Following is a Web version of a document from USAID's 1997 Congressional Presentation. Please note that some formatting may have been lost in the automated conversion of the original file. This document is also available for download in its original WordPerfect 5.1 format.

FY 1997 Economic Support Funds: $35,000,000

Introduction

The United States national interest is defined in the commitment to support democracy and the nation building process now underway in Cambodia. The increased stability of the region, brought on by Cambodia's move to democracy and market economics, will lead to expanded opportunities in trade and investment and to reduced tensions throughout this part of the world. Cambodia is a major casualty of the Cold War era. The country is slowly emerging from one of humanity's most brutal episodes of social, political and economic destruction. Consequently, Cambodia continues to be one of the world's poorest nations, lagging well behind the development of its Southeast Asian neighbors. The Royal Government of Cambodia (RGC) remains weak, and depends heavily on foreign assistance, which provides nearly half of its operating budget.

The Development Challenge

While many other countries in the East Asia region have enjoyed three decades of growth and improvements in social welfare, Cambodia has been torn by strife and civil war. Key social and economic indicators illustrate the degree of poverty still facing this developing nation: per capita income is $180, infant mortality is 115 per thousand, life expectancy is less than 50 years, and literacy rates among adults are below 50% for males and 22% for females. These problems are compounded by the rapidly spreading HIV/AIDS epidemic, potentially the most severe in Southeast Asia. Decades of war and fratricide have left Cambodia with a population skewed in age and gender: nearly half the population is under 15 years of age, and more than 55% of the adult population is female. This imbalance in age and gender creates high dependency ratios, a source of instability. In addition, years of war and neglect have ravaged the physical infrastructure, while sustained poverty has had a negative impact on human health and well-being. Productivity in agriculture and other sectors has declined for a number of reasons, including poor health status, the prevalence of landmines, and limited education, to name a few. Cambodia is a country with considerable natural resources suitable for rapid economic development, yet a lack of government legislation and enforcement is resulting in rapid environmental degradation. With fertile alluvial soils, abundant but unharnessed irrigation water, and a tropical monsoon climate with excessive rainfall, Cambodia was once a rice-exporting country and thus has significant unexploited agricultural potential. The Mekong River is a major source of untapped capacity in irrigation and hydroelectric power. The Tonle Sap River and coastal areas are potentially rich sources of marine life, with promise for expanded catches if managed prudently. At present, an estimated 85% of the population is rural, and the country enjoys one of the lowest population densities in Asia. Cambodia has some of the last remaining tracts of virgin rain forest in Southeast Asia. However, where Cambodia is rich in natural resources, it is poor in human resource development. The current population aged 18 to 36 lacks the basic skills necessary for more than subsistence living. The education system, totally destroyed along with the educated cohort of teachers, managers and other skilled professionals, remains in critical condition today, unable to provide the human resources to support sustained development. The RGC has combined donor resources with good macroeconomic management to improve Cambodia's economic performance. Growth in 1995 is estimated to be 7%, up from 4% in 1994. Inflation has been reduced to under 10% in 1995, down from 18% in 1994. The fiscal deficit has improved as the RGC has increased revenues. The 1996 budget projects using increased revenue and containment of military expenditure to increase investment in the health and education sectors. Simultaneously, the government is encouraging private investment into value-added export industry.

Other Donors

At the March 1995 Paris meeting of the International Committee for the Reconstruction of Cambodia (ICORC), donors pledged nearly $900 million in new assistance. The United States remains the second largest bilateral donor. Other major donors include Japan, France, Australia, the Netherlands, and Sweden, providing sizeable programs over a wide spectrum of development sectors. Major multilateral contributors are the Asian Development Bank, the International Monetary Fund, and the World Bank.

FY 1997 Program

The USAID strategy in Cambodia is a transitional one, shifting from an emphasis on meeting emergency needs through relief and rehabilitation to a focus on reconstruction and setting the stage for sustainable development and economic growth. Over this transition period, FYs 1995-97, the program is concentrating on three strategic objectives, while exploring possibilities for the sustainable development program to come. The three strategic objectives support both Agency goals and Cambodian development priorities.

