and capacities strengthening for Paediatric Care.
• Exclusive and complimentary feeding promotion; IYCF re-inforcement.
• Maternity Waiting Houses
4. Next Steps
• Costing of priority interventions, commitment to fund and identification of external
support where necessary: JAPR process
• Identification of priority ODs for CSS, MPA and CPA strengthening using CDHS,
HIS, and other appropriate data sources
• Identification of HR, supplies and equipment gaps in health facilities for MPA and
CPA implementation through facilities checklists distributed with AOP Guidelines.
• In AOPs at all levels, increase planned expenditure on the 5 HS Priorities, including
the interventions recommended here by 20%.
• Ensure quarterly monitoring and reporting of AOP implementation at all levels of the
system, with special focus on RH’s and OD’s.
• Align interventions with existing MoH policy and projects, especially for those
focused on districts with special needs (GAVI, GFATM, HSSP, Contracting, HEF,
CSS Costing etc.)
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Maternal & Reproductive Health and Child and Newborn Health Priority, 2008
Areas
Bottleneck for improving maternal health
& reproductive health
Interventions i
Infrastructure • weak referral- commune-HC-CPA1-CPA2/3 • Continue Government and donor support for better infrastructures
• Inadequate basic infrastructure/resources: and resources:
fuel, power, safe water, transport,
− supplies, equipment, medical materials
equipment, budget
− MPA kits
Financial • Service cost (lack of equity fund) • EF supported reproductive health
• Community-Based Health Insurance
Service
• CPA Capacity: Low capacity of districtbased
RH to manage EOC,
• Implement CPA Guidelines
• Development of clinical management guideline for maternal and
reproductive health
• EOC training and implementation
• Outreach, outreach PLUS
• Maternal death audit
• Training & systematic post training follow-up
•
• HC not available 24 hours • Promote the initiative of Maternity preparedness plan • MPA
Level of
implementation
• CPA and
• MPA levels
• CPA and MPA
levels
• Central level
• CPA levels
• MPA levels
• Place to stay before & post-delivery -
“maternity waiting home”
• Maternity waiting home for remote provinces - at RH for high risk
pregnant women
• CPA
• Human resource: shortage of trained/skilled
staff/MW, Coverage of pre and in-service
training & Low salary and lack of
incentives, staff competency
• Quality of safe abortion services,
• Implement recommendations made by Midwifery Review
• Promote linkages between Traditional Birth Attendant to health
facilities for skills birth attendant
• PMG
• Enforcement the implementation of the Professional Ethic
• Promote and strengthen Safe abortion practices
− Capacity building
− supplies, equipment, medical materials
• Central level
• CPA level
• MPA level
especially
• Both private and
public
• CPA level
• MPA level
• Community
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Knowledge
• High unwanted pregnancy
• Low contraceptive services
• Low nutritional status
• Limited knowledge on safe
motherhood/abortion
− MPA kits
− Enforcement the implementation of Safe Abortion Law
• CBD, long term method
• BCC/IEC
• Iron/folate supplementation for pregnant women
• BCC/IEC
• BCC/IEC
• VHSG
• MPA
• Community
level through
outreach
• MPA
• Community
level through
outreach
• Community
level
Socio-cultural • Family & community belief • Education, • Community
level
Areas
Infrastructure
Bottleneck for improving child and
newborn health
• Inappropriate/not functioning pediatric ward
in RH (supplies, equipment, and HR)
•
Interventions i
• Continue Government and donor support for better infrastructures
and resources:
− supplies, equipment, medical materials
Level of
implementation
•
Financial
• Access to appropriate funding for CSS
intervention
• Service cost (lack of equity fund)
• Alignment to the Cambodia Child Survival Strategy
− Dissemination of Child Survival Strategy
• EF supported child health
• Community-Based Health Insurance
• All levels
• CPA levels
• MPA levels
Service
• Lack of integrated approach for service
delivery
• Establish the coordinating mechanism for child survival at
province (/OD) level
• Provincial level
• OD level
• Slow progress in scaling up score card
interventions
• Scale up 12 score card intervention implementation ii
− Expansion of IMCI implementation (Training and Refresher
• Central
• Provincial level
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• Insufficient resources and capacity for CPA
level
• Staff motivation and attitudes
• Lack of competencies and skills for neonatal
care at MPA and community level (neonatal
resuscitation, cord care, temperature
management, detection of infection…)
Training of Updated IMCI, included low-osmolarity ORS and
zinc supplementation) iii
− Strengthen IMCI Follow-up after training
− Integration and implementation of IMCI into medical and nursing
and midwifery education
− Policy update for vitamin A distribution
− Enforcement of Sub-decree of marketing on IYCF products
• Strengthen implementation of CPA Guidelines (including supplies,
equipment and human resources)
• Capacity building on pediatric care, including neonatal care at RH
− Emergency Triage Assessment and Treatment (ETAT)
− Essential Pediatric Care
o Newborn resuscitation iv
o Treatment and care for neonatal sepsis
o Treatment and care for severe infections
• Development of clinical management guideline for children and
newborn
• Performance-base incentive
• PMG
• Enforcement of the implementation of the Professional Ethic
• Capacity building and implementation on:
− Early initiation of breastfeeding within 1 hour after birth
− Neonatal resuscitation
− Temperature management, including kangaroo mother care
− Early detection of neonatal infection
− Antibiotic for premature rupture of membranes
• Continue Government and donor support for better infrastructures
and resources:
− supplies, equipment, medical materials (MPA Kits)
• OD level
• MPA level
• CPA level with
close monitoring
and supervision
from specialized
institutions
• Central
• CPA/MPA level
• Public and
Private
• MPA level with
close
supervision
from OD/RH
• Community
with close
monitoring and
supervision
from health staff
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Knowledge • Infant and Young Child Feeding • Increase number of BFHI
• Finalize standardized guideline for BFCI based on standard
guidelines for community IMCI
Socio-cultural
• Knowledge on 12 IMCI key family and
community practices
•
• Finalize standard guidelines for community IMCI
• Scale up C-IMCI implementation
• BCC for both providers and consumers
• •
•
• CPA level
• Community
levels
• Central
• OD level
• Community
level
i The monitoring and evaluations have not been described in the intervention lists. Indeed, the group acknowledges the important and vital roles of monitoring and
evaluation in marking progress of interventions and also key components for success. The reason is that all interventions must bear with them the monitoring and
evaluation components according to the agreed monitoring and evaluation framework.
ii The 12 Score Card Interventions are as follow:
Preventive interventions
1. Early initiation of breast feeding
2. Exclusively breastfeeding
3. Complementary feeding
4. Vitamin A supplementation
5. Insecticide treated nets
6. Vector control for aedes aegypti
7. Measles immunization
8. Tetanus toxoid
Curative interventions
9. Oral re-hydration treatment
10. Antibiotic for pneumonia
11. Malaria treatment
12. Skills birth attendant
iii
1. CS is always the top priority of the MoH and Health development partners. In scaling up process, we should
- 14 -

−
−
−
Thoroughly look to any specific intervention that is (are) neglected or with slower progress in scaling up than other; and
Take into account three things: feasibility, achievability (In short period, especially for 2008, with full conscious that all the medium and long term
intervention are not missed), and sustainability
Focus on the neglected areas: curative care
2. Several reason that IMCI was emphasized.
− IMCI is the strategic approach for service delivery of most score card interventions
− There is now an update protocol for diarrhea treatment (low-osmolarity ORS and zinc) and other update protocol for common childhood illness
available and more convenient for both supply and demand sides that need to be introduced
− The sustainable way for scaling up is pre-service training, since the in-service one is very costly that could not be supported by both partners and
MoH itself for long run
3. Many other specific score card interventions are also list down, like vitamin A, IYCF, newborn care...
iv The newborn interventions emphasized by the Cambodia Child Survival Strategy are as follow:
Preventive interventions
1. Early initiation of breast feeding
2. Weighing newborn to assess for low birth weight
3. Kangaroo mother care
4. Hepatitis B vaccine with 24 hours
Curative interventions
5. Clean delivery
6. Clean cord care
7. Newborn resuscitation
8. Newborn temperature management
9. Detection and referral of neonatal infection
10. Management of neonatal infection
11. Antibiotic for premature rupture of membranes and
12. Corticosteroid for preterm labor
- 15 -

HEALTH SERVICE DELIVERY
Health Service Delivery is one of the six key areas of work under the Health Sector Strategic
Plan 2003-07, and includes five key health service delivery strategies. Health services and
strategies to improve their delivery have a central place in the Strategic Plan, and the
remaining key areas of work and associated strategies are expected to support the
achievement of health service delivery outcomes. This section of the report provides an
overview of progress made during the year 2006 under each of the strategies, and linked with
the 2006-2007 Health Sector Priorities identified in the JAPR 2006. These are:
Develop linked Child Survival and Reproductive Health interventions, including
HIV/AIDS
• Emergency Obstetric Care
• Attendance at Delivery by Trained Health Providers
• Expand from Integrated Management of Childhood Illness to a broader Child Survival
strategy (Child Survival Scorecard)
• Full MPA Status at Health Centers
• Reproductive Health including Birth Spacing Services
The HSD provides detail on the indicators, targets and priorities for each of the five health
service delivery strategies [see HSD table].
Current Situation and Achievements:
Strategy 1: The Ministry of Health continued to make steady progress toward achieving its
goal of establishing a network of fully equipped and staffed health centers and referral
hospitals across the country. Currently, the health coverage plan 2005 is finalized and
distributed to all municipal and provincial health departments. A total of 881 health centers
received MPA drugs during 2006, which was slightly below the target of 915 health centers.
For the 2007-2008 period, supplying essential drugs under the MPA package will remain a
priority for the MOH.
Strategy 2: Utilization of public health services rose over the past recent years. Currently,
the average number of contact (new case consultations) per inhabitant per year is 0.56 which
reached the 2006 target of >0.50. For children under the age of five years, the average number
of contact also reached its target of 1.0. Immunization activities are still the MoH primary
strategies for reducing childhood morbidity and mortality. The national coverage of DPT3
vaccine was 81% slightly lower than the target of 89 percent coverage. Vitamin A
supplementation activities for children aged 6-59 months olds, during the first round resulted
in a coverage rate of 77 percent, exactly meeting the 2006 target. Progress in meeting targets
set for child survival strategy was also remarkable.
Coverage of health centers implementing IMCI expanding to 456 HCs, which was higher than
the annual target of 404 health centers.
Reproductive health activities showed moderate improvements, continuing the trend from the
year before. The ANC2 coverage was 59%, almost met the 2006 target of 60%, whereas the
TT2 for pregnant women fell far short of the target set of 70%, with only 50% receiving the
vaccine. Thirty four percent (34%) of birth deliveries were attended by trained health
professional, which fell below the 2006 target of 40 percent. Eighty six percent (86%) of
pregnant women received iron/folat supplementation (60 tablets) for their first visits either at
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health centers or during outreach activities, against the set target of 60% in 2006. However,
only 39% of post-partum mothers received iron/folate supplementation (42 tablets) either at
health centers or during outreach activities, which fell below the set target of 60%. Current
use of modern contraceptive method among women in reproductive aged 15-49 years old for
birth spacing and limiting remained at 27% (data available only for public sectors), below the
set target of 35% in 2006.
Strategy 3: The complementary package of activities (CPA) guideline was developed and
distributed to all municipal and provincial health departments and concern institutions. In
2006, the number of hospitals offering baby friendly services increased to seven, including the
Kampong Trabek RH/Prey Veng province, Kampong Speu RH, Banteay Meanchey RH, the
National Maternal and Child Health Center (NMCHC), Svay Rieng referral hospital, Stung
Treng RH, and Phnom Penh Red Cross health center, which met the set target.
For the population as a whole, the rate of hospital admissions at 18.4 per 1,000 fell short of
the target of >25 per 1,000 population. For children under the age of five years, however, the
target of >45 hospital admissions per 1,000 was significantly exceeded with an annual rate of
64 per 1,000.
Strategy 4: All health centers across the country were implementing DOTS for tuberculosis
treatment (TB). The case detection rate of smear positive pulmonary TB at an estimated 65
percent fell marginally short of the target of 70 percent. However, the TB cure rate
successfully remained high at more than 85% (which according to the WHO recommendation
is only 85%).
The number of operational districts with VCCT centers remarkably increased to 150 sites in
all operational districts across the country. At the end of 2006, there were 44 health facilities
provided opportunistic infections (OI) and ART services in all 19 municipal and provinces. A
total of 20,131 active patients, including 18,344 adults and 1,787 children were receiving
ART. Eighty one percent (81%) of malaria endemic villages were provided with retreatment
and replacement of impregnated bed nets, which was slightly below the annual target of 85
percent.
Malaria severe case fatality rate decreased to 7.9% as compared with the target of 10.2%,
while malaria incidence rate increased to 7.2% per 1,000 population against the target of
5/1000. Dengue case fatality rate was less than 0.9%, exactly met the target (

- Lack of midwife and qualified staff in midwifery skill in some health centers
- Lack of budget for health centers to conduct outreach activities mainly in the
catchment areas less than 10 Km radius.
- Dissemination of modern contraceptive still did not reach remote areas, coupled with
the shortage of qualified staff in reproductive health and as well as limited knowledge
of the community in reproductive health.
- Inadequate sites for IMCI training
- In some health facilities, data from outreach activities for instance vitamin A
supplementation was not recorded in the yellow card
- Delay in drug procurement coupled with irrational use of drug
- Delay in gas supply for refrigerators for immunization activities in some provinces
- Lack of budget and fuel for some activities including monitoring and supervision
- Lack of incentive for health staff remains a cause of concern to the MoH, coupled with
low salaries contributed to low performance of health sector activities
Targets for 2007 and Priorities for 2007-2008
- Further upgrading health centers for providing full MPA services
- Lobby the government to provide fund to health centers for conducting outreach
activities within the catchment areas of less than 10 Km radius
- Increase deployment of midwife and qualified staff in midwifery skill and
reproductive health in the areas of needs mainly in remote areas
- Enhance wide dissemination of reproductive and birth spacing messages to all
population, especially those living in remote areas
- Strengthen the implementation of DOTS strategy for tuberculosis treatment in all
health centers across the country
- Continue to expand more VCCT sites in all operational districts, as well as
opportunistic infections (OI) and ART services for pediatric care.
- Expand IMCI training sites
- Continue expanding re-treatment, replacement and distribution of bet-nets to people
living in malaria prone areas and
- Continue expanding deworming coverage among children aged 12-59 months old
through outreach activities.
- 18 -

Health Service Delivery: Indicator, Baseline 2002, Target/Priority 2007-2008
Strategy 1: Further improve coverage and access to health services, especially for the poor and other vulnerable groups through planning the location of health facilities and
strengthening outreach services.
Indicators Baseline 2002 Target
2006
Achievement
2006
Constraint Priority
2007-2008
Target
2007
Target
2008
1 Nb HC received MPA drugs 812 915 881
(EDD)
2 Number of Functioning Health
Centers with Basic MPA*
3 Number of Functioning Health
Centers with Medium MPA
4 Number of Functioning Health
Centers with Full MPA
5 Number of Referral Hospitals
with CPA1**
6 Number of Referral Hospitals
with CPA2
7 Number of Referral Hospitals
with CPA3
8 Average number of outreach Baseline to be 6 outreach per
visits per remote village **** per established village per year
year
9 Up-dated health coverage plan No baseline Finalized HCP
distributed
NA 115 PM
NA 330 PM
To increase
provision of MPA
drugs to all HCs
895 910
NA 470 447 out of 967 470 out of
972
NA 22 Hospital dept
NA 30 27 32
NA 17 17 18
PM
DPHI :Finalized
and distributed,
Website
*A defined functioning HC should meet some or all of the following criteria: (a) adequate supply of MPA drugs, (b) at least 5 staff of which one is a secondary midwife, (c)
open at least 4 hours per day and with 24 hours on call service, (d) providing all basic MPA services every day, (e) at least 1 outreach session to every village every 2
months, (f) referring patients, (g) community participation.
HC with Basic MPA: Adequate MPA drug, at least 4 health staff, and provision of some basic MPA services
HC with Medium MPA: Adequate MPA drug, at least 4-5 health staff including 2 nd midwife or secondary nurse trained in midwifery, 1 outreach/2months (6 outreaches per
year), health center management committee (HCMC) met at least once every 3 month.
HC with Full MPA: Adequate MPA drug, at least 5 health staff or more including 2 nd midwife, provision of full MPA services (Health care activities and Management and
Training activities, See MPA Guideline), 24 hours on duty, 1 outreach/2months (6 outreaches per year), HCMC met at least once every 3 month.
- 19 -

** CPA1: Referral hospital without general anesthesia surgery, CPA2: RH with general anesthesia surgery, CPA3: RH with general anesthesia surgery and supplementary
activities
***
Definition of remote village will be developed in 2003. If it is not yet developed, it should use the definition developed in the Outreach guideline 2001, which is more
than an hour transport.
Strategy 2 Strengthen the delivery of quality basic health services through health centers and outreach based upon MPA
Indicators Baseline 2002 Target
2006
Achievement
2006
Constraint
10
Review of MPA services No baseline Revised MPA DPHI + Hospital
service
dept
11
Guideline for health posts No baseline DPHI + Hospital
dept
No. of health centers that 45 health centers 404 HCs 456
12
implement IMCI
(5%)
CDC
X
13
14
15
16
17
No. of health centers implement
MPA Module 10 (Nutrition)
Average number of outreach
visits per village per year
Consultations (new cases) per
inhabitant per year
- All consultations
- Children under 5 years
Percentage of children under 1
year that received DTP3
Percentage of pregnant women
who received at least 2 ANC
consultations
0 383 HCs (41%) MCH/Nutrition
12 outreach
visits per village
per year
12 PM
[DPHI]
0.38
0.54
> 0.5
1.0
0.56
1.0
64% 89% 81%
[DPHI]
29 % 60% 59%
[MCH]
Percentage of deliveries attended
by trained public health staff at 20.3 % Public sector : 34%
-Different target
pop. from
different sources
- Lack of
financial support
for HC outreach
within the radius
0.5
1.0
-Provide data on
target pop. by the
MoH to all level.
-Lobby for
financial support
for HC outreach
within the radius
0.5
1.0
Target
2008
500
90% 90%
60% 65%
55% 60%
- 20 -

Indicators Baseline 2002 Target Achievement Constraint
2006
2006
facility and at home (HC and RH) 40% [MCH] skills in some HC
Priority
2007-2008
Target
2007
Target
2008
18
19
20
21
Percentage of pregnant women
who received at least TT 2
vaccinations
Percentage of married women
aged 15-49 years using a modern
contraceptive method (current
users by 31/12) (public sector
services)
Percentage of children aged
6-59 months who received
vitamin A:
- Round 1**
- Round 2
Percentage of women who
received 1 capsule of vitamin A
within 8 weeks of delivery
45 % 70% 50%
[NIP]
17% (18.3%) Public: 35% 27%
(CDHS2005)
[MCH]
57%
34%
85%
13% 65%
R 1 = 77%
R 2 = 78%
VA Coverage not
yet complete
[MCH /
Nutrition]
50%
[MCH /
Nutrition]
-Different target
pop. from
different sources
- Lack of
financial support
for HC outreach
within the radius
< 10Km
-Misconception
on birth spacing
-lack of
appropriate
information on
BS modern
method in remote
areas
-Lack of trained
staff in remote
areas
-Provider does not
record VAC on
Yellow card during
outreach activities
-Lack of fuel for
monitoring
-Inconsistency of
VAC : different
colors and shape
-Some RHs do not
record VAC in
HO2
-Some HCs do not
record VAC for
-Provide data on
target pop. by the
MoH to all level.
-Lobby for
financial support
for HC outreach
within the radius
< 10Km
75% 78%
30% 35%
85% 85%
65% 80%
- 21 -

X
x
x
X
Indicators Baseline 2002 Target
2006
Percentage of pregnant women
who received 60 iron/folate
supplements during the 1 st visit,
either at health center or during
outreach.
Percentage of pregnant women
who received 30 iron/folate
supplements during the 2 nd visit,
either at health center or during
outreach.
Percentage of postpartum
mothers who received 42
iron/folate supplements, either at
health center or during outreach.
Percentage of household
consumed iodized salt
Achievement
2006
0 60% 86%
[MCH]
0 60% 58%
[MCH]
0 60% MCH
39%
12%
(CDHS 2000)
80% 73%
(CDHS 2005)
MCH
Constraint
Postpartum women
in HC1
-Lack of iron tablet
(stock out at CMS)
due to increasing
demand
-Lack of trained
staff on IDA
-Lack of fuel for
monitoring
-Lack of trained
staff on IDA
-Lack of fuel for
monitoring
- Non-iodized salt
still flows from
Thailand and
Vietnam ( across
the border ).
- Some provinces
among all(24)
cannot access to
MPA # 10 training
(only MPA # 10
provinces: 11
provinces now)
Priority
2007-2008
Target
2007
80% 80%
80% 80%
80% 80%
80% 85%
Target
2008
- Areas around
production site still
used non-iodized
salt, esp-Kep and
Kampot OD.
-X: New indicators for 2006-2007, -HIS: Health information system
*
Functioning VHSG: ≥ 5 meetings per year: Functioning HCMC: ≥ 10 meetings per year. The baseline for 2002 will be established later this year
- 22 -

**
The 2002 baseline and 2003 targets shows higher coverage for the March distribution due to the fact that vitamin A was distributed as part of the measles campaign.
No measles campaign is planned for 2004 and hence, the target for the March and November distribution are the same. 3 rd
Strategy 3 Strengthen the delivery of quality care, especially obstetric and pediatric care, in all hospitals through measures such as CPA
Indicators Baseline 2002 Target
2006
Achievement
2006
Constraint
Priority
2007-2008
Target
2007
Target
2008
22 CPA guidelines
23
24
*
**
Number of hospitals
implementing the baby friendly
hospital initiative
Number of hospital discharged
(admissions) per 1000
population ** :
- All discharged
- Children under 5 years
CPA guideline
finalized
distributed
Hospital Dept.
Done
0 3 hospitals more 7 hospitals
[MCH]
-Criteria for
selection not
appropriate
-Lack of
encouragement
for the staff
-Lack of
monitoring
20.6
28
>25
>45
18
64
These hospitals will start implementing the initiative during 2003, but may not yet meet all the criteria by end of 2003
This includes admissions reported by all national hospitals, as well as the Kantha Bopha hospitals in Phnom Penh
DPHI
13
>25
>65
>25
>65
- 23 -

Strategy 4: Strengthen the management of cost-effective interventions to control communicable diseases.
25
Indicators Baseline 2002 Target
2006
Report that fully analysis the
reasons for slow progress in
reducing child mortality.
Achievement
2006
No baseline Child survival
Cambodia profile
2005
Child survival
progress report
2004.
[CDC]
Constraint
The child survival
costing is
underway.
The findings
coming the ten
pediatric wards
and hospitals
assessment did
not come up with
satis factory
result due to a
huge investment
in this sector in
tern of equipment
and supply and
capacity building
on pediatric care.
The expansion of
the IMCI
coverage is not at
a satisfactory
speed due to a
limited number of
training sites.
Priority
2007-2008
CS progress
report 2005-06
CS strategic plan
2007-10
Target
2007
To finalize
the costing
exercise
report and
make it
available for
use.
Continue to
organize the
annual QI
workshop on
the pediatric
care and
increase the
technical
visits from
the central
level
To expand
the IMCI
training sites
Target
2008
CS progress
report 2007
26
Nb. of health centers
implementing DOTS
381 (386) health
centers
All HCs
All HCs
CENAT
Irregular child
survival
management
committee
(CSMC)
Limited financial
resource
Strengthen the
implementation
of DOTS at all
HCs.
Maintaining
DOTS at all
HCs.
Maintaining
DOTS at all
HCs.
- 24 -

27
28
29
30
Detection rate of smear positive
pulmonary TB
Nb. of Operational Districts with
voluntary counseling and testing
(VCCT)
Percentage of children aged 12–
59 months who received
mebendazole:
- March
- November
Review of disease surveillance
system
57% ≥70% 67%
CENAT
21 Operational
Districts (22)
No baseline
available (not
included in HIS
reports)
No baseline
20 more VCCT
sites in 4 more
OD
41 VCCT
(total at the
moment 150 sites
in all ODs)
NCHADS/VCCT
40% 56.7%
- Basic specimen
collection kits at
all province
- Install and
training database
at all PHD
- At all levels of
all provinces
-Ongoing
implement
CNM
CDC
Low awareness
about TB among
population.
Expanding access
to treatment and
care as fast as
possible within
the health system,
while ensuring
the quality, long
term
sustainability and
effectiveness.
CNM
≥70% ≥70% ≥70%
Expand 6 sites of
Pediatric
OI/ART services
Increase
Mebendazole
coverage through
outreach activities
CNM
20 more
VCCT sites
20 more
VCCT sites
60% 65%
Guidelines for outbreak response
CDC
31 at provincial and Operational
District levels
No baseline
% of endemic villages that have 74 % 85% 81%
32 re -treatment and replacement of
bed nets annually
33
Malaria case fatality rate (severe 10.85 %
10.2% 7.90%

* Not yet computed since we are awaiting information from HIS (these indicators are based on data from public health facilities)
- 26 -

Strategy 5 Strengthen the management and coverage of support services such as laboratory, blood safety, referral, pharmaceuticals, equipment and other medical supplies
and maintenance of facilities and transport.
Indicators Baseline 2002 Target
2006
Achievement
2006
Constraint Priority 2007-
2008
Target
2007
Target
2008
36
37
38
39
Hosp Dept
Percentage of patients who
Hosp Dept
received antibiotics
- IPD *
100% < 70%
- OPD ** 50.2% < 48%
Percentage of children under 5 81.4 % > 98%
ORS ***
years with diarrhea and treated in
health centers who received
Percentage of essential drugs (15 7.6 % 5.2% 5.71%
faced stock-out ***
items listed) at health center that
[EDD]
Review of the existing referral
system
No baseline
referral guideline
distributed
referral guideline
already
distributed at
launching in 2006
[MCH]
- Procurement
problems
(delayed delivery,
short shelf life)
- Irrational use of
drugs
- Lack of
knowledge on
drugs
management and
responsibility of
store keeper
- Staff turnover
- Lack of
communication
,staff motivation
and budget for
transportation
Insufficient
budget for
printing
-Staffs training (
HC and RH ) on
drugs
management and
drugs use ( RUD
)
-Staffs motivation
Print more 5000
copies (English
and Khmer) and
distribute
5% 5%
- 27 -

40
41
Nb. of RHs that have blood bank
or depot 31
37 (Blood
depots)
32
[Blood Bank]
Nb. of HCs with refrigerator 96 All HCs All HC
[EPI]
-Unawareness of
population on
blood donation
due to lack of
blood stock in
Provincial Blood
Transfusion
Center and Blood
depots.
-Irregular
supervision
(Monitoring &
Evaluation) on
Provincial Blood
Transfusion
Center
-Lack of HR and
equipments at
provincial level
-Untimely
supplies of gaz
for vaccine
maintenance in
some provinces.
- Lack of
financial and
technical supports
for maintenance
of refrigerators
-Improve
Promotion of
voluntary nonremunerated
blood donor
-Improve the
quality of process
to collect, test,
store, transport of
blood and blood
components.
-Improve
appropriate
clinical use of
blood
( training medical
doctor on clinical
guideline,
creation of
hospital
Transfusion
Committee and
monitoring
clinical use of
blood)
-All HCs are
equipped with
refrigerators
37 42
-All HCs are
equipped
with
refrigerator
-All HCs are
equipped
with
refrigerator
- 28 -

42
X
X
X
*
Nb of high temperature
incinerators
Percentage of provincial labs and
blood banks supervised by NIPH
Percentage of blood donor
samples for validation testing
(HIV, HBS, HCV, Syphilis)
from provincial level were sent
to NIPH
Percentage of CEQAS* panel
including blood bank (HIV) from
NIPH were sent to provincial
level.
* Cambodian External Quality
Assurance Scheme
24 All ODs 54 OD
[EPI]
General Lab +
Blood banks
81. 12%
Blood banks
80.95%
Blood banks
86.36%
General Lab +
Blood banks
85.50%
Blood banks
85.71%
Blood banks
100%
(93% archived)
More than 8%
increased
compared to the
target 2005
[NIPH]
82.95%
0nly 2% achieved
compared to 2005
100% achieved
[NIPH]
Lack of financial
and technical
supports for
maintenance of
incinerator
-
Even we have
some
transportation
problem (
Gasoline supply
is not on time)
1. No incentive
support.
( before support
by US CDC
GAP) to
Provincial Lab.
staff
2. Some
provinces
no specimens
sent to NIPH
only NTBC no
feed back result
to NIPH for
evaluation
Strengthen
management in
maintaining
incinerators
All ODs
All ODs
Based on information collected during supervision of a limited number of Referral Hospitals (21 Referral Hospitals in 2002). The Ministry of Health standard is 70% of
all in-patients
**
Based on information collected during quarterly supervision of all health centers. The Ministry of Health standard is 32% of all outpatients
***
Based on information collected during quarterly supervision of all health centers.
- 29 -

BEHAVIOR CHANGE COMMUNICATION
I-Introduction
Behavior change is the second of the eight essential core strategies of the Ministry of Health
2003-2007. For facilitating successfully implementation of the behavior change strategies,
Ministry of Health establishes Behavior Change Working Group, which has its mandate to
support the National Center for Health Promotion in coordinating the Behavior Change
Initiatives. Further, the Health Sector Strategic Plan 2003-2007 determines three main
strategies for behavior change of providers and consumers for enhancing health of
Cambodian people contributing to the poverty alleviation. There are many organizations,
governments and non-government actively involvement in the implementation of these three
strategies and there were a lot of achievements were made.
II-Current situation/achievement
Strategy 6:
1. Produce and disseminate TV spots on colostrums, Exclusive Breastfeeding,
supplementary food, and documentary on Exclusive Breastfeeding.
2. One round table on Exclusive Breastfeed conducted
3. Question and answer radio program about Exclusive Breastfeeding on national and
Bayon radio station
4. Revise Curriculum MPA-7
5. Produce spot TV on Birth Preparedness
6. Conducted training on provider change intervention to referral hospitals in Phnom
Penh and provinces
7. Coaching on provider behavior change intervention
8. Clients’ rights and providers’ rights and duties approved by MoH
9. IEC materials on clients’ rights and providers’ rights and duties drafted.
Strategy 7:
1. Baseline survey on clients’ rights and providers’ rights conducted
Strategy 8:
1. NCHP website was launch
2. Functioning the BCC forum in five provinces: Svay Rieng, PreyVeng, Stoeung Treng,
Mondulkiri, Kampongspeu provinces
3. The draft of Anti-smoking law has been revised for resubmission to MoH.
4. 8 smoke free hospitals, schools, and temples were established
5. One ToT on Quit Smoking conducted
6. On air talk show about adverse effects of tobacco use on health
7. Sub-decree on Marketing of IYCF Products widely disseminated for high level
officials from relevant line ministries, PHD/OD directors PHD/OD/Nutrition Focal
Person from all 24 provinces and representative of milk companies, private hospitals
were participated.
III-Constraints
Though many achievements were made in last one year, we are facing constrains.
- 30 -

1. There was a delay in finalizing the revision of MPA Module 7, clients' rights and
providers' right and duties
2. Delay in functioning IEC database
3. Limited skills of staff of Health Promotion Unit of the PHD in facilitating BCC
Forum
4. Unclear define the institution in producing IEC material on the role and responsibility
of health providers.
5. Unclear defined roles of NCHP in food hygiene
6. Lack of human resources of fund for successfully implementing the three-BCC
strategic plan.
IV-Priorities for 2007-2008
For the year 2005-2006, many priorities were raised on the table attached, but in this section,
we just highlight some of them:
1. Continue to broadcast the existing TV spots
2. Review existing indicators and establish new targets in the area of IYCF till 2010
3. MPA Module 7 revise and Finalize
4. Training MPA-7 to 24 Provinces
5. Provide training on PBCI to PHPU /PHD to 6 provinces
6. Disseminate and implement the consumers' rights and providers’ rights and duties
7. Reactivate and reinforce the existing community network in 5 provinces
8. Anti-smoking law will be approved by council of ministers and ratified by National
Assembly and Senate and its implementation.
9. Continue to establish smoke free workplace and conducting a campaign on the
adverse effects of tobacco use
10. Conduct training on quit smoking in SiemReab, Kg. speu, Takeo, Ratanakiri,
K. Kong, Pailin
11. Develop sub-decree to implement the Anti-Tobacco law.
V- Conclusion and recommendation
Strategy 6, 7 and 8 of the Health Sector Strategic Plan 2003-2007 is still useful tool for all the
organizations working in the behavior change fields. Though many achievements were
made, we faced some issues for accomplishing some indicators. This because we lack of
human and financial resources and there is no clear indication about which organization
responsible for implementation of each indicator.
- 31 -

