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Cambodia
>> Regional Overview >> Cambodia Overview ACTIVITY DATA SHEET
PROGRAM: Cambodia
TITLE AND NUMBER: Improved Reproductive and Child Health, 442-002
STATUS: Continuing
PLANNED FY 2001 OBLIGATION AND FUNDING SOURCE: $ 7,250,000 ESF
PROPOSED FY 2002 OBLIGATION AND FUNDING SOURCE: $7,000,000 ESF
INITIAL OBLIGATION: FY 1995 ESTIMATED COMPLETION DATE: FY 2002Summary: Cambodia's history of conflict has made it very difficult for the government to provide quality health services. As a result, Cambodia has some of the lowest health outcomes in Asia. Infant mortality and under-five mortality rates are exceedingly high (95 per 100,000 live births and 125 per 1000 live births, respectively). National immunization coverage has increased, but fewer than 50 percent of children complete the series. One-half of the children under five years of age are malnourished, which affects their growth and learning abilities. The maternal mortality rate is one of the highest in Southeast Asia. Though modern contraceptive prevalence has risen from 16 percent in 1998 to 19 percent in 2000, there is a high unmet need for family planning services. Poor access to family planning methods contributes to high levels of unsafe abortions.
Access to health facilities is a major problem. The physical infrastructure of the country is still in dire need of repair. The public health system has suffered deeply, particularly at the district level and below, which has left the primary health care delivery system virtually nonfunctional. Quality of care is very low. The destruction of the educated classes during the Khmer Rouge period has adversely affected the quality of education and left a poorly-skilled workforce and under-trained professional corps. The Ministry of Health (MOH) is aware of all of these constraints and is actively moving to address them, with substantial technical assistance from a variety of organizations and donors. To date, the USAID program has been primarily focused on building human capacity and increasing access to quality maternal, reproductive health, and child survival services in target rural areas through nongovernmental organizations (NGOs).
To develop a long-term framework for the program, during FY 2001 USAID is conducting a comprehensive health sector assessment and designing a new strategy. Using data from this process, USAID will identify required adjustments to key technical and programmatic interventions for the transition period, as well as the development of other interventions for the longer term.
Key Results: The three key results for this objective are: (1) expanded supply of reproductive and child health services; (2) increased access to reproductive and child health (RCH) services; and (3) strengthened demand for RCH services. Intermediate results for this objective will continue to focus on access, supply, and demand. Additional results will focus on strengthening health systems.
Performance and Prospects: There has been very substantial performance over the past year on this objective. Recently, in testament to the success of USAID implementing partners working in target areas through village development committees, the Government of Cambodia incorporated partner-generated ideas and operating procedures into its national rural development policy. Nationwide, 1,500 referral, mid-level, and health center directors and pharmacists have been trained in logistics management practices and procedures. Ongoing monitoring activities ensure their continued use and will maximize the benefits of a reliable drug and commodity supply. Through an innovative water filtration and hand pump installation activity of an implementing partner in northeastern Cambodia, 142,000 people-over 40% of the total rural population of two remote provinces-benefit from clean water. When the activity started in 1993, only 13% had access to safe water. In family planning, the USAID-supported Reproductive Health Association of Cambodia's outreach program served approximately 215,000 clients, a 60% increase over 1999. Sales of the socially marketed OK-brand of oral contraceptive increased by 87% over 1999 to approximately 425,000 monthly cycles. Finally, in collaboration with the United Nations Children's Fund (UNICEF) and United Nations Fund for Population Activities (UNFPA), USAID co-funded the first Demographic and Health Survey conducted in Cambodia. The survey is currently being finalized and will provide the first, truly national population-based survey and the first provincial-level estimates for a wide range of health and other social indicators. As a result of these activities, target area populations have benefited directly from the expanded supply and increased access for reproductive and child health services. Moreover, national level impact has been achieved in logistics management practices and rural development policies-particularly noteworthy, as these effects will continue to garner benefits for years to come.
In FY 2001, all ESF funds will be used to expand and strengthen the activities noted above. Vitamin A activities targeted to children under age 5 will be expanded, and USAID will continue to provide support for quality health facility level improvements in areas such as antenatal care, breastfeeding, and tetanus vaccination. With support to the Reproductive and Child Health Alliance, guidelines for clinical management of safe motherhood and reproductive health services will be implemented. An alliance of USAID partners will develop and expand a workplace intervention in reproductive health in the garment industry in Phnom Penh that will focus on young women between the ages of 16 and 29.