Agency Goal: Building Democracy

Strategic Objective 1: Strengthening Democratic Institutions

Democracy has been demonstrated to be an important element in the process of economic development and nation building. Recovering from over two decades of civil war, Cambodia has a fragile democracy. This fragility is demonstrated by political crises which have occurred, but which have each time been resolved. Donor resources have been essential to the growth and evolution of democracy in Cambodia by providing assistance to such democratic institutions and processes, including elections, the judiciary, the indigenous non-governmental organizations (NGO), and the national assembly. USAID's resources will focus on the three areas described below:

The upcoming elections for local office in 1997 and national office in 1998 are crucial to solidifying a democratic tradition. Planning for the upcoming elections is in a very preliminary stage, but discussions have been held with the Government and among donors and a wide array of NGOs active in this sector. Work has been initiated with the RGC in laying out a clear calendar of events necessary for successful elections; talks also are underway on financing the election process. While RGC plans are not yet firm, the USAID strategy anticipates accomplishing the following intermediate results:

. Establishment of an electoral framework and plan, and means for implementing that plan, which are supportive of free and fair elections, including the participation of civil society;

. Civic education programs carried out by the NGO community; and

. Election monitoring to insure free and fair procedures.

The sine quae non to democratic development in Cambodia is the establishment of the rule of law. At present there is no single basis for Cambodia's legal system. A whole new set of laws and regulations must be written to address the issues facing Cambodia as a democratic, market-oriented country in today's world. There are few Khmer qualified to undertake this task. Likewise, there are only a few lawyers and university graduates with any background in common law capable of working in a business community that is increasing its links with the Association of Southeast Asian Nations (ASEAN) countries and the broader international market. At the provincial level the court system is badly in need of rehabilitation, with minimally trained judges, prosecutors and court administrators. The courts also are burdened by a reputation for corruption, incompetence and lack of respect for human rights, especially towards women, minorities and the poor. There is, nonetheless, growing evidence that the RGC better understands the requirements of operating in a modern legal system and is prepared to take the steps necessary to reform.

To support the RGC, court training, human rights and legal education interventions have been designed to increase competence and transparency in the legal system. Expected intermediate results include:

. Legal and procedural reforms supportive of business development and human rights;

. More knowledgeable lawyers, judges, prosecutors and court personnel concerning the law and how to apply it;

. Improved court management;

. A public more knowledgeable about its rights;

. Improved monitoring and defense of human rights; and

. Improved capacity of the Cambodia Bar Association to form and support the legal profession and the concept of public defenders.

Finally, the third area of focus in democracy calls for a greater legislative role in the policy process. USAID plans a limited effort to enhance legislative support services which, in turn, will result in improved articulation of laws, especially those promoting a fair and transparent framework for business and respect for human rights. Limited efforts will further the understanding of women's issues in the legislature. USAID will be attentive to the close fit between these efforts and the rule of law. Results expected include:

. Enhanced legislative support services resulting in improved quality of laws; and

. Improved understanding of women's issues within a legislative context.

Agency Goal: Encouraging Broad-based Economic Growth

Strategic Objective 2: Promoting Sustainable Economic Growth

Cambodia's tragic experiences of the last several decades have rendered its economy a shambles and its people among the poorest in the world. USAID aims to improve the foundation for sustainable economic growth through its interventions in education, the environment, and improving the policy framework. The massive deficit in human capacity is one of the most serious constraints facing future development. Most of the population aged 18-36 lack even the most basic skills needed in a modern economy. Literacy rates are below 35% overall. The entire education system was completely dismantled under the Khmer Rouge and remains a shambles to this day. USAID works with the RGC and the private sector to support key interventions to address human resource needs. One component of this strategy is to strengthen the primary education system that is the foundation of human capacity development. USAID will collaborate with the RGC in a national primary education program that will upgrade teacher skills and curricula. Intermediate results are expected to show increased completion rates, decreased repetition rates, and higher average test scores. Other expected results include:

. Improved curricula and text books utilized in cluster schools;

. Functioning resource centers in cluster schools;

. More effective teaching techniques being utilized; and

. Effective donor coordination in education policy formulation.