Strategy 6: Change for better the attitudes of health providers sector-wide to communicate effectively with the consumers, especially regarding the needs of the poor through
sensitization and building inter-personal communication skills.
Indicators Baseline 2002 Target
2006
1 IEC materials on
IPC skills
NNP develop
IPC training
materials on
Breastfeeding
Counseling.
6 new hospitals
will be declared as
Baby Friendly
hospital (Total =
10)
Achievement
2006
- 2 TV spots on
colostrums
-1 spot on
exclusive BF
-1 spot on
supplementary
food
-1 documentation
on exclusive
breastfeeding (BF)
-One round table
on beast feeding.
-Broadcast those
spots on TVK,
TV3, TV5, TV
Apsara, TV Bayon.
-Question and
answer radio
program on nat.
and Bayon radio
station
-87% new-borns
breastfed within
first hour after
birth.
-100% new born
received only
breast-milk on the
day of discharge.
-1999 village
implemented as
Baby Friendly
Community
Constraint
-Limited time in
broadcasting spots
due to budget
constrain (broadcast
only from 1-8
August 2007 on the
World Breastfeeding
Week)
- Behavior change on
infant young child
feeding require
involving of all level
- Limit budget in
providing knowledge
to health staff all
nation wide on
Infant Young Child
Feeding
- Difficulties in
encouraging staff to
maintain Baby
Friendly Hospital
status due to time
constraints and
motivation.
- Lacking of IEC
material to educate
the mother
Priority
2007-2008
-Continue to
broadcast the
existing TV spots
-Review existing
indicators and
establish new
targets in the area
of IYCF till 2010
Target
2007
- Continue to
broadcast the
existing TV spots
-Select 6 more
hospital to
implement BFH
Calmet,
Municipality, Prey
Veng ,Oudong ,
Romeas Hek Kg
Thom hospital .
- 933 villages
selected to
implement BFC
Target
2008
- Continue to
broadcast the
existing TV
spots
-Continue
to implement
BFH .
-Continue
to implement
BFC .
- 32 -

Indicators Baseline 2002 Target
Achievement
Constraint
Priority
Target
Target
2006
2006
2007-2008
2007
2008
none Monitoring the
2 IEC materials on
professional ethic * implementation of
the professional
ethic
3 IPC materials Review and
update IPC
curriculum on
BS/RH
4 Number of
Referral(RH)
hospitals and
Health
Centers(HC)
implemented
"Provider
Behavior Change
None
- Conduct training
on Module 7 to 5
provinces
- One TOT to
PHPU and MCHU
of new provinces.
- 14 step-downs
training to new
ODs
-Officially
accepted by
Ministry of Health
on training
curriculum
-Organize second
dissemination
workshop on PBCI
No achievement
was made
-Recruit consultant
to revise MPA-7
- Started to Revise
Curriculum MPA-7
(one WS) at the
end of the Year.
-Spot TV on Birth
Preparedness was
finished
1-Conducted
training on
provider change
intervention to :
-Kampot Referral
hospital : 6 courses
-Municipal
Referral hospital :
-No budget
-No clear department
assigned for leading
this task.
-Limited time frame
to revise training
curriculum
-Delay recruit
consultant
-Delay Procurement
1-Kampot Referral
Hospital:
-Chief of Referral
hospital didn't
change his behavior
for
good model
-Referral hospital
-Seeking donor
agency for
funding
- TV and radio
spot, posters,
booklets and
leaflet on
professional ethic
will be produced
-Dissemination
workshop on the
professional ethic
-MPA Module 7
revise and
Finalize
-Training MPA-7
to 24 Provinces
-Dissemination
On air
1-Provide training
on PBCI to PHPU
/
PHD to 6
provinces
success : Kg
Thom,
Kg speu, Kg
Monitoring the
implementation of
the professional
ethic
- Conduct training
on MPA Module 7
to 5 provinces
( EU/UNICEF) and
18 ODs ( UNFPA)
project
-On air of TV spot
1-One training on
PBCI' s Evaluation
skill to PHPU /
PHD
2-One Training of
trainer on PBCI to
PHPU / PHD 6
provinces
Monitoring the
implementation
of the
professional
ethic
None
None
1-monitoring on
PBCI at Steung
Treing Kg
Thom, Kg Speu,
Kg Chhnang,
Svay Reing, and
Kampot
2-Continue
* Request to remove this indicator from the report, since there is no achievements made since the implementation of the sector health strategy 2003-2007
- 33 -

Indicators Baseline 2002 Target
Achievement
Constraint
Priority
Target
Target
2006
2006
2007-2008
2007
2008
Intervention "
5 IEC material on
the role and
responsibility of
health providers
none
training manual
-Implement PBCI
in Kratie,
Sieamreap &
Kampot provinces
and Phnom Penh
municipality.
-Organize ToT on
PBCI in targeted
areas
-Organize training
course on pretraining
needs
assessment of
PBCI to targeted
areas
Monitoring the
implementation on
the role and
responsibility of
8 courses
2-Coaching on
provider behavior
change intervention
-Clients’ rights and
providers’ rights
and duties
approved by MoH
didn't
1-have equity fund
program
2-Municipal
Referral hospital
-hospital is locate
alone to Sam Dach
Or hospital where
people
can get free of
change for
service
Delay in finalizing
clients’ rights and
providers’ rights and
duties
Chhnang,
Kampot Steung
Trienge and Svay
Reing
2-Straingtheng
and
extand PBCI into
5 provinces
Disseminate and
implement the
providers’ rights
and duties
(Kampot, Kg
Thom, Kg
Chhnang, Svay
Rieng steung
Trieng and Kg
Speu )
3-monitoring
and evaluation on
PBCI at Municipal
Referral Hospital
4-Coorperat and
technical support
on PBCI's
activities these 6
provinces: Steung
Trieng, Kg Thom,
Kg Chhang Kg
Speu and Svay
Rieng.
- Disseminate and
implement the
providers’ rights
and duties in five
cooperate and
technical
support to 6
provinces :
Steung Treng,
Kg Thom, Kg
Speu,
Kg Chhnang,
Svay Rieng and
Kampot
3- Entrance on
PBCI to
Sihanouk Ville,
Takeo, Kg
Cham and Prey
Veng
4- Training on
PBCI need
assessment,
monitoring and
evaluation to
PHPU/PHD in
Sihanuk Ville,
Takeo, Kg
Cham and Prey
Veng
5-ToT in PBCI
to PHPU/PHD
in Sihanuk
Ville, Takeo, Kg
Cham and Prey
Veng.
-Implement and
monitor the
implement the
providers’ rights
- 34 -

Indicators Baseline 2002 Target
Achievement
Constraint
Priority
Target
Target
2006
2006
2007-2008
2007
2008
health providers
None -Disseminate the
6 Dialogue on the
role of the NCHP
in managing BCC
research * coordination role
of NCHP on
behavior change
research
-Implement the
approved role
and the IEC
providers’ rights
and duties drafted
None
No clear responsible
departments assigned
for leading and
initiating this
dialogue
-Assign
departments
assigned for
leading and
initiating this
dialogue
-Define the role
of the NCHP in
managing BCC
research
-NCHP
implement its role
provinces
-Monitor the
implement the
providers’ rights
and duties in five
provinces
-Assign
departments
assigned for
leading and
initiating this
dialogue
-Define the role of
the NCHP in
managing BCC
research
and duties in
five provinces
-NCHP
implement its
role
* Request to remove this indicator from the report, since there is no achievements made since the implementation of the sector health strategy 2003-2007
- 35 -

Strategy 7: Empower consumers, especially the poor and women to interact with other stakeholders in the development of quality health services through mass media and
interpersonal communication.
Indicators
1 Review existing
materials on
consumer right
2 Reactivation and
reinforcement of
the existing
community
volunteer network:
- HCMCs
- VHSGs
Baseline
2002
Target
2006
None -Conduct a
baseline survey on
clients’ rights and
providers’ rights.
-Produce IEC
materials on
clients’ rights and
providers’ rights.
-Lunching and
testing clients’
rights and
providers’ rights in
four provinces
Kampot,
Kg. Thom, Pursat,
Kg Cham
None - Reactivate and
reinforce the
existing
community
network in 4
provinces -
Monitoring the
implementation of
the Primary Health
Care Policy and
Guideline for the
implementation of
the Primary Health
Care Policy
Achievement
2006
-Baseline survey
on clients’ rights
and providers’
rights conducted
-IEC materials on
clients’ rights
drafted.
No achievements
made
Constraint
Delay in
finalizing
clients’ rights
No funding
Priority
2007-2008
Disseminate and
implement the clients’
rights
Reactivate and
reinforce the existing
community network in 5
provinces
-Monitoring the
implementation of the
Primary Health Care
Policy and
Guideline for the
implementation of
the Primary Health Care
Policy
Target
2007
- Disseminate and
implement the
clients’ rights in
five provinces
-Monitor the
implement the
clients’ rights in
five provinces
-Monitoring and
strengthen the
activities of the
VHSGs in 5
provinces: Svay
Rieng, Prey Veng,
Kg. Speu,
Mondulkiri, and
StoeungTreng
Target
2008
-Implement and
monitor the
implement the
clients’ rights in
five provinces
-Monitoring and
strengthen the
activities of the
VHSGs in 5
provinces: Svay
Rieng, Prey
Veng, Kg. Speu,
Mondulkiri, and
StoeungTreng
- 36 -

Strategy 8: Promote healthy lifestyles and appropriate health seeking behavior through advocating for healthy environments and implementing counseling and behavior
change.
Indicators Baseline 2002 Target
2006
1 Reactive and update the
existing IEC database
Existing
2 Reactive the BCC Forum Draft ToR of
BCC Forum
-IEC database
functioning
-NCHP website
is accessible
Conduct regular
meeting
3 Policy on BCC/IEC
development and
coordination
None - Review BCC
policy.
-Develop the
implementation
guidelines
4 The role and
responsibility of different
departments within MoH
and other key ministries
for food hygiene * None Workshop for
dissemination
the roles and
responsibility of
NCHP for food
hygiene
Achievement
2006
NCHP website
was launch
Functioning the
BCC forum in
five provinces:
Svay Rieng,
PreyVeng,
Stoeung Treng,
Mondulkiry,
Kampong Speu
No achievement
was made
Constraint
-delay in
functioning IEC
database due to
lack of IT
person to
functioning it.
-Continuous
Updating the
NCHP website
-Limit skill of
the Provincial
Health
Promotion Unit
of the PHD in
facilitating the
BCC forum
Lack of
expertise human
resource on
food hygiene
Priority
2007-2008
-Recruit IT
consultants and
train the NCHP
staff on database
-Make the NCHP
website current
-Continue to
Functioning the
BCC forum in five
provinces: Svay
Rieng, PreyVeng,
Stoeung Treng,
Mondulkiri,
Kampongspeu and
expend to other 19
provinces
-Draft and
approved the roles
and responsibility
of NCHP for food
hygiene
Target
2007
-IEC database will
be updated and
functioning
-NCHP website
will serve the most
up-to-date NCHP
information
-Continue to
Functioning the
BCC forum in five
provinces: Svay
Rieng, PreyVeng,
Stoeung Treng,
Mondulkiri,
Kampongspeu and
expend to other 19
provinces
Workshop for
dissemination the
roles and
responsibility of
NCHP for food
hygiene
Target
2008
-IEC database
will be updated
and functioning
-NCHP website
will serve the
most up-to-date
NCHP
information
-Functioning the
BCC forum in 24
provinces
Implement the
approved roles
* Request to remove this indicator from the report, since there is no achievements made since the implementation of the sector health strategy 2003-2007
- 37 -

Achievement
2006
Constraint
Priority
2007-2008
Target
2007
Target
2008
Indicators Baseline 2002 Target
2006
and implement
the agreed roles
5 Anti-smoking law None -Anti-smoking
law will be
approved by
council of
ministers and
ratified by
National
Assembly and
Senate.
and
implemented -
Establish smoke
free workplace
and conducting a
campaign on the
adverse effects
of
tobacco use.
-Conduct
training on quit
smoking
-Develop subdecree
to
implement the
Anti-Tobacco
law.
6 Marketing breast milk
substitute
Draft the policy
/law on
marketing breast
milk substitute
National
implementation
of sub-degree.
-The draft of
Anti-smoking
law has been
revised for
resubmission to
MoH.
-8 smoke free
hospitals,
schools, and
temples were
established
-On air talk
show about
adverse effects
of tobacco use
on health
organized.
-One ToT quit
smoking
training
conducted
Sub-decree on
Marketing of
IYCF Products
widely
disseminated for
high level
officials from
relevant line
The delay in
ratification of
the Antismoking
law
-Delay
implementation
of sub decree
Anti-smoking law
will be approved by
council of ministers
and ratified by
National Assembly
and Senate.
and implemented –
Continue to
establish smoke
free workplace
and conducting a
campaign on the
adverse effects of
tobacco use.
-Conduct training
on quit smoking in
SiemReab, Kg.
speu, Takeo,
Ratanakiri, K.
Kong, Pailin
-Develop subdecree
to
implement the
Anti-Tobacco law.
Implementation
and Coordination
of sub decree with
inter ministries
and implement the
agreed roles
-Anti-smoking law
will be approved by
council of ministers
and ratified by
National Assembly
and Senate.
and implemented -
Establish smoke
free workplace and
conducting a
campaign on the
adverse effects of
tobacco use and on
cigarette
advertising ban.
-Conduct training
on quit smoking
SiemReab, Kg.
Speu, Takeo,
-Develop subdecree
to
implement the
Anti-Tobacco law.
Dissemination and
Orientation for
effective
implementation of
the Joint Prakas for
enforcement of the
Sub-decree on
Marketing of Foods
-Establish smoke
free workplace
and conducting a
campaign on the
adverse effects
of
tobacco use and
on cigarette
advertising ban.
-Conduct
training on quit
smoking in
Ratanakiri, K.
Kong, Pailin
-Develop subdecree
to
implement the
Anti-Tobacco
law.
- Monitoring and
Evaluation
of the reporting
and enforcement
sister m under
sub decree
- 38 -

Indicators Baseline 2002 Target
Achievement
Constraint
Priority
Target
Target
2006
2006
2007-2008
2007
2008
7 IEC materials for Health
education for NCHADS
None
8 IEC materials on malaria Poster, leaflet.
T-shirt, hat,
video sport,
song
24 provincial
AIDS offices
will implement
outreach and
peer education
to sex workers
Malaria health
education
messages will
reach 70% of the
villagers in 22
provinces
ministries,
PHD/OD
directors
PHD/OD/Nutriti
on Focal Person
from all 24
province and
representative of
milk companies,
private hospitals
were
participated.
A set of SOP for
outreach and
peer education
to sex workers
4,400bags,
8,800games ,
22,000poster
stories and
8,8000cartoon
magazines(scho
ol health
children)
3radio spots,
4songs , 1VDO
stories , 3VDO
spot ,5,000Wall
Calendars,
5,000Desk
calendars,
5,500Caps,
5,800T-Shirts
Luck of
coordination
with involved
NGOs
- IEC
distribution still
keep at
Provincial and
health center
- IEC material
not reach to
remote area
Updated SOP for
outreach and peer
education to sex
workers
4,400bags,
8,800games ,
22,000poster
stories and
8,8000cartoon
magazines(school
health children)
3radio spots,
4songs , 1VDO
stories , 3VDO spot
,5,000Wall
Calendars,
5,000Desk
calendars,
5,500Caps, 5,800T-
Shirts
,10,250flipcharts,
for IYCF
\
Coordination
meetings with all
stakeholders
-Strengthening IEC
distribution to
community
- Develop IEC
material for
community needed
-Develop IEC
material for school
health children
Coordination
meetings with all
stakeholders
-Strengthening
IEC distribution
to community
- Develop IEC
material for
community
needed
-Develop IEC
material for
school health
children
- 39 -

Indicators Baseline 2002 Target
Achievement
Constraint
Priority
Target
Target
2006
2006
2007-2008
2007
2008
9 IEC materials for Health
education of CNAT
Poster, leaflet.
Flip chart,
Booklet,
Billboard, T-
shirts, Caps
video spot,
Disseminate TB
health education
to TB patients
and general
population in 24
provinces
,10,250flipchart
s,
52,500leaflets,
30,272posters.
1,780News
letters and 2020
books.
TB patients and
most of general
population
received health
education
messages on TB
-The level of
TB awareness
among
population is
still low.
-Knowledge
and skill on
BCC among
health staff are
still limited.
52,500leaflets,
30,272 posters.
1,780News letters
and 2020 books.
Continue the
dissemination of
TB health
education to TB
patients and general
population in 24
provinces
* Produce &
distribution of TB
health education
materials:
-Poster, leaflets.
-Flip chart,
-Booklet,
-T-shirts, Caps.
*Disseminate TB
health education
messages through:
-TV spot,
-Radio
-newspaper.
-World TB day
Continues
* Produce &
distribution of
TB health
education
materials:
-Poster,
-leaflet.
-Flip chart,
-Booklet,
-T-shirts, Caps.
*Disseminate TB
health education
messages
through:
-TV spot,
-Radio
-newspaper
-World TB day
- 40 -

QUALITY IMPROVEMENT
I-Introduction
This is the summarized report on the activities Quality Assurance Office (QAO) and Quality
Improvement Working Group had been done in 2006 and on the priorities that are going to be
done in the next years. Moreover, some constrains that our working group met are going to be
shown in this report. We have the honor to tell you that not only this QAO, one of the offices
in the Hospital Department Services, but also the Quality Improvement Working Group, have
been created in the Ministry of Health so as to coordinate the activities involving with
stakeholders that have implemented the health care services in Cambodia.
Strategy 9: Introduce and develop a culture of quality in public health, service delivery and
their management through the use of MoH quality standards; and
Strategy 10: Develop and implement minimum and optimum quality standards for the public
and private sectors through established structures and use of appropriate tools.
Since its creation in late 2003, the QAO has been an integral part of the QIWG providing
assistance in carrying out the technical and administrative tasks to focus the efforts of the
QIWG on strategic/policy issues, as well as in many collaborative projects with health
partners.
Functions of the QIWG
• Assure over-all coordination and monitoring of the implementation of QA strategies
included in the HSSP 2003-2007 and priority activities identified in the Joint Annual
Performance Review;
• Assure that the development and implementation of standards, guidelines and tools
based on MOH priorities, including capability-building support;
• Facilitate the formulation of Cambodian QA policy and regulatory framework, in
collaboration with key stakeholders;
• Assist in the development and testing of a national licensing and accreditation system
for public and private health facilities according to the agreed priorities;
• Ensure availability and accessibility of resource materials related to quality assurance,
in coordination with the MoH library and NIPH and website;
• Conduct performance monitoring activities in pilot areas and facilitate
implementation of remedial actions for performance gaps;
• Provide technical and administrative support to the Quality Improvement Working
Group (QIWG);and
- 41 -

• Recommend strategies and identify TA needs for the continuous enhancements of
systems, policies and procedures pertaining to quality assurance
II-Current Situation and Achievements
Accomplishments of the QIWG
• Assure over-all coordination and monitoring of the implementation of QA strategies
included in the HSSP 2003-2007 and priority activities identified in the Joint Annual
Performance Review; Efforts to implement the National Policy should not start from zero.
To this end, the QAO assisted in creating a matrix that lists the different strategies
enumerated in the Policy vis a vis the ongoing and planned activities of the health sector.
Further reviews and revisions of this matrix were facilitated by the QAO, with assistance
from GTZ.
• Assure that the development and implementation of standards, guidelines and tools based
on MoH priorities, including capability-building support; In 2006, the QAO was
extensively involved in the refinement, translation and pilot-testing of a Referral Hospital
Assessment tool in the selected referral hospitals in collaboration with URC-HSSC and
GTZ. The QAO is also an integral member of the core group on health technology
assessment (HTA) with a background on developing and/or reviewing clinical practice
guidelines and creating mechanisms to implement them in clinical facilities. The core
group completed an advance course on clinical pathways in Manila in 2006. A requisite
of the course was the creation of pathways suited for Cambodia – paediatric pneumonia
and diarrhoea pathways. One national workshop was completed in 2006, introducing the
concept of clinical pathways as an implementation tool. Unfortunately, the QAO was not
involved in the 2006 revision of the CPA guidelines.
• Facilitate the formulation of Cambodian QA policy and regulatory framework, in
collaboration with key stakeholders; After the signing of the National Policy in October
2005, the next step was to have this available in print format ready for dissemination to
key stakeholders in the health sector. The QIWG met to discuss and translate the
document from its original English into Khmer. After several revisions, the QAO, with
GTZ support, managed to have an initial 500 copies made followed by another 500
copies.
Dr. Sok Po presented the content of the National Policy and directions set forth by it to
the TWG-H in December highlighting the areas where necessary integration and
collaboration should happen with other sectors such as health financing and human
resource development.
In order to share information and clarify the role of the provincial health departments and
the operational districts in making the policy successful, the QAO, together with GTZ and
URC, conducted a workshop with PHD and OD Directors. The Roadmap was introduced
to further illustrate how 5 key strategies interlinked and how they should ideally build up
on each other's success.
- 42 -

In order to support the MoH to implement the provisions of the National Policy, a
roadmap (also referred to as master plan for QI) was created which identifies 5 key
strategies – empowering consumers, institutional management, clinical practice,
professional development and management development. These have to be spearheaded
by dedicated working groups that will take lead in the different but related activities for
each strand.
In 2006, 1 formal group – Clients Rights WG – and 2 informal groups – Health
Technology Assessment (HTA) Core Group and the Hospital Reform Group showed
specific outputs which are related to the National Policy. These 3 groups are being
considered to take the role for the first 3 strategies.
Reports and minutes of meeting detailing the activities of the Clients Rights WG, the
HTA Core Group and the Hospital Reform group are available with the QAO, NCHP and
GTZ.
Two other working groups – on professional development and management development
need further work but the key players have already been identified by the QIWG. The
QAO will take lead in furthering the discussions.
• Assist in the development and testing of a national licensing and accreditation system for
public and private health facilities according to the agreed priorities;
Preliminary work on development of accreditation standards and tools for private clinics
started in November 2006 in collaboration between PSI-KfW-GTZ-QAO, as another
piece in implementing the National Policy. The QAO is the chair of the Task Force on
Accreditation for this collaboration.
The QAO has been involved from the beginning as regards the development of an
Accreditation system for the Cambodian health sector. Hence, they have been active
members in the consultancy missions in 2006 of Dr Charles Shaw and Dr Madeleine
Valera. They attended meetings and worked on documents that were pertinent to the
consultancies.
• Ensure availability and accessibility of resource materials related to quality assurance, in
coordination with the MoH library and NIPH and website;
The QAO keeps an inventory of the most recent documents shared by other organizations
and partners on QI. Ideally, these documents can be better used if they were integrated
and shared by most, if not all, relevant agencies in the health sector. This has been
mentioned several times in many reports, including that of Dr Shaw's. This is all very
good and the QAO and other health partners agree with this. But the current situation in
Cambodia does not yet permit us to achieve this in full.
Primarily, the QAO has no authority over the vertical programs to enable it to set
directions on how to proceed with, for instance, clinical guideline development. The
QAO is currently seen as keeper of the documents, not yet an analyser nor an expert that
can provide input to the vertical programs.,The vertical programs themselves have their
own systems for technical and administrative matters. To some degree they do not yet see
- 43 -

themselves integrating with the directions of the QAO in line with the national policy. At
times it is even very difficult for the QAO to request for copies of their documents for the
QI library. In some cases, a fee was required to obtain a copy.
• Conduct performance monitoring activities in pilot areas and facilitate implementation of
remedial actions for performance gaps;
The QAO has been involved year-round with assessments of health facilities. To date, 14
hospitals in 11 provinces have been assessed – with some of them already completed a reassessment.
The hospitals assessed are listed as follows:
1. Battambang RH, Battambang
2. Maung Russey RH, Battambang
3. Kampong Cham RH, Kampong Cham
4. Kampong Thom RH, Kampong Thom
5. Stung RH, Kampong Thom
6. Kampot RH, Kampot
7. Chhlong RH, Kratie
8. Kratie RH, Kratie
9. Mongkul Borei RH, Mongkul Borei
10. Oddar Meanchey RH, Oddar Meanchey
11. Phnom Penh Municipal RH, PNH
12. Pursat, RH, Pursat
13. Siem Reap RH, Siem Reap
14. Sihanoukville RH, Sihanoukville
• Provide technical and administrative support to the Quality Improvement Working Group
(QIWG); The QAO acts as the secretariat of the QIWG managing invitations, logistic
preparation, as well as creating the minutes of each meeting. The group completed 4 out
of 6 planned meetings for the year. The topics covered and discussed include:
1. Concept and content of the National Policy for Quality
2. Roadmap for the implementation of the National Policy for Quality
3. Quality Improvement Inventory Matrix
4. Results of referral hospital assessment
In many instances, it was the QAO providing the information and sharing directions to
the QIWG, rather than the other way around. It is quite understandable at this stage
because everyone is still in a learning curve, including the QIWG and the QAO. At this
time, the QAO is able to share more information because they are having more exposure
given the many and varied collaborations with health partners.
In the future, the leadership role of the QIWG will be strengthened given the National
Policy taking a clearer direction using the roadmap and the QI matrix.
• Provide technical and administrative support to the Hospital Management/Reform
Working Group; The QAO also serves as secretariat of the Hospital Management WG
managing invitations, logistic preparation, as well as creating the minutes of each
meeting. The group completed 7 out of 12 planned meetings for the year. The topics
covered and discussed include:
- 44 -

1. General hospital management and necessary core values
2. Job descriptions
3. Hospital autonomy
4. Nursing process
5. Feedback on the international conference: Hospital Management Asia
• Recommend strategies and identify TA needs for the continuous enhancements of
systems, policies and procedures pertaining to quality assurance. Among the technical
assistance identified and proposed by the QAO in 2006 include:
1. Quality Management Training
2. How to improve clinical practice through the use of guidelines
3. How to improve the use of guidelines in hospitals
III- Constraints :
• Despite the ever-increasing workload of the QAO, there was no attendant increase in
its current manpower, which numbers only three (3). With their functions including
travels to the provinces sometimes for days at a time and with numerous meetings and
workshops to attend for its many projects, it was difficult to distribute tasks to only 3
people.
• Even as progress is made on the Quality Assurance policy, however the transferring
from policy to the real-activities was very low. Within the MOH itself, there seems to
be little motivation from other units to coordinate activities directly with the QAO.
Other health partners continue with their plans disjointed from the overall plan set by
the National Policy. For some that do recognise the policy, more work has to be done
to improve coordination.
• Some partners and departments within the ministry itself have come to expect that the
QAO act as an extension of their manpower for specific tasks such as medical
missions and ongoing facility assessment. It is for the good of the QAO to be involved
in the develop phases since they are at the policy level, but with the current staffing of
3, it may be detrimental to their other functions to be relied upon for ongoing
repetitive tasks.
• The QIWG members seem to be inactive in supporting to QA policy. As mentioned
above, this could be partly explained by the learning curve that the QIWG is also
going through.
• There is no report from coming from the provincial QA teams on the progress of the
activities. Hence, the QAO does not have information to analyse the progress of the
QA activities in the provinces.
IV-Priorities for 2007 – 2008
We select some activities, some of which are in strategy 9 and 10, which we consider as the
prioritized ones being achieved in 2006 – 2007.
- 45 -

A-Strategy 9
The points described below are considered as the prioritized ones in the strategy 9, which we
are going to achieve in 2006 – 2007 in order to fulfil this strategy.
• We are going to classify the documents in the registry into more meaningful groups.
• Revision of the first draft of the HC assessment tool will be done.
• The hospital assessment tool is used on a national scope; the QAO will have to
assess it.
B-Strategy 10
The points described below are considered as the prioritized ones in the strategy 10, which
we are going to achieve in 2006 – 2007 in order to fulfil this strategy.
• A group that will work for the creation of the national standards is going to be
established.
• A set of national standards will be drafted.
• Exploring the way to relate to updating the CPA guidelines.
• Rewards and reinforcement system would be worthwhile to look at trends in
performance of HCs over time.
• Directions for Quality Circle (QC) meetings must be clearer than it was. We must
identify what we want them to achieve.
• Using national data prioritize which guidelines would be most worthwhile to update
first.
• Follow up HTA course for core group
• 2 nd workshop on HTA to refine the process of CPG development
• Advocacy for specialty societies in their roles in CPG development. It will involve a
series of meeting with the leadership of the different societies prior to the 2 nd
workshop to sensitize them.
V- Conclusions and Recommendation
• The accreditation is the one that could not be achieved in recent time. To be
achieved, we need 3 years more; however we have already conducted this concept
through Sun Quality Health Network.
• All of the prioritized activities described above can be achieve unless the fund
would be handled on time.
The leadership of the referral hospitals is very important in order to achieve the quality
improvement in the hospitals; however it can be improved by quality improvement project
with in the hospital or Quality Circle (QC) or hospital assessment tool.
- 46 -

Quality Improvement: Indicator, Baseline 2002, Target/Priority 2007-2008
Strategy 9: Introduce and develop a culture of quality in public health, service delivery and their management through the use of the MoH quality standards.
Key indicator
Baseline
2002
9.1 Qualified active QI WG in place
Meetings of WG on QI every WG exists
2 months with following
members:
QA responsible
1. NIPH
at central MoH
2. MoH Planning
level not yet
Department
appointed.
3. MoH Hospital
Department
4. MoH HR Department
5. MoH Finance
Department
6. NMCHC
7. Kampong Thom Hospital
& PHD
8. Pursat Hospital & PHD
9. Medical Association
10. TA (GTZ, URC, BTC,
RACHA, MEDICAM)
Target
2006
• QIWG meetings
to be held
regularly at least
every two months.
• At least 2/3 of
members attend
each meeting
• Record of
Minutes for each
QIWG meeting
• QIWG to make
in depth plan for
2005 activities
9.2 Capacity building for QM
Number of persons / teams
trained in Quality
Management
- International QM training 3 persons • 2 people from
QIWG,
Departments &
Provincial QI
team
- HSMT by NIPH
60 teams in
Achievements
2006
• QIWG
meetings were
held regularly
every two
months.
• At least 2/3 of
members
attended each
meeting
• Recorded of
Minutes for each
QIWG meeting
• 4 persons were
trained: Dr.Sann
Sary, Dr. Chon
Sinoun, Mrs.
Lim Khankryka,
Dr.Tek Kim
San.
12 teams 12 teams (44
tranees) were
Constraints
• Some members
were not
participate as they
promised.
Some people that
has been trained
no longer work
with QIWG.
Priorities
2007 - 2008
QIWG
meetings to be
held regularly
at least every
two months.
• At least 2/3
of members
attend each
meeting
• Record of
Minutes for
each QIWG
meeting
• 2 people from
QIWG/
Departments
/Provincial QI
team
Target
2007
QIWG meetings
to be held
regularly at least
every two months.
• At least 2/3 of
members attend
each meeting
• Record of
Minutes for each
QIWG meeting
• 2 people from
QIWG/
Departments /
Provincial QI team
Target
2008
QIWG
meetings to
be held
regularly at
least every
two months.
• At least 2/3
of members
attend each
meeting
• Record of
Minutes for
each QIWG
meeting
• 2 people
from QIWG/
Departments /
Provincial QI
team
No No No
- 47 -

Key indicator
Baseline
2002
whole country
received training
by 2002
Target
2006
Achievements
2006
trained
Constraints
Priorities
2007 - 2008
Target
2007
Target
2008
- Hospital Management
training by NIPH
- Planning cycle training
according to HSSP.
65 teams to be
trained in
Hospital
management
0 Continue to
support by TA &
follow up
6 teams 6 teams were
trained
Continue to
support by TA &
follow up
9.3 Collection and coordination of the development of National quality standards by
QA office
Number of documents being None, but many
collected, revised and coded documents exist
by QA Office staff & QI somewhere.
Team members
- Laws and PRAKAS
- Standards
- Guidelines
- Protocol
% of standards identified
being completed regarding to
the gaps
• Continue to
collect of all
documentation
related to quality
standards.
• Establishment
of National
Registration
system.
•Some
documentations
related to quality
standards were
collected.
• Continue to
seek for
appropriate
system of
registration and
updating.
lack of trainers 6 teams (36
trainees)
Continue to
support by TA
& follow up
• Continue to
collect of all
documentation
related to
quality
standards.
6 teams (36
trainees)
Continue to support
by TA & follow up
• Continue to
collect of all
documentation
related to quality
standards.
0 N/A N/A N/A N/A N/A N/A
6 teams (36
trainees)
Continue to
support by TA
& follow up
• Continue to
collect of all
documentation
related to
quality
standards.
% of standards updated and
registered
0 N/A N/A N/A N/A N/A N/A
Strategy 10: Develop and implement minimum and optimum quality standards for the public and private sector incorporating pro-poor and
gender issues through established structures and use of appropriate tools
- 48 -

Key indicator
Number of PHD's that create a
Quality Assurance team
Number of OD's implementing
pilot QA activities
Number of meeting /
workshop in a pilot province
attended by QI member from
central level
Number of public hospitals
with quality licence
A national standard for quality
accreditation of public health
centres
Number Private health care
facilities with quality licence
(Law No. NS/RKM/1100/10
of 2000)
Number of Private
practitioners with quality
Baseline
2002
Pilot provinces
Pilot provinces
Pilot provinces
Pilot provinces
Pilot provinces
Some clinics are
registered
(Phnom Penh:
28 out of 36 IPD
are illegal)***
Some
practitioners are
Target
2006
Siem Reap, Kampot
and Kg Cham create
QAT
- Kg Cham
- Internal medicine
and surgery wards
- 10 HCs in SMOD
and 10HCs in BKOK
4 in KgT, 4 in Siem
Reap, 4 in Kg Cham,
4 in KP, 4 in Pursat
Hospital quality
performance
assessment tool test
in Pusat and Kg
Thom.
All pilot provinces
will obtain
accreditations
- Clear quality
standards for
practitioners
licensing and
registration are
developed
- Illegal clinic and
polyclinics reduced
Achievements
2006
Constraints Priorities
2007 - 2008
Not yet created 3 others
provinces
Target 2007 Target 2008
3 others provinces
Not yet start - 3 more ODs - Full
wards in Pursat
provincial hospital -
All 31HCs in PS
province
One meeting
was conducted
with
participation of
QA central
14 hospitals in
the country
assessed by
Hospital
Assessment
lack of staff
and budget to
perform
assessment
Full
participation
of QA central
30 hospitals in
the country
will assess by
Hospital
Assessment
tools
tools
Not yet start All pilot
provinces test
accreditations
standard
-Initiative
process started
- Illegal clinic
and polyclinics
- lack of staff
and budget to
work out
- lack of law
enforcement
All
practitioners
in pilot area
are registered,
licensed and
monitored
with good
quality
-At least 70%
of get clinics
4 in KgT, 4 in Siem
Reap, 4 in Kg Cham,
4 in KP, 4 in Pursat
10 hospitals in the
country will assess by
Hospital Assessment
tools
All pilot provinces
test accreditations
standard
Clear quality
standards for
practitioners licensing
and registration are
developed
- At least 70% of get
clinics and polyclinics
- 3 more ODs -
Full wards in
Pursat
provincial
hospital - All
31HCs in PS
province
4 in KgT, 4 in
Siem Reap, 4
in Kg Cham, 4
in KP, 4 in
Pursat
20 hospitals in
the country will
assess by
Hospital
Assessment
tools
All pilot
provinces test
accreditations
standard
All
practitioners in
pilot area are
registered,
licensed and
monitored with
good quality
-At least 70%
of get clinics
- 49 -

