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Note: This document may not always reflect the actual appropriations determined by Congress. Final budget allocations for USAID's programs are not determined until after passage of an appropriations bill and preparation of the Operating Year Budget (OYB).

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CAMBODIA

	FY 1997	FY 1998	FY 1999
	Actual	Estimate	Request
Economic Support Funds.............	$35,000,000	$20,000,000	$20,000,000

Introduction

The United States' national interest in Cambodia lies in preserving the fragile gains that have been made since the 1991 Paris Peace Accords and the watershed UN-supervised elections of 1993. This interest is pursued through programs that help protect human rights, promote the democratic process, and bring higher standards of living to a population traumatized by decades of civil war, genocide, and foreign occupation. These interests were threatened in July 1997, when Second Prime Minister Hun Sen ousted his coalition partner First Prime Minister Norodom Ranariddh in a violent military clash. In response, the U.S. suspended two-thirds of its $38 million a year aid program, leaving in place activities that were demonstrably humanitarian in nature and/or were promoting the democratic process without providing direct support to the Government of Cambodia. The suspension remains in place as of this writing pending the outcome of parliamentary elections now scheduled for July 1998.

Development Challenge

In direct reflection of the country's tragic history, Cambodia ranks 124th on the United Nations' Human Development Index of 157 countries. Government and non-government organizations alike are institutionally weak and highly dependent on external donor assistance. Per capita GDP is still less than $300 a year and life expectancy is less than 60 years. Infant and maternal mortality rates are among the highest in the world and are presently being exacerbated by the HIV/AIDS epidemic, which is rapidly undermining the social and economic fabric of the country. Years of war and neglect have ravaged the country's physical infrastructure, which contributes further to keeping the population in a state of poverty. Cambodia was once a rice-exporting country and still has significant unexploited agricultural potential. An estimated 85% of the population is rural, and the country enjoys one of the lowest population densities in East Asia. However, productivity in agriculture and other rural sectors has suffered from the presence of land mines, low levels of domestic and foreign investment, and the continuing absence of on-farm management skills. The current population aged 18-36 lacks the basic skills necessary for more than subsistence living. The education system, which was almost entirely wiped out along with the educated cohort of teachers, managers, and other skilled professionals at the hands of the murderous Khmer Rouge, remains in critical condition today and is unable to support economic growth and the establishment of democratic processes. Given the seriousness of Cambodia's problems, USAID does not foresee graduating the country from development assistance in the near future.

However, significant progress has been made. Prior to July 1997 the economy was growing at a brisk 6% per year (it is now down to about 2% per year as a result of a fall-off in tourism and direct foreign investment associated with the recent political instability) and the government had a good record managing its modest (by developing country standards) external debt.

--    In democracy, USAID activities have expanded the reach of human rights and democracy NGOs nationwide, improving the monitoring and reporting of human rights violations and increasing the transparency and professionalism of the judiciary.

--    In primary education, USAID has established a nationwide base of in-service teacher training based on increased community participation and a new teaching methodology. Over 70 “cluster school” committees have been established, and in-service teacher training programs

for grades 1-3 was underway when the program was suspended last July. In addition to increasing the quality of primary education and the level of community participation, the program seeks reduced dropout rates for girls as a special objective.

--    In maternal and child health, new policies, protocols, and planning tools have been developed and put into place by the Ministry of Health with USAID assistance. A standard package of services has been introduced in 23 districts serving 165,000 women and children. In the private sector, a USAID-supported reproductive health NGO served more than 39,000 clients in a single year.

--    In HIV/AIDS, USAID has completed seroprevalence and behavior analyses of the fast-spreading epidemic that were used in the formulation of Cambodia's first national strategic plan, which in turn helped USAID develop a major new awareness and prevention program. A program to promote the marketing of condoms has proven highly successful, with about 20 million units distributed in 1996-97.

--    In economic growth, about 300 kilometers of secondary and tertiary roads in Banteay Meanchey and Siem Reap provinces have been demined and rehabilitated, generating over 80,000 workdays of employment and contributing greatly to opening up fertile rice producing areas. Separately, micro-finance programs have benefitted over 55,000 rural women.

--    In the environment, prior to the suspension USAID was leading a consortium of donors working to strengthen the newly-established Ministry of Environment. Assistance was focused on development of a national environmental protection plan (NEAP) and the preservation of national forests that currently comprise about 25 percent of Cambodia's remaining forest cover.

--    Lastly, under the program of assistance to war and mine victims, last year over 1,900 amputees were fitted with prosthetic devices. From this group, 478 orphans and 449 adults were given vocational training and other assistance to help them seek gainful employment. About 1,250 people with mental illnesses were treated by health care professionals trained at a USAID-supported facility in Siem Reap.