A second component of the human resource development strategy is to strengthen business and public policy skills in Cambodia. A linkage between Georgetown University in Washington, D.C. and the Faculty of Business at the University of Phnom Penh is upgrading undergraduate business education and providing small business management skills to entrepreneurs. USAID also works with the RGC to upgrade the business, economic and policy analysis skills of a subset of the over 7,000 graduates of former eastern bloc universities. The elimination of the majority of the educated leaders by the Khmer Rouge means that Cambodia is faced with implementing a private sector growth strategy with a civil service trained in a Marxist-socialist tradition. Success in human resource development at the higher educational levels requires a reform of the present system. The intermediate results from these activities include:

. Revised policy developed and presented to the legislature to revamp the higher education system of Cambodia;

. Majority of Faculty of Business graduates hired by the private sector as a result of revised curricula and upgraded staff training;

. Graduates of small business training program open new or expand existing businesses; and

. Program developed to train (on and off shore) and place 400 former eastern bloc graduates in business and economic positions.

Cambodia is a country with considerable natural resources and conditions suitable for rapid economic development. To develop these natural resources in a sustainable manner, USAID supports the adoption and implementation of a national environmental action plan. This plan will assist the RGC to develop a long-term, comprehensive management plan. Expected results include:

. An action plan that addresses major environmental concerns and reflects the concerns of diverse elements of the populations is adopted by the legislature; and

. Donors and the RGC agree to fund portions of the plan's recommendations.

Several factors limit Cambodia's capacity to achieve and sustain broad-based economic growth. These constraints include, but are not limited to, the lack of a fully market-oriented policy framework, an inexperienced private sector, and an untrained labor force at all levels. USAID will continue to provide technical assistance and training to address this constraint and to support Policy Reform,with the following results expected:

. Cross cutting agricultural policy changes made in the fertilizer and rural credit systems to ensure continued Asian Development Bank (ADB) agricultural sector loans; and

. Medium-term strategy developed in conjunction with the Council for Cambodian Development to increase private sector investment in Cambodia.

Agency Goal: Stabilizing Population Growth and Protecting Human Health

Strategic Objective 3: Increased Access to Basic Human Services

Cambodia faces a host of serious problems in the social sectors as a result of poor government infrastructure, rural poverty, and insufficient financial and human resources. These problems are reflected in the poorest social indicators in the region, including a mortality rate of 181 per 1,000 for children under five and maternal mortality ratios estimated at 500 per 100,000. Approximately 80% of Cambodians live in rural areas and continually express the need for basic health services to ensure maternal and child survival, a safe water supply, and access to affordable credit.

This objective will strengthen the capacity of the government and NGOs to provide sustainable family support services. Activities to date include water and sanitation, microcredit, child survival, hospital rehabilitation, birth spacing, women's skill development, community development, vocational training, prosthetics, and demining. Examples of success stories include a social marketing program for condoms, which in one year has reached sales of 1 million condoms a month. Through USAID grantees, there is now an active national birth-spacing policy, protocols, and a standardized curriculum. USAID grantees work with the Ministry of Health in seven provinces to introduce birth spacing through the public sector, reaching over 150,000 women. USAID's grant to Helen Keller International is introducing iodized salt to Cambodia. USAID completed an HIV/AIDS assessment in October 1995, producing groundbreaking data concerning the impact of the epidemic. A prevalence study for HIV/AIDs and sexually transmitted diseases (STDs) has been designed, and in March 1996, USAID will expand sentinel surveillance from 7 to 18 provinces.

As Cambodia moves towards reconstruction, USAID is focusing the portfolio on Agency goals, country priorities, and building on successes of the Private Voluntary Organization (PVO) Co-Financing project. Data analysis shows an unmet need for contraception of over 75%, and the region's fastest population growth rates at 2.8. Cambodia has HIV prevalence rates growing at a faster rate than even the peak years of the Thai epidemic. Given these data and the criteria above, improved maternal child health (MCH) will be a key strategic objective. The RCG has identified its as their number one health sector priority. USAID's new MCH strategy will focus on integrated reproductive health and child survival, including birth spacing, STD/HIV prevention, safe motherhood, childhood diarrheal disease, andacute respiratory infections, through interventions and assistance to the RCG, NGOs and the private sector. Key intermediate results include:

. Leadership role for quality MCH care assumed by the public sector;

. Improved human resource capacity in the MCH sector; and

. Improved MCH commodity accessibility and management.

Specific interventions in support of the above include:

. Medical protocols, guidelines, curricula and supportive policies in place;

. Private and public sector, health care providers have improved knowledge and are delivering quality MCH care;

. Commodity logistics management capacity developed in the public sector;

. Appropriate, high quality MCH products offered in the private sector; and

. Voluntary surgical sterilization services piloted.