Key indicator
licence (Law No.
NS/RKM/1100/10 of 2000)
**
Degree of user satisfaction
with public services in Pilot
area
Baseline
2002
registered.
(Phnom Penh:
517 out of 557
are illegal)
Target
2006
by a further 20%
Achievements
2006
were reduced by
80% in Phnom
Penh
Constraints
Priorities
2007 - 2008
and polyclinics
are legal
- Start to
develop tools
for exit
interview.
are legal
Target 2007 Target 2008
and polyclinics
are legal
** Including physicians, pharmacists, dentists, midwives and laboratory technicians, etc….
*** Decentralisation to register and licence was decided in 2002.
- 50 -

HUMAN RESOURCE DEVELOPMENT
I-Introduction
The high maternal mortality ratio (MMR) and infant mortality rate (IMR) in Cambodia
remain a great concern for the Ministry of Health (MoH) and Health Development Partners.
One of the major factors is the serious shortage of midwifery staff and incompetent staff
working at the periphery level of health services. Therefore, the three strategies related to
HRD of the Health Strategic Plan 2003-2007 were set for meeting the shortage of staff
working at lower level of health services and to equip existing with appropriate skill for better
service delivery. The achievement of the set strategies will lead the improvement of the safe
delivery as well as the reduction of the presence MMR and IMR status:
1. to increase the number of midwives and strengthening their skills through continuing
education contribute to the quality improvement of health service delivery
2. to reduce mal-distribution is considered as an effective mean to ensure the availability
of health service around the country especially at the rural areas
3. to provide comprehensive training and education in both management and technical
skills plays as support measure for the improvement of the health sector.
After the 1980's, the production of health workforce has been facing to the quality rather than
quantity. A lot of continuing education has been conducted to fulfill the gap of basic
education. The senior midwives have gone through the basic education focusing mainly on
technical aspect, but less on management of midwifery activity when they have placed at the
community level. The promotion and advocacy of midwife profession is still limited. At
present, Traditional Birth Attendance (TBA) plays an important role for giving delivery at the
community. There is less trust and less satisfaction given to our young trained midwives in
addition to socio-cultural condition. In addition to this, the updating of midwifery skills and
knowledge done by National Programs still not enough to cover the needs, especially where
there is shortage of midwifery staff.
In order to increase the number of midwives, the revitalization of the primary nurse midwife
course aims at fulfilling the number of midwives working at the periphery level. The
graduates will be allocated to the vacant post at the rural areas. They will play a management
role for safe delivery and replacing the role of TBA when their competency will be
recognized.
II- 2006 Achievement and plan for 2007-2008
There were some constraints to affect the speed of the project implementation activity such as
shortage of gasoline of the MoH, changing rate policy from the MoEF. The achievement in
2006 is shown as followed:
1. Increase number of midwives and provision of midwifery skills
A. Increase the number of midwives
a. Production of Post basic midwifery graduates
There are 85 midwife graduates and 88 new intakes recruited for fiscal year 2006-2007 for
TSMC and the 3 RTCS. The increasing of new intakes reflects from the huge number of MoH
posts given from the Government that lead to many applicants for this great opportunity.
- 51 -

Based on the production capacity of the TSMC/RTCs and the availability of clinical sites, the
number of new intakes for post basic midwifery will maintain to 80 per year for 2007 and
2008.
b. Production of Primary midwifery graduates
The number of the first batch graduates of the primary nurse midwife implemented in the four
RTCs graduates is 398. Among them, 192 are primary midwives. The intakes of the second
batch for fiscal year 2006-2007 are 246 in which 146 are primary midwife students. The
selection based on the identification of vacant post suggested from relevant PHDs and
choosing applicants leaving in the community near by the HC coverage. Based on the
experience from the previous batches, the students with educational background of class 7,
10, or 11 affect to the low quality of teaching and learning activity. It is recommended to
review the selection criteria due to most applicants have high school diploma for the
recruitment of new intakes this year. It is planned to recruit primary midwifery students 120
for 2007 and same for 2008 with the proposed selection criteria at the 4 RTCs. Consideration
should be made on the recruitment of intakes after 2008 based on the number of midwives
new allocation to health facilities.
c. Revitalization of the 3 year program of Midwifery pre service training
Due to the recently implementation of the post basic midwife, the plan to revitalize of the
three year midwifery program was suspended and it is recommended to wait for the finding of
Midwifery Mission Team as well as decision from Top MoH. Therefore, curriculum
development should be started in 2007 and expected to be finalized it end of 2008.
B. Provision of midwifery skills
There are 84 HC staffs receiving the 4 month midwifery course. Among them 60 are funded
by HSSP, 12 by RACHA, and 12 by BTC. RACHA also support 117 staff to the LSS course.
The continuing education for HC staff is managed by the TSMC/RTCs with the collaboration
from relevant PHDs. In the other hand, JICA support 40 midwives working at RHs for CPA
midwifery course managed by the NMCHC. Same as in the previous year, it is expected to
have 100 HC staff trained in midwifery skills (Midwifery 4 month course, NMCHC course,
LSS course) every year for 2007 and 2008.
1. Strengthen human resource planning to reduce mal distribution (Strategy 12)
The two strategies related to equitable distribution of qualified staff to health facilities
remain effective for HR management:
• Identification of staff needed for each level of health service
• Provision of appropriate skills and knowledge to staff for better service delivery
a. Identification of staff needed for each level of health service
The combination of Standard Staffing Level formula and the CPA Guidelines into the HR
Database provide clear direction to the PHDs for staff needed at their organization. The
promotion of using the HR database is very crucial to use it as mean for the purpose of staff
management. The utilization of HR database is first started with the identification of vacant
post for midwives. Therefore in reflection to the gap identified by the HR database and in
consultation with both Departments and relevant PHDs, in 2006, 51 midwives have been
recruited to the vacant posts against 100. Among them, 34 are Primary Midwives and 17 are
Secondary Midwives of the post basic midwifery course. The expectation of at least 70% of
- 52 -

HCs will have midwifery graduates allocated in 2007 and 2008 for the remaining 194 HCs
without midwifery staff.
b. Provision of appropriate skills and knowledge to staff for better service delivery
In 2006, there are 170 HCs are equipped with staff trained in midwifery skills (midwifery 4
month, LSS courses) and 29 HCs with midwifery graduates. There are 14 RHs equipped staff
in Basic Surgery (BST) and 14 RHs in Anesthetist (ISAR) courses. It is planned to have at
least 9 RHs equipped with staff graduates from BST and 14 RHs having staff trained in ISAR
course.
2. Enhance management and technical skills for all health workforces
(Strategy 13)
The MPA and CPA service packages give clear direction what knowledge and skills needed
for staff for service delivery in addition with the knowledge and skills they have learned
through the basic education.
It is planned to provide the MPA training course to staff at HC level based on the Training
Need Assessment (TNA). In 2006, the TNA supposed to be implemented at the 24 provinces
under the management of TSMC/RTCs. Due to the shortage of gasoline and modification of
policy rate from the MoEF, the implementation of the TNA has not been achieved as planned.
As result, the MPA course has been delay due to waiting of TNA result. In 2007 and 2008,
the MPA training course will be provided according to TNA result with the expected number
of 6 staff per HC.
To support the CPA service package, lab training has been provided to the staff with 149
participants. In 2007 and 2008, it is planned to provide lab training course 5 times a year with
the estimation of 36 participants per course.
As in the previous year, there are 16 physicians trained with Basic Surgery (BST) and 25
nurses trained with Anesthetist (ISAR) courses. It is planned to have 16 physicians trained
with BST and 20 nurses trained with ISAR starting mid 2007 to 2008.
To improve the management skills of health managers, 44 managers received the hospital
management (HMT) course and will have 35 managers attend the HMT in 2007 and 2009.
The management for quality service delivery is the main concern of health development
partners. This should be drawn one part from maintaining and controlling the quality of
education for health in both public and private training institutions. Recently, the increasing
of private training institutions made the promotion of quality control of the education for
health very crucial. The MoH with the collaboration from the MoEY&S and relevant
institutions has finalized the draft of sub decree to be submitted to the Council of Ministers
for approval. The enforcement of the standards on training for health stipulated in the sub
decree will enable the MoH to have close collaboration with the Ministry of Education Youth
and Sport in promoting and controlling the quality of training for Health.
III-Constraints
The delay of implementation of AOP should be addressed such as flexibility of per diem rate
for traveling, shortage of gasoline, in order to smoothly implementation activities. The delay
of one of the activities will give a burden of works to the implementation levels including
PHDs, TSMC/RTCs as well as relevant responsible institutions for its management and
monitoring processes.
- 53 -

IV-Priorities
In order to having midwife staff for the health services, the primary training program could
address the MoH staff shortage but it is not quite sure that the reduction of MMR and IMR in
Cambodia could be solved. Based on the experience from the previous batches of the North
East provinces, the selection of students who have no high school diploma has created a lot of
difficulty in the teaching and learning activities. It is suggested that the selection criteria
should be revised for the quality of teaching and learning In addition, the survey from the
Midwifery Team Mission shown that the skills and knowledge of midwifery staff at the health
services is still limited. Therefore, efforts should be focused on the improving the quality of
services of midwifery staff as well as the quality of midwifery graduates.
To maintaining and controlling the quality of training for health in both public and private
training institutions, the standards on training/QAP should be developed as annexes of the sub
decree on training for health.
V-Conclusion
The shortage of midwifery staff remain problem for the MoH. The two strategies, provision of
midwifery skills to existing staff and increase the number of midwives, are first priority for all
stake holders. This could be done through close collaboration, sharing resources with the
endorsement from the top MoH and health development partners.
- 54 -

HRD Indicators, Baseline, Targets /Priority 2007-2008
Strategy 11: Increase the number of midwives through quality basic training and strengthening the capacity and skills midwives already trained through quality continuing
education
Indicators
1 Number of new
midwives post basic
graduates
2 Number of new primary
midwife graduate from
RTCs
Baseline Target 2006
2002
0 Up to 80 new
entrants and up to
80 new graduates
0 - Up to
approximately 38
primary midwifery
students recruited
at each of the 4
RTCs .
Achievement
2006
- 88 new intakes
recruited for
fiscal year
2006-2007
- 85 will be
graduated from 3
RTCs and
TSMC.
- 398 Primary
Nurse Midwife
graduates from
the 4 RTCs for
fiscal year 2006-
2007. Among
them, 192 are
Primary midwife
graduates
- 246 Primary
Nurse Midwife
new intakes
recruited for the
4 RTCs for fiscal
year 2006-2007.
Among them,
146 are Primary
midwife students
Not achieve
Constraints
Have only
approximately 80
applicants per year
applying this course
Issue related to
selection criteria
in which having
students from 10
year class affected
to learning and
teaching quality.
Priority
2007-2008
Up to 80 new
entrants recruited
and up to 80 new
graduates from
TSMC and 3
RTCs every year.
Continue to
implement the
primary nurse
midwife course at
the 4 RTCs with
appropriate
selection criteria
Target
2007
Up to 80 new
entrants recruited
and up to 80 new
graduates from
TSMC and 3
RTCs every
year.
Up to 120
Primary
Midwives
gradated and up
to 120 new
intakes recruited
every year
Target
2008
Up to 80 new
entrants recruited
and up to 80 new
graduates from
TSMC and 3
RTCs every
year.
Up to 120
Primary
Midwives
gradated and up
to 120 new
intakes recruited
every year
3 Number of secondary
- Curriculum
Recommendation Waiting for Curriculum Curriculum
midwife graduates from
pre service training
program
0 development for 3
year midwifery
program
to wait for
Midwifery
Review’s finding.
decision from
Top MoH
development for
3 year midwifery
program
development for 3
year midwifery
program
4 Number of staff 395 - Up to 80 HC staff - 84HC staff (60 Implementation of 100 HC staff will 100 HC staff will
- 55 -

completing basic EOC
will receive 4 funded by HSSP,
4-month midwifery be updated be updated
course (MPA 11 and 12,
month midwifery 12 by RACHA,
, LSS and NMCHC midwifery skills. midwifery skills.
4 month, MCH course,
LSS)
course
- 40 midwives will
receive NMCHC
RH/CPA course
- 50 midwives will
receive LSS course
and 12 by BTC)
received 4 month
midwifery
course
-19 midwives
received NMCH-
RH/CPA course
-117 staff from
91 HCs received
LSS course
CPA courses to fill
the HCs where
there is no
qualified
midwifery staff
Strategy 12: Strengthen human resource planning to reduce mal-distribution of the numbers and type of workforce through identification of
posts and the reallocation of staff
Indicators
Baseline Target 2006 Achievement Constraints Priority
Target
Target
5 The number of HC
having staff with
updated midwifery
skills (4 month, MCH
course, Life saving
skills, post basic
midwifery and primary
nurse and midwife)
6 % of facilities at each
level with appropriately
qualified staff according
to guidelines for OD
2002
361 100 HCs will be
equipped with
updated midwifery
skills staff
-At least 70% of
midwifery post
will be filled with
new midwifery
graduates
2006
170 HCs are
equipped with
updated
midwifery skills
(4 month, MCH
course, Life
saving skills) and
midwife
graduates (Post
Basic Midwives
and Primary
Midwives)
- Only 51% of
Midwifery post
are fulfilled (34
post are filled by
Primary
Midwives and 17
by Post Basic
Midwives).
Not enough
applicants applied
for the midwifery
post at HC level.
2007-2008
Provision of
midwifery skills
to HC staff every
year (4 month,
MCH course, Life
saving skills) and
100 % allocation
of midwife
candidates who
applied to MoH
post
At least 70% of
midwifery
graduates applied
to work at
194HCs where
have no
midwives.
2007
100 HCs will be
equipped with
Midwives and
staff with
midwifery skills
and 100 %
allocation of
midwife
candidates who
apply to MoH
post
At least 70% of
midwifery
graduates
applied to work
at 194HCs where
have no
midwives.
2008
100 HCs will be
equipped with
Midwives and
staff with
midwifery skills
and 100 %
allocation of
midwife
candidates who
apply to MoH
post
At least 70% of
midwifery
graduates
applied to work
at remaining
HCs where have
no midwives.
7 Number of referral 21 - 16 surgeons from - 14 RHs - Provision of - 9 RHs will be - 9 RHs will be
- 56 -

hospital (CPA2 &
CPA3, total 51) with at
least 2 doctors formal
trained in basic surgery
at least 9 RHs to be
graduated from the
BST,
- 20 nurses from
ISAR course
equipped with 16
surgeons
graduated from
BST course
- 16 RHs
equipped with
nurses graduated
from ISAR
course.
BST, ISAR, and
OTN courses to
RH staff
equipped with
Basic Surgeons
- 14 RHs with
ISAR nurses
equipped with
Basic Surgeons
- 14 RHs with
ISAR nurses
Strategy 13: Enhance the management and technical skills and competence of all Ministry of Health workforce through quality, comprehensive training and education and
retention and support measure
Indicators
Target 2006 Achievement Constraints
Priority
Target
Target
8 Number of HC staff
received MPA training
according to need
assessment
9 % targeted staff
received management
training-HSMT and
HMT
10 Accreditation for
training courses and
training institutions
developed by the end of
2006
Baseline
2002
HSMT-71%
Ods;-62%
PHDs HMTcurriculum
developed
5652 HC staff to be
trained with MPA
(6 staff /HC)
through TNA
- 35 health
managers at PHD
& OD levels will
attend the HSMT
- 35 RH managers
will attend the
HMT course
Finalize QAP -
Finalize the details
of 9 point
indicators
-Continue to
develop school
approval criteria
for each field as
tools to meet the
ACC requirement
2006
No activity
- No HSMT
course provided
- 44 RH
managers attend
the HMT course
- 30 % of QAP
was finalized.
- Sub Decree on
Training for
Health is
submitted to the
Council of
Ministers
Delay in
implementing of
TNA as planned
that lead to no
MPA course
2007-2008
Provision of
MPA course
based on the TNA
result
-Provision of
HSMT based on
demand from
PHDs
- HMT course
will be provided
for RH managers
every year
-Enforcement of
QAP
implementation
2007
5652 HC staff to
be trained with
MPA (6 staff
/HC) through
TNA
-Provision of
HSMT based on
demand from
PHDs
- 35 RH
managers will
attend the HMT
course
All public
training
institutions
(UHS,TSMC,4
RTCs) are
targeted to
implement QAP
and Sub decree
on Training for
Health
2008
5652 HC staff to
be trained with
MPA (6 staff
/HC) through
TNA
-Provision of
HSMT based on
demand from
PHDs
- 35 RH
managers will
attend the HMT
course
All public
training
institutions
(UHS,TSMC,4
RTCs) are
targeted to
implement QAP
and Sub decree
on Training for
Health
11 Percentage of provincial Provision of Provision of lab 149 lab staff Provision of 5 Provision of 5 Provision of 5
- 57 -

laboratory staff trained
at NIPH
lab courses at
NIPH
courses at NIPH
attended lab
training courses
at NIPH.
lab courses with
35 participants
per course at
NIPH
lab courses with
35 participants
per course at
NIPH
lab courses with
35 participants
per course at
NIPH
- 58 -

HEALTH FINANCING
Strategy 14: Monitoring the regularity and adequacy of funds to the health sector
In 2006 the percentage of national budget allocation for health was 1.08% of GDP (targeted
1.26%). However, budget allocation for health as %of government budget was 6.64% of total
government budget (against a target of 10%). The estimation of total expenditure for health is
261,741 Million Riels as 92.8% of the total adjusted budget. Total national budget for health
per capita is 4.64 US (target 4.59 USD).
There were not budget for priority action program at provincial level. The PAP budget only
implemented at central level. The total budget have been approved by the Parliament were
260,973 Million Riels.
The national expenditure for health was better than year 2005. At the first six months the cash
released for chapter 11 was 36.12% of total budget, at central level and 19.10% at provincial
level (In 2005: central 4% and province 22%).
Chapter
Adjusted budget
2006
Expenditure 2006
Jan - Jun ° Jan - Dec °
11 145.045.000.000 41.311.952.412 28% 133.546.137.194 92%
Central level
96.912.000.000 32.117.153.876
33%
93.317.875.563
96%
Provincial level
48.133.000.000
9.194.798.536 19%
40.228.261.631
84%
13 (PAP & ADD) 79.588.000.000 34.422.921.644 43% 75.510.995.114 95%
Central level
71.378.000.000
3.865.921.644 47%
67.301.152.314
94%
Provincial level 8.210.000.000 557.000.000 7% 8.209.842.800 100%
Total 11 &13
224.633.000.000
75.734.874.056 34%
209.057.132.308
93%
Central level
168.290.000.000 65.983.075.520
39%
160.619.027.877
95%
Provincial level
56.343.000.000
9.751.798.536 17%
48.438.104.431
86%
The review lessons from evaluation of ADD and PAP system has been finalized and
disseminated to the provinces.
The public procurement in 2006 had been improved compare to 2005. The procurement of
drugs was going smoothly and achieved 113.3% of total drug budget.
The reporting of the study of increase health service cost with increased utilization was
finalized by the end of February 2006
Constraints:
- 59 -

• The delay of cash disbursement was happened so far and still continued in 2006
• Lack of staff with capacity there for delay of expenditure report.
Strategy 15: Allocate financial resources to improve the accessibility of health services
for the poor through alternative health financing schemes:
The proportion of annual budget increase that was allocated to the provinces, out of total
budget, was 26% against target 60%. The government budget allocation remained quite
centralized and has not necessarily solved basic budgetary problems.
The recurrent national budget allocate to provinces as proportion out of total provincial-city
budget was 51% including drugs against target 66%, and 42% excluding drugs (Target 35%).
The proportion of budget allocate to health centers and referral hospital for operating
expenditures (excluding drugs) was not available because of the budget envelope for each
province did not calculate based on budget formula.
The government committed cash to support the poor patients was 471,298,749 Riels, for 4
national hospitals and 2 operational districts (non contracting district).
In addition MoH has been review of Health Financing Management Guideline, Master Plan
on Social Health Insurance, and finalized the development of the CBHI Guideline, and HEF
monitoring tool, and HEF reporting form.
HEF implemented in 23 non contracting districts, and 6 contracting districts against target of
41 (Including in non contracting ODs, and 11 contracting ODs).
The number of poor patients with assistant from equity funds has been increase from 47,600
to 89,320 patients against target 200 000 patients.
The proportion of Health facilities (ODs) deliveries EF has been increase to 38% against
target of 54% out of total 76 ODs.
Number of poor individuals/ household who has been pre- identification was 432,415 poor
persons, it about 86,483 households.
The proportion of health facilities (ODs) deliveries EF has increase through the target 38%
(29 ODs).
Through the calculation a proportions of poor patients exempted from user fee have been
increases especially at health center level. The result shown that, the poor patients exempted
was stable as 2005 16% (out of total IPD), and 3%- 18% (out of total OPD), against target of
16% at the referral hospitals and 16% at health centers. In addition for the National Hospital
this proportion was about 11% (out of total IPD).
Based on the report calculation, the average unit cost of the contribution from user fee per
cases is DUS 5.59 (IPD) at RHs and DUS 0.19 DUS (OPD) at HCs level.
CBHI within country has been increase from 4-8, it's seem slowly improvement. The total
number of insured who received a CBHI card increase from 12,398- 33,122 members (7,012
households), and the number of insured with assistance and reimbursement from CBHI has
been increase from 28,293- 98,484 patients for OPD, IPD were 764 - 2,187 patients.
The implementation of the contracting as a strategy to improve access to public health facility
in poor areas in 11 ODs are on going. The review contracting strategies are in process.
- 60 -

Constraints:
• The national budget allocated to provincial level based on the passed experience and
was not based on the annual operational plan.
• Delayed in setting up the system to financing to poor through the national budget and
the accounting staff at the hospitals have no capacity in spending budget to support
the poor patients.
• New financial reform, program based budgeting and new government account codes
with unclear guideline or norm.
• No more priority action program.
• Delayed in implementation of inter ministerial Prakas on government subsidy to the
poor.
• Lack HEF operator with the capacity and skill to implement in other non contracting
districts
• Delay implementation of health equity fund schemes in contracting district
• No development partnership harmonization in planning budgeting on HEF was
limited
• Lack of promotion on EF to the poor area.
• Poor management on Health Financing Schemes at HCs and RHs level
• Delay in development of legislation on CBHI.
Strategy 16: Ensure transparent, efficient and health expenditures through strengthening
resource allocation, coordination of different source of funds and monitoring:
The report of public Expenditure Tracking Survey (PETs) have been finished and
disseminated.
Constraints:
• No financial report system officially for national programs, HCs and RHs.
• The budget allocation to provincial (RHs and HCs) in 2007 was not based on the
annual operational plan.
• The department of internal audit has been established but has no functioned yet.
Priorities 2007-2008:
1. Budgeting based on the program.
2. Increase public expenditure per capita in health.
3. Improve disbursements and cash released, especially in the first semester for better
planning and implementation.
4. Closer coordination between MoEF and MoH regarding new process of requests,
Program Based Budgeting.
5. Set up the financial reporting system for program based budgeting.
6. Building the capacity of accounting staff in the new process of program based
budgeting, and new code account.
7. Negotiate with MoEF to find the solution of allocating budget to Provincial level.
8. Continue to allocate the national budget for saving the poor by using the government
budget.
9. Train the account staff at the hospital to know how to use the government budget to
support the poor patients.
10. Improve donors coordination to reduce the overlap spending
11. Expend subsidy schemes to 12 ODs in 2007, and 8 ODs or more in 2008
- 61 -

12. Continue and expend HEFs in 11 contracting ODs thought Health Sector Support
Project (HSSP)
13. Improve information and promotion system on health equity fund
14. Strengthen the capacity on health financing the management to HCs and RHs and
National Hospital.
15. Continue contracting in 2007 and to consider on extension to 2008 after the result of
the study review contracting strategy.
16. Strengthen the capacity on CBHI to provincial, district level, and other NGOs
17. Develop legislation on CBHI
18. Develop tool for monitoring and evaluation on CBHI schemes
- 62 -

Health Financing: Indicator, Baseline 2002, Targets/Priority 2007-2008
Strategy 14: Ensure regular and adequate flow of funds to the health sector especially for service delivery through advocacy to increase resources and strengthening financial
management
Indicators Baseline 2002 Target 2006 Achievement
2006
1 Budget allocation as % of GDP
(Annual budget allocation to the
Ministry of Health)
1.15% 1.26% 1.08%
Constraint Priority 2007-
2008
Increase budget
proposal for
health
Target
2007
Target
2008
1.08% 1.10%
2 National health budget as
proportion of government budget 10.44% 10% 6.84% 7.29% 8%
3 Proportion of recurrent
expenditures compared to total
recurrent budget ("Recurrent"
refers to Chapter 10,11,12,13,31) 96% 95% 92.8%
4 Public expenditure per capita in
health
5 Budget expenditure for health
after 6 and 12 months as % of
total budget allocation for
Chapter 11 and 13 by national
and provincial level (Approved:
Mandated ceilings agreed on by
the Ministry of Economy and
Finance. Cash released: Amount
of cash released from the
national and provincial treasury
for operating expenditures)
Including drugs
= 2.94 USD
Excluding drugs:
1.7USD
Chapter 11 by
June
National:
Approved: 4%
Cash released:
4%
Provincial:
Approved: 21%
Cash released:
15%
Including drugs
= 4.59 USD
Excluding
drugs: 3 USD
Chapter 11 by
June
National :
Approved: 35%
Cash Released:
35%
Provincial:
Approved: 35%
Cash Released:
35%
Including drugs =
4.64 USD
Excluding drugs:
3.35 USD
Chapter 11 by
June
National :
Approved:
36.12%
Cash Released:
36.12%
Provincial:
Budget allocation
to provinces based
on the passed
experience not
based on the AOP
Law budget
allocation the
Health Sector
to negotiate
with MoEF for
budget
allocation to
provinces
should base on
the AOP
Improve the
health
expenditure
base on the plan
There will have
no PAP or
Chapter 11 any
more (should
change to chapter
60, 61 and 62)
99% 99%
Including drugs
= 5.87 USD
Excluding
drugs: 3..85
USD
Operating cost
for non
program
by June
National :
Approved:
40%
Cash Released:
35%
Provincial:
Including
drugs =
6 USD
Excluding
drugs:4 USD
Operating
cost for non
program
by June
National :
Approved:
40%
Cash
Released:
35%
Provincial:
- 63 -

Chapter 13 by
June
National:
Approved: 62%
Released: 13%
Provincial:
Approved: 47%
Cash released:
22
Chapter 11 by
Dec.
National:
Approved: 90%
Cash released:
90%
Provincial:
Approved: 80%
Cash released:
64%
Chapter 13 by
Dec.
National:
Approved: 90%
Cash released:
Chapter 13 by
June
National:
Approved:50%
Cash released:
40%
Provincial:
Approved:50%
Cash released:
40%
Chapter 11 by
Dec.
National:
Approved: 95%
Spend = 95%
Provincial:
Approved: 95%
Spend = 95%
Chapter 13 by
Dec.
National:
Approved: 95%
Spend = 95%
Provincial:
Approved:
12.82%
Cash Released:
19.10%
Chapter 13 by
June
National:
Approved:
51.96%
Cash released:
47.45%
Provincial:
Approved:32.25
%
Cash released:
6.78%
Chapter 11 by
Dec.
National:
Approved:
99.4%
Spend = 99.4%
Provincial:
Approved: 91.6%
Spend = 82%
Chapter 13 by
Dec.
National:
Approved: 97.5%
Spend = 94.3%
Approved:
40%
Cash Released:
35%
Operating cost
for program
by June
National :
Approved:
40%
Cash Released:
40%
Provincial:
Approved:
40%
Cash Released:
40%
Operating cost
for program
by Dec.
National:
Approved:
99%
Spend = 99%
Approved:
40%
Cash
Released :
35%
Operating
cost for
program
by June
National :
Approved:
40%
Cash
Released:
40%
Provincial:
Approved:
40%
Cash Released
: 40%
Operating
cost for
program
by Dec.
National:
Approved:
99%
Spend = 99%
Provincial:
Approved:
99%
Spend = 99%
- 64 -

6 Review lessons from evaluation
of ADD and PAP systems
7 Procurement of drugs and
medical supplies through
competitive tender
53%
Provincial:
Approved: 90%
Cash released:
80%
TORs developed
for the study
Approval from
MEF for
commitment to
purchase drugs
Contract signed
with supplier
and MOH
Approved: 95%
Spend = 95%
CMS receipt
100% of total
allotment for
drugs and
medical supplies
requirement in
2005.
Approved: 99%
Mandate: 99%
Provincial:
Approved: 100%
Spend = 100%
Finished
Reporting and
disseminated to
the provinces
CMS receipt
100% of total
allotment for
drugs and
medical supplies
requirement in
2005.
Central
Approved:
113.3%
Mandate: 113.3%
CMS receipt
100% of total
allotment for
drugs and
medical
supplies
requirement in
2007.
Approved:
100%
Mandate:
100%
CMS receipt
100% of total
allotment for
drugs and
medical
supplies
requirement
in 2008.
Approved:
100%
Mandate:
100%
Strategy 15 - Allocate financial resources to improve the accessibility of health services for the poor through alternative health financing schemes
Indicators Baseline 2002 Target 2006 Achievement
2006
8 % of annual budget increased
allocated to provincial level
(RHs & HCs) 60% 26%
9 Proportion of budget to
provinces out of total budget
(Proportion of budget allocated
to recurrent costs at provinces
out of total MOH budget)
Including drugs
= 66%
Excluding drugs
: 34%
Including drugs
= 66%
Excluding drugs
=35%-40%
Including drugs
= 51%
Excluding
drugs=42%
Constraint
Budget allocate
provinces not base
on the AOP, based
on the previous
experience
Budget allocate
provinces not base
on the AOP, based
on the previous
experience
Priority
2007-2008
Target
2007
Target
2008
To discuss with
MoEF to solve
the problem 60% 60%
To discuss with
MoEF to solve
the problem
Including
drugs = 66%
Excluding
drugs
=35%-40%
Including
drugs = 66%
Excluding
drugs
=35%-40%
- 65 -

Indicators Baseline 2002 Target 2006 Achievement
2006
Constraint
Priority
2007-2008
Target
2007
Target
2008
10 Allocation of budget to Health
Centers and Referral Hospitals:
operating budget as proportion of
total budget (excluding drugs)
11 Government commitment to
financing services for the poor at
HCs and referral hospitals
12
Scaling up equity fund as a
strategy to promote access in
poor ODs
Referral
Hospitals: 18%
Health Center:
15%
Chapter 31
experiment in
process for
equity fund at
Takeo Province
Hospital
5 ODs
Budget allocate
to: RH 20%
HCs: 30%
(Proportion to
total provincial
budget)
To allocate
national budget
for EF to 13
ODs (Non
contracting
districts)
-Increase EFs
Schemes from
16 to 30 in non
contracting
ODs.
-Continue EFs
in 11
contracting ODs
N.A.
Disseminated
Prakas on subsidy
to the poor
patients
Allocate
government
budget for
subsidy in 1 ODs,
and 3 National
hospital
HEF has been
increase from 16
to 30 ODs (
including 7 to
contracting ODs)
Budget allocate
provinces not base
on the AOP, based
on the previous
experience
- Delay the
implementation of
the Prakas on
subsidy to the poor
patients
Delay in selection
HEFI for 11
contracting districts
To discuss with
MoEF to solve
the problem
Introduce and
expand subsidy
schemes to the
poor patients
from 12-20
ODs and 5
national
hospitals
Increase HEFs
Schemes from
30-45 ODs
(including 11
contracting
ODs) and 5
national
hospitals
Budget
allocate to:
RH 20%
HCs: 30%
(Proportion to
total provincial
budget)
Introduce
subsidy
schemes in 12
ODs and 5
national
hospitals
-Increase EFs
Schemes from
30- 40 ODs
(including 11
contracting
ODs), and
5 national
hospitals
Budget
allocate to:
RH 20%
HCs: 30%
(Proportion to
total provincial
budget)
Expand
subsidy
schemes from
12- 20 ODs
and 5 national
hospitals
Review the
Prakas on
subsidy to the
poor patients
Increase EFs
Schemes from
40- 45 ODs
and continue
in 5 national
hospitals.
13 Number of poor individuals/
household who has been preidentification
NA
Increase a
number of
individuals/
household who
received an
identification
Number of poor
households
86,483 (432,415
poor persons) has
been preidentification
Increase a
number of
individuals/
household who
received
identification.
Increase a
number of
individuals/
household who
received an
identification
Increase a
number of
individuals/
household who
received an
identification
14 Increase a - Number of poor Increase a Increase a Increase a
- 66 -