Enormous progress has been made in the development of the public health sector in an extremely short time. There is a very positive policy environment and openness to new approaches and NGO/private sector involvement in Cambodia. Therefore, USAID expects that Cambodia's health system will continue to make significant progress toward the goal of making quality health services accessible nationwide. However, the progress will be in stages, and will take time. Meanwhile, the development of the basic skeleton of a health care delivery system is still in progress. Cambodia faces extremely high levels of infant, child, and maternal mortality and, as a result, the need to deliver effective interventions is urgent and cannot wait for full development of the health care system. At the same time, interventions cannot be delivered without such a system and will always be constrained by the level and pace of health system development. Any effort to improve health conditions in Cambodia must, therefore, incorporate development and strengthening of service delivery systems along with a focus on specific high-impact cost-effective interventions.
Possible Adjustments to Plans: USAID is assessing its current programs and will redesign its health portfolio by the end of FY 2001. FY 2002 will be a transition year from the old to the new strategy.
Other Donor Programs: The World Health Organization (WHO) supports infectious disease and national-level vector control programs. In addition, WHO provides technical advisors for health sector reform and the provincial health management teams in several provinces. UNICEF supports the national immunization and essential drugs programs, as well as provincial health advisors in four provinces. UNICEF and WHO, together with the MOH, continue to support introduction and adaptation of the Integrated Management of Childhood Illness initiative, with pilot tests beginning in early 2000. UNFPA, with European Union funding, coordinates a youth reproductive health project implemented by seven local and international NGOs. UNFPA also supports continuing analyses of the 1998 national census data. The World Bank and Asian Development Bank support provincial-level health system strengthening projects in eleven and four provinces and municipalities, respectively. Germany provides technical support to the National Institute of Public Health. Australia provides technical support for primary health care activities at the provincial level. A coordination committee of government, donor, international, and implementing agencies meets monthly for joint review, planning, and monitoring of health activities.
Principal Contractors, Grantees, or Agencies: USAID implements its RCH activities through U.S., international, and local NGOs. Grantees include CARE International, Helen Keller International, Partners for Development, Reproductive Health Association of Cambodia, Population Services International, and World Vision International. USAID's Global Bureau partners include AVSC International and John Snow, Inc.
FY 2002 Performance Table
Cambodia: 442-002
Performance Measures:
Indicator FY97 (Actual) FY98 (Actual) FY99 (Actual) FY00 (Actual) FY00 (Plan) FY01 (Plan) FY02 (Plan) Indicator 1: Couple-years of protection (CYP) 102,557 138,992 162,268 194675 185,000 203,000 220,000 Indicator 2: Percentage of target population with access to safe water 16 41 49 NA 54 58 62 Indicator 3: Number of Number One brand condoms sold 10.5 11.5 12.9 16 14 17.2 18.5 Indicator Information:
Indicator Level (S) or (IR) Unit of Measure Source Indicator Description Indicator 1: IR Absolute number of couple-years of protection. Service statistics from partners CYP is a summary measure of protection against pregnancy provided by birth spacing services based on volume of commodities sold or distributed. Each commodity has a specific conversion factor to estimate the duration of contraceptive protection, thus allowing aggregation into a single figure. Conversion factors incorporate assumptions about failure rates and other factors that impact the duration of protection. Indicator 2: IR Percentage. Biannual surveys in randomly sampled communities in the target areas conducted by implementing partners. Target areas are the communities in which the implementing partner works, namely areas of two northeastern Cambodian provinces. To be counted in the numerator, a household must be within 200 meters of a project-installed well or if outside 200 meters, use a project-designed family water filter for the household's drinking water. The denominator for this indicator grows as security constraints make more of the target population accessible for implementing partner activities. Indicator 3: IR Number of Number One brand condoms sold - millions Population Services International social marketing sales figures Baseline and targets are calculated from actual and projected sales figures. U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 6,954 DA 6,712 DA 242 DA 1,100 CSD 0 CSD 1,100 CSD 15,700 ESF 9,689 ESF 6,011 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Fiscal Year 2000 2,200 DA 542 DA 1,500 CSD 558 CSD 4,000 ESF 4,444 ESF 0 SEED 0 SEED 0 FSA 0 FSA 0 DFA 0 DFA Through September 30, 2000 9,154 DA 7,254 DA 1,900 DA 2,600 CSD 558 CSD 2,042 CSD 19,700 ESF 14,133 ESF 5,567 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Prior Year Unobligated Funds 0 DA 0 CSD 0 ESF 0 SEED 0 FSA 0 DFA Planned Fiscal Year 2001 NOA 0 DA 0 CSD 7,250 ESF 0 SEED 0 FSA 0 DFA Total Planned Fiscal Year 2001 0 DA 0 CSD 7,250 ESF 0 SEED 0 FSA 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 0 DA 0 DA 9,154 DA 0 CSD 0 CSD 2,600 CSD 7,000 ESF 0 ESF 33,950 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA
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Last Updated on: May 29, 2002 |