Poverty lending and microfinance are successful areas of USAID support and offer positive opportunities for further assistance. The current program has a focus on the poorest urban and rural women with subsequent impact on increasing household security. Anticipated ongoing results include:

. Increased women's access to affordable credit; and

. Increased number of viable rural financial institutions.

Because of the potential for impact on household security that these interventions hold and the lack of affordable financial services in rural areas, USAID will do further analysis of the sector to consider additional future funding. Also, USAID will continue ongoing activities supporting the rehabilitation of war victims, one of the special objectives in the program. While demining is proceeding, land mines continue to claim 150-200 victims a month, and it will take many more years to remove this threat throughout Cambodia. This is a special humanitarian objective rather than a development one. It includes efforts to increase the number of fitted prostheses, to improve psychological treatment of war-related trauma, and to enhance demining operations.

USAID/Cambodi a Strategic Objective	Encouraging Economic Growth	Stabilizing Population Growth & Improving Human Health	Protecting the Environment	Building Democracy	Total
1. Strengthening Pluralism and Governance	0	0	0	11,500,000	11,500,000
2. Supporting Broad-based Economic Growth	12,000,000	0	1,000,000	0	13,000,000
3. Meeting Basic Human Needs	6,000,000	4,500,000	0	0	9,500,000
Total (ESF)	18,000,000	4,500,000	1,000,000	11,500,000	35,000,000

USAID/Cambodia Representative: Joseph Goodwin

PROGRAM: Cambodia
TITLE AND NUMBER: Strengthen Democratic Institutions, 442-SO01
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1997: $11,500,000 (ESF)
INITIAL OBLIGATION: FY 1995: ESTIMATED COMPLETION DATE: FY 1998

Purpose: To strengthen democratic institutions through activities which promote the rule of law and a functioning civil society, to enhance the legislative capacity of the National Assembly, and to develop a fair elections system.

Background: U.S. national interest is to assist the Royal Government of Cambodia (RGC) in building a nation based on democratic principles and practices, including respect for human rights. Following two decades of civil war and purposeful dismantling of civil society, the major institutions of democratic governance have been systematically destroyed. Rehabilitation of the rule of law, the judiciary, electoral processes, and a national legislature are all fundamental prerequisites for Cambodia's transition into a sustainable and economically viable democratic society. At present, prospects for building a nation under democratic rule are hopeful, as evidenced by a gradual transition to peace. Strengthening key democratic institutions will promote the participation of all Cambodians and deepen their commitment to their emerging nation, rendering it less fragile.

USAID Role and Achievements to Date: USAID's $30 million Cambodia Democracy Initiatives project has played a pivotal role in supporting the transition to a more stable and prosperous democratic nation. Grantees funded by USAID have established a Department of Law in Cambodia's Business Faculty and continue strengthening the 120- member National Assembly, provincial court system, newly established Cambodia Bar Association, professional media organizations, and an array of human rights and public policy organizations. These local entities interact with marginalized populations, especially women and minorities, and are striving to reduce corruption and to promote a more civil society. USAID has helped introduce internationally recognized fair business practices, fair labor practices, and the presence of public defenders in court. USAID-supported non-governmental organizations (NGOs) were prominent in supporting preparations for the May 1993 elections, and have taken an effective lead in the early preparations for local-level and national elections scheduled for 1997 and 1998, respectively.

Description: USAID provides assistance primarily through provision of training and technical advisors in three critical areas: establishing the rule of law, promoting free and fair elections, and increasing the role of the legislature in establishing national policy. Three U.S. NGOs have major grants to help strengthen the rule of law: (1) the International Human Rights Law Group, which works throughout the country in the provincial courts; (2) the American Bar Association, which provides advisory assistance to the newly formed Cambodian Bar Association and several ministries; and (3) the University of San Francisco, which is teaching law and training Khmer teachers in law at both the University of Phnom Penh and the Cambodia Bar Association. The Asian-American Free Labor Institute is helping to write and implement labor law. The Asia Foundation (TAF) works to improve the capacity of the National Assembly; to expand legal education; and to support local organizations engaged in human rights training and monitoring and the development of independent, responsible media and public policy. Three U.S. grantees were active in the successful 1993 national election, including the National Democratic Institute, which is still active along with the International Republican Institute, and TAF local NGOs in elections preparations. USAID plans a new program of elections assistance, to include voter education and election monitoring to facilitate upcoming local and national elections.