Indicators Baseline 2002 Target 2006 Achievement
2006
Constraint
Priority
2007-2008
Target
2007
Target
2008
15
16
Number of poor patients with
assistant from equity funds. 5,234
Percentage of Health facilities
(ODs) deliveries HEF out of total
health facilities.
Proportion of poor patients
exempted from user fees at
Health centre and referral
hospitals
7%
RHs: 16
HCs: 12
number of poor
patients with
assistant by
Equity Funds
from 47,600 to
200,000
- Develop a
standard
information
system
Increase a
proportion of
Health facilities
(ODs) deliveries
EF from 28% to
39%.
RHs: 16 %
HCs: 16%
patients with
assistant by
Equity Funds
89,320
- Finalized
monitoring tool
and reporting
form
The proportion
of health
facilities (ODs)
deliveries EF has
increase 28% to
38% (29 ODs).
RHs: 16%
HCs: 18%
NH: 11
No participation
and harmonization
in planning and
budgeting of HEF
schemes from
NGOs and
Poor management
on Health
Financing at HCs,
RHs and NHs
number of poor
patients with
assistant by
Equity Funds
from 89,320 to
250,000
Increase a
proportion of
Health facilities
(ODs) deliveries
EF & subsidy
from 38% to
59% (45 ODs).
RHs: 17% -16%
HCs: 17%-16%
number of
poor patients
with assistant
by Equity
Funds from
89,320 to
150,000
Increase a
proportion of
Health
facilities
(ODs)
deliveries EF&
subsidy from
38% to53%
(40 ODs).
RHs: 16 %
HCs: 16%
number of
poor patients
with assistant
by Equity
Funds from
150,000 to
250,000
Increase a
proportion of
Health
facilities
(ODs)
deliveries EF&
subsidy from
53% to 59%
(45ODs).
RHs: 10%
HCs: 10%
17 Average unit cost of contribution
from user per cases( OPD &
IPD)
18 Number CBHI Schemes
Implemented. 1
NA NA OPD: 0.19 USD
IPD: 5.59
- Collaborate
with MEF to
develop sub
degree on SHI
- Increase
number of
CBHI schemes
Total number of
CBHI schemes in
2006 is 8.
Some health
facilities didn't
provide report / or
incorrect report
Delay in
development of sub
decree on CBHI
Improve the
monitoring
information
system on HF
- Develop sub
decree on CBHI
- Increase
number of
CBHI schemes
from 8-30
Improve the
monitoring
information
system on HF
- Develop sub
decree on
CBHI
- Increase
number of
CBHI schemes
from 8-20.
Improve the
monitoring
information
system on HF
- Increase
number of
CBHI schemes
from 20-30
- 67 -

Indicators Baseline 2002 Target 2006 Achievement
2006
Constraint
Priority
2007-2008
Target
2007
Target
2008
19 Number of insured members
with assistant (Reimbursement)
from Community based Health
Insurance (CBHI)
NA
from 4-8.
Increase a
number of
insured with
assistant from
CBHI:
OPD: 28,293-
60,000
-Number of
insured with
assistant from
CBHI:
OPD: 98,484
IPD: 2,187
Increase a
number of
insured with
assistant from
CBHI:
OPD:
98,484- 300,000
IPD:
2,187- 12,000
Increase a
number of
insured with
assistant from
CBHI:
OPD: 98,484-
200,000
IPD:
2,187-6,000
Increase a
number of
insured with
assistant from
CBHI:
OPD: 200,000-
300,000
IPD:
6,000-12,000
20 Number of insured member/
household cover by Community
based health insurance (CBHI)
21 Contracting as a strategy to
improve access in poor areas
Increase a
NA number of
insured from
12, 398-25,000
peoples
( 2,655HH-
5,080HH)
5 ODs Continue
contracting in
11ODs.
Number of
insured members
are 33,122
(7,012HH)
- Contracting in
11 ODs are
ongoing
- Review
contracting
strategy in the
process
Limited NGOs
with capacity
introduce CBHI
within country
Process of the
allocation of the
national budget
has been change
during the contract
Increase a
number of
insured
household from
7, 012HH-
200,000HH
Continue
contracting in
11ODs.
Increase a
number of
insured
household
from 7,
012HH-14,000
Continue
contracting in
11ODs.
Increase a
number of
insured
household
from14,000H
H-200,000HH
Extend
contracting in
11ODs.
Review and
examine based
on the result
the review
study on
contracting
strategy.
Strategy 16 - Ensure transparent, efficient and effective health expenditures through strengthening resource allocation, coordination of different sources of funds and
monitoring.
Indicators Baseline 2002 Target 2006 Achievement
2006
Constraint
Priority
2007-2008
Target
2007
Target
2008
- 68 -

22 Strengthen resources allocation
for expenditures at different
levels based on appropriate roles
and responsibilities
23 Improvement in monitoring of
financial performance
Costing of
services at
provincial and
district referral
hospitals and
health centers
conducted
PAP
performance
indicators
established
-To be finalized
the model for
resource
allocation for
the poor.
-Building
capacity of
DBF’ staff on
Program Based
budgeting
Setting and
disseminating
the new
financial
reporting system
of all levels
N/A
Disseminated the
new public
financial reform
to all health
facilities at both
levels
Did not allocated
budget base on the
budget formula
New process and
unclear guideline
Budget
allocation did
not base on the
AOP
Setting and
disseminating
the new
financial
reporting
system of all
levels
Budget
allocation
should base on
the AOP
Setting and
disseminating
the new
financial
reporting
system of all
levels
Budget
allocation
should base on
the AOP
Setting and
disseminating
the new
financial
reporting
system of all
levels
- 69 -

INSTITUTIONAL DEVELOPMENT
Introduction
The work of the Institutional Development Working Group is guided by the institutional
challenges identified in the Health Sector Strategic Plan 2003-2007. This section of the report
identifies the current situation and achievements, constraints and priorities for each of the four
strategies identified in the plan.
Current Situation and Achievements
Strategy 17 - Organization and management reform of structure, systems and
procedures of the Ministry of Health (MoH) to respond effectively to change.
There has been considerable progress made in this area during 2006. Based on the functional
analysis report and the approval by High Level Group, and with the technical support from
OPM, the incentive reform process began with the design of the Merit- Based Pay Initiative
(MBPI) scheme .The design was discussed in several meetings of the High Level Working
Group attended by representatives from CAR, MEF and Health Partners and finally was
agreed on 14 November, 2006. Based on the agreement, a draft operational manual for the
implementation was developed and it is in the final stage of review by Health Partners. The
funding mechanism for the MBPI Scheme was finalized and agreed in a High Level Working
Group and Health Partners meeting on 28, November, 2006 .The scheme will be funded
jointly by Government and Health Partners following the Sub Decree 98 .Based on the
agreement, a draft Memorandum of Understanding (MoU) was prepared and is in the final
stage of review by Health Partners. The scheme will be implemented to cover 160 positions at
the central MoH during 2007 and based on the lessons learnt and experience gained; the
scheme will be extended to cover 2 PHDs and 2 National Programmes
Under Institutional Development Programme, the sub sector (Primary Health Care; Hospital
Services; National Programmes and Central MoH) assessments were completed with the
technical support from OPM .The findings and recommendations were presented in national
level workshop during 19-20 October, 2006. Based on the feedback, IDP Synthesis report was
prepared incorporating all the essential elements of the sub sector reports and was presented
to IDWG in January, 2007.The IDP synthesis report is of the key documents for Mid Term
Review.
Standard staffing levels for referral hospitals and health centres have been developed and
these standards have been approved and disseminated and incorporated into the HR database
so that variances can be reported.
To address the mal-distribution of staff and attempt to attract staff to remote geographical
areas, the MoH follows strictly the Royal Government Circular on the implementation of
annual cadre plan and also identified the different difficult regions and made the interministerial
Prakas between MoH and MEF on the use of equity fund.
A Priority Mission Group in Kampong Trach District has been continued its implementation.
Further proposals for additional PMGs in Takeo province and in the North West region of
Cambodia have been prepared and submitted to CAR for consideration.
- 70 -

The HR database was maintained and updated step by step throughout the year with the
technical assistance of the VSO volunteer to maintain and compare all the members of
working staff and reported quarterly.
Annual Operational Plan guideline for 2007 has been developed and disseminated to all health
institutions. Health sector AOP 2007 by institution was successfully completed and Health
sector AOP 2006 also published and disseminated
Monitoring and evaluation activities during the period included the undertaking of the Joint
Annual Performance Review in 2006 which combined the National Health congress with the
Joint Annual Health Sector Review. The Demographic Health Survey finding report was
finalized and there has been considerable strengthening of the Health Information System
with the introduction of revised forms for data collection and also revision to the HIS
software.
Strategy 18 - Effective public private partnerships to improve accessibility, quality and
affordability through the participation of private sector participation and enforcement
of regulation
The focus of activity undertaken in this area was the continuation of registration of doctors
and medical assistants in both public and private practice. At the end of 2006 69% of medical
doctors and medical assistants had registered. A Royal Decree for establishing a Dental
Council was issued in 2005 and the membership of Dental Council has been approved by subdegree.
The government and donor coordination has been greatly strengthened by the establishment
of a Technical Working Group for Health with joint MOH and health partner membership.
This has replaced the former CoCom forum. SWiM study conducted as part of MTR.
Strategy 19 - Enhancing MoH capacity to address chronic and other non-communicable
diseases and emerging public health problems
The main activities addressing chronic and other non-communicable diseases were centered
on tobacco control, the development of a National Diabetes Control Programme and cancer
and the development of Guideline of Arsenicosis. It is also included the utilization of helmet
wearing among motor-cyclist to prevent the serious injury.
While the legislation for tobacco control has not been approved by the Council of Ministers
and ratified by the National Assembly there has been some activity in awareness programmes
for target audiences such as Buddhist monks, teachers and local authorities.
The national strategy for the prevention & control of non-communicable disease was
developed and finalized. The guidelines for the management of Diabetes & hypertension
patients in RHs were drafted.
Cancer registration needs to be strengthened in all provinces. The capacity of physicians and
nurses to diagnose and treat cancer, especially palliative care needs to be improved.
The rate of helmet use has increased 20 %, but the continuance of mass media education is
required in order to improve result.
Strategy 20 - Further developing the health sector to strengthen management
effectiveness and service delivery responsiveness through enhanced management, good
leadership, appropriate decentralization and de concentration and institutionalized
sector wide management.
- 71 -

The Ministry of Health Performance Management System was developed under the
supervision of the High Level Working Group by the Department of Personnel, with support
from OPM, through a consultation process across the central Ministry. The approved
Performance Management System was launched by the Minister for Health on 23 rd January
2006.
The Performance Management System was implemented in all departments within the central
Ministry of Health in February 2006. A workshop was held for all Directors and Team
Leaders to introduce the PMS, followed up with hands-on support in each department. In the
first quarter, most teams developed Team Annual Objectives and Team Quarterly Work
Plans.
In April 2006 with further hands-on support from OPM, teams conducted first quarter reviews
(where team quarterly work plans were available) and second quarter Team Quarterly Work
Plans were developed. At the end of the second quarter in June 2006, a PMS refresher
workshop was delivered in each department, and some departments were trained on the
implementation of individual quarterly work plans for the third quarter. Further support was
provided in the review and development of team and individual quarterly work plans.
Ongoing support is being provided to review quarterly work plans as well as to establish
Quarterly team and individual work plans. The progress is reviewed every quarter with all the
departments and this programme has been well received by many departments at the central
MoH .During December, 2006, Department of Personnel with technical support from OPM
organized one day workshop to review the Quarter-3 and the progress of the Quarter -4 plans.
Performance management system shall be an integral part of MBPI scheme.
The recommendations of the functional analysis carried out during 2005 will be key basis for
the development of department organizational development plans for the implementation of
MBPI Scheme during 2007.
Constraints/Lessons learned
Reported constraints contributing to non-achievement of targets vary among the activities.
The shortage of funding, staff capacity and limited time for operational activities are
frequently quoted. This is a challenge for the MoH and it is hoped that the continued
strengthening of the planning process through medium-term and annual planning coupled
with the introduction of the Performance Management System will help to address this.
The process of the implementation of the MBPI scheme has given several lessons : clarity ,
understanding and agreement of the concept ; design in particular revised pay bands and
structure ; management of the non selected staff ; the funding arrangements and the
mechanism and the operation of the scheme among the key stakeholders : MoH ; CAR ;MEF
and Health Partners.
Priorities for 2007-2008
Priorities and targets have been developed for 2007-2008 for each of the strategies. These
build on the work already initiated and also represent some new initiatives. The priorities for
2007-2008 for the Institutional Development Working Group are:
1. Prepare and disseminate the Institutional Development Plan to provide guidance on the
roles and functions throughout the MOH and incorporate any changes in management
- 72 -

structures and processes into the rolling plans, annual plans and financial planning
processes for the sector.
2. Strengthen the link between activity planning and budgeting through the development of
Programme Budgeting for priority programmes and revision of the Annual Operational
Plan guidelines for 2008.
3. Finalize the Merit-based Pay Initiative scheme design for MOH personnel and conclude
the agreement negotiations with CAR, MEF and the health partners and start
implementation.
4. Continue the implementation of Performance Management System across all central
departments and build capacity for sustained management for the system.
5. Implement personnel policy to address mal-distribution of staff.
Conclusions and recommendations
Institutional development Plan needs to be the central theme for the 2007-2010 planning cycle
and the key recommendations will be translated in to meaningful actions to strengthen the
development process. Institutional Development Working Group will be reorganized to
include more key senior managers in the Central MoH; National Programmes and Health
Partners. The implementation of Performance Management System is a key to set standards in
the work performance and needs to be natured in all the departments across the central MoH.
The MBPI scheme is now well poised to be implemented during 2007 and the steps in the
implementation process will provide wider opportunities for MoH senior managers on
performance related pay management system. The process of implementation will be
documented so that the same could be applied for the proposed extension to selected PHDs
and National Programmes.
- 73 -

Institutional Development: Indicators, Baseline 2002, Targets/Priority 2007-2008
Strategy 17: Organizational and management reform of structures, systems and procedures in the Ministry of Health to respond effectively to change
Indicators Baseline 2002 Target 2006 Achievements
2006
Constraints Priorities
2007-2008
Target
2007
1 Staff posts redefined, Data collected
-Provide -Accurate HR
staffing levels
for functional
Microsoft Data for
(establishments) set, job analysis in 7
Access management
descriptions prepared and sites
training for decision making
internal employment
2 staff
procedures reviewed
database
administrators.
- Accurate HR data
quarterly report used for
decision making.
- Personnel policy to
address mal distribution
of staff and to attract
staff to the remote area
developed and approved
- SSLP for RH and HC
used for employment and
training decisions
- MoH MBPI posts
defined
-HR Database
updated regularly
and reported
quarterly
-Staff Lists
received from all
PHD’s June 2006
(50% updated to
the
databases )
-Contract of new
recruit
-SSLP for RH &
HC approved
-Lack of
understanding
of some PHD s
in filling in the
personnel
statistic form
-Updating of
database in bulk
is time
consuming
-Maintain HR
Database and
review the
reporting
functionality.
-Supply
regular
quarterly
reports
-Review and
improve
information
processes for
collecting/rece
iving
information/sta
ff data from
the PHD’s and
MHD
-Improve the
skills of the
database
administrators
-Accurate, timely
and relevant
production of
reports
-Improved
information
processes
between central
and provincial
units
Target
2008
-Continue
implementatio
n from 2007
2 Number of staff with
performance base salary
supplement
Staff performance
according to agreed
performance indicators
-Design Team
presented scheme
design to the
Minister in
Agreements
required to be
reached with
health partners,
Complete
necessary
agreements.
Staff performance
according to
agreed
performance
Expand
scheme to
PHD and OD
- 74 -

3 All levels of the MoH
respond appropriately to
change
-Further PMG approved
and implemented
-PMG indicators are
achieved
ID plan developed and
approved
Implement functional
analysis
recommendations
AOPs developed into
detailed work plans
September 2006.
-Extend the
Implementation
of PMG in Kg.
Trach District
-PMG proposal
prepared and
submitted to CAR
for
implementation in
2007 in Takeo
and North-West
region
-The IDP
synthesis report
submitted to
MTR
-Department OD
plans preparation
is in process
using the
recommendation
of functional
analysis
-Work plan for
2006
were developed
-The performance
management
system(PMS)
successfully
adopted
by central
departments and
all
staff have been
CAR, MEF and
State Secretariat
for Public
Function
Limited
Capacity to
implement PMG
procedures
-Time constraint
due to the length
of time for
approval
process as
approval
required
from other
ministries
-Sometimes a
heavy workload
on
staff responsible
for
completing
related
activities
Selection and
recruitment to
essential core
posts.
Implement and
monitor
performance
management
system.
Monitoring the
implementatio
n of PMG and
establish
further PMG
-Follow up
MTR
recommendati
on
-ID group to
hold workshop
for relevant
units about the
contents of the
IDP
-Monitor and
evaluate
implementatio
n of
IDP
indicators
-Further PMG
approved and
implemented
-PMG indicators
are achieved
-Hold workshop
-Implement
programme
activities as
scheduled in ID
plan
-Monitor and
evaluate progress
of programme
each quarter
Further PMG
approved and
implemented
-Implement
programme
activities as
scheduled in
ID plan
-Monitor and
evaluate
progress of
programme
each quarter
- 75 -

4 Develop integrated
planning and budgeting at
all levels
Revised
planning
manual
-Sector AOP produced
by agreed finding
-Guidelines for preparing
AOP 2007
trained to
complete
PMS
documents
-Each department
has clearly
identified
working
objectives
-PMS process is
continuing
-Health sector
AOP 2006
published and
disseminated.
-AOP guide line
for AOP 2007
developed and
disseminated to
all health
institutions
-Finalized Health
sector AOP 2007
Delayed
accomplishment
-Health sector
AOP and three
year rolling
pan
- AOP
Guideline
-Health sector
AOP 2008 and 3
year rolling plan
2008-2010
-Guidelines for
preparation AOP
2008
Health sector
AOP 2009.
-Rolling Plan
2009-2011
-AOP
guideline 2009
5 An effective monitoring
framework in place
Initial
monitoring
and evaluation
framework for
the Health
Strategic Plan
- DHS dissemination to
all levels
- Introduce ME
Framework and tool to
central and provincial
levels
- Central, PHD and OD
implement revised HIS
forms and software.
- DHS finding
report finalized
- JAPR 2006
conducted
- Revised HIS
software was
implemented and
used
- GIS training to
provincial and
OD levels.
- 02 training
course on data
use were
- Limited time
- Limited staff
capacity in
using of HIS
software and
GIS
- Coordination
between HIS
and national
program is
limited
-DHS
dissemination
to all levels
- Finalized
M&E
framework and
tools and
introduce to
central and
facility levels.
- Develop 05
year HIS
strategic plans
- Improve staff
-DHS
dissemination to
all levels
- Finalized M&E
framework.
- Develop 05 year
HIS strategic
plans
- Improve staff
capacity through
training on data
use for planning,
monitoring and
evaluation.
- Continue to
disseminate
DHS to all
levels
- Introduce
M&E
framework to
central and
facility levels..
- Improve staff
capacity
through
training on
data use for
- 76 -

conducted to
provincial, OD
and health facility
levels.
- Spot check was
conducted to
some health
facilities in order
to improve health
information data.
capacity
through
training on
data use for
planning,
monitoring
and evaluation.
- Refresh
training on
HIS software
and GIS
- Post training
follow-up
- Refresh training
on HIS software
and GIS
- Post training
follow-up
planning,
monitoring
and evaluation.
- Post training
follow-up
- 77 -

Strategy 18: Effective public private partnership to improve accessibility, quality, and affordability through the promotion of private sector
participation and enforcement of regulations
Indicators Baseline 2002 Target 2006 Achievements
2006
6 Medical practitioners
Strengthen the
69% medical
registered and aware of
implementation of Royal doctors were
professional ethics
decree on the
registered.
establishment of Medical
Council and the Subdecree
on medical ethic
Continue to review the
membership of medical
council in provincial
level according to royal
decree on medical
council establishment
Membership of Dental
Council at national level
established
Disseminate the royal
decree on the
establishment of Dental
Council
Royal decree on Midwife
Council and Nurse
Council establishment
Drafted and approved
Membership of
Dental Council
has
been approved by
sub-degree
Constraints
-Lack of
funding to
promote all
Medical Council
-Some of
membership did
not render pay.
Priorities
2007-2008
Continue to
post the
membership of
Medical
Council at all
provinces.
-Disseminate
of the Royal
degree of
Dental
Council.
-Post
the
membership of
Midwife
council and
Nurse Council
Target
2007
Continue to
disseminate sub
degree of
professional
ethics and
promise of
membership of
Medical Council.
-Post the
membership of
Dental Council to
provinces.
-Establish
Midwife Council
and Nurse
Council
Target
2008
-Supervise and
suggest to all
official and
private doctors
to register.
Establish sub
degree of
professional
ethics of
Dentist.
-Establish sub
degree of
professional
ethics of Nurse
and Midwife.
- 78 -

7 Effective donor
coordination mechanism
in place
SWiM progress access
MTR in 2006
SWiM study
conducted as part
of MTR
Consultant
selected by WB
office could not
cover all the
TOR due to
time constraint
Follow up
recommendati
on
Set up specific
action plan
Set up specific
action plan
Strategy 19: Enhance Ministry of Health capacity to address chronic and other non-communicable diseases and emerging public health
problems through raising awareness and developing comprehensive plans
Indicators Baseline 2002 Target 2006 Achievements
2006
8 Evidence based strategies - Interministerial
- National tobacco Reviewed by
to prevent non
control law finalized and MOH
communicable diseases committee for approved
in place
education and
reduction of
tobacco use in
Cambodia
drafting
9 Quality data on NCDs
available to inform
policy and strategy
Prevalence of Cancers
and other common NCD
legislation law
-National
policy in
Cancer
prevention
and control
available
Cancer
Registration:
Phnom Penh
hospital
Cancer
registry
Implementing the policy
thru raising awareness on
breast self examination
Extension the collection
of Cancer cases in 5
provinces
Training done in
3 ODs in Prey
Veng Province
(HSSP)
The extension to
the 5 provinces
not done data
collected only in
central hospitals
Constraints
political
commitment
No national
budget, no
outside support.
Data can only
collected in PP
because of lack
of mean to
diagnose at
provinces. No
analysis due to
funds and
technical
problem of the
computer.
Priorities
2007-2008
- Antismoking
law
ratified.
-FCTC
implementatio
n
Extension to
remaining
ODs
Continue the
cancer
registration
from central
hospitals.
Target 2007 Target 2008
National Tobacco
Control law
finalized and
approved
Training in other
OD of Prey Veng,
Kg.Cham,
Kg.Thom,
Kampot
Ensuring the data
analysis by
updating the
software
Anti-smoking
law will be
disseminated
and
implemented
Continue to
the remaining
ODs & Northeast
Provinces
Continue the
registration in
PPenh
- 79 -

National Strategy for the
prevention and control of
non communicable
disease 2007-2010.
Guidelines for the
management of Diabetes
& hypertension patients
in RHs.
Rate of utilization of
helmet wearing among
motocyclist & seatbelt in
Phnom Penh.
Develop finalize national
strategy for the
prevention & control of
non-communicable
disease.
Develop guidelines for
the management of
Diabetes & hypertension
patients in RHs.
2 surveys on utilization
of helmet wearing
increase 20%
Strategy
developed and
finalized.
Draft developed.
2 surveys of
helmet wearing
increased from
11.3% t0 15.3%
and to 21.4%.
3 TV spot on
helmet wearing.
1 TV spot on
alcohol drinking.
Need fund
workshop
finalization and
printing.
Finalization
and approval
of strategy.
Dissemination
and
implementatio
n of the
strategy
Guidelines
approved for
implementatio
n.
Increase
awareness and
knowledge on
helmet
wearing
among
motobike
riders and
reduce alcohol
drinking for all
transportation
drivers .
Approved,
printing,
dissemination
thru WK and
implementation.
Finalization,
approval printing.
Available for
training.
Guidelines used
by health staff in
pilot clinic.
Utilization of
helmet wearing
and seatbelt used
increase to 30%
in PPenh.
Mortality rate
from RTA and
other injury
decrease to 5%
Continue the
implementatio
n according to
the plan of the
strategy until
2010.
Training
health staff in
other RHs.
Utilization of
helmet
wearing and
seatbelt used
increase to
35% in PPenh.
Mortality rate
from RTA and
other injury
decrease to
5%.
*Arsenicosis Mitigation
Program
-Arsenicosis Detection
(Outbreak)
-Arsenicosis Detection
and Surveillance
-Arsenicosis Guideline
Development (Khmer
and English)
None
August 2006
Case Detection
-Case
Confirmation
(selected areas in
Kandal & Prey
Veng Provinces)
- Technical and
Financial
supports
- base line of
highly risk
related arsenic
water
contamination
-Detect new
cases and
Surveillance
-Guideline of
Arsenicosis
Development
-Arsenicosis
IEC materials
Development
-Detect new cases
and Surveillance
-Guideline of
Arsenicosis
Development
-Arsenicosis IEC
materials
Development
-Detect new
cases and
Surveillance
- 80 -

-Arsenicosis IECs
Development
Strategy 20: Further develop the health sector to strengthen management effectiveness throughout the health service by: enhancing
management and leadership culture sector-wide, increasing effective decentralization and deconcentration, institutionalizing
sector wide management
Indicators Baseline 2002 Target 2006 Achievements
2006
10 Enhance management Management Continue
-PMS
capacity resulting in the and leadership implementation implemented in
MoH departments development
all the
working effectively in an program
departments
integrated manner on approved for
-Quarterly
agreed objectives in funding
reviews
accordance with good
conducted to
governance
assess the
progress
-Workshop in
December 2006
to present the
progress and to
develop plans for
2007 was
conducted to all
departments
Constraints Priorities 2007-
2008
-The
commitment of
the Department
Directors was
varied that
reflected in slow
progress in
some of the
departments
-High
expectation of
the staff on the
incentives in
particular MBPI
scheme
Continue the
implementation
Development of
departmental
quarterly team
and individual
work plans
Assess the
training needs
and organize the
training
programmes
Build in PMS in
the MBPI
implementation
process
Effective
functioning of
the Performance
Review
Committee
Target
2007
All departments
implement PMS
All department
team leaders are
trained and in
turn they impart
training to the
team members
Continue the
quarterly
monitoring and
review process
Operationalise the
functioning of
Performance
Review
Committee
Target
2008
PMS well
established and
operational in
all the
Departments
Extension of
PMS to selected
Provincial
Health
Departments
and National
Programmes.
11 Increase effective
decentralization and
deconcentration
Functional
analysis in 7
sites
All staff have a copy
of their post
description
- Performance
management
agreements in
place
-Training PMS
-Many
Ministries
involvement.
- Currently the
PMS is used as
-Develop team
objectives
reflected in
departments
AOP
-Central levels
staff to be trained
and integrated
into
the MBPI
-Roll out to
PHD and OD
level.
- 81 -

12 Sector wide management
institutionalized
First sector
wide plan
completed and
approved
- Performance
management
agreements in place
-Performance
management system
in operation
Will be discussed
Follow up guidance
from MEF about
Medium Term fiscal
frameworks.
process
completed at the
central MoH level
-Monitored and
evaluated on
activities of PMS
progress .
-AOP 2007
completed
-MTEF not
completed
a management
tool, but
monetary
incentivisation
has not yet been
introduced
Lack of
information
from donors
-Develop annual
and quarterly
work plan
for team and
individuals
-Establish pilot
group for MBPI
implementation
Follow up
recommendation
from SWiM
review
programme.
-Monitor and
evaluate
implementation
of activities plan
Specific action
plan set up
Specific action
plan set up
- 82 -

Welcome Remark by H.E. Dr. Nuth Sokhom, Minister for Health
During the Opening Ceremony of the 28th National Health Congress
and the 5th Joint Annual Performance Review
5 th March 2007
− My respect come to Excellency Keo Puthreasmey, Deputy Prime Minister of the Royal
Government of the Kingdom of Cambodia;
− Excellencies, Lork Chomteav, Ladies and Gentlemen;
− National and International Guests;
On behalf of the Ministry of Health and on my own behalf, I would like to highly
welcome Yours Excellency Deputy Prime Minister that makes your precious and scarce time
to participate as high honoree in the opening ceremony of the 28th National Health Congress
and the 5th Joint Annual Health Performance Review 2007 which is a very important annual
meeting of the Ministry of Health and health development partners. Today meeting is
participated by the leaders of the Ministry of Health; relevant ministries; provincial and
municipality governors; local authorities; health development partners; national and
international organizations; representatives of the communities and health officials working at
all levels, all together is more than 300 participants.
As in other year, the 28th National Health Congress and the 5th Joint Annual
Health Performance Review, 2007 has 3 main objectives which is the main agendas of this 3-
day meeting. Those are:
1. Review the progress and achievement in health sector during the past year by
analyzing strength and weakness in the implementation of the annual operational plan
(AoP) 2006, in the context of implementing the National Strategic Development Plan
2006-2010 of the Royal Government of Cambodia;
2. Based on the above-mentioned analysis, the congress with discuss on the
identification of the health sector priority for 2007-2008, and determine the strategy
and essential activities to address the identified priorities;
3. Referring to the above-mentioned priorities identified, the Ministry of Health will
provide guidance and recommendations for preparing and developing the annual
operational plan 2008 of all health institutions at all level, that includes the budget
plan necessary to support the implementation of the activities planned.
− Excellency Deputy Prime Minister;
− Excellencies, Lork Chomteav, Ladies and Gentlemen;
− National and International Guests;
Health sector development and strengthening has undergone in the long term vision of
the poverty reduction, which is the top priority and objective of the macro economic policy of
the Royal Government of Cambodia. Therefore, the functioning health system that is based on
the equity, effectiveness and quality principles and has full responsibility on the health status
of its people will have direct and indirect impact on the long term process of poverty
reduction. In this context, I would like to have your permission to make my remark on several
important points as follows:
- 83 -

• The Ministry of Health clearly determines the health sector policies in improving the
health and well being status of Cambodia people to contribute to the economic
development and poverty reduction in Cambodia, through the implementation of the
Health Sector Strategic Plan 2003-2007, in which the major contributing factor is
strengthening the leading roles and management capacity of the Ministry of Health for
effectively ensure the sustained health sector development for both immediate and
long term, which strongly required to enhance the coordinating mechanism for
effectively advocating and mobilizing resources within country and from external
supports. This clearly means that all expenses are toward addressing priority health
issues of people, especially the poor and those living in rural-remote areas. At the
same time, encourage the active involvement of all relevant institutions; civil society;
private sectors and all health development partners in the common goal of
strengthening health system to deliver quality health care services to people. With
strong commitment and efforts as well as support from all health development
partners, similar to previous year, there are substantial achievement in health sector
that will be mentioned in the annual summary report delivered by H.E. Prof. Eng
Huot, Secretary of State for Health in the following session.
• The Ministry of Health has its clear objective in improving access to quality health
care services of general population, especially the poor through the re-habilitation and
expansion of health infrastructure, and through strengthening management and
technical capacity of the health facilities to deliver minimum and complementary
package of activities at the health center and referral hospital level, with collaboration;
support and participation of private sector, non governmental organizations and
community. Health education on preventive measures and health promotion have been
considered as main strategy in services delivery through promoting and improving
awareness and understanding on the right of customer and the right of provider in the
context of professional ethic.
• The Ministry of Health is very proud, since the Royal Government of Cambodia
considers health sector as a priority area in Government's investment to social sector.
It is notable that the annual government health budget has been increased gradually
during several past years, especially in 2007 that the national budget for health sector
approved by the National Assembly is approximately 82 million US dollars or
approximately 5.87 UD dollars per capita per year. Nonetheless, the amount is still
low comparing to the need for delivering basic health care services, which required at
least 12 US dollars per capita per annum. This clearly means that most of funding
support to health sector still depends on external support for short and medium term.
It is also notable that the Royal Government decides to allocate fund to support the
health equity fund. This is the direct investment by the Royal Government in the
improvement of health status of the poor, since the health equity fund would remove
the barrier to the poor in getting access to health care services at the public facilities.
Currently, the number of the poor who get access to health care services through the
support of health equity fund is approximately 90,000 (89,320). The Ministry of
Health has been developing other health care financing like the community-based
social health insurance initiative to prevent the pro-poor from falling to be poor due to
health care expanses.
− Excellency Deputy Prime Minister;
− Excellencies, Lork Chomteav, Ladies and Gentlemen;
- 84 -

− National and International Guests;
Although the health status of Cambodia people has been gradually improved, the
maternal health is still our concern. Therefore, I would like to request to the congress to
review and thoroughly analyze the strategies and activities for reducing maternal mortality
and all essential need for supporting to effectively and successfully implement those strategies
and activities, and I would like to appeal to all relevant institutions; local authorities; civil
societies; national and international organizations and the community to continue and even
increase their support and active collaboration in all health sector activities to achieve the
common goal of improving the health status of Cambodia's people, especially mothers and the
poor who are vulnerable.
The Ministry of Health highly evaluates its provincial and municipal health
department and health officials and health staff at all level for their efforts in making progress
and achievement in health sector during 2006, and highly appreciate the considerable
contribution and supports for both financial and technical of all health development partners
in the process of re-habilitating and developing health infrastructures; the institutional
development and capacity building; and health ethic to support the health service delivery to
the Cambodia's people.
Finally, I hope that the 28th National Health Congress and the 5th Joint Annual
Health Performance Review 2007 will achieve good and satisfactory results, and I would like
to I would like to wish Excellency Keo Puthreasmey, deputy prime minister; Excellencies; Lork
Chumteaves; and all members of the Congress the five Buddhist blessings: longevity, peace, health,
strength and wisdom.
Thank you.
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Summary Report on Health Sector Achievements in 2006 and Priorities for 2007-2008
By H.E. Prof. Eng Huot, Secretary of State for Health
on the 28 th Health Congress and the 5 th Joint Annual Performance Review
5 th March, 2007
Excellency Keo Puth Reasmey, Deputy Prime Minister of the Royal Government of
Cambodia, Honorable Representative of the Prime Minister, Samdech Hun Sen,
Excellencies, Lok Chum Teav, Ladies and Gentlemen,
Distinguished National and International Guests,
Honorable Members of the Congress,
On behalf of the leadership of the Ministry of Health and all health officials and staff at all
levels in Cambodia, I have the honor to express our highest appreciation and warmest
welcome to Excellency Deputy Prime Minister for taking your valuable time to honorably
preside in the opening ceremony of the 28th Health Congress and the 5th Joint Annual
Performance Review (JAPR), which is held from March 5-7, 2007. The JAPR provides a
good opportunity for the MoH and its staff of all levels, relevant institutions, provincial
governors responsible for the health sector, development partners, and representatives of the
commune councils to jointly review the achievements and progress made and constraints
encountered on the implementation of the Health Sector Strategic Plan 2003-2007 and to set
priorities for 2007 and 2008.
The achievements produced so far are attributed to the result of priorities that have been
provided to the health sector, of political support, and of the strong commitment of the Royal
Government of Cambodia led by Prime Minister Samdech Hun Sen in regard to the
development of the health sector. They are also the result of the efforts of the leadership of the
MoH and its officials and staff at all levels in collaboration with and with the support of all
health development partners. These achievements cannot be separated from the active
participation of local authorities and communities.
To continue, let me briefly report to you on the achievements accomplished in 2006 and the
priority objectives for 2007-2008, which will be the topic for discussion in this congress and
review meeting:
1. Health Service Delivery
The delivery of public health services to the people has been expanded through the
development of health infrastructure and the main focus on the provision of basic health
services at health center and referral hospital level, as well as through outreach activities,
together with other public health programs especially with respect to maternal, newborn and
child health, disease control, and health education and promotion.
With regard to the implementation of the National Health Coverage Plan, by the end of 2006 a
total of 881 health centers have received drugs, supplies and medical equipment based on
MPA. Utilization of public health facilities has increased during the past several years. In
2006, on average the number of new contacts in outpatient consultation per person per year is
0.56 in relation to the target of 0.5 and the target of 1 new contact for outpatient consultation
for children under 5 has been reached. The numbers of health centers implementing Integrated
Management of Childhood Illness (IMCI) have increased to 456, or 52 higher than the target
(404).
Immunization remains a primary strategy to reduce infant morbidity and mortality. The
coverage rate of DPT-3 is 81%, against the target of 89%, and vitamin A supplementation
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coverage for children aged 6-59 months is 77% and 87% for the first and second round
respectively.
Second ANC coverage is 59% against the target of 60%. TT-full protection for pregnant
women is 76% and deliveries attended by trained health personnel are 44%. The coverage of
iron/folate supplementation to pregnant women attending first ANC at health centers or
during outreach activities is 86%, 26% higher than the target (60%). However, the coverage
of iron/folate supplementation to post-partum women is only 39%. The rate of married
women aged 15-49 using a modern contraceptive method is 27% [CDHS 2005].
Voluntary counseling and confidential testing (VCCT) activities have increased remarkably;
in 2006 a total of 41 new VCCT sites were established, bringing the total number of VCCT
sites to 150. At present, there are 44 health facilities offering opportunistic infections (OI) and
ART services in 19 provinces and municipalities. A total of 20,131 active AIDS patients,
including 18,344 adults and 1,787 children, were receiving ART treatment. By the end of
2006, the prevention of mother-to-child transmission program (PMTCT) has been
implemented in 60 sites in health centers and referral hospitals in 39 operational districts and
21 provinces and municipalities.
Tuberculosis control and treatment activities have also increased significantly as all health
centers in the country have implemented the DOTS strategy. The detection rate of pulmonary
tuberculosis with smear positive is 65% against the target of 70%. The TB control program
continued to keep the success cure rate at a high level, over 85%, which is the WHO target. In
addition, the community DOTS program has been expanded to a further 125 health centers.
Bed net treatment and insecticide treated nets (ITNs) distribution activities remain a priority
in malaria prevention, particularly in malaria endemic areas. In 2006, 81% of malaria endemic
areas have been provided with ITNs and retreated nets, nearly achieving the target (85%).
Reported severe malaria deaths have declined to 7.9% against the target of 10.2%. Deaths
from severe dengue have dropped to a level lower than 0.9%, achieving the target.
Deworming in children aged 12-59 months has increased markedly; in 2006, 56.7% of
children aged 12-59 months have received deworming medicine (Mebendazole), 16.7%
higher than the target (40%).
Avian influenza epidemic control measures have been actively implemented in close
collaboration with relevant institutions and neighboring countries with the technical and
financial support of various development partners.
2. Behavior Change and Communication
Numerous achievements in regard to providers and consumers’ behavior change have been
produced through production and dissemination of TV spots and short movies, and roundtable
discussions have been organized in order to inform the public about the importance of
colostrum, exclusive breastfeeding and complementary food. The Sub-Decree on Marketing
of Products for Infant and Young Child Feeding has officially been disseminated. Education
on the effects of tobacco has been developed and a total of 8 smoke free
hospital/school/pagoda programs have been created. Furthermore, the “providers’ behavior
change intervention” training program has been developed successfully in the Phnom Penh
Municipal Referral Hospital and in a number of provinces.
3. Quality Improvement
Quality improvement has been taken care of, both in the public and private sector, with a
focus on quality of health service delivery and infrastructure. Achievements produced by the
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Quality Assurance Office include the creation of quality assessment tools and a total of 12
provincial and municipal hospitals have been assessed. In addition, the Quality Assurance
Office has been involved in the creation and testing of a national licensing and accreditation
system to facilitate health services, both in the public and private sector, in accordance with
the priorities agreed upon and in collation with development partners.
4. Human Resource Development
One of the highest priorities in human resource development in the health sector is staff
training and distribution in support of the development and functioning of referral hospitals
and health centers in providing basic health services.
With regard to post basic midwifery training (3+1), a total of 85 midwives have graduated and
88 students have been newly recruited for academic year 2006-2007 at the Technical School
of Medical Care (TSMC) and 3 regional training centers (RTCs). The increase in the number
of new students will mean additional civil service posts to be provided by the Royal
Government to the MoH. A total of 398 students have graduated from four RTCs as first
batch primary nurses-midwives, including 192 primary midwives. A total of 246 students
have enrolled in the second Batch for the academic year 2006-2007, including 146 primary
midwifery students. Recruitment has been dependent upon the number of posts available and
upon female candidates who live near health centers in need of midwives. The MoH plans to
recruit an additional 120 midwifery students every year for school year 2007-2008 at the four
RTCs.
In addition, a total of 84 health centre staff have received a 4-month midwifery course. In
2006, a total of 170 health centers have staff with training in midwifery skills (4-month course
and life saving skill course), 29 health centers have staff who have just completed their
midwifery course, 14 referral hospitals have staff who have received training in basic surgery,
and 14 other referral hospitals have staff with nursing training in reanimation and anesthesia.
5. Health Financing
The MoH is a priority ministry that receives funding support from government and the
international community and, in addition the national budget is increased every year. The
national budget that was provided to the health sector in 2006 is 1.08% of the GDP (target
1.26%) or 6.64% of the total national budget, against the target of 10%. Total budget spent in
2006 is 261,741 Million riel or 94.8% of the 2006 adjusted budget plan. Per capita
expenditure from the national budget in 2006 is US$4.64.
In 2006, the MoH has received the national budget in the amount of 471,298,749 riel for equity
funds to support poor people in improving access to health services at 4 national hospitals and 2 referral
hospitals.
Equity fund projects have been implemented in 30 ODs including 7 contracting districts. The numbers
of poor patients covered by equity funds have increased from 46,700 in 2005 to 89,320 in 2006.
On health insurance, the numbers of community-based health insurance (CBHI) schemes have increased
from 4 to 8 and a total of 33,122 household members from 7,012 households have been issued a CBHI
card.
6. Institutional Development
A Merit Based Pay Initiative (MBPI) has been proposed based on the functional analysis report and has
been discussed by the High Level Working Group of the MoH with the involvement of representatives
of the Council for Administrative Reform, the Ministry of Economy and Finance, and health partners,
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and this has been agreed upon in principle on November 14, 2006. A set of draft implementation
guidelines and a draft MoU are being developed for the Priority Mission Group (PMG) scheme and the
MBPI.
Standard numbers of staff for referral hospitals and health centers have been determined and included in
the Complementary Package of Activities (CPA).
Excellencies, Lok Chum Teav, Ladies and Gentlemen,
Distinguished National and International Guests,
Honorable Members of the Congress,
Despite the aforementioned achievements as a result of implementation of the health sector strategic
plan, the MoH recognizes that there remains a lot of work that are essential and crucial and that are the
key factor in accomplishing success in the health sector, as well as in achieving the Royal Government’s
millennium development goals, which will need a concerted effort and collaboration. These include:
1) Preparing a second long-term health sector strategic plan 2008-2015 and continuing to
strengthen and improve the preparation and implementation of the Annual Operational Plan, as
well as to strengthen monitoring and evaluation mechanisms and systems at all levels of the
country’s health system.
2) Continuing to strengthen and improve the provision of sufficient funds and to distribute and use
the budgets available in an effective and efficient manner, as well as to strengthen the supply of
materials, equipment and drugs according to needs and in a timely manner, especially the supply
of essential drugs and medical equipment necessary for the functioning of CPA and MPA
services.
3) Strengthening the development, management and distribution of human resources according to
the actual needs of each health facility.
4) Promoting and expanding health education and promotion campaigns and active community
participation in health sector development.
5) Promoting the improvement of quality of care and treatment services at all levels of health
facilities.
6) Expanding the implementation of health equity funds and community based health insurance
more broadly so as to increase access to appropriate services for poor people, especially those in
remote areas.
7) Continuing to strengthen partnership and transparency and promote progress in harmonization
with the donor community, bilateral and multilateral cooperation, NGOs and other development
partners, including agencies within the MoH such as departments, units, national programs and
provincial/municipal health departments, as well as to coordinator the alignment of all activities
and interventions in line with agreed upon policies and strategies.
Excellencies, Lok Chum Teav, Ladies and Gentlemen,
Distinguished National and International Guests,
Honorable Members of the Congress,
In response to the issues mentioned above, one of the main tasks that the Health Congress and the Joint
Annual Performance Review Meeting needs to accomplish is identifying health sector priorities for the
years 2007 and 2008. The main priority that should be the theme to be discussed is interventions on
maternal, infant and child health, with emphasis on strengthening and improvement of care and
treatment service at all levels, particularly at health centers and referral hospital level, through the
implementation of child survival strategy 2006-2010 and the national reproductive health strategy 2006-
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2010. Therefore, I wish to call on all health development partners to direct their funding support towards
the implementation of these strategies.
Finally, I would like to wish Excellency Keo Puth Reasmey, deputy prime minister, and all members of
the Congress the five Buddhist blessings: longevity, peace, health, strength and wisdom. I also wish the
Congress and the JAPR a successful end.
Thank you.
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Opening Remarks by
Dr Michael J. O’Leary, WHO Representative
on behalf of Health Partners
Joint Annual Performance Review,
5 th March 2007
Y.E. Keo Puthreasmey Deputy Prime Minister,
Y.E. Nuth Sokhom, Minister of Health,
Y.E. Secretaries of State for Health,
Distinguished guests, colleagues, ladies and gentlemen
I am honoured and very pleased to be here today to make a few remarks on behalf of the
Health Partners, at this opening of the National Health Congress and Joint Annual
Performance Review 2007.
During 2006 the Ministry of Health has achieved good progress in addressing the many
challenges it faces in the health sector. At last year’s JAPR, five priority areas were identified
for the coming year, focusing especially on child survival and reproductive health. These are:
• emergency obstetric care;
• attendance at delivery by trained health providers;
• implementation of the Child Survival Scorecard interventions;
• full MPA status at health centers; and
• reproductive health including birth spacing services.
Joint Monitoring Indicators to track progress are concerned with:
• the improved and timely disbursement of funds in the health sector;
• greater access in the community to midwifery services;
• skilled attendance at deliveries;
• tracking of the numbers of health centers with full MPA status, and
• the increased use of health facilities in the public sector by the population at large.
The draft JAPR report indicates a number of clear achievements in these and other areas. For
example, the use of health services and the attendance of public health staff at deliveries has
increased; a wide range of behaviour change messages were made known through the media;
and the timely release of funds from an increased budget has improved. The drafting of a
Merit Based Pay Initiative, an Institutional Development Report, and a National Strategy for
the Prevention and Control of Non-Communicable Disease; plus the finalization of the
Guidelines for the Complementary Package of Activities are a few of many accomplishments
that will contribute to further improvement of health sector performance.
This progress is also reflected in the health status impact data that have been generated by the
Cambodia Demographic and Health Survey, or CDHS 2005. For example, the results in the
preliminary report showed antenatal clinic attendance almost doubled. The Total Fertility
Rate is reduced. Preliminary unofficial information from the final CDHS also suggests that
HIV prevalence may have declined amongst adults 15-49 years of age. This shows what
Cambodia can accomplish if the political will and financial and human resources are
adequately mobilised by both government and development partners.
Gains in child survival are especially encouraging, with a decrease of more than 30% in infant
and under-five mortality. Two-thirds of children between 12 and 23 months of age are fully
vaccinated, and 60% of children are exclusively breastfed during their first six months. Major
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challenges certainly remain, for example in ensuring the nutritional status of children after
weaning, and of adult women, and in the adequate availability of micronutrients.
But overall child survival efforts appear to be bearing fruit. The Cambodia Child Survival
Strategy should be officially disseminated this month. A major costing exercise has been
undertaken, which can sharpen the resource focus on scorecard interventions.
These significant achievements are supported by and consistent with the average 6-7% socioeconomic
growth in Cambodia until 2004, which increased to 13.5% in 2005 and is estimated
at almost 10% for 2006.
But of course not every effort has yet proven successful. The preliminary information of the
CDHS 2005 also indicates no significant change of the Maternal Mortality Ratio compared to
the previous CDHS in 2000. This impact indicator is difficult to measure, and reliable
adjustments are reflected only if a major change in the actual number of maternal deaths
occurs. In addition, it is an indicator less sensitive to socioeconomic changes than are the
Infant Mortality Rate and the Total Fertility Rate, and more dependent on a wider variety of
factors within and outside the health sector. Thus reducing the MMR requires attention to a
broad range of challenges in the health and other sectors, as reflected in the overall status of
health care systems and in the supporting environment.
The Ministry of Health focused preparations for this JAPR by identifying in more detail the
bottlenecks to progress in improving reproductive, maternal, newborn, and child health, and
in the continuum of care for mothers and children, and what would be required to remove
these bottlenecks. A pertinent one was reinforced by the midwifery review in late 2006: the
need for more and better skilled midwives in remote areas. The government has taken an
essential step to improve the payment of midwives to facilitate their deployment. Some donor
agencies are providing support through new initiatives for safe motherhood; others are
working to ensure that mothers and children have access to quality health services, and to
meeting basic needs for healthy life. But more is needed if the success in fighting HIV/AIDS,
is to be matched. Besides additional donor funding, an increased government allocation to the
health sector needs to complement these initiatives to ensure sustained outcomes.
The Ministry of Health’s focus on maternal and child health is a priority shared and endorsed
by health partners. Improved maternal and child health and a continuum of care includes
convincing mothers to use regular antenatal care, to deliver their babies with a skilled birth
attendant who can refer to a hospital in case of problems, and to protect themselves and their
children through vaccination and well baby clinics.
Even more fundamentally, this requires attention to the basic needs of all people – for an
adequate supply of clean water and nutritious food, good sanitation, proper housing, personal
security and the protection of human rights, and equity of access to health services and
education. These are goals which we all share.
I wish you much success these coming days in analysing the progress of the health sector
during the past year and in determining the priorities for the Annual Operational Plan 2008.
Thank you.
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Opening Address by H.E. Keo Puthreasmey
Deputy Prime Minister and Highest Representative of Samdech Hun Sen,
Prime Minister of the Royal Government of Cambodia
Joint Annual Performance Review, Ministry of Health
5 th March 2007
− Excellencies, Lork Chomteav, Ladies and Gentlemen;
− National and International Guests; and
− Members of the congress;
On behalf of the Royal Government of Cambodia and on my own behalf, I have great
honor to participate in opening ceremony of the 28th Health Congress and the 5th Joint
Annual Performance Review, whish has been considered as an annual forum of health sector
participated by broad national and international audiences in the main objective is to review
the performance and achievement made by the health sector during the year 2006 and to
determine the direction for the health activities in the coming year in its mission to deliver
preventive; curative health care services and health promotion to all Cambodia's people,
especially the poor. Through the summary report delivered by H.E. Prof. Eng Huot, Secretary
of State for Health, we all know that the health sector has made a great and proudly progress
and achievement. In fact, most of main indicators of health service delivery; health
infrastructure development and human resource development show that we are on tract of
making good progress. On behalf of the Royal Government of Cambodia, I would like to
express my honest gratitude to the leaders and officials of the Ministry of Health as well as all
health staff at all level for actively and ceaselessly accomplishing their tasks during the past
year; and would like also to express my deepest thanks to all relevant institutions; authorities
at all levels; all health development partners; national and international and non governmental
organizations and community for their supports to the progress in health sector in Cambodia.
I would like to take this opportunity to make my remark on the preliminary result of
the Cambodia Demographic and Health Survey 2005 that was mentioned by H.E. Dr. Nuth
Sokhom, Minister for Health, which shows a substantial reduction in the infant and under five
mortality rates; the reduction in HIV/AIDS transmission and the improvement of nutritional
status of children. These are really an optimistic and encouraging message showing that
Cambodia may achieve the millennium development goal set by the Royal Government of
Cambodia by the year 2015, except the maternal status, which remains the major concern not
just for health sector but also for the government as well. Therefore, this is really the
appropriate forum to pick up this issue; to discuss thoroughly to find out the route-causes and
to determine appropriate and effective strategy and activities to address this issue by taking
into account the Cambodian context, such as political; social economic; demographic;
cultures and tradition as well as the organizational structure; management and service delivery
function of the health system, especially the resource available for the medium and long term.
− Excellencies, Lork Chomteav, Ladies and Gentlemen;
− National and International Guests; and
− Members of the congress;
The Royal Government of Cambodia, under the wise leadership of the Prime Minister,
Samdech Hun Sen, always provides full support to the investment on health for development.
In Cambodia context, healthy population is essential and has both direct and indirect impacts
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on achieving economical goal. Improving health status of population is an important
component of increasing production which is strongly required for economic growth and
development and is also the foundation for poverty reduction. In deed, unwell health
determines the aspect of poverty and is worsening factor that make poverty gradually worsen.
Therefore, the Royal Government of Cambodia gives priority to health sector to reflect the
political commitment of the Royal Government towards humanity development by 2015.
Macro economic supporting policies of the Royal Government allow rapid economic growth
during the past 10 years. Benefit that the health sector received from economical growth is the
increased annual national budget allocation for health sector, hence the expanses of health
budget, even though national and other available sources effectively and efficiently by all
health institutions and facilities, at national; provincial, operational district; referral hospital;
and health center for insuring the improvement of health status of people. That is an effective
and efficient investment. Similarly, I would like to remind all of you, Excellencies; Lork
Chomteav; Ladies and Gentlemen, that good governance is the center of the rectangular
strategy of the government. Therefore, it is imperative to continue strengthening good
governance of health system by focusing on equity; effectiveness and efficiency; quality and
full responsibility. With all of these in place, I strongly believe that progress made in the
context of public financial management and public administrative reform of the Royal
Government of Cambodia will essentially contribute to effective good governance in health
sector.
− Excellencies, Lork Chomteav, Ladies and Gentlemen;
− National and International Guests; and
− Members of the congress;
I strongly believe that based on the common vision of poverty reduction and in the
context of implementing National Strategic Development Plan 2006-2010 of the Royal
Government of Cambodia, the health sector will continue to implement its mission in
improving health and well being of all Cambodia people, especially mother and children and
the poor which is an important contribution to achieve Cambodia Millennium Development
Goal by the year 2015.
Finally, I would like to I would like to wish Excellencies; Lork Chomteav; and all members
of the Congress the five Buddhist blessings: longevity, peace, health, strength and wisdom. On behalf
of the honorees, I would like to declare the 28th National Health Congress and the 5th Joint
Annual Health Performance Review 2007 open!
Thank you.
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Closing Remarks
Dr Michael J. O’Leary, WHO Representative
on behalf of Health Partners
Joint Annual Performance Review, Ministry of Health
7 th March 2007
Y.E. Sok An, Deputy Prime Minister of the Royal Government of Cambodia,
and High Representative of Samdech Hun Sen,
Prime Minister of the Royal Government of Cambodia,
Y.E. Dr Nuth Sokhom, Minister for Health,
Excellencies, Distinguished Guests, Ladies and Gentlemen,
On behalf of the health partners I am again honored to address the delegates to this 28 th
National Health Congress and Fourth Joint Annual Performance Review. We appreciate the
opportunity to be with you over these last three days, and to observe the dynamic discussions
across all operational levels of the Ministry of Health in Cambodia.
This Congress has again shown the will of the Ministry of Health to examine critically its
performance in a transparent manner. We appreciate the open dialogue between the central
ministry and the provincial, operational and facilities levels. We have noted especially the
emphasis given by the delegates and leaders to health sector priorities, the bottlenecks faced
by the Ministry in pursuing these priorities, and the specific interventions proposed for
addressing these bottlenecks.
We would like to focus on the priorities identified, and the interventions proposed to achieve
results in the months to come. We fully support the priorities identified for 2007-2008, which
are:
• Emergency Obstetric Care
• Attendance at Delivery by Trained Health Professionals
• Child Survival Scorecard Interventions
• Full MPA at all Health Centers
• Reproductive Health including Birth Spacing Services
In this context, we support the emphasis given by the Ministry to the recommendations of the
Midwifery Review as one of the most urgent steps to support these health sector priorities.
We support the attention given during this Congress to translating these priorities into
improved service delivery through making MPA and CPA work at the facilities level. This
will require sustained attention to many of the bottlenecks discussed and the interventions
proposed over the past 3 days. This means ensuring that facilities have the drugs and medical
supplies they need, and that health care workers at those facilities are better paid, better
trained and better supported. It also means extending health financing mechanisms such as
health equity funds and health insurance, that link improved access for poor people to better
quality of service for all people.
As noted in your discussions, even poor people will not make use of free facilities where the
quality of service is poor. Many of the presentations and interventions have recognized that
these challenges of quality improvement become even more complex in the private sector.
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We also applaud the concern demonstrated during these discussions for gender issues and for
the need for gender responsive health services.
This JAPR has set new targets for the next year, within the 6 Key Areas of Work. These
targets need to be translated into implementable planning in the coming AOP cycle. But even
careful priority-based planning does not guarantee results. We applaud the MoH’s renewed
emphasis on strengthening and monitoring of AOP implementation at all levels, including
reports on the performance and process indicators in the annual plans.
Beyond the identification of priorities and interventions, there must be the means to meet
critical targets; the financial and other resources without which plans are only dreams. And
these resources must actually reach the facilities that are to implement activities. We support
the Ministry’s leadership in calling for a 20% increase in resource allocations to the priority
areas and interventions, and we also recognize the complexities of achieving and monitoring
this target. We remain committed to strengthening partners’ alignment with these health
sector priorities.
We commend the increase in the overall health budget allocation for 2007. We would like to
emphasize that a rapidly growing national economy presents an opportunity to ensure
continued rapid growth in health investment. But these increases will only be truly effective
when they reach the district and facility levels.
In closing, we wish to affirm that we recognize and appreciate the Ministry of Health’s
leadership in setting priorities and strategies for the health sector. We are keen to continue a
substantive dialogue as partners with the Ministry and we recognize that this dialogue takes
place on many levels. We look to the Ministry of Health for guidance and support in ensuring
that this open communication remains a key part of our relationship. We look forward to
continuing our regular and constructive engagement with our counterparts and friends in the
Ministry of Health.
Thank you.
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Wrap-up of the 28 th Annual Health Congress and the
5 th Joint Annual Performance Review
by HE. Dr. Nuth Sokom, Minister for Health
7 th March 2007
The 28th Annual Health Congress and the 5th Joint Annual Health Sector Review had been
conducted from 5-7 March 2007, at the Cambodiana Hotel, Phnom Penh and presided over by
H. E. Keo Puth Rasmey, Deputy Prime Minister of the Royal Government of the Kingdom
of Cambodia.
1. H. E. Nuth Sokhom, Minister for Health delivered the welcome remark during the
cheerful opening ceremony, emphasizing 3 mains agenda of the 28th Annual Health Congress
and the 5th Joint Annual Performance Review:
− Review the progress and achievements in health sector in 2006, by identifying
strength and obstacles in the context of implementing the National Strategic
Development Plan 2006-2010 of the Royal Government;
− Identify health sector priorities for the year 2007-2008, and determine strategy and
essential activities to address priority issues identified; and
− Formulate recommendations for planning and implementing the annual operational
plan 2008 of all health institutions including planning for budget necessary to
support the implementation the decided plan.
2. H.E. Prof. Eng Huot, Secretary of State for Health briefly informed the honorees and
distinguishes guests the achievement in health sector in 2006 by emphasizing that these
achievement is the result of the priority consideration and commitment of the Royal
Government of Cambodia led by Samdach Hun Sen, the Prime Minister toward health sector
development in Cambodia. The report focus on the 6 main components, namely 1) Health
service delivery; 2) Behavior change communication; 3) Quality improvement; 4) Human
resource development; 5) Health financing and 6) Institutional development. H.E. Secretary
of State for Health also emphasized that beside the achievements made there are also issues
that need to be solved urgently in order to improve the quality of public health services as
well as to improve the health status of Cambodia population. He also suggested priorities for
health sector that need to be implemented in short and medium-term.
3. Doctor Michael O'Leary, the WHO Representative in Cambodia gave the remark on
behalf the health development partners by appreciating the achievements made in 2006,
especially the reduction of infant and under-five children mortality; the reduction of HIV
transmission and the improvement of nutritional status as well as the improvement of the
socio-economic status of the country. He also expressed concern of the health development
partners for the slow progress in reducing maternal mortality compared to the result of the
CDHS 2000. He appealed the attention to the congress toward maternal, reproductive, child
and newborn health.
4. H. E. Keo Puthrasmey, Deputy Prime Minister, and the highest representative of
Samdach Hun Sen, the Prime Minister of the Royal Government of the Kingdom of
Cambodia highly evaluated the health sector achievements made in 2006, especially the
reduction of infant and under-five children mortality; the reduction of HIV transmission and
the improvement of nutritional status and other achievements in public health sectors. H.E.
Deputy Prime Minister re-iterated the commitment and support of the Royal Government of
Cambodia to health sector as the priority with consideration that improving the health status is
an important component in increasing the productivity and participating in national economic
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enhancement. And H.E. Deputy Prime Minister declared the open of the 28th Annual Health
Congress and the 5th Joint Annual Health Sector Review.
5. Professor Sann Chan Soeung, Deputy Director General for Health reported to the
congress the health sector achievement focusing on the delivery of public health care services
through the health infrastructure development and health services delivery at health centers,
referral hospital and through outreach activities together with other public health programs,
especially the maternal newborn and child health programs; the communicable disease control
programs and the health promotion activities. As of 2006, 90 per cent of health centers
country wide received MPA supplies and provide MPA services. The public facility
utilization increased to 0.56 per capita per annum for general population and to 1.0 per capita
per annum for under-five children.
81 per cent of under-1 year children received DTP-3 and 87 per cent of children aged 6-59
months received vitamin A supplementation. The proportion of pregnant women attending
ANC-2 was 59 per cent where the proportion of pregnant women who is fully immunized
against tetanus was 76 per cent. 44 per cent of deliveries were attended by trained health
workers and approximately 27 per cent of married women aged from 15-49 years are
currently using one of the modern contraceptive methods.
The number of VCCT center increased to 150 country-wide and there are 44 health facilities
providing treatment for opportunist infections and ART services. The PMTCT has been
implemented in 60 health centers and referral hospital where the DOTS treatment has been
implemented in all health centers across the country. The BK+ pulmonary tuberculosis
detection rate increased and the rate of success treatment is kept at a high level that is even
higher than that of the WHO's recommendation. Furthermore, the community DOTS was
established and implement through 125 health centers.
Malaria and dengue control activities increased. Insecticide treated nets have been distributed
and re-impregnated in 81 per cent of villages in endemic areas. The case fatality rate of severe
malaria has been reduced to 7.9 per cent and the case fatality rate of severe dengue was less
than 0.9 per cent.
In addition, the avian influenza control measures have been implemented in close
collaboration with other involved institutions and neighboring countries under the technical
and financial support from health development partners.
6. Doctor Lim Thai Pheang, Director of the National Center for Health Promotion
reported to the congress the progress and achievement in behavior change communication that
have been implemented through the development and production and dissemination of health
promotion and educational message in form of radio and TV spots, short documentaries and
round table discussion by focusing on the important of exclusively breastfeeding. The subdecree
on marketing of products for infant and young child feeding was officially
disseminated. The health education on advert effects of tobacco has been developed and the
program for hospital-school-pagoda without smoke has been implemented in 8 sites.
The health congress discussed and agreed on the importance of the changes in the attitude and
behavior of both providers and clients in the improvement of the quality of health services;
and the importance of raising awareness of public on health care seeking behavior and healthy
life-style. The congress acknowledged that the above-mentioned tasks would depend on many
factors: the commitment of and appropriate motivation for the providers together with the
improvement of quality of health services; encourage VHSG to mobilize active community
participation in health development activities and other activities; and the continuity of the
health education activities focusing on specific health topic and target population.
- 98 -

7. Professor Koum Kanal, Director of NMCHC reported on the quality improvement that
focusing to both public and private as well as the quality of health services and health
infrastructures by emphasizing that improving quality of health services is essential in
promoting the public facility utilization as well as promoting the health status of Cambodia
people.
The congress discussed and concluded that: 1) the ownership and leadership of health official
and health staff plays an essential role in improving quality of health services delivered; 2) the
use of quality circle in health facilities with active participation of health official and health
staff; 3) appropriate fund allocation with effectively and efficiently use of fund available as
well as appropriate human resource distribution and management, sufficiently and timely
supply necessary medical equipment and drugs according to the need to provide MPA and
CPA services; and 4) appropriate motivation and incentive mechanism that links to the system
for accreditation and strengthening the implementation of professional ethic.
8. Ms. Keat Phuong, Director of Human Resource Development Department reported on
the progress and achievement in the component of human resource development which has
been given high priority, especially the appropriate training and distribution to support the
development and function of the health facilities to enable the provision of basic health
services. Training midwives to fill the gap is the critical and urgent issue. Due to additional
official posts provided by the Royal Government the Ministry has been enabled to recruit
additional nursing and midwifery students by giving priority to remote areas. In addition to
the basic training, the Ministry focuses as well on skills training including midwifery and lifesaving
skills, basic surgical skills and nursing reanimation and anesthesia.
The congress discussed on the selection criteria for primary midwives and suggested to give
priority according to the provinces rather than to region. The congress also suggested
allocating adequate fund to training institution in order to improve the quality of training.
9. Doctor Khuoth Thavary, Deputy Director of the Finance and Budgeting Department
reported to the congress about the achievement made in the health financing component. The
Royal Government considers the health sector as one of the priority areas by increasing
national budget for this sector every year and including funding for equity fund to enable the
poor to receive health care at public facilities.
The congress considered that the progress in the health financing reform is still limited and
sustainability is the essential issue to tackles. The congress focused on expanding the
implementation of equity fund and the social health insurance initiative. All emphasized on
the need of adequate and timely fund allocation according to the need including the allocation
and effectively and efficiently use of fund available; and stressed on strengthening the
transparency and harmonization in designing, planning and implementing the annual
operational plan. The congress requested to all national hospitals to facilitate and provide
services to the poor referred to their facilities even though they are covered by the equity
fund.
10. H.E. Professor Koeut Meach, Deputy Director General for Administration and Finance
reported to the congress the achievement in the health institutional development component.
The performance-based incentive scheme and the priority mission group have been developed
to enhance the effective human resource distribution, extend the health services to ruralremote
areas and to improve the quality of health services delivered. The projects were
designed based on the result of functional analysis and in consultation with the high level
working group of the Ministry of Health with participation from the representative of the
Administration Reform Council; Ministry of Economic and Finance; and other health
development partners, and thereafter, were agreed in principle. The standard number of staff
- 99 -

for referral hospital and health center was identified and incorporated into national CPA
guideline.
The congress requested for strengthening the implementation of the professional ethic by
considering critical roles of professional boards (medical, dental, midwives, pharmacist, and
nurse board) and local authority, by further requesting the local authority and professional
boards to strictly implement their roles and responsibilities based on collaborative, justice and
independent principle. Gender issue, control of private sector including clinics and
pharmacies were also discussed.
11. Doctor Tea Kim Chhay, Director of the Drug-Food-Medical Equipment and Cosmetic
Department reported to the congress the status of the gender in the Ministry of Health since
the establishment of the working group for gender in 2006. The awareness and knowledge in
gender, focusing on progress, equity and equality had been disseminated to leaders and
officials and staff of the Ministry of Health. The congress noted that the technical and
financial support to gender activities is still limited, like the inclusion of gender into strategy
and annual operational plan of each institution of the Ministry. The congress appealed for
closer collaboration between PHD and relevant institutions as well as the local authority.
12. The congress also discussed the issue related to the control of private sectors, including
clinics and pharmacy/depots. The congress noted that currently some legislative documents
concerning the establishment and functioning as well as controlling private sectors, like law
on running private professional business, sub-decree on procedure and criteria for running
private business, prakass on social marketing have been developed and ratified as well as
disseminated and the committee to control the private sectors at all levels have been
established and functioning. As result, the number of unregistered private business decrease
notably.
Concerning the unregistered pharmacy/depot as well as counterfeit drugs that currently have
advert impacts on people health was also discussed. The congress agreed on the strategy to
eradicate the counterfeit drugs through strengthening and re-enforcing the implementation of
legislations and regulations, strengthening the monitoring and punishment for any uncompliance.
The congress also suggested the importance of professional morality and
professional ethic, inter-ministries collaboration, and active participation and collaboration of
the private sectors itself. It was noticed that the solution the above-mentioned issues is
specifically difficult and complicated, especially to ban the illegal clinic and illegal
ambulance services. Based on the responsibility and compliance principles, all leaders and
officials of the Ministry of Health at all levels, local authorities and the relevant individual
participating in the congress commit to eradicate all illegal phenomenon with suggesting
strengthening collaboration and support from local authorities as well as moral and financial
support to the implementation.
The congress agreed that the basic weapon to eradicate the illegality of private sectors is the
decision of the Royal Government signed by Samdach Hun Sen, the Prime Minister of the
Royal Government establishing the committee to eradicate the counterfeit drugs and illegal
private health care facilities by re-enforcing: 1) awareness raising through dissemination of
educational messages; 2) administrative procedures; and 3) judiciary procedure. The congress
requested to speed up the process in establishing committee in 5 provinces that have not had
the committee yet. H.E. Doctor Sok Pheng, Under-Secretary of State for Health shared with
the congress the experiences in managing hospital through the establishment of council for
discipline which has role in motivating or punishing those who commit wrong doing against
law/regulation with active participation from PHD.
- 100 -