Host Country and Other Donors: The United States and France are the major donors in establishing the rule of law. Coordination of assistance plans and activities between the donors is increasing. Australia, Sweden, and Denmark will increase their involvement in this sector. The broader donor community has an interest in the elections, although donors have not yet outlined the scope of their planned support. NGOs, assisted by USAID, collaborate closely with RGC counterparts. The RGC is unable to contribute financially to USAID-funded NGO programs due to its limited resources; a host-country contribution has been waived in this case.

Beneficiaries: Improved legislation, stronger rule of law, and free and fair elections will benefit the entire Cambodian population. Beneficiaries directly involved in grant-funded training activities include: 40 lawyers in training; 300 students at the Faculty of Business; 50 journalism students; 2 journalism associations containing 50 media organizations; 10 local NGOs; 120 members of the National Assembly; clerks, judges, and prosecutors in 15 provincial courts; 15 USAID-trained lawyers; and 10 public defenders trained in-country.

Principal Contractors, Grantees or Agencies: Grantees are those identified in the description above, except for the elections element, which is yet to be determined.

Major Results Indicators: USAID may rely on qualitative data concerning systemic improvements to a greater extent than quantitative data in this sector, due to the nature of the programs, and the absence of adequate baseline data. Selected results indicators include:

- Legal and procedural reforms supportive of business development and human rights are approved;
- The National Assembly is more effective and better informed in amending and initiating legislation, especially on issues relating to business development, human rights, and the status of women;
- Lawyers, public defenders, judges, prosecutors, and court staff are more skillful in applying the law, with a 50% increase in the number of defendants represented by qualified defenders;
- Court management systems are improved, as indicated by compliance with legal norms in the area of criminal justice in 21 trial courts throughout Cambodia;
- The public is more knowledgeable about their rights (surveys may be used to collect baseline and outcome data) ;
- Improved monitoring and defense of human rights, especially on behalf of women and minorities, with strategies/mechanisms for human rights education, advocacy and monitoring in place in 70% of the provinces by 1999;
- Support of an electorial system which produces free and fair elections, as indicated by the implementation of local elections in 1997 and national elections in 1998.

Purpose: To strengthen the foundation for sustainable economic growth by improving the quality of primary education, environmental management, and the human resource base for private sector growth.

Background: The limited human capital resource base is one of the most serious constraints to future development in Cambodia. During the reign of the Khmer Rouge, a large majority of the educated population was either killed or forced to flee, leading to the loss of one generation. Attempts to re-establish the dismantled education system in the early 1980s by the Vietnamese occupation forces fell far short of expectations, so yet another generation is at risk. At present, the literacy rate is 35% overall, and the majority of the population aged 18-36 lacks even the most basic skills needed in a modern economy (e.g., accounting, management, computers, and English language). Managerial skills have been identified by many ministries as the single most important human resource factor needed to meet its goal of becoming a member of the Association of Southeast Asian Nations (ASEAN) by 1997. In addition, the lack of effective advocacy, legislation, and enforcement is resulting in rapid environmental degradation.

USAID Role and Achievements to Date: USAID is presently launching an effort to retrain primary school teachers throughout Cambodia. This effort will begin field activities in mid-1996 and complements the activities of other donors in primary education. Since 1993, USAID, through grants to Georgetown University, has supported the Faculty of Business to train professors and assist in curriculum development, and to implement an entrepreneurial skills short course for small business operators. This short course has now been expanded to four provinces. USAID also provides assistance to establish the Cambodian Development Council's Strategic Planning Unit. The unit will be responsible for developing a human resource plan and a public and private investment framework. To assist with planning and coordination of assistance in the agricultural sector, a small amount of policy assistance is being provided to the RGC's Council on Agriculture and Rural Development. Finally, to assist the RGC in the area of environmental management, USAID participates in a multi-donor effort to develop and adopt a national environmental action plan. The action plan will help frame conditions for sustainable economic growth, include local input in the development of strategies for key thematic areas (e.g., forests, inland fisheries, coastal zones), and in the process, foster more sustainable use of the country's considerable, but dwindling, natural resources.