13. Professor Koum Kanal, Director of NMCHC reported the result of Midwifery Review
to the congress emphasized the main focus which is the need for competent and the lack of
midwifery skills at front line health facilities, and stressed that the issues will be increasing
due to the fact that approximately 30 per cent of midwives are nearly coming to retired age.
Therefore, the congress requested to increase the number of student recruited for basic
midwifery training and strengthen the selection and dissemination of midwifery professional
according to the real need with considering the motivation and support morally and
financially.
14. Doctor Hong Rathmony, Deputy Director of Communicable Disease Control
Department reported to the congress the result of a technical consultation workshop which
was held on 19 February 2007, under the chairmanship of H.E. Professor Eng Huot, to
identify, prioritize and cost feasible interventions for health sector priorities for the coming
year.
He reported that for the past 3 years the JAPR has set priorities for the next AoP. These
priorities have helped the health sector focus its objectives and activities on Maternal, Child,
and Reproductive Health. The current HS Priorities are: Emergency Obstetric Care,
Attendance at Delivery by Trained Health Providers, Implementation of the 12 Child Survival
Scorecard Interventions, emphasizing on IMCI and other interventions those have been
considered to be feasible for the short and medium-term implementation, Full MPA Status at
Health Centers, Reproductive Health including Birth Spacing Services. These require
implementation of many different kinds of interventions, some of which may be especially
useful in solving important bottlenecks to improving performance. Core issues had been
identified: 1) bottlenecks in improving maternal, child and reproductive health; 2)
interventions that could solve some of these bottlenecks in one year; and 3) costing and
funding information for these interventions. A matrix detailing the results of these
consultations follows at the end of this document.
Based on the examination of key bottlenecks, interventions were identified for
recommendation to the 2007 Joint Annual Performance Review. Several of these
interventions are already funded and in implementation, several others link closely to ongoing
projects, others however represent gaps that may be of special interest to health partners.
Therefore, the group suggested taking into account the implementation of these intervention
in two different contexts: system-wide implementation and the implementation in the areas
where there is special need, as well as to consider the gap in funding and implementation and
the next steps. The group also suggested aligning interventions with existing MoH policy and
projects, especially for those focused on districts with special needs (GAVI, GFATM, HSSP,
Contracting, HEF, CSS Costing etc.)
15. H.E. Doctor Nuth Sokhom, Minister for Health reported to H.E. Sok An, Deputy Prime
Minister, Highest Representative of Samdach Hun Sen, the Prime Minister of the Royal
Government of Cambodia, that although a lot of achievements made as reported, the congress,
through the profound and thorough discussion, found major core issues that need to be solved
urgently in the year 2007 and 2008 through the identification of priority activities for health
sector as follows:
a) Develop the second long-term health sector strategic plan 2008-2015 and continue to
strengthen and improve the design, planning and implementing the AoP and
strengthen the monitoring system and mechanism at all levels of health system
country-wide;
b) Continue to strengthen and improve the adequate funding provision, including the
effective and efficient distribution and use of fund available, as well as strengthen the
- 101 -

adequate and timely supply of medical equipment and drugs according to the real
need, especially those essentially required for functioning and providing CPA and
MPA services;
c) Strengthen the human resource development and management according to the real
need of each health facilities;
d) Motivate and expand the media campaign for health education and health promotion
and encourage the active participation of the community in health activities and
health sector development;
e) Improve the quality of health services at all health facilities at all levels;
f) Expand the implementation of health equity fund and the community-based social
health insurance initiative to increase the accessibility of the poor and pro-poor,
especially those in rural-remote areas;
g) Continue to strengthen partnership and transparency as well as improved
harmonization with donor community, bilateral and multilateral collaborations, nongovernmental
organizations and other health development partners, including within
the Ministry of Health itself: departments, national centers, national programs and
PHD; and to facilitate the alignment of all activities and interventions to existing
national policies and guidelines that have already been agreed upon.
H.E. Minister also stressed that the above-mentioned top priorities required the commitment
of all level of health system to ensure that goals, objectives and activities of the AOP 2007-
2008 appropriately and adequately reflect the priorities and to link with the allocation of all
fund available toward addressing the priority issues and effectively use those fund to achieve
the expected results. This is clearly means that the procedure in developing the AOP 2007-
2008 must take into account these above-mentioned 5 priorities by clearly indicate the target
for each priorities.
H.E. Minister appealed and requested to all health development partners and relevant
institutions to continue support technically and financially to health institutions at all levels in
designing, planning and implementing health sector plan and create better collaborative
environment to achieve the above-mentioned priorities.
H.E.Minister re-iterated the gratitude to H.E. Sok An, Deputy Prime Minister, Highest
Representative of Samdach Hun Sen, the Prime Minister of the Royal Government of
Cambodia for taking his precious time participating as honoree in the closing ceremony of the
28th Annual Health Congress and the 5th Joint Annual Health Sector Review that proves the
commitment and support of the Royal Government to health sector and greatly encourages
leaders, officials and health staff at all levels as well as all health development partners
including donor community, international and local organizations, bi and multilateral
collaborations and other civil society that have been helping health sector in Cambodia.
H.E.Minister also expressed his sincere thanks to and praised the congress for their
commitment and effort jointly review the health sector performance and identified the
priorities for the coming year that made the congress successful.
Finally, H.E. Minister wished H.E. Sok An, Deputy Prime Minister, Highest Representative of
Samdach Hun Sen, the Prime Minister of the Royal Government of Cambodia, and all
members of the Congress the five Buddhist blessings: longevity, peace, health, strength and wisdom.
Thank You
- 102 -

Agenda JAPR, 5-7 March 2007
Hotel: Cambodiana
Day 1: 5 March
7:30-8.30 Registration
8:30-8:35 Salute the National Anthem
8:35-9:00 - Welcome address HE. Dr. Nuth Sokhom, Minister for
Health
9:00-9:30 - Report on Health achievement 2006 HE Prof. Eng Huot, Secretary of
State for Health
9:30-9:40 - Welcome remarks Dr. Michael J. O’Leary, Health
Partner Representative
9:40-10:30 Opening speech HE. Keo Puthreasmey, Deputy Prime
Minister, and High Representative of
Samdech Hun Sen, Prime Minister of
the Royal Government of Cambodia
10:30-11:00 Tea Break
11:00-11:10 - Introduction on JAPR Process Dr. Sao Sovanratnak, Deputy
Director, - Objectives of the JAPR DPHI
11:10-12:00 Health service delivery Prof. San Chann Soeung, Deputy
(Q-A)
Director General for Health
12:00-01:30 Lunch Break (provided)
1:30-2:00: Dissemination of CPA guideline Dr. Chi Mean Hea, Deputy Director
General for Health
2:00-3:00: - Behavior change Dr. Lim Thai Pheang, Director
(Q-A)
Nat. Center for Health Promotion
3:00-3:30: Tea Break
3:30-4:30: - Quality improvement Prof. Koum Kanal, Director, NMCH
(Q-A)
4:30-5:30: - Human resource development Mrs. Keat Phuong, Director, HRD
(Q-A)
Day 2: 6 March
8:00-8.45 Social Health Insurance H.E Dr. Mam Bun Heng, Secretary
of State for Health
8:45-9.30 Health financing Mr. Lay Huon, Director, Budget and
(Q-A)
- 103 -
Finance Dept. and Mrs. Khuot
Thavary, Deputy Director, Budget
and Finance Dept.
9:30-10:00 Institutional development HE. Prof. Koet Meach, Director
(Q-A) General, Budget and Admin.
Dept.
10:00-10:30 Tea Break
10:30-12:00 Plenary session: Chaired by HE. Minister for Health
12:00-1:30 Lunch Break (provided)
1:30-2:00 Progress on Equality, Equity of Gender Mrs. Chin Chheav, Deputy Director
(Q-A)
in Health Sector General, Budget and
Admin. Dept
2:00-2:30 Management and control of private clinics Dr. Sann Sary, Director, Hospital
(Q-A)
Dept.
2:30-3:00 Management and control of private Prof. Tea Kim Chhay, Director,
pharmacies, (Q-A)
Drug Department

3:00-3:30 Dissemination on the regulation for Dr. Chi Mean Hea, Deputy Director
private practice of nurse and midwife General for Health
and physiotherapy (Q-A)
3:30-4:00 Tea Break
4:00-5:30 Plenary session: Chaired by HE. Minister for Health
Day 3: 7 March
8:00-8.30: Midwifery review and recommendation Prof. Koum Kanal, Director,
(Q-A)
NCMCH
8:30-9.00: Outputs of the consultative meeting on the Dr. Hong Rathmony, Deputy
Maternal and Child Health, (Q-A)
Director, Priority Intervention for
CDC Dept
9:00-9:30 Tea Break
9:30-11:30 Plenary session: Chaired by HE. Minister for Health
11:30-12:00 Annual Operational Plan and 3 Years Dr. Lon Mondol, DPHI
Rolling Plan 2008-2010, (Q-A)
12:00-1:30 Lunch Break (provided)
1:30-2:00 Harmonization within the Ministry of Health Dr. Char Meng Chuor, Deputy DG
and concerned government institutions
(Q-A)
2:00-3:30 Plenary session: Chaired by HE. Minister for Health
3:30-4:00 Tea Break
4:00 Arrival of HE. Sok An, Deputy Prime Minister of the Royal Government of
Cambodia, and High Representative of Samdech HUN SEN, Prime Minister of the
RGC
4:00-4:10 Closing remarks Dr. Michael J. O’Leary, Health
Partner Representative
4:10-4:30 Wrap up of JAPR HE. Dr. Nuth Sokhom, Minister for
Health
4:30-5:30 Closing address HE. Sok An, Deputy Prime Minister
5:30-5:35 Salute the National Anthem
Agenda is subject to changed if necessary.
- 104 -

dMeNIrkarerobcMsikçasalaénkarBinitü
eLIgvijrYmKñaelIsmiT§plsuxaPi)al
Workshop Proceeding for the Joint Annual
Performance Review
2007
evC¢> esA suvNÑrtn³
GnuRbFannaykdæanEpnkar nig B½t’mansuxaPi)al
matika Content
• sar)an Background
• eKalbMNg Objectives
• dMeNIrkarsikçasala Workshop Proceeding
• lTæplrMBwgTuk Expected Outputs
1
2
sar)an Background
• KMeragkargarsMrab;Binitütamdan nig vaytMél karGnuvtþn¾Epn
karyuTæsaRsþsuxaPi)al 2003-2007
Framework for M&E HSP 2003-2007
• ÉksarKMeragRTRTg;vis½ysuxaPi)al
HSSP Project Document (ADB, DFID,WB, UNFPA)
• karbegIátRkum Core Team, RkumRTRTg;kargar,
RkumkargarTMag 6
Establishment of Core Team, Support Group, 6
working groups for 6 key Areas of HSP
• karrYmbB©ÚalKñaénkareFIVsnñi)at nig karBinitüeLIgvijrYm
KñaelIvis½ysuxaPi)al Merger of the Joint Annual
Health Sector Review and the National Health
Congress
= Joint Annual Performance Review (JAPR)
3
4
• EbbbTénkarRKb;RKgebIkTUlay ³karxitxMcUlrYmrbs;édKU
GPivDÆn¾kñúgkarGnuvtþn¾kartamdan nig karBinitüeLIgvijelI
karrIkcMerInrbs; Epnkar yuTæsaRsþsuxaPi)al 2003-
2007.
• Sector Wide Management (SWIM) process: Joint
efforts of health partners in implementing,
monitoring and reviewing the progress of the
Health Strategic Plan 2003-2007.
eKalbMNg Overall objective
“BRgwgPaBCaédKUenAkúñgkarGPivDÆn¾vis½ysuxaPi)al edIm,IsMerc
eKalbMNgénEpnkaryuTæsaRsþsuxaPi)al CaBiess tamry³
karRKb;RKgebIkTUlay”.
“To strengthen the partnership in health sector
development to achieve the goals of the health
strategic plan (HSP), especially through sector wide
approach”.
5
6
1

eKaledA Specific objective
• BinitüeLIgvijrYmKñaelIkarrIkcMerInelIkarGPivDÆn¾vis½ysuxa
Pi)al enAkñúgqñMa 2006 kMNt;emIlkarlM)aknana kñúgkar
Gnuvtþn¾Epnkar yuTæsaRsþsuxaPi)al nig karkMNt;GaTiPaB
2007-2008.
• Review progress made during the 2006 in Health
Sector Development, and identify constraints in the
implementation of the health strategic plan, and
priorities for 2007-2008.
dMeNIrkarsikçasala
Workshop Proceeding
•karcUlrYmrbs;édKUGPivDÆn¾suxaPi)al
Participation of health partners
•karbgðaj Presentations
•karBiPakSatamRkum Plenary Discussion
7
8
lTæplrMBwgTuk Expected Outputs
• begIánkaryl;dwgGMBIEbbbTénkarRKb;RKgebIkTUlayenAkñúg
cMeNamédKUGPivDÆn¾ ¬TMagenAEpñksaFarN³ nig ÉkCn¦
enAkñúgkarGPivDÆn¾vis½ysuxaPi)al .
Increased awareness on the sector wide
management process among stakeholders
(public and privates) in health sector
development
•karpþl;mtieyabl; Gnusasn_ b¤k¾GaTiPaBepSgeTot sMrab;
GnuvtþEpnkaryuTæsaRsþsuxaPi)al.
Comments and feedback and
recommendations/ additional priorities for the
implementation of the HSP
9
10
CMh‘anbnÞab; Next Steps
JAPR 2007
sUmGrKuN
Planning at all levels for 2008
Annual Operational Plan and 3 Year Rolling
Plan 2008
11
12
2

Summary Report on
key area of health service delivery 2006
Prof. San Chann Soeung
Deputy Director General for Health
5-7 March 2007
Cambodiana Hotel
1
Strategy
• Five strategies:
1-Further improve coverage and access to health
services, especially for the poor and other vulnerable
groups through planning the location of health
facilities and strengthening outreach services.
2-Strengthen the delivery of quality basic health
services through health centers and outreach based
upon MPA
3-Strengthen the delivery of quality care,
especially obstetric and pediatric care, in all hospitals
through measures such as CPA
2
Strategy
4-Strengthen the management of costeffective
interventions to control
communicable diseases
5-Strengthen the management and coverage of
support services such as laboratory, blood
safety, referral, pharmaceuticals, equipment
and other medical supplies and maintenance
of facilities and transport.
Achievement 2006
MPA: HCs received MPA drug: 881
HIV/AIDS:
150 VCCT centers established in all ODs
TB:
All HCs implementing DOTS
Detection rate of smear positive pulmonary TB:
65%
Maintain high cure rate of tuberculosis of more
than 85 %.
3
4
Malaria/Dengue/Mebendazole:
• % of endemic villages that have re-treatment
and replacement of bed nets annually: 81%
• Malaria incidence: 7.2/1000
• Malaria case fatality rate (severe case only):
7.9%
• Dengue case fatality rate:

MCH (Cont)
• % of children under 1 year that received
DTP3: 81%
• % of children aged 6-59 months who
received vitamin A round 1: 77%
• No. of health centers that implement
IMCI: 456
• No. of hospitals implementing the baby
friendly hospital initiative: 07
Outpatient/Inpatient
• New case per inhabitant per year: 0.56
• Number of hospital discharge per 1000/year: 18
CPA:
• CPA guideline finalized and disseminated to all
institutions under health system
Essential drug:
• % of essential drugs (15 items listed) at health
center that faced stock-out: 5.71%
7
8
Constraints
• Some HCs could not provide full MPA
• Lack of trained staff in midwifery skills in
some health centers
• Lack of financial support for HC outreach
activities within the radius of

Dr. Lim Thai Pheang
Director, National Center for Health
Behavior Change Communication
(BCC)
Tel: 012 922 640
E-mail: nchp@camnet.com.kh
Contents
1. Strategy of Behavior Change
Communication
2. Current situation/Achievements
3. Constraints
4. Priorities for 2007-2008
1
2
Strategy of Behavior Change
Communication
• Strategy 6: Change for the better the
attitudes of health providers sectorwide
to communicate effectively with
consumers, especially regarding the
needs of the poor, through
sensitization and building interpersonal
communication skills
Strategy of Behavior Change
Communication
• Strategy 7: Empower consumers,
especially the poor and women, to
interact with other stakeholders in
the development of quality health
services through mass media and
inter-personnel communication.
3
4
Strategy of Behavior Change
Communication
Strategy 8: Promote healthy lifestyles
and appropriate health
seeking behavior through advocating
for healthy environments and
implementing counseling and
behavioral change activities
5
Current situation/achievements,
strategy 6
1. Produce and disseminate TV spots on
colostrums, Exclusive Breastfeeding,
supplementary food, and documentary
on Exclusive Breastfeeding.
2. One round table on Exclusive
Breastfeed conducted
3. Question and answer radio program
about Exclusive Breastfeeding on
national and Bayon radio station
6
1

Current situation/achievements,
strategy 6
4. Revise Curriculum MPA-7
5. Produce spot TV on Birth Preparedness
6. Conducted training on provider change
intervention to referral hospitals in
Phnom Penh and Kampot province
7. Coaching on provider behavior change
intervention
7
Current situation/achievements,
strategy 6
8. Clients’ rights and providers’ rights
and duties approved by MoH
9. IEC materials on clients’ rights and
providers’ rights and duties drafted.
Current situation/achievement,
strategy 7
1. Baseline survey on clients’ rights and
providers’ rights conducted
8
Current situation/achievement,
strategy 8
1. NCHP website was launched
2. Functioning the BCC forum in five
provinces: Svay Rieng, PreyVeng,
Stoeung Treng, Mondulkiri,
Kampongspeu provinces
3. The draft of Anti-smoking law has been
revised for resubmission to MoH.
Current situation/achievement,
strategy 8
4. 8 smoke free hospitals, schools, and
temples were established
5. One Training of Trainer on Quit
Smoking conducted
6. On air talk show about adverse effects
of tobacco use on health
9
10
Current situation/achievement,
strategy 8
7. Sub-decree on Marketing of IYCF
Products widely disseminated for high
level officials from relevant line
ministries, PHD/OD directors
PHD/OD/Nutrition Focal Person from
all 24 provinces and representative of
milk companies, private hospitals were
participated
Constraints
1. There was a delay in finalizing the
revision of MPA Module 7, clients'
rights and providers' right and duties
2. Delay in functioning IEC database
3. Limited skills of staff of Health
Promotion Unit of the PHD in
facilitating BCC Forum
11
12
2

Constraints
4. Unclear define the institution in
producing IEC material on the role and
responsibility of health providers.
5. Unclear defined roles of NCHP in food
hygiene
6. Lack of human resources of fund for
successfully implementing the three-
BCC strategic plan
Priorities for 2007-2008
1. Continue to broadcast the existing TV
spots
2. Review existing indicators and establish
new targets in the area of IYCF till 2010
3. MPA Module 7 revise and Finalize
4. Training MPA-7 to 24 Provinces
13
14
Priorities for 2007-2008
5. Provide training on Provider Behavior
Change Intervention to PHPU /PHD at
6 provinces
6. Disseminate and implement the
consumers' rights and providers’ rights
and duties
7. Reactivate and reinforce the existing
community network in 5 provinces
Priorities for 2007-2008
9. Anti-smoking law will be approved by
council of ministers and ratified by
National Assembly and Senate and its
implementation
10. Continue to establish smoke free
workplace and conducting a campaign
on the adverse effects of tobacco use
15
16
Priorities for 2007-2008
9. Conduct training on quit smoking in
SiemReab, Kg. speu, Takeo, Ratanakiri,
K. Kong, Pailin
10. Develop sub-decree to implement the
Anti-Tobacco law.
Conclusion and recommendation
The second core strategy of the Health Sector
Strategic Plan 2003-2007 is still useful tool for
all the organizations working in the behavior
change fields. Though many achievements
were made, we faced some issues for
accomplishing some indicators. This because
we lack of human and financial resources and
there is no clear indication about which
organization responsible for implementation of
each indicator.
17
18
3

Ministry of Health
Quality Improvement
Working Group
Presented by Prof. Koum Kanal
Chairman of QIWG
Outline of the presentation
I-Strategy 9 and Strategy 10
II-Current situation and achievements
III-Constrains
IV-Priorities for 2007-2008
V-Conclusion and recommendation
1
2
I-What did QIWG-QAO achieve in 2006
• Strategy 9:
Introduce and develop a culture of quality in public
health, service delivery and their management through
the use of the Ministry of Health (MoH) quality
standards.
• Strategy 10:
Develop and implement minimum and optimum quality
standards for the public and private sectors
incorporating pro-poor and gender issues through
established structures and use of appropriate tools.
II-Achievements
• Assure over-all coordination and monitoring of the
implementation of QA strategies included in the HSSP
2003-2007 and priority activities identified in the Joint
Annual Performance Review.
• Assure that the development and implementation of
standards, guidelines and tools based on MoH priorities,
including capability-building support.
• Assist in the development and testing of a national
licensing and accreditation system for public and private
health facilities according to the agreed priorities.
3
4
II-Achievements - Cont’d
• Ensure availability and accessibility of resource materials
related to quality assurance, in coordination with the MoH
library and NIPH and website;More realistic timeline of 5
years was clarified.
• Conduct performance monitoring activities in pilot areas
and facilitate implementation of remedial actions for
performance gaps;
• Provide technical and administrative support to the
Hospital Management/Reform Working Group;
II-Achievements - Cont’d
• Facilitate the formulation of Cambodian QA policy and
regulatory framework, in collaboration with key
stakeholders
• Recommend strategies and identify TA needs for the
continuous enhancements of systems, policies and
procedures pertaining to quality assurance
5
6
1

III-Constrains
• Despite the ever-increasing workload, there was
no attendant increase in its current manpower
(QAO).
• Even as progress is made on the Quality
Assurance policy, however the transferring from
policy to the real-activities was very low.
III-What prioritized points will be achieved
next
• We are going to classify the documents in
the registry into more meaningful groups.
• Finalize of the HC assessment tool will be
done.
• The hospital assessment tool is used on a
national scope; the QAO will have to assess
it.
7
8
III-What prioritized points will be achieved
next
• A group that will work for the creation of the
national standards is going to be established.
• A set of national standards will be drafted.
• Rewards and reinforcement system would be
worthwhile to look at trends in performance of HCs
over time.
• Directions for Quality Circle (QC) meetings must
be clearer than it was. We must identify what we
want them to achieve.
III-What prioritized points will be achieved
next
• Using national data, prioritize which guidelines
would be most worthwhile to update first.
• Follow up HTA course for core group
• 3rd workshop on HTA to refine the process of
CPG development
• Advocacy for specialty societies in their roles in
CPG development. It will involve a series of
meeting with the leadership of the different
societies prior to the 3rd workshop to sensitize
them.
9
10
IV-Conclusion and Recommendation
• The leadership of the referral hospitals is very important in
order to achieve the quality improvement in the hospitals;
however it can be improved by quality improvement project
with in the hospital or Quality Circle (QC) or hospital
assessment tool..
• The accreditation is the one that could not be achieved in
recent time. To be achieved, we need 3 years more;
however we have already conducted this concept through
Sun Quality Health Network.
• All of the prioritized activities described above can be
achieve unless the fund would be handled on time.
Questions
Comment
Recommendation
Thank you for your attention
11
12
2

The Strategies of HRD 2003-2007
HRD JAHSR 2006 Achievement
& Plan 2007-2008
• Increase the number and strengthen the
capacity and skills of midwives (Strategy
11)
• Strengthen human resource planning to
reduce mal-distribution (Strategy 12)
HRD Department
• Enhance the management and technical
skills of health workforces (Strategy 13)
HRD JAHSR 2005 Ahievement & PlanHRD JAHSR 2007 Achievement &
Plan
2
Increase the number and strengthen the
capacity and skills of midwives (Strategy 11)
Increase the number and strengthen the
capacity & skills of midwives (Strategy 11)
• Achievement for
production
1. Midwives post basic
graduates: 85/80
2. Primary midwives
graduates from 4 RTCs
: 192/120
3. Secondary midwives:
wait for midwifery
review finding &
decision of MoH
• Constraint
– Low educational
background of
Primary Midwife
students (class 10)
made difficulty in
learning & teaching
• Achievement for
provision of midwifery
skills
4. CE courses 220/100
– 4 month midwifery
course: 84 participants
– RH/CPA midwifery
course:19
– LSS course :117
• Constraint
– Delay of HSSP budget
NMCHC used JICA
budget
HRD JAHSR 2005 Ahievement & PlanHRD JAHSR 2007 Achievement &
Plan
3
HRD JAHSR 2005 Ahievement & PlanHRD JAHSR 2007 Achievement &
Plan
4
Strengthen human resource planning to reduce
mal - distribution (Strategy 12)
Strengthen human resource planning to reduce
mal-distribution (Strategy 12) cont.
• Achievement for staff allocation
5. HCs having staff with updated
midwifery skills – 170 / 100
6. % of health facilities with
appropriate staff :
– 51 of midwifery posts are
fulfilled (34 are P Midw, 17
are Sec Midw)
- CPA Guidelines approved in
addition with the promotion of
using HR Database for staff
management
• Constraint
• Achievement
– 100% of graduates
primary midwives
applying are recruited
and allocated to areas
where is a deficit of
midwives
7. RHs with at least 2
surgeons for RH - 14
RHs with 16 BST , and
16 RHs with 25 ISAR
• Constraint
– Few Midwife
graduates applied
for MoH post due to
delay of staff
recruitment
HRD JAHSR 2005 Ahievement & PlanHRD JAHSR 2007 Achievement &
Plan
5
HRD JAHSR 2005 Ahievement & PlanHRD JAHSR 2007 Achievement &
Plan
6
1

Enhance the management and technical skills
of health workforces (Strategy 13)
Enhance the management and technical skills
of health workforces (Strategy 13) cont.
• Achievement
8. MPA training according to
TNA – not done.
9. Targeted staff received
management training
- 0/35 for HSMT
- 44/35 for HMT
• Constraint
– Delay of TNA
implementation
- Shortage of human
resource to
manage both
courses
• Achievement
10. Accreditation of
training for health :
draft of sub decree on
training for health
submitted to CM for
approval
11. Provincial lab staff
trained at NIPH : 149
• Constraint
HRD JAHSR 2005 Ahievement & PlanHRD JAHSR 2007 Achievement &
Plan
7
HRD JAHSR 2005 Ahievement & PlanHRD JAHSR 2007 Achievement &
Plan
8
Priorities 2007-2008
Priorities 2007-2008 cont.
• Training:
– Midwifery program
• Basic education
– One year post basic at TSMC/3RTCs: 80 /
year
– Primary course at 4 RTCs: 120 / year
•CE
– 100 HC staff trained with midwifery skills / year
(Mid 4 month, NMCHC- HC & RH courses,
LSS)
– Management programs
• Hospital management training: 36/year
– MPA programs
• 6 staffs / HC / year: at least 5,500 staffs based on
TNA
– CPA programs
• BST and ISAR: 16, 20 / year
• Lab course: 175 / year
HRD JAHSR 2005 Ahievement & PlanHRD JAHSR 2007 Achievement &
Plan
9
HRD JAHSR 2005 Ahievement & PlanHRD JAHSR 2007 Achievement &
Plan
10
Priorities 2007-2008 cont.
Priorities 2007-2008 cont.
• Recruitment:
– Strengthen HR Database and incorporating of
CPA guidelines for staff management
– Promotion the use of HR Database for
employment and training decision
– Recruit all applied midwife graduates
(Secondary and Primary ) and allocate to the
post where midwives are needed
• Enhancement quality of training:
– Develop standards on training for health as
annexes of Sub Decree
– Implementation of Quality Assurance Program
(QAP) for internal MoH evaluation on quality
of training
HRD JAHSR 2005 Ahievement & PlanHRD JAHSR 2007 Achievement &
Plan
11
HRD JAHSR 2005 Ahievement & PlanHRD JAHSR 2007 Achievement &
Plan
12
2

Management and control of
private clinics
2006
Dr. Sann Sary
Director, Hospital Department
JAPR2007
2500
2000
1500
1000
500
0
1-cMnYnbnÞb;BieRKaHBüa)alCMgW-extþ>Rkug
Cabinet of consultation at provincial and municipality
2114
1815
1092
1022
888
927
Total No License License
2005 2006
1
2
700
600
500
400
2-cMnYnbnÞb;BieRKaHBüa)alCMgWmat;eFμjextþ>Rkug
576
465
461
382
25
20
15
18
3-cMnYnmnÞIrBhuBüa)alextþ>Rkug
22
14
19
300
10
200
100
83
115
5
4
3
0
Total No License License
0
Total No License License
2005 2006
2005 2006
3
Polyclinics at provincial and municipality
4
90
80
70
60
50
40
30
20
10
0
4-cMnYnmnÞIrsMrakBüa)alextþ>Rkug
85
77
49
42 43
28
Total No License License
14
12
10
8
6
4
2
0
5-cMnYnmnÞIrsmÖBextþ>Rkug
13
12
8
7
6
4
Total No License License
2005 2006
2005 2006
5
6
1

6-cMnYnmnÞIrBüa)almat;>eFμjextþ>Rkug
7-cMnYnmnÞIrBiesaFn_extþ>Rkug
25
20
21
18
80
70
60
62
75
57
55
15
10
5
0
12
7
5
3
Total No License License
50
40
30
20
10
0
20
5
Total No License License
2005 2006
2005 2006
7
8
2

Gender in Health Sector
by: Ms. Chin Cheav
Vice Chairwoman of the
Gender Mainstreaming Action Group (GMAG) of the MoH.
National Health Congress and Joint Annual Performance
Review
05 – 07 March 2007
Background of GMAG
• The MoH established the GMAG on 11
March 2005 and reassigned on 13
January 2006.
• It was established to promote gender
equity in health sector including equity
between female and male health staff and
promoting gender responsive health
services.
1
2
Roles of the GMAG
• Coordinate, cooperate and advocate to
promote gender equity in the health sector
• Provide knowledge about gender to health
personnel at all levels
• Participate in promoting qualified female
health staff to decision making positions.
Roles of the GMAG (Con't)
• Participate in developing and providing
recommendations on AoPs in order to
ensure it responds to gender needs
• Monitor, evaluate and provide
recommendations on health activities to
ensure they are gender responsive
3
4
Key Issues
• Gender is not yet systematically mainstreamed into
all policies, plans or programs
• Limited gender concepts among health personnel
• The GMAG has limited resources –both financial
and non financial - to mainstream gender
• Lack of technical support on institutional
arrangement and capacity building of the GMAG
Achievement
• Provide training on gender mainstreaming to
344 health personnel
• Advocate for qualified female health
personnel to obtain appropriate posts
• Develop and disseminate the MoH's Five
Year Gender Strategic Plan
5
6
1

Key Strategies
• Increase the knowledge of gender equity at all
levels of the health sector
• Ensure that both the formulation and
implementation of the AoPs are gender responsive
• Increase the knowledge, skills, capacity of the
female health staff through increased participation
in training
Key Strategies (con't)
• Provide opportunity, encouragement and
enabling environment for the female health
staff to hold decision – making posts
• Sensitize and support all programs and
activities of the MoH to ensure that every
program and activity is gender responsive
7
8
Challenges
• The GMAG has not been well recognized
due to the fact that gender seems "new
word" to health personnel
• Members have limited time due to their own
core work at their respective departments
and programmes
• Limited capacity of some members
• Limited financial support
Recommendations
• Consideration of gender issues and involvement of
GMAG in the development of the health sector
strategic plan 2008 – 2010
• Inclusion of gender equity and activities into
institution's strategies, policies, AoPs and
integration of gender issues/activities into the
MoH's reports
• Capacity building of the GMAG members
• Gender sensitization for health personnel
• Technical and financial support
9
10
THANK YOU
11
2

karRKb;RKgesvakmμ»sfÉkCn
nigskmμPaBlb;bM)at;»sfEkøgkøay
bgðajeday elakRsI sa®sþacarü Ta KWm qay
Pharmaceutical Management on Private Services
and
Actions taken to eliminate counterfeit drugs
presented by Professor Tea kim chhay
05-07 March 2007
Contents
1. Objective of National Drug Policy of MOH.
2. Legislation and Regulation Related Counterfeit
Drugs.
3. Statistic of pharmaceutical premises
4. Sort of Drugs need to pay attention.
5. Focus Points need to control.
6. Actions Undertaken to Eliminate Counterfeit Drugs.
7. Prosecutions to the Court.
8. Counterfeit Drugs Detected in year 2005-2006.
9. Pictures of Counterfeit Drug Detected.
10. Conclusion.

eKaledAéneKalneya)ayCatiGMBI»sf
Objective of National Drug Policy
• Fana)annUvKuNPaB RbsiT§PaB nigsuvtßiPaB»sf nigtMélsmRsb
To ensure the availability of drugs which are safe,
effective and good quality to the population at an
affordable price compatible with national resources.
• FanakarpÁt;pÁg;»sfeGaydl;édRbCaCn nig ENnaMkareRbIR)as;
»sfsmRsb
To rationalize the supply and use of drugs throughout the
country.
Legislation and Regulation related to the
Elimination of Counterfeit Drugs
1. Law on the Management of Medicines Promulgated
by code No. 0696/02 dated 17 June 1996
(Trafficking of Counterfeit drugs shall be subject to a
fine of 20.000.000 Riels to 50.000.000 Riels or/and
an imprisonment from 5 years to 10 years.)
(c,ab;sþIBIkarRKb;RKg»sf 17mifuna1996)
2. Sub Decree No 44 dated 10 August 1994 on Drug
Registration. (GnuRkwtüsþIBITidæakar-bBa¢ika»sf 10 sIha 1994)

Legislation and Regulation related to the
Elimination of Counterfeit Drugs
3. Government Decision No. 33 dated 29-08-06 on the creation of Interministerial
Committee and Provincial Committees to eliminate counterfeit
drugs and illegal Health services.
(esckþIsMercrbs;raCrdæaPi)alsþIBIkarbegáItKN³kmμakarGnþrRksYg nigextþRkug
edIm,IlubbM)at;»sfEkøgkøay nigesvasuxaPi)alxusc,ab;)
4. Administration Order of MOH No. 616 dated 01-08-03 on the prohibition of
selling of Counterfeit Drugs.
(saracrsþIBIkarhamlk;»sfEkøgkøay)
5. Administration Order of MOH No. 252 dated 15-03-05 on the sticking of
vignette on the Pharmaceutical box.
(saracrsþIBIkarbiTltb½RtelIRbGb;»sf)
6. Ministerial Letter to Drug Facilities related to Orphan Drugs No 1186 date
03.11.2006
(esckþICUndMNwgsþIBI»sfkMr elx 1186 cuHéfTI 03>11>06)
Statistic of Pharmaceutical Premises
Drug Manufacturers……………… 7
Syringe packaging plants………..2
Drug Import-distributors…….138
Drug Importer subsidiaries……..8
Drug commercial presents………7
Pharmacy wholesalers…………50
Pharmacy Retailers……………..710
- Phnom Penh 286
- Provinces 424
Depot of Pharmacies……………808
- Phnom Penh A=69, B=110
- Provinces A=149, B=480
Illegal Drug Stores……………..1619
- Phnom Penh 103
- Provinces 1516

Sort of Drugs need to pay attention
• Smuggled medicines. (»sfrt;Bn§)
• Unregistered medicines. (»sfmincuHbBa¢ika)
• Mislabeled
medicines.(»sfKμanpøaksBaØac,as;las;)
• Suspected medicines (source, identity,
printing, packaging… ). (»sfKμanRbPBc,as;las;)
• Plastic bag medicines. (»sfKμankarevcx©b;RtwmRtUv)
Focus points need to control
• International entry points. (RckcUlGnþrCati)
• Provincial border entry points. (RckcUlRBuMEdn)
• Illegal entry points. (Rckrebog)
• Distributors of medicines (importers, wholesalers
manufacturers, smugglers, traffickers …)
(GñkEckcay»sf ¬GñknaMcUl> Gñklk;duM> Gñkplit> Gñkrt;Bn§¦)
• Retailers of medicines (pharmacies, depot of pharmacy A and
B, unlicensed drug stores).
(Gñklk;ray ¬»sfsßan> »sfsßanrg> pÞHlk;»sfKμanc,ab;¦)
• Health provider (cabinet of consultation, private clinic (legal and
illegal). (Gñkpþl;esvasuxaPi)al ¬bnÞb;BieRKaHCmW> KøInikmanc,ab;¼Kμanc,ab;)

Actions taken to eliminate counterfeit drugs
• -To create Inter ministerial committee and provincial Committees to eliminate
Counterfeit drugs according to the government Decision No 33.
(begáItKN³kmμakarGnþrRksYg nigextþRkug edIm,Ilb;bM)at;»sfEkøgkøay>>> eyagesckþI
sMercelx 33rbs;raCrdæaPi)al)
• -To seize or confiscate illegal import medicines, suspicious medicines,
unregistered medicines, mislabeled medicines, plastic bags medicines
smuggling across borders.
• (Xat;Tuk»sfnaMcUlxusc,ab;> »sfsgS½y> »sfKμancuHbBa¢ika> »sfEkøgbnøM> »sfKμan
pøaksBaØa Edlrt;Bn§tamRBuMEdn )
• -To organize workshops to increase counterfeit medicines awareness,
improve professional Ethic and law enforcement.
(erobcMsikçasalaedIm,IelIkkMBs;karyl;dwgBI»sfEkøgkøay> elIkkMBs;mnsikaviC¢aCIv³
nigkarGnuvtþc,ab; )
Actions taken to eliminate counterfeit drugs
• To conduct ordinary and extraordinary inspections according
to the agenda. (cuHRtYtBinitüRKwHsßan»sftamkmμviFI )
• To collect suspicious medicines samples for testing.
(RbmUlTij»sfsgS½ymkeFVIkarviPaKKuNPaB)
• To Control transportation cars to assure that all drugs are borne
of vignette indicating the name of distributor and Cambodian
registration number (CAM…).
(RtYtBinitürfynþEdldwk»sfeTAEckcaytamextþ )
• To confiscate and file to the Court in severe infractions.
(Xat;Tuk nigksagsMNuMerOgbBa¢ÚneTAtulakarkñúgkrNIbTelμIsFn;Fr )
• To punish the violators according to the prescribed penalty.
(pþnÞaeTascMeBaHGkñRbRBwtþbTelμIstameTasbBaØatþi )

Actions taken to eliminate counterfeit
medicines
• To develop and distribute counterfeit drug alert information, posters or brochures to
increase public awareness especially drug retailers.
(erobcMesovePA»sfEkøgkøay nigEckcaydl;RKb;»sfsßan »sfsßanrg)
• To exchange counterfeit drug information with ASEAN FDA and WHO regional office
to investigate counterfeit drugs.
(pøas;bþÚrB_tmanCamYyGaC£aFr FDAnigGgÁkarsuxPaBBiPBelakedIm,IRsavRCavrk»sfEkøgkøay)
• To set up agenda for meeting of the inter-ministerial counterfeit drugs committee and
provincial committee to evaluate the implementation, achievement, constrains and
report to the government.
(erobcMkmμviFIRbCMuKN³kmμakarGnþrRksYg nigextþRkúgedIm,IvaytMél)
• To provide adequate and sufficient financing support for testing, preparing of posters
and the functioning of inter-ministerial committee and provincial committee.
(pþl;fvikarRKb;RKan;kñúgkarviPaK karerobcMesovePA(b½NÐrUbPaB) nigkarRbRBwtþeTArbs;KN³kmμakar)
Prosecution
• 28 infractions cases have been filed to the Court in
year 1995. (12 out off 28 infractions cases have been
judged ).
(28krNIRtUv)anbB¢ÚaneTAtulakarkñúgqñaM1995 (12kñúg28krNIRtUv)anCMnMCMrH)
• 5 infractions cases have been filed to the Court in year
2000. ( 2 out off 5 infractions cases have been judged)
(5krNIbTelIμsRtUv)anbB¢ÚaneTAtulakarkñúgqñaM2000(2krNIRtUv)anCMnMCMrH)

Counterfeit drugs detected in year 2005-
2006
• 8 counterfeit drugs detected by DDF based on
visual inspection and information from
manufacturers of origin.
( »sfEkøgkøaycMnYn8muxRtUv)anrkeXIjedaynaykdæan»sf )
• 9 counterfeit drugs detected by TLC and
Laboratory testing.
(»sfEkøgkøaycMnYn9muxRtUv)anrkeXIjedaykarviPaKKuNPaB )
Picture of counterfeit drugs detected
in year 2005-2006
• Counterfeit drug
• Genuine drug

Picture of counterfeit drugs
detected in year 2005-2006
• Genuine drug
• Counterfeit drug
Picture of counterfeit drugs detected in
year 2005-2006
Genuine drug
Counterfeit drug

Picture of counterfeit drugs detected
in year 2005-2006
• Genuine drug
• Counterfeit drug
Picture of counterfeit drugs detected
in year 2005-2006
• Genuine drug
• Counterfeit drug

Picture of counterfeit drugs detected in
year 2005-2006
• Genuine drug
• Counterfeit drug
Picture of counterfeit drugs detected
in year 2005-2006
• Genuine drug
• Counterfeit drug

»sfEkøgkøay Counterfeit Drugs
»sfEkøgkøay Counterfeit Drugs

snñidæan
• Effectiveness of the elimination of counterfeit medicines depend on
edIm,IeGaymanRbsiT§PaBkñúgkarlb;bM)at;»sfEkøgkøay H
1- the existing of adequate and sufficient Legislation Regulation.
RtUvBRgwgc,ab; nigbTbBaØtiepSg²
2- the conducting of inspections according to the agenda
RtUvcuHRtYtBinitü nigtamdantamkmμviFIEdl)aneRKagTuk
3- the punishment according to the prescribed penalty.
RtUvpþnÞaeTascMeBaHCnNaEdlRbRBwtþelμIsnigc,ab;
4- high Responsibility and Professional ethic of drug manufacturers,
importers, wholesalers, retailer and health providers.
RtUvmankarTTYlxusRtUvx

Report of Comprehensive
Midwifery Review
in Cambodia
Presented by Prof Koum Kanal
at the
28 th National Health Congress
and
5 th Joint Annual Performance Review
5-7 March 2007
1
Presentation outline
• Background
• Midwifery in Cambodia
• Results: Coverage, Competency -
Motivation of Midwives, Training (Preservice
and In-service), Retaining
midwives and Attractiveness of midwifery
as a Profession
• Recommendations
2
1

Background (1)
• Cambodia has made remarkable progress over
the last decade, although the health sector still
faces persistent challenges.
• The `Comprehensive Review of Midwifery’ in
Cambodia is being conducted at the request of
the Ministry of Health of the Kingdom of
Cambodia (MoH). Funding support has been
provided by UNFPA. In addition, the results will
be submitted, as one of the components of the
Mid Term Review (MTR) of the Health Sector
Strategic Plan, 2003-07 (HSP), and the Health
Sector Support Project, 2003-07 (HSSP).
3
Background (2)
Key indicators
2000
(CDHS)
2004
(HIS)
2005
MMR (/100000 lbs)
437
472
U5 MR (/1000 lbs)
124
83
% of PW who are
anemic
57.8
47
% of ANC
37.7
69
4
2

Background (3)
Key indicators
2000
(CDHS)
2004
(HIS)
2005
% of PW received
Tetanus toxoid
44.8
51
76.6
% of delivery attended
by THPs
31.8
33
44
% of delivery at health
facilities
10
16.4
22
5
Background (4)
• The `Review Team` appointed by MoH
commenced work 4th July 2006 by drafting a
detailed work plan. Implementation of the plan
started immediately following approval of the work
plan by the Technical Working Group Health
(TWG-Health) 11th July 2006.
• The Review covered 4 specific but interlocking
areas:
– Coverage and Competency (Functional Assessment of
Midwives in post)
– Training (Pre-service, In-service)
– Recruitment, Deployment and Retention; (especially in
rural areas) and Incentives
– Attractiveness of the Profession
6
3

Midwifery in Cambodia (1)
• Midwifery training was reintroduced across the
country in the early 1980’s. This followed the
decimation of the health workforce during the
Khmer Rouge period.
• In the early period of reintroduction of midwifery
training, there were two basic training
programmes. One programme delivered
qualifications to become a primary level midwife,
the other a secondary level midwife.
7
Midwifery in Cambodia (2)
• In 1996, both the primary and secondary midwifery
courses were stopped and the new post-basic
midwifery programme was eventually introduced in
2002. The new post basic-nursing midwifery
curriculum is one year, following three-years
preparation as a nurse, therefore making total
length of training four years in duration. This
programme, commonly known as the 3+1
programme, saw the first midwifery graduates
enter into service in 2003. Graduates exiting from
this programme obtain a Diploma in Midwifery and
may enter the civil service against the post of
Secondary Midwife (SMW).
8
4

Midwifery in Cambodia (3)
• In 2003, the Ministry of Health also introduced a
1-year Primary Nurse-Midwifery programme
specifically for use in the North-East Region.
This programme was designed to address the
severe shortage of midwives in the North-East,
and a lower entry requirement (completed grade
7 schooling) was adopted to ensure that local
women who were willing to live and work in that
region were eligible for some elementary training
in nursing and midwifery. Graduates from this
programme may enter into civil service against
the post of a Primary Midwife (PMW).
9
Midwifery in Cambodia (4)
• In 2005, The Ministry of Health decided to expand
this one-year programme nationwide and revised
the curriculum. Successful graduates following the
midwifery field of study, will get a Diploma in
Primary Midwifery, and will be eligible to enter Civil
Service against the post of Primary Midwife.
• In 2004/2005, one private sector post-basic (1
year after nursing) midwifery training programme
was initiated at the International University (IU) in
Phnom Penh. The University intends to produce
20 graduates per year and use the national 1-year
post-basic curriculum. The first batch of graduates
is expected in 2006.
10
5

Midwifery in Cambodia (5)
• IU also is planning to start a four-year midwifery
course (Bachelor in Midwifery) for none nurse
entrants, to commence later in 2006.
• Despite all of the above training programmes,
there remains a growing shortage of midwives,
particularly in rural and remote areas. There is a
very low level of applicants to the Post-basic
(3+1) Midwifery programme, and the
attractiveness of midwifery as a profession is
considered to be decreasing due to low civil
service status, low salaries, limited interest of
young people to live and work in rural/remote
areas, and fear of health risks, especially
HIV/AIDs.
11
Results: Coverage (1)
• It is clear that midwives in Cambodia are
working in many different sectors throughout the
country, including in the private sector and for
NGOs. Estimates suggest approaching 4,000
midwives reside in the country. Give that number
of these are retired and that some 2,626 are
working in the public sector, it is obvious that the
majority of them are employed in the health
sector, mainly in public service.
12
6

Results: Coverage (2)
No of MWs working in Public services at different levels
PHD
OD
RH
HC
HP
PM
31
16
%
23
17
%
150
22
%
817
51
%
18
95
%
SM
158
84
%
115
83
%
533
78
%
780
49
%
1
5%
Total
189
100
%
138
100
%
683
100
%
159
7
100
%
19
100
%
13
Results: Coverage (3)
• According to the MoH standard, as used by Personnel Department,
a HC should have 3 midwives – 2 primary and 1 secondary – and a
FDH should also have 3 midwives, 1 primary and 2 secondary.
Chart 3.1 Comparison of Midwives' Site of Work (n=2,626)
1%
7% 5%
61%
26%
PHD
OD
RH
HC
HP
14
7

Results: Coverage (4)
Of the 936 HCs (including
FDHs):
•164 (18%) have no midwife
•362 (39%) of HCs have only 1
midwife
•226 (24%) have 2 midwives
•97 (10% ) have 3 midwives,
•87 (9%) have more than 3
midwives (ranging from 4 to 19)
•463 (50%) of HCs did not have a
secondary midwife, (included
within this are the 18% of HCs that
have no midwife)
Chart 3.2a. Midwife Coverage at HCs
(n=936)
10%
24%
9% 18%
HC with no
MW
HC with 1 MW
39%
HCs with and with no Secondary Midwives (n=936)
35%
15%
50%
HC with 2
MWs
HC with 3
MWs
HC with more
than 3 MWs
HCs with no SM
HCs with one SM
HCs with more than 1 SM
15
Results: Coverage (5)
• A comparison of the actual number of midwives currently
working at HCs and RHs with the MoH standard, shows
that there is a need for an additional 808 PMWs and 534
SMWs in order to cover all the current HCs and three
levels of RH throughout the country according to the
national standard.
Chart 3.3 Comparison of MoH Standard and Actual Numbers
of Midwives for HCs and RHs
2000
1775
1847
1500
1000
967
1313
MoH Standard
500
Actual
0
PMW
SMW
16
8

Results: Coverage (6)
• Almost 30 percent of midwives currently on MoH payroll
may be expected to reach the age of retirement in the next
five years. There is a large gap in terms of number of
midwives under 30 years of age. MoH may like to consider
ways in which it can recruit more women between the ages
of 23 to 30 into the service, to give a better age balance and
not create problems in later years.
1000
Chart 3.4 Age Range M idw ives
900
800
Numbers
700
600
500
400
300
200
Prim ary
Mw s
Secondary
Mw s
100
0
50+ 45-49 40-44 30-39

Results: Coverage (8)
• To increase coverage there is need to increase the
average number of births undertaken by each midwife,
as well as get many more midwives into practice.
• Innovative efforts will be required to recruit some of the
midwives who will be due to retire back into service
under casual labour contracts and re-deploy some
midwives, especially those currently working in nonmidwifery
areas.
• In addition, MoH may like to look at other ways of
increasing productions, possibly by approving more
training places, especially at TSMC.
• To increase the number of births that take place in a HC
however will require more than just having a health care
provider present. Attention is needed to address what is
referred to as “the enabling environment”.
19
Results: Coverage (9)
• HCs need to be able to offer services 24/7, or
women will simply not use them for birth. Referral
systems need to be in place and operational,
because if women and or babies with complication
cannot be transferred quickly there is a risk that
deaths may ensue, (either in the HC or on way to
RH). If this occurs, communities will lose confidence
in the HC and in the staff that work there.
• Equally, the same will happen if the midwives do not
possess the skills to offer, not just good womenfriendly
care, but are technically competent to
recognise early signs of compilations and able to
take action to stabilize the women or baby and
make an effective referral.
20
10

Results: Coverage (10)
• The evidence from the Functional assessment however
shows that not all midwives functioning in HCs have
these technical skills and, not all offer women-friendly
care.
• Efforts to increased coverage of births by a trained
provider – a midwife, must include strengthening the
“enabling environment” and increasing the competencies
of the current midwives, so that more women will use
midwives in HC.
• Studies from many parts of the world show there is a
direct positive correlation between births by a formally
trained (skilled) healthcare provider and ANC. The same
has been found in Cambodia. Efforts should therefore
be strengthened to increase ANC coverage, in particular
in HCs.
21
Results: Competency (1)
• Three tools for the functional assessment were
developed:
– Self-assessment of clinical competencies (tool 1)
– Knowledge assessment (tool 2)
– Observed assessment of clinical skills (tool 4)
• 185 Midwives, both PMWs and SMWs, were
assessed with tool 1 in RHs and HCs in five
randomly selected ODs (Oudong, Preah Sdach,
Sampeou Loun, Preah Net Preah, Angkor
Chum, Stong) and in Rattanakiri, Kratie and later
in Phnom Penh and sub-sample of 58 midwives
was further assessed using tools 2 and 4.
22
11

Results: Competency (2)
Traditional competencies:
• Taking an antenatal history
(ANC)
• Identifying second stage (id 2nd
stg)
• Managing second stage (mg 2 nd
stg)
• Managing a normal birth (mg nl
del)
• Assessing Apgar scores
(APGARS)
• Assisting with immediate
breastfeeding (ast brfdg )
New competencies:
• Completing a partograph
• Performing active management
of third stage (AMTS)
• Manually removing a placenta
(man remov)
• Diagnosing and treating a
newborn infection (nb infect)
• Diagnosing and treating
postpartum sepsis (Pp sepsis)
• Recognizing eclampsia (rec ecl)
• Managing eclampsia (mg ecl)
• Resuscitating a newborn (nb
resusc)
23
Results: Competency (3)
Chart 4.1. MWs' self reported confidence in
selected competencies n=185
120
100
Percentage of midwives
80
60
40
20
not confident
confident
0
A NC id 2nd stg mg 2nd stg mg nl del A PGARS ast brfdg
Traditional clinical competencies
24
12

Results: Competency (4)
Chart 4.2. MW's self reported confidence in selected
clinical competencies n=185
Percentage of midwives
120
100
80
60
40
20
not
Confident
t
0
partograph
h
A MTS
man
removal
Placenta
Newborn
infect
Pp
rec
mg
Newborn
Resuscitation
"New" clinical competencies
25
Results: Competency (5)
Chart 4.3. Comparison across cadre of MWs' self-reported
"feel confident" in selected competencies n=167
Percentage of midwives
100
90
80
70
60
50
40
30
20
10
0
86
78
ANC
h
59
83
47
72
69
86
47
78
id 2nd stage mg 2nd stage mg n.
labour
APGAR
Traditional clinical competencies
81
91
Asst BF
1mw
2mw
26
13

Results: Competency (5)
Chart 4.4. Comparison across cadre of MWs' self-reported
confident" in selected competencies (n=167"feel confident”)
Percentage of midwives
80
70
60
50
40
30
20
10
0
29
61 6062
partograph ATMS
38
53
man remov
Placenta
41
23 23
Newborn Pp
Infect. sepsis
50
43
76
13
27
23
42
Rec ecl mg ecl Newborn
Resus
1mw
2mw 93
"New" clinical competencies
27
Results: Competency (6)
• The average age and
years of experience were
similar in the two groups.
Secondary midwives
reported attending more
births, which is not
surprising since many of
them work at hospitals.
Primary midwives, many
of whom had less formal
education and midwifery
education, reported
attending more days of inservice
training.
Chart 4.9. Reported births by individual midwives in
last 12 months
31%
14%
9%
9%
37%
0 births (n=5)
1-19 births (n=5)
20-49 births (n=22)
50-99 births (n=18)
100 births (n=8)
28
14

Results: Competency (7)
• It appears that there is wide variation in the content of the
continuing education courses held in peripheral sites, and it
was difficult to assess their effect. Numbers were too small
to look at the effect of any of the other competencies in
these short in-service courses. For this reason we
compared competencies of midwives who attended inservice
courses with standardized curricula, the Life Saving
Skills (LSS) trainings and/or greater than 1 month
midwifery update courses at TSMC, RTCs or NMCHC. The
greatest increases in competency in infection prevention,
active management of third stage and bimanual
compression appeared to occur in midwives attending
LSS, while the greatest improvement in competency in
newborn resuscitation appeared to occur in midwives
attending other > 1 month midwifery update courses at
NMCHC or regional training schools. Current competency
levels of those assessed, however, are below 70 percent in
all clinical skills.
29
Results: Competency (8)
• PMWs appear to be as competent as SMW in terms of
traditional competencies, but less so in terms of the “new
competencies”. Given that it is the “new competencies” have
a direct impact on reductions of maternal and newborn
death and morbidity, and that many HCs are operating with
one a PMW, this finding is of concern.
• Every effort should be made to increase the levels of
competence and confidence of all midwives, but particularly
the PMWs working in HCs, where births are taking place.
Greater attention needs to be given to supportive
supervision by technically skilled supervisors. A system
should be established whereby all midwives, in particular
those working where there is no medical doctor, should
have their competence assessed locally and action taken to
address areas of weakness. This should be an urgent
priority.
30
15

Results: Competency (9)
• The large number of days of in-serve train
undertaken by all midwives does not appear to
have a significant impact on the overall level of
competence of midwives, although the longer
trainings (4 weeks or more duration) do appear to
be associated with a higher level of competence.
Given these findings a review of all ins-service
trainings should be considered to make them
more effective and to ensure that short trainings
build and support one another.
31
Results: Competency (10) -
Motivation of midwives
• Most midwives’ responses indicated recognition that
pregnancy can be dangerous and a desire to help
women through a potentially dangerous period in
their lives. Many mentioned a desire to help lower
maternal and infant mortality. Others mentioned a
desire to care for and serve people including their
family, their village/community, poor people and
people in remote, underserved areas.
• Many midwives from health centres cited a lack of
professional care in their village as being a primary
motivator. In addition, the desire to have a means
of earning a living, advice, and encouragement from
family was frequently mentioned as motivators.
32
16

Results: Competency (11) -
Motivation of midwives
• Interestingly over half of the sub-sample said they did not
want to change from their current site of work in either 1 or 5
years. Almost twice the number of primary than secondary
midwives desired no change.
• Those who did not want to change mentioned the fact that
they lived near their family, or that they were nearing
retirement as the primary factor in their desire to continue
where they were working.
• Those desiring a change cited the following factors
influencing their wish to move: retirement, to be closer to
their family (including parents, children and/or spouse), work
for an NGO, work in a village without a midwife
• Of those desiring a change (apart from retirement),
increased salary, opportunity for clinical upgrading,
adequate equipment and opportunity to work with more
experienced clinicians would make them want to continue in
their current posting.
33
Results: Pre-service Training (1)
Criteria
International
standard
1-Year Post basic
nursing (3+1)
1-Year Primary
Nurse-Midwife
Length of program
Ratio theory:
practice
18 months
minimum, (average
of 72 weeks at 35
hrs/week, excl.
vacation
40% : 60%
1,370 hrs (at 35
hrs/week = 39
weeks)
54% : 46%
Midwifery content
incl. IMCI = 435 hrs
(at 35 hrs/week =
12.5 weeks)
44% : 56%
Curriculum model
Competency based,
up-to-date evidence
underpinning
practice, with
foundation in Public
health
Theory and practice
not integrated.
References used
out of date.
Includes some
Public health
Theory and practice
not integrated.
References used
out of date. Has little
Public health
34
17

Results: Pre-service Training (2)
Criteria
International
standard
1-Year Post basic
nursing (3+1)
1-Year Primary Nurse-
Midwife
Minimum no
of births
Clinical
experience
20 (ideal 40 +)
Hands on practice
in real setting
supervised by
clinical experts
prepared for their
role as mentor
16-20
Hand on mainly in
term 3.
Preparation of clinical
mentors not yet in
place
Document calls for only 6
(1 st admission only just
commenced outside NW,
and only just
commencing midwifery
component at time of the
review, so it is hard to
say what average
number of births will be)
Hands on in term 3 only.
Preparation of clinical
mentors not yet in place
35
Results: Pre-service Training (3)
Criteria
International
standard
1-Year Post basic
nursing (3+1)
1-Year Primary
Nurse-Midwife
Competencies
Must include all
essential Core
competencies of a
midwife
Some modern/"new
competencies "
missing
Some modern
competencies missing
and time for
development of
competencies is
insufficient, especially
for "new
competencies"
Midwifery
Model
Partnership with
women, follows
International Code
of Ethics for
Midwives
Lack of inputs and
emphasis on
women's rights,
choice and
interpersonal skills
Lack of inputs and
emphasis on women's
rights, choice and
interpersonal skills
36
18

Results: Pre-service Training (4)
The 1-Year Primary Nurse-midwife curriculum:
• There is need to increase the amount of midwifery hours and
content and increase the time for clinical hands-on experience, by
reducing the number of hours for unnecessary nursing procedures.
• Midwifery content (both theory and practice) should be spread
throughout the full duration of the programme and not confined only
to term 3, to avoid overloading clinical areas in Term 3 due to the
overlap with the 1-year Post basic-nursing (3+1) midwifery students.
• Having a more flexible allocation, one where smaller groups of
students can rotate through clinical areas, ideally more than once
(so they can follow the principles of adult learning and have
opportunity for repeated reflective practice) would be highly
beneficial.
• A career plan needs to be devised for PMWs that will allow them to
progress and develop the full competencies of a midwife and be
able to upgrade to secondary midwife
37
Results: Pre-service Training (5)
The 1-Year Post basic Nursing (3+1) midwifery
curriculum:
• Need some modifications.
• Evaluate clinical competencies of graduates and consider if
the clinical allocation could not be more integrated
throughout the duration of the course and if experience of
normal births could be include much earlier in the program
than it is at present.
• More focus is required on the skills that will save lives,
especially care of newborns, newborn resuscitation and on
interpersonal skill development- to foster a more womanfriendly
approach to service delivery
38
19

Results: Pre-service Training (6)
Standard for Midwife teachers:
• 50% of midwife teachers seen had clinical "experience"
• No midwife teacher seen appears to have undertaken
any advanced midwifery study
• One third of midwife teachers appear to have undertaken
adequate education preparation, although 12 out of the
21 had undertaken the short Training of Trainers based
at TSMC
• Only one third midwife teachers seen had received LSS
training
• The media age of all midwife teachers seen was 45
years, the youngest being 32 years of age, the eldest 56
years of age.
39
Results: Pre-service Training (7)
Midwifery training institutions:
• Inadequate Midwifery textbooks, models/ manikins,
training dolls, equipment to practice resuscitation of
newborn, equipment for LSS
• 1 of the 4 RTCs had no "proper" (functioning) clinical
skills/practice room
Student accommodation:
• Insufficient rooms for students, no room for preparing
food
General environment:
• Running water was a major problem in all RTCs except
TSMC, bathrooms in most RTCs were inadequate
40
20

Results: Pre-service Training (8)
Educational process:
• Educational process were not very student-centered, did
not support problem-based learning, critical thinking and
decision making
• None had adequate QI mechanism - none had formal
mechanism for monitoring progress of students that
included clinical staff
Clinical practice:
• Most RTCs had inadequate clinical sites, both in terms of
number of sites and quality of sites for clinical practice
• No RTCs had a formal mechanism for preparing clinical
sites for students prior placement or for involving clinical
staff in the assessment of students' progress
• Clinical facilities were not interested in students
• Teachers form RTCs did not come to work with their
students
41
Results: Pre-service Training (9)
Competencies in new graduates: the overall
competency is uniformly well below other midwives
assessed, questions must be asked concerning if current
graduates are exiting from programmes with the full
compliment of essential core competencies
Chart 5.1. Comparison of competency in selected
skills: New graduates/All midwives
60
53.4
% of MWs observed to be competent
50
40
30
20
10
0
41.4
25.9
22
22 22
8.6
0
infect prev inf resus bimanual active mgmt
selected skills
all MW (n= 58)
new (n= 9)
42
21

Results: In-service Training (1)
Life saving skill Program:
• The external evaluators point out, has serious
consequences for maintenance of quality.
• Lack of content on newborn resuscitation. RACHA have
already requested the assistance of American College of
Nurse-Midwives (ACNM), the originators of the LLS
course, to incorporate the 2-day training on newborn
resuscitation into a revised LSS course.
• Lack of clarity on standards that can be and should be
used to monitor and improve quality of care, as well as
monitor compliance with and effectiveness of protocols.
43
Results: In-service Training (2)
The 6 weeks CPA midwifery course and the HC
midwifery course at NMCHC:
• JICA felt that much progress has taken place in the 6 weeks
CPA midwifery course in terms of updating the skills of
trainers for these programmes, as evidenced by the wider
use of more modern teaching and learning methods.
• The details of the midwifery course for HC appears this
course is more of a general midwifery refresher course.
• NMCHC have difficulties in follow-up of trainees due to lack
of finances. Consideration should be given to other options
for refreshing and or topping-up the skills of midwives
working in HCs, possibly using a on-the-job assessment of
their skills by clinically competent supervisor with hands on
experience, NMCHC could then be responsible for training
the supervisors, which, due to the lesser numbers, would be
more feasible.
44
22

Results: In-service Training (3)
4 month midwifery course for Primary nurses
working at a HC where there is no midwife
posted:
• As the 4 month course utilizes the same teachers,
facilities and learning resources as for Pre-service
midwifery, this was not considered a major problem.
• As the number of HCs with no midwife reduces, so will
the necessity for this programme. However, MoH may
wish to consider using this course as a route for primary
nurses who wish career advancement to be able to train
as a primary midwife, then later as a secondary midwife,
as the duration of 4 months is currently longer than the
midwifery component of the 1-year Primary Nursemidwife
programme.
45
Results: In-service Training (4)
• There is great need for better coordination of Inservice
training programmes, especially the very
short courses.
• There is great need for a total Quality Assurance
and Improve mechanism that supports, not just
monitoring of these trainings, but follow up of all
trainings and improvements, based on trainee
feedback and on measurable impact.
• There is a need for more clarity about national
standards of midwifery.
46
23

Results: Retaining midwives(1)
• It is clear that MoH currently absorbs a large
proportion of the total estimated numbers of
trained midwives in the country. However, many
midwives leave public services to take up a
position in the private and NGO sectors.
47
Chart 6.1 Prefered Place of Work on Completion of Preservice
Midw ifery (all students n=167)
Ot her - incl NGOs
33% HCs
49%
4%
RTC
12%
RH
2%
Private
48
24

Results: Retaining midwives (2)
• Responses for why current Midwives wanted to
become a midwife include
– Recognition that pregnancy can be
dangerous; desire to help pregnant women;
desire to lower maternal and infant mortality
– Desire to serve/care for people (their family,
their village, poor people, people in remote
areas)
– Lack of professional care in their village
– Desire to earn a living
– Family encouragement/advice
49
Results: Retaining midwives (3)
• The most frequently mentioned factors that
would keep already qualified midwives in their
post included
– More salary;
– Opportunity for upgrading;
– Opportunity for learning new knowledge and
skills;
– Adequate equipment, and
– Opportunity to work with more experienced
midwives
50
25