Description: USAID will focus on four activity areas: training of primary school teachers and development of school clusters to support teacher training efforts; training in entrepreneurial skills for potential middle-level managers, including support to the Faculty of Business for degree and non-degree training and continuing education; assistance to develop a national environmental plan and to eventually attract other donor/international finance institution support; and assistance for planning and coordination in the agricultural and rural development ministries.

Host Country and Other Donors: As USAID's program of assistance moves away from emergency relief, development and implementation of activities will increasingly conform to RGC initiatives, such as the RGC's investment plan for the education sector. This will ensure not only that USAID's activities are consistent with RGC objectives, but that they also are coordinated with those of other donors. Other donors contributing to improvements in primary education include the European Union, France, Australia, the United Nations Children's Fund (UNICEF), and the Asian Development Bank.

Beneficiaries: The beneficiaries of USAID's assistance under this activity are numerous. First will be Cambodia's children, who will be better able to learn through improved teaching techniques taught by more qualified teachers. Second, both the public and private sector will benefit, as skills are better matched to jobs and trainees who, through skills enhancement, are better able to perform job functions and are better able to function in the private sector. There also will be those who start their own business and those who get jobs created by expanding businesses. Better aid coordination in the agricultural and rural sectors will also hopefully result in a more equitable distribution of assistance in rural areas, in addition to greater emphasis on integrated activities, and, hence, benefit those in areas that havebeen neglected until now. Finally, Cambodians in general will benefit as improved environmental management and sensitivity to environmental issues results in adoption of more sustainable natural resource uses.

Principal Contractors, Grantees, or Agencies: USAID will implement ongoing activities through a variety of methods, including grants and cooperative agreements to U.S. private voluntary and nongovernmental organizations, and contractors. Current grantees include a consortium among CARE, the World Resources Institute, the World Wildlife Fund, the International Development Research Centre, and PACT. Contractors include Development Alternatives, Inc. and its consortium members.

Major Results Indicators:

- 9000 teachers and administrators trained each year in utilizing student-centered teaching methodologies (country-wide coverage by the year 2002;
- 75 school clusters are established each year, with functioning resource centers in cluster schools constructed and stocked, allowing country-wide coverage by 2002;
- Percentage of Small Business Training Program graduates employed by the private sector increases by 10 percent per year (baseline to be determined based on enrollment data);
- Functioning Council on Agriculture and Rural Development providing planning and coordination assistance to the rural sector;
- Recommendations on agricultural credit policy changes developed for the Committee on Agriculture and Rural Development (CARD) by June 1997 and the target for adoption by the Royal Cambodian Government is December 1997;
- National Environment Action Plan developed and adopted by the RGC by April 1997;
- National Environment Investment Program developed in collaboration with and for multilateral bank funding in 1998.

PROGRAM: Cambodia
TITLE AND NUMBER: Increased Access to Basic Human Services, 442-SO03
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1997: $9,500,000 (ESF)
INITIAL OBLIGATION: FY 1995; ESTIMATED COMPLETION DATE: FY 2000

Purpose: To strengthen the capacity of public organizations and non-governmental organizations (NGOs) to provide sustainable family support services.

Background: Cambodia has some of the highest maternal and child mortality rates in the world, the region's highest population growth rate (2.8), and an alarming increase in HIV/AIDS. More than 80% of the population does not have access to potable water; many do not have access to basic health care, affordable credit, or passable roads. Many Cambodians suffer from physical and mental impairments related to 25 years of war, and an estimated 8-10 million land mines are still present in the country. Local NGOs, which before 1992 were not allowed to exist, have been supported with sub-grants and technical and organizational training to improve their ability to deliver services at the village level. This program addresses these and other needs and includes existing NGO grant activities programmed under the Private Voluntary Organization Co-Financing project and the Family Health and Birth Spacing project.

USAID Role and Achievements to Date: USAID's support for a social-marketing program has resulted in condom sales of up to 1 million per month, contributing strongly to the nascent HIV/AIDS prevention program of the Ministry of Health. NGOs supported by USAID have succeeded in rehabilitating hospitals and training health workers to deliver health care and birth spacing-services, convincing the Ministry of Health to adopt vitamin A and iodine-deficiency programs, installing wells and latrines to improve sanitation and control diarrheal disease, and assisting the Ministry of Health to develop dengue hemorrhagic fever control programs. USAID's NGO grantees have provided 7,086 prosthetic limbs and 2,519 wheelchairs to-date, and have played a crucial role in helping the RCG develop strategies for sustainable services for the disabled.