Results: Attractiveness of midwifery as
a profession (1)
• During the High-Level Midwifery Forum held in
December 2005, a number of references were
made to the decrease in popularity to train as a
midwife. It appears that in 2004/5 there was a
problem recruiting an adequate number of students
onto midwifery programmes. RTC Directors report
that for 2006, numbers of students enrolled onto all
midwifery programmes has dramatically increased.
They were unable to explain why there had been
an increase in numbers, but suggested the
publicity from the High-level Forum and the
promise of better pay and incentives may have
51
contributed to this.
Results: Attractiveness of midwifery as
a profession (2)
• The MoEY&S were willing to discuss with MOH
possibility of promoting attended births in their
schools health programme, this would be an
informal way of both encouraging future parents
to seek professional care, but also give higher
profile to the work of a midwife.
• Without exception midwives showed a high
regard for their chosen profession. Reasons
given for both becoming a midwife and staying
in the profession were mainly to do with
assisting women and helping to save lives.
Midwives clearly valued the support from the
government and especially from MoH.
52
26

Results: Attractiveness of midwifery as a
profession (3)
• Cambodia Midwives Associations (CMA) does
have a strong base and good national networks.
Midwives across the country are prepared to pay
the small contribution to be members of CMA,
however the work of CMA has been limited in
recent years due to sickness and recent death of
the Executive Office. CMA is in the process of
refocusing their management structure.
• Communities are recognized the larger public
role that midwives can play, in terms of
education about health, staying healthy and to
offer care and advice if sickness arises.
53
Recommendations: Area 1- Coverage and
competencies:
• Maps out phased increases of numbers of student
midwife, as well as options for career pathways that
allow advancement for all midwives, including the
options for primary midwives to undertake further
training to become a secondary midwife, should be
developed and added to the current HR
development plan.
• Urgently modify the content and structure of Primary
Nurse-midwife programme (short-term action)
• Address current skills deficit, specifically the need to
increase support to Primary Nurse-midwives
• Increase community support for and dialogue with all
54
midwives
27

Recommendations: Area 2- Preservice
Education and In-service
Training (1)
• Introduce an independent, externally verifiable
national examination/assessment of
competence from all midwifery programmes
• Increase collaboration between training centers
and clinical sites
• Use of more clinical facilities for training. In
particular use of clinical facilities with high
numbers of cases, especially births
55
Recommendations: Area 2- Pre-service
Education and In-service Training (2)
• Improve the availability of quality teaching and
learning resources (re-equipping institutions with
the necessary Teaching & Learning Resources
will required short- term action; better
collaboration with clinical facilities, working with
new facilities preparing clinical sites and clinical
instructors and mentors, will required long-term
action)
56
28

Recommendations: Area 2- Pre-service
Education and In-service Training
• Increase capacities of teachers and ensure
career pathways and adequate preparation for
future teachers. As an interim measure, there is
need to immediately address the clinical skills of
midwife teachers and increase the number of
part-time clinical instructors used in RTCs,
drawing form competent midwives in current
practice at RHs.
57
Recommendations: Area 3- Recruitment,
retention, deployment (1)
• Current plans and agreements for upgrading midwives
onto high pay-band should be implemented as quickly as
possible
• Consider lesson learnt from the education sector for
creating of special handship postings, which carry with
them incentive packages
• Incentives for teachers to follow-up students in clinical
areas should include travel allowances
• An incentive package, which could be a mixture of small
one-off payments and for support for updating training,
could be considered to encourage midwives working in
non-midwifery areas agree to being-deployed to a
midwife post
• Future recruitment of midwives should follow national
guidelines and priorities areas of need
58
29

Recommendations: Area 3- Recruitment,
retention, deployment (2)
• PHDs should report annually to MoH on numbers of new
midwifery recruits, leavers and numbers of those with
midwifery qualification working in non-midwifery areas.
• Exit interviews should be established for all who leave
service and results collated centrally
• Quota systems can be established for training places for
hard to post/underserved areas, it may be possible to
use incentives schemes for supporting students from
these areas
• Establish community support groups for local midwives
in rural areas. This will particularly help midwives not
from the area, to feel a sense of connection with the
community and may results in better retention of staff.
59
Recommendations: Area 4-
Attractiveness (1)
• Strengthen midwifery leadership and midwives
contribution to policy-making, by investments in
and support for CMA. This to include as an
immediate measure, assistance to support the
establishment of a central head office. Assist
CMA to create partnership between CMA and
leading woman’s groups and associations, for
mutual support and synergies.
• Assist CMA to re-establish links with ICM
• Develop and implement a plan of action for
creating a national focal point for midwifery.
60
30

Recommendations: Area 4- Attractiveness (2)
• It is recommended that MoH, as a matter of
urgency, appoint a High-Level Midwifery
Taskforce. The first task of this High-Level
Midwifery Taskforce would be to consider all the
above issues and decide on strategic actions to
move to the next phase of developing midwifery in
Cambodia.
• The High-Level Midwifery Taskforce will develop a
national strategy, as well as oversee and monitor
the implementation of a national Operational Plan
for Increasing Equitable Access to Quality
Midwifery Care. The Chair of this Taskforce
should minimally be at the level of Secretary of
State.
Thank you
61
31

The Health Financing
Achievements in 2006
&
Priorities for 2007-2008
Khuot Thavary
JAPR 2006
Prepared by DBF, Ministry of Health
Contents
Strategy 14:
Ensure regular and adequate of funds to the health
sector especially for service delivery through
advocacy to increases and strengthening
financial management.
I. The Indicators and the achievements in
2006
II. Constraints
III. Total Health expenditure
IV. Priorities for 2007 - 2008
1

Contents (Cont.)
Strategy 15: Allocate financial resources
to
improve the
accessibility of
health
services for the poor through
alternative health financing
schemes
I. The Indicators and the achievements in 2006
II. Constraints
III. Total Health expenditure
IV. Priorities for 2007 - 2008
Contents (Cont.)
Strategy 16:
Ensure transparent, efficient and affective health
expenditures through strengthening resource
allocation, coordination of different sources of
funds and monitoring
I. The Indicators and the achievements in 2006
II. Constraints
III. Total Health expenditure
IV. Priorities for 2007 - 2008
2

A.Strategy 14:
Ensure regular and adequate of
funds to the health sector
especially for service delivery
through advocacy to increases
and strengthening financial
management
I. The indicators and the achievements
in 2006
Indicators
Baseline
2002
Target
2006
Achievemen
t 2006
1 Budget allocat ion as %
of GDP (A nnual budget
allocation to the
Ministry of Health)
2 N at ional healt h budget
as pr opor t ion of
gover nment budget
3 Pr opor t ion of r ecur r ent
expendit ur es compar ed
to total recurrent
budget ("Recurrent "
refers to Chapter
10 ,11,12 ,13 ,3 1)
1.15 % 1.2 6 % 1.0 8 %
10 .4 4 %
10 % 6.84%
96% 95% 92.8%
3

I. The indicators and the
achievements in 2006 (Cont.)
4
Indicators Baseline 2002 Target 2006 Achievement
Public expenditur e per
capita in health
Including
drugs =
2.94 USD
Excluding
drugs:
1.7USD
Including
drugs =
4.59 USD
Excluding
drugs: 3
USD
I ncluding
drugs =
4.64 USD
Excluding
drugs: 3.35
USD
I. The indicators and the
achievements in 2006 (Cont.)
5
Indicators Baseline 2002 Target 2006
Achievement
Budget expendit ur e f or
healt h af t er 6 and 12
months as % of total
budget allocat ion f or
Chapt er 11 and 13 by
nat ional and pr ovincial level
(Appr oved: Mandat ed
ceilings agreed on by t he
Minist r y of Economy and
Finance. Cash r eleased:
Amount of cash r eleased
f r om t he nat ional and
provincial treasury for
oper at ing expendit ur es)
Chapt er 11 by J une
Nat ional:
Appr oved: 4%
Cash r eleased: 4%
Pr ovi nci al :
Appr oved: 21%
Cash r eleased: 15%
Chapt er 13 by J une
Nat ional:
Appr oved: 62%
Released: 13%
Pr ovi nci al:
Appr oved: 47%
Cash r eleased: 22
Chapt er 11 by J une
Nat ional :
Approved: 35%
Cash Released: 35%
Pr ovi nci al :
Approved: 35%
Cash Released: 35%
Chapt er 13 by J une
Nat ional:
Approved:50%
Cash released: 40%
Pr ovi nci al :
Approved:50%
Cash r eleased: 40%
Chapt er 11 by J une
Nat ional :
Appr oved: 36.12%
Cash Released: 36.12%
Pr ovi nci al:
Appr oved: 12.82%
Cash Released: 19.10%
Chapt er 13 by J une
Nat ional:
Appr oved:51.96%
Cash released: 47.45%
Pr ovi nci al:
Appr oved:32.25%
Cash released: 6.78%
4

I. The indicators and the
achievements in 2006 (Cont.)
Indicators Baseline 2002 Target 2006
Achievement
Chapt er 11 by Dec.
National:
Appr oved: 90%
Cash r eleased: 90%
Pr ovi nci al:
Appr oved: 80%
Cash r eleased: 64%
Chapt er 11 by Dec.
National:
Appr oved: 95%
Spend = 95%
Pr ovi nci al :
Appr oved: 95%
Spend = 95%
Chapt er 11 by Dec.
National:
Appr oved: 99.4%
Spend = 99.4%
Pr ovi nci al:
Appr oved: 91.6%
Spend = 82%
Chapt er 13 by Dec.
National:
Appr oved: 90%
Cash r eleased: 53%
Pr ovi nci al:
Appr oved: 90%
Cash r eleased: 80%
Chapt er 13 by Dec.
National:
Appr oved: 95%
Spend = 95%
Pr ovi nci al :
Appr oved: 95%
Spend = 95%
Chapt er 13 by Dec.
National:
Appr oved: 97.5%
Spend = 94.3%
Pr ovi nci al:
Appr oved: 100%
Spend = 100%
I. The indicators and the achievements in
2006 (Cont.)
Indicators Baseline 2002 Target 2006 Achievement
6
Review lessons
f r om evaluat ion TORs developed
of ADD and PAP for the study
syst ems
Finished
Repor t ing and
disseminat ed t o
the provinces
7 Pr ocur ement of
drugs and
medical supplies
t hr ough
compet it ive
tender
Approval f rom
MEF f or
commit ment t o
pur chase dr ugs
Cont r act signed
wit h supplier and
MOH
CM S r eceipt
100% of total
allot ment f or
drugs and
medical supplies
r equir ement in
2005.
Approved: 99%
Mandate: 99%
CM S r eceipt
100% of total
allotment for
drugs and medical
supplies
r equir ement in
2005.
Cent r al
Approved: 113.3%
M andat e: 113 .3 %
5

II.
Constraints
• There were two ways in preparation of
budget.
• Budget allocation did not follow the AOP
• Low budget allocation to the Health Sector
• The delayed of cash disbursement for both
levels, central and provincial level.
• Lack of staff with capacity.
• Many processes were changed within the
year.
III. Total Health Expenditure
29,11% = 8.15
USD
15,61% = 4.37
USD
55% = 15.48
USD
Government (Health Expenditure Report 2006, included Counterpart funds)
Out of Pocket (CSES 2003-04)
Donors
6

IV. Priorities for 2007 - 2008
• Increase budget for health by strengthen
capacity of all health facilities in
preparing the AOP.
• Negotiate with MoEF for budget
allocation to PHDs.
• Set up the financial reporting system for
PBB
• Train/inform the accounting staff with the
new system
• Follow up and strengthen monitoring
system.
B. Strategy 15:
Allocate financial resources to
improve the accessibility of health
services for the poor through
alternative health financing
schemes
7

I. Achievements
8
9
Indicators
% of annual budget
increased allocated
to provincial level
(RHs & HCs)
Proportion of
budget to provinces
out of total budget
(Proportion of
budget allocated to
recurrent costs at
provinces out of
total MOH budget)
Baseline
2002
Including
drugs = 66%
Excluding
drugs:34%
Target 2006
Achievement
2006
60% 26%
Including
drugs = 66%
Excluding
drugs=35%-
40%
Including
drugs = 51%
Excluding
drugs=42%
I. Achievements (cont.)
Indicators Baseline 2002 Target 2006 Achievement
10
11
Allocation of budget
to HCs and RHs:
operating budget as
proportion of total
budget (excluding
drugs)
Government
commitment to
financing services
for the poor at HCs
and referral
hospitals
RHs: 18%
HCs: 15%
Chapter 31
experiment in
process for
equity fund at
Takeo
Province
Hospital
Budget allocate
to: RH 20%
HCs: 30%
(Proportion to
total provincial
budget)
To allocate
national budget
for EF to 13
ODs (Non
contracting
districts)
N.A.
Disseminat
ed Prakas
on subsidy
to the poor
patients
8

I. Achievements (cont.)
Indicators Baseline 2002 Target 2006 Achievement
12 Scaling up
equity fund
as a strategy
to promote
access in
poor ODs
13 Number of
poor
individuals/
household
who has
been preidentification
5 ODs
NA
-Increase EFs
Schemes from 16
to 30 in non
contracting ODs.
-Continue EFs in
11 contracting ODs
Increase a number
of individuals/
household who
received an
identification card
HEF has been
increase from 16
to 30 ODs (
including 7 to
contracting ODs)
Number of poor
households
86,483 (432,415
poor persons) has
been preidentification
I. Achievements (cont.)
Indicators Baseline 2002 Target 2006 Achievement
14 Number of
poor patients
with assistant
from equity
funds.
15 Percentage of
Health
facilities
(ODs)deliveri
es HEF out of
total health
facilities.
5,234
7%
Increase a number
of poor patients
with assistant from
EF from 34,512p to
200,000p
- Develop a
standard
information system
Increase a
proportion of
Health facilities
(ODs) deliveries
EF from 28% to
39%.
- Number of poor
patients with
assistant from EF
73,000p
- Finalized
monitoring tool
and reporting form
The proportion of
health facilities
(ODs) deliveries
EF has increase
28% to 39% (30
ODs).
9

I. Achievements (cont.)
Indicators Baseline 2002 Target 2006 Achievement
16 Proportion of poor
patients exempted
from user fees at
Health centre and
referral hospitals
17 Average unit cost of
contribution from user
per cases( OPD &
IPD)
18 # CBHI Schemes
Implemented.
RHs:
16
HCs:
12
RHs: 16 %
HCs: 16%
RHs:
16%
HCs:
18%
NH: 15
NA NA OPD:
$0.19
IPD:
$5.59
1 - Collaborate
with MEF to
develop sub
degree on SHI
- Increase # of
CBHI schemes
from 4-8.
Total # of
CBHI
schemes
in 2006
were 8.
I. Achievements (cont.)
Indicators Baseline 2002 Target 2006 Achievement
19 Number of
insured members
with assistant
(Reimbursement)
from Community
based Health
Insurance (CBHI)
20 Number of
insured member/
household cover
by Community
based health
insurance (CBHI)
cards
NA
NA
Increase a number
of insured with
assistant from
CBHI:
OPD: 28,293-
60,000
Increase a number
of insured from
12, 398-25,000
peoples (
2,655HH-
5,080HH)
-Number of
insured with
assistant from
CBHI:
OPD: 98,484
IPD: 2,187
Number of
insured
members are
33,122
(7,012HH)
10

I. Achievements (cont.)
Indicators Baseline 2002 Target 2006 Achievement
21
Contracting as a
strategy to
improve access
in poor areas
5
ODs
Continue
contracting
in 11ODs.
- Contracting
in 11 ODs are
ongoing
- Review
contracting
strategy in the
process
II. Constraints
• The cash released at provincial level for
first semester still delayed.
• Budget allocation to both levels was not
followed the AOP.
• The Prakas on subsidy to the poor
patients was delayed, and also delayed of
implementation this Prakas too.
• Big changed in PAP budget procedure
11

II. Constraints (Cont.)
• Delay in selection of HEFI for 11 contracting
districts
• Unsatisfactory participation and harmonization in
planning and budgeting of health equity fund
schemes from NGOs and poor management on
health financing at health centers, referral
hospitals and national hospitals.
• Delayed in development of sub-decree on CBHI
II. Constraints (Cont.)
• Limited NGOs with capacity introduce
CBHI within country
• Delayed in cash released to contractors
for contracting districts, national budget.
12

III. Priorities for 2007 - 2008
• To discuss with MoEF to solve the
problem of budget allocation.
• Introduce and expand subsidy schemes to
the poor patients from 12-20 ODs and 5
national hospitals.
• Increase HEFs Schemes from 30-45 ODs
(including 11 contracting ODs) and 5
national hospitals
III. Priorities for 2007 – 2008
(Cont.)
• Increase the number of individual/ household
who/which is received the identification card.
• Increase the number of poor patients with
assistant by Equity Funds from 73,000 to
250,000.
• Increase the proportion of Health facilities (ODs)
deliveries EF & subsidy from 39% to 59% (40
ODs).
• Improve the monitoring information system on
HF
13

III. Priorities for 2007 – 2008
(Cont.)
• Develop sub decree on CBHI- Increase number
of CBHI schemes from 8-30
• Increase a number of insured with assistant from
CBHI:
– OPD: 98,484p- 300,000p
– IPD: 2,187p- 12,000p
• Increase the number of insured household from
7, 012HH-200,000HH
• Continue the contracting schemes in 11 ODs.
Strategy 16:
Ensure transparent, efficient
and affective health expenditures
through strengthening resource
allocation, coordination of different
sources of funds and monitoring
14

I. Achievements
Indicators Baseline 2002 Target 2006 Achievement
22
23
Strengthen
resources
allocation for
expenditures at
different levels
based on
appropriate
roles and
responsibilities
Improvement in
monitoring of
financial
performance
Costing of
services at
provincial and
district
referral
hospitals and
health centers
conducted
PAP
performance
indicators
established
-To be finalized the
model for resource
allocation for the
poor.
-Building capacity
of DBF’ staff on
Program Based
budgeting
Setting and
disseminating the
new financial
reporting system of
all levels
N.A
Disseminated the
new public
financial reform to
all health facilities
at both levels
II. Constraints
• Did not allocated budget base on the
budget formula
• Many new procedures and unclear
guidance for the public financial
management.
15

III. Priorities for 2007 – 2008
• Budget allocation should base on the
AOP.
• Setting and disseminating the new
financial reporting system for all levels.
THANKS!
16

Budget 2007
Total budget
increased : 75,913 MR 29% of 2006
Central : 61,919 MR 35% of 2006
Province : 13,994 MR 17% of 2006
Budget Plan 2007
Million Riels
Budget
Chapter
Description
Type of Budget
Total Non Program Program
336.926 218.231 118.695
Central level Sub - total 238.576 218.231 20.345
60 Purchase 58.620 56.303 2.317
61 External Service 10.074 9.493 581
62 Other External Services 22.135 15.983 6.152
64 Personnel Expense 13.100 13.100 -
65 Subsidy and Social Aid 134.561 123.266 11.295
63 Tax and VAT 86 86 -
Provincial level Sub - total 98.350 - 98.350
60 Purchase 28.275 28.275
61 External Service 16.410 16.410
62 Other External Services 11.476 11.476
64 Personnel Expense 38.318 38.318
65 Subsidy and Social Aid 3.850 3.850
63 Tax and VAT 21 21
17

Constraints
• Two big Reforms for The Public Financing
with unclear guidance
• Two ways in preparing the annual budget
proposals at the PHDs
• No PAP budget in 2007
• No system to monitor the expenditure
(budget and expense by activity)
Priority activities for 2007-2008
• Set up the financial reporting system for
PBB
• Negotiate with MoEF for budget allocation
to PHDs.
• Train/inform the account staff with the new
system
• Follow up and strengthen monitoring
system.
18

suxdumμnIykmμ nig kartMrg;CUr rvagGgÁPaB-
EpñkrdæaPi)alBak;B½næsuxaPi)al
Harmonization & Alignment Among
Health Related Government
Entities/Units
evC¢> c em:gcY GKÁnaykrgsuxaPi)al
Dr Char Meng Chuor, Deputy-DG for Health
erobcMsMrab;bgðajkñugsnñi)atsuxaPi)alelIkTI28
A presentation at the 28th National Health
1
eKalbMNg nwg visalPaBénkarbgðaj
Objectives and Scope of Presentation
eKalbMNgCarYm³ CMrujsuxdumμnIykmμ nigkarcat;tMrg;CUrkñúgvis½ysuxaPi)al
Overall Objective: Enhance harmonization and Alignment in the Health Sector
eKalbMNgedayET,k³
CMnYycMeBaHkarBIPakSakñúgevTikasaFarN³edIm,IelIkCabBaðaEdlpSarP©ab;CamYynUv
mtisMeNI kñúgkarelIkMBs;suxdumμnIykmμ-kartMrg;CYr kñúgcMeNam GgÁPaBsßab½n
Bak;B½nævis½ysuxaPi)al edayepþatCasMxan;elI kareFVI suxdumμnIykmμ-tMrg;CYr kñúg
karerobcMeKalneya)ay-yuTæsaRsþ karerobcMEpnkarskmμPaB-fvika
karpþl;hirBaØvtßú karerobcMEpnkarlTækmμ karpÁt;pÁg; EdltMrg;CYrtamEpnkar
RbtibtiþRbcaMqñaMEdl)anGnumtirYcehIy k¾dUcCakarRKb;RKgbuKÁlikpgEdr. 2
1

Specific Objective: Assist to the plenary
discussion to raised issues together with
suggestion/recommendation directions for
improving the Harmonization and Alignment
among health related government
institutions with focus harmonization and
Alignment in policy/strategy development,
operational plan/budgeting, financing,
procurement plan/supplies aligned with the
approved annual operational plan; project
proposals to development partners; and
monitoring/evaluation.
3
visalPaBénkarbgðaj³ erobrab;RtÜs²GMBI GgÁPaB-Epñk
rdæaPi)alEdlBak;B½nænwgvis½ysuxaPi)al
Scope of presentation:
Brief Narrative health related government entities/institutions
kMNt;cMNaM³ enHminEmnCakarbgðajGMBIrbkKMehIj-Gnusasn¾ rbs;kar
sikSa-RsavRCavNamYy dUcCa karsikSaGMBIkarRKb;RKg TUTaMgvis½y dUc
EdlTIRbwkSaFnaKarBIPBelakkMBugEteFVIenaHeT.
NB: This is NOT a presentation on the Finding/Recommendation
of any study such the SWiM Review being conducted by two
International Experts selected by the World Bank.
4
2

niymn½y1rbs; suxdumμnIykmμ nig kartMrg;CUr
suxdumμnIykmμ³ KåCakarxitxMRbigERbgedIm,ItMrg;CUr-eFVIgayRsYl nigsMrb
sMrYl nUvrebobeFIV-KitKUr nig nitiviFI kñúgbNþaédKUrGPivDÆn¾ eBalKårvag
rebobeFIV-KitKUr nig nitiviFI kñúgcMeNamGñkpþl;CMnYy nig rebobeFIV-KitKUr
nig nitiviFI rbs;rdæaPi)alpg.
kartMrg;CYr³ KÅCakarxitxMRbwgERbgbBa©Úl eKalneya)ay-nitiviFI-RbB½nækarpþl;mUlniFi-Epnkar
nig kartamdan skmμPaBrbs;Gñkpþl;CMnYy[tam
eKalneya)ay-nitiviFI-RbB½næ-karpþl;mUlniFi-Epnkar nig kartamdan
rbs;rdæaPi)al.
Éksareyag³ esckþIRBagr)aykarN¾BInitüeT,IgvijelIkarRKb;RKgebIk
5
TUlay vKÁTI1 ¬elak essuIl¦
• A definition of Harmonization and Alignment
• Harmonization: Efforts to streamline, simplify and
coordinate approaches and procedures among
development partners, meaning among both
donors and those of government
• Alignment: Efforts to bring policies, procedures,
systems, funding, planning and monitoring cycle
of donors activities in line with those of
government.
• Ref.: Draft SWiM Review Report, Phase I (Cecil
Haverkamp)
6
3

sar)anfñak;Cati ¬raCrdæaPi)al¦
•raCrdæaPi)al)anGnumtiEpnkarsuxdumμnIkmμqñaM2006-2010 EdlkñúgenaH
mankarBak;B½nænwg suxdumμnIykmμ-kartMrg;CYr rvagédKUrGPivDÆn¾ nig RksYg
suxaPi)alEdr
•suxdumμnIykmμ-kartMrg;CYr rvagédKUrGPivDÆn¾ nig RksYgsuxaPi)al Gac
nwgTamTar suxdumμnIykmμ-tMrg;CYr épÞkñúgRksYg suxaPi)alEdr manCa GaTi¾
GgÁPaB b¤ mRnþIsuxaPi)al KYreRbIPasa-CMh‘r ÉkPaBKñakñúgTMnak; TMngCa
mYyédKUrGPiDÆn¾
7
• Background at National Level (Royal Government
of Cambodia)
• The Royal Government of Cambodia adopted the
Harmonization and Alignment Plan 2006-2010,
which concerns also Harmonization between
Development Partners and Ministry of Health.
• Harmonization between Development Partners
and Ministry of Health may require Harmonization
within MOH e.g. MOH entities/units/staff should
have common message in dealing with
development partners
8
4

suxdumμnIykmμ nig kartMrg;CUr rvag
GgÁPaB-EpñkrdæaPi)alBak;B½næsuxa
Pi)al k¾manEdr
The is also Harmonization &
Alignment Among Health Related
Government Entities/Units
kgkarBarRBMEdnelx 402 ¬]tþrmanC½y¦
Battalion 402 (Oddar Meanchey)
9
sar)ankñúgvis½ysuxaPi)al³
GIVEdleyIg)anÉkPaBKña4qñaMknøgmk
enHCaelIkdMbUgehIy EdlRksYgsuxaPi)almanEpnkaryuTæsaRsþ sMrab;
vis½yTaMgmUldl;GñkEdl Bak;B½næTaMgGs;eRbIR)as; . mann½yfa TaMgEpñk
ÉkCn nigédKUsuxaPi)al k_dUcCabuKÁliksuxaPi)al nigGñk déTeTot .
eKalbMNg KWcg;eGayTUTaMg vis½ysuxaPi)al eFIVkarenAkñúgRkbx½NÐén
EpnkaryuTæsaRsþenH nig lTæplrMBwgTuk EdlmaneQμaH fa karRKb;RKg
vis½yebIkTUlay . ¬dkRRsg;BI EpnkaryuTæsaRsþsuxaPi)al qñaM
2003-2007 v:UlUm1 CMBUk3¦
10
5

• Background in the health Sector: What we have
been agreed for the past 4 years
•
• (Health Sector Strategic Plan, Vol. 1 Chap. 3)
11
KYrpþl;eyabl;KñaGMBI
•etIGñkNaxøHEdl)aneFVIkarCamYyKñaknøgmk
•etIeFVIkarCamYyKñay:agNa nig manTMlab;Nal¥-Naminl¥
•etIKYreFIVy:agNa[kan;Etl¥
Subject for Debate
• Who have been working together
• How they have worked together, and what was good/bad
practices
• How to work together better outcome
12
6

GgÁkarelxenHeRbIR)as;sMrab;Et
kñúgkarBiPakSaeRkApøÚvkar
É>]>-elakCMTav rdæelxaFikar-Gnurdæ>10rUb
xuTÞkal½y-elxapÞal;
TIRbikSa
RKb;fñak;
na> fvikanighirBaØvtßú
na> rdæPal
na>buKÁlik
KNkmμkar-Rkum
kargar¬100enA
fñak; kNþal¦nig
GgÁRbCuM-snñi)at
RKb;fñak;>>>
18 kmμviFICati
GKÁna> rdæ)al-hirBaØvtßú
elxaFikardæan
9 mCÄ> -viTüsßanCati
6 mnÞIreBTüfñak;Cati
4 salabec©keTs
EfTaMevC¢saRsþtMbn;
sßab½n-GgÁPaBrdæBak;B½nævis½ysuxaPi)al
É>]> rdæmRnþIRksYgsuxaPi)al
24 mnÞIsuxaPi)alextþ-Rkúg
77 RsukRbtibtþi
na> Epnkar nig B>s>
na> GPiv> FnFanmnusS
na> shRbtibtþikar GnþrCati
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13
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14
7

kgVl; nig Gnusasn¾elITisedAGnaKt
esñIsMuBIsmaCik-GgÁsnñi)at
Issues and recommendation on Future Direction
To be recommended by the congress participants
15
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16
KarRTRTg;karpþl;esvaCaRbcaMenAmUldæan
8

• Participants are requested to raised issues together
recommendation concerning harmonization and Alignment
(H&A) among MOH entities/committees in specified theme
such as
• H&A in Policy/Strategy Development for each sub-sector
• H&A in Planning: AOP linked with budget (Domestic-
External Resource), Project Proposals to development
partners ..ect.
• H&A in Monitoring and Evaluation: Information System,
Supervision by -MOH staff- partners, Project Reports,
Survey/Studies
• H&A in Technical Standard/protocol in services delivery,
health education ...
• H&A in Resource Management: Financing , procurement
plan and supplies aligned with approved AOP, annual
procurement aligned with AOP ; salary and incentives ...
ect.
• H&A in Personnel Management: Salary, incentives, travel
allowance, support to outreach activities
17
ÉksarEckcaysMrab;CaCMnYysμartIkñúgkarBiPakSaman³
•cMlgxøwmsarénkarbgðaj
•Rbkasrbs;RbsugsuxaPi)alelx 020 cuHéfø 10 Ex sIhaqñaM 2004
•taragbBaI¢rkmμviFICatinana
•taragbBa¢IraynamRkúmkargarBak;B½næRksYgsuxaPi)al ¬fñak;kNþal-Cati¦
•Epnkarsuxdumμniykmμrbs;raCrdæPi)alkkm

190
EXCLUSIVELY FOR DISCUSSION at the 28th
National Health Congress (Unofficial uses)
5 Secretary of State;
5 Under-secretary of State;
Health Related Government Entities/Units
Cabinet & SP
Minister of Health
Procurement
Unit
Other Ministries: NAA; CAR (Salaries & Incentives),
MOEF, MOP; CDC; Women Aff.; Social Aff.; Education;
National Disaster Cttee; Rural Dev.; Environment;
Information; Agriculture; Defense/Police...
Financial
controllers
Advisors
(RGC/
MOH)
Dep. of
Administration
Dep. of
Personnel
Committee/
Working
Groups (100
at Central
Level);
Meeting,
Congress ..
18 National
Programs
DG Adm. and
Finance
Dep. of Budget
and Finance
DG's Secretariat
9 National Center/
Institutions a
6 National Hospitals b
4 Regional Schools of
Technical Medical Care c
DG's Secretariat
Dep. of Health Planning and
Information
24 Provincial Health Departments
77 Operational Districts
Health
DG Health
69 Referral Hospitals 968 Health Centers
77 Health Posts
Dep. of Human Resource Dev.
Dep. of Intern. Cooperation
Dep. of Drug, Food &
cosmetics
Dep. of Hospital Services
Dep. of Preventive Medicine
Dep. of Com. Disease Control
Dep. Internal Audit
Provincial/District
Governors
Commune Councils and
Village Chiefs
VHSG
(26000)
NB:
a : NCHADS, NCTB/Lepr, NCMalaria, NCMCH, NIPH, NCTraMed, NCDrugQuaCon, NCBloodTran, CMS
d: Excluding units establisshed for external aids projects such as HSSP, PR's Office (Global Fund), Other PMUs
b : Excluding Hospitals in NCMCH and NCTB/Lepr. c : Battambang, Kampot, Kg. Cham and Stung Treng
Directorate General of Inspection
Bureau of
Inspection
DG's Secretariat
National
Pharmaceutical
Factory
Bureau of
Control
Pasteur
Institute
UNIVERSITY OF MEDICAL
SCIENCES
Faculty of Medicine
Faculty of Odonto-stomatology
Faculty of Pharmacy
School of Technical Medical Care
19
Those who have worked together since the launching of the health sector strategic plan 2003-2007
3 H.E. DGs
11 Mr./Mrs Directors
+ 44 Vice-Directors of
Dep. at Headquarter
21 Mr./Mrs. Director
and 88 Vice-Directors
of National
Institution/Centers
H.E. Minister together
with 5 Secr. of State, 5
Under-Secr. of Sates;
Advisors (RGC/MOH)
Committees;
Working Groups,
Task-Force (100 at
Central Level;
Forum, Meeting,
Workshop..
Other
Ministries/Institutions
Governing Board and
Executive Managers in
Public Enterprises
Local Authorities:
Provinces, Districts,
Commune, Villages
4 Mr./Mrs Directors
and 13 Vice-Directors
of RTCs
18 Managers of
National
Programs
: Development Partners (Donors); NGOs, Private
Entities ...
24 PHD, 77OD, 96HC,
57HP, >26000VHSG
20

191
Working together Within Units (DGs, Dpts...)
Minister, Secretary of State and
Under-Secretary of State
Senior Managers:
Number of Decision Marker/Manager in MOH
Nb. of
Director
11
Nub. of Deputy
Director
Average Nb. of Vice
Deputy Director
All Directorate General
3
9
3.0
All Departments at Central Level
11
48
4.4
National Center/Institutes
21
88
4.2
Provincial Health Department
24
118
4.9
Regional Training Centers
4
13
3.3
62
276
4.4
21
Special notes
• National Program/Institution-National hospital report to DG Health (Health Sector Strategic Plan 2003-2007,
Volume I, page 14; Sub-decree Nb. 67article 12)
• The MOH Structure should have been reviewed in the 1st Year of it Implementation i.e. in 2003 (Health Sector
Strategic Plan 2003-2007, Volume I, page 14)
• National Programs, National Centers/Institutions and National Hospitals are not shown on the
MOH' s Organigram attached to the Sub-decree 67 but these entities are described in some articles.
• Calmette is Public Enterprise with administrative characteristic (Sub-decree 67)
• Cambodia Pharmaceutical Enterprise is Public Enterpise with Economic Characteristic (Subdecree
67)
• Pasteur is Enterprise with mission on public services under convention (Sub-decree 67)
• Distribution of Role of MOH' s Leaders (Minister, Secretary of State, Under-Secretary of State) in
Prakas Nb. 020 dated 10 Aug 2004
22