Aside from health, USAID's program to-date has established more than 100 women' village banks, trained RCG and village social workers in carrying out community development projects, provided vocational training to orphans, women, and disabled veterans, funded the installation of hundreds of wells, latrines, and low-technology treadle pumps, and contributed to the creation and strengthening of three Khmer-American and 18 local NGOs that deliver village-level services and serve as engines of civil society.

Description: Over the next few years, USAID's primary focus in this sector will be on maternal and child health (MCH). Current and projected MCH activities aim to improve delivery of MCH, including birth-spacing services, in both the public and private sectors; to limit transmission of sexually transmitted diseases and HIV/AIDS; to reduce child mortality and morbidity from diarrheal disease and acute respiratory infections; and to improve nutrition in women and children. Support also will be given to mental health programs, an area of serious concern in Cambodia.

Host Country and Other Donors: The United Nations' Children's Fund (UNICEF), with assistance from Japan and the World Health Organization (WHO), supports the national immunization program. UNICEF and other bilateral donors also support the essential drug distribution system. WHO provides technical advisors to the Ministry of Health in health systems planning, continuing education, and management information systems. The United Nations' Population Fund provides contraceptives and support for a nationwide census. The Asian Development Bank, Japan, and the World Bank support health infrastructure development. Cambodia provides personnel and is instituting major reforms to rationalize and improve the country's health system.

In the water and sanitation sector, UNICEF and the European Union support installation of wells and latrines in certain parts of the country. Donors such as United Nations Development Programme (UNDP), the United Kingdom, France, Holland and Australia support NGO efforts in prosthetics, demining, and to a more limited extent, mental health. The micro-credit/enterprise sector receives funding from the International Labor Organization, UNDP, and the French Development Fund (Caisse-Francaise de Developpement); the European Union and the Asian Development Bank are developing credit programs as well.

Beneficiaries: For MCH activities, primary beneficiaries include an estimated 2.1 million children under 5 years of age, and 2.6 million women of reproductive age. Secondary beneficiaries, particularly for STD interventions, include 2.7 million men of reproductive age. Cambodia's disabled veteran population is conservatively estimated at 50,000; disabled civilian numbers are not known, but they are unacceptably high due to the continuing presence of land mines. In the realm of mental health, 100 physicians to be trained will, in turn, treat patients throughout the country. Demining verification surveys at 900 sites will enable villagers in adjacent areas (estimated at about 500 per village) to know definitively where mines are located and thereby avoid injury. Many more Cambodians already benefit from potable water, hospital rehabilitation, primary health care, vocational training, and credit that USAID grantees have provided since 1992.

Principal Contractors, Grantees, or Agencies: USAID implements the above activities through U.S., international, and local NGOs, working collaboratively with the Ministries of Health and Rural Development. Grantees include the American Red Cross, CARE, Family Planning International Assistance, Handicap International, Harvard School of Public Health, Helen Keller International, Doctors Without Borders, Population Services International, Salesian Missions and PACT. In addition, selected USAID centrally-managed contracts and cooperative agreements will be accessed for technical support.

Major Results Indicators
- Improved delivery of reproductive health care and child survival services as indicated by:
Infant mortality rate reduced from 115 per 1,000 to 100 per 1,000 by the year 2000;
Child mortality rate reduced from 181 per 1,000 to 155 per 1,000by the year 2000;
Contraceptive prevalence increases from 7 to 17 percent by the year 2000;
- Increased marketing of MCH products, as indicated by 80% of pharmacists (from a baseline of zero) adhering to appropriate prescribing practices;
- Improved case management of diarrheal disease and acute respiratory infection (baseline and targets to be determined);
- Improved micronutrient status in children (baseline and targets to be determined);
- Increased access to affordable credit will be increased for Cambodian women from 286 women served by 7 village banks, to over 3,000 women utilizing 78 banks; 3 local NGOs and employees of the Ministry of Rural Development will be trained in successful village banking methods;
- Mental health services/treatment provided to approximately 2,000 patients by 1999 (baseline: zero);
- An annual production/fitting level of 1,560 prosthetic/orthotic devices (no baseline as Cambodia's population disabled by mines continues to increase, and replacement of prosthetic/orthotic devices is needed approximately every 2 years);
- 300 kilometers of laterite road in Cambodia's northwest provinces will be rehabilitated.