Under the current aid suspension, USAID continues to support highly effective direcet-impact humanitarian programs (maternal-child health, HIV/AIDS prevention, and assistance to war and mine victims) and certain democracy and human rights programs that work direcly with Cambodian NGOs. Suspended programs include activities in the environment, primary education, and rural economic growth. The U.S. continues to press for improvements in human rights, the safe return of opposition politicians who fled the country during the July fighting, and the establishment of conditions for free and fair elections, all of which constitute near-term prerequisites for the renewed provision of direct elections support to the Government of Cambodia and, in the longer term, for the resumption of other, currently suspended programs. Assuming reasonably free and fair elections and a renewed budgetary commitment to resolving Cambodia's long term development problems, USAID plans to continue ongoing program and resume presently-suspended activities, with modifications as necessary to adjust to the post-elections climate.

Other Donors

Prior to the aid suspension the U.S. was the second largest bilateral donor after Japan. Other major donors include France, Australia, the European Union, Netherlands and Sweden. Cambodia also receives assistance from the World Bank and the Asian Development Bank. The International Monetary Fund has suspended its program in Cambodia due to lack of transparency in the management of state forestry revenues.

FY 1999 Program

Our FY 1999 program assumes acceptable elections will be held in 1998. In democracy and human rights , our programs in the post-election period will focus on strengthening civil society and indigenous institutions of excellence that promote human rights and the rule of law. In m aternal-child health and HIV/AIDS prevention we will continue to build on past success and work toward achieving financial sustainability and fine tune the existing programs to maximize achievements of results. Under a resumed and redefined, primary education program we will working on a smaller than national scale. We will continue to fund NGO activities which address basic needs of war and mine victims, with a special emphasis on women. USAID has cancelled a planned intervention in the agriculture sector and replaced it with two smaller but related special objectives, in micro-finance, which will continue support for and expansion of rural financial services for the rural poor, particularly women, and environmental management , under which we will work with NGOs to promote environmental awareness and constituency building in addition to support for community-level environmental awareness activities .

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CAMBODIA
FY 1999 PROGRAM SUMMARY
(in thousands of dollars)

USAID Strategies and Special Objectives	Economic Growth & Agriculture	Population & Health	Environment	Democracy	Human Capacity Development	Humanitarian Assistance	TOTALS
SO 1. Strengthened democratic processes and respect for human rights - ESF	---	---	---	6,000	---	---	6,000
SO 3. Improved quality of primary education - ESF	---	---	---	---	4,000	---	4,000
SO 4. Improved maternal and child health - ESF	---	4,500	---	---	---	---	4,500
SpO 1. Enhanced assistance for war and mine victims - ESF	---	---	---	---	---	2,500	2,500
SpO 2. Reduced transmission of HIV/AIDS and STIs among high risk populations - ESF	---	1,500	---	---	---	---	1,500
SpO 3. Improved government and NGO capacity to manage natural resources - ESF	---	---	1,000	---	---	---	1,000
SpO 4. Expanded access to sustainable financial services - ESF	500	---	---	---	---	---	500
Total - ESF	500	6,000	1,000	6,000	4,000	2,500	20,000

USAID Director, Gordon West

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ACTIVITY DATA SHEET

PROGRAM: Cambodia
TITLE AND NUMBER: Strengthen democratic institutions, 442-SO01
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1999, $6,000,000 (ESF)
INITIAL OBLIGATION: FY 1992 ESTIMATED COMPLETION DATE: FY 2000

Purpose: To reinforce the democratic transition by strengthening the capabilities of public interest processes and institutions, particularly in the non-government sector, and by strengthening the country's legal, regulatory, and judicial systems.

Background: Since 1992 USAID has been working to help Cambodians establish democratic principles and practices, in particular increased respect for human rights. In the course of two decades of civil war and foreign occupation, virtually all of Cambodia's principal institutions of democratic governance were destroyed or dismantled. Rehabilitation of the rule of law, the judiciary, electoral processes, the national legislature, and local level governance are all fundamental prerequisites for Cambodia's transition to a sustainable and economically viable democratic society. The fragility of the current juncture was evidenced in July 1997, when force of arms--rather than the rule of law--was used to resolve disputes within the government. Efforts to strengthen the country's democratic institutions and increase the accountability of government, police, and military officials are designed to facilitate Cambodia's continuing transition to a democratic society.

USAID Role and Achievements to Date: USAID's $50 million Cambodia Democracy Initiatives project has played a pivotal role in the country's democratic transition thus far. USAID-funded grantees have established a successful community legal education program and have strengthened the newly established Cambodia Bar Association, professional media organizations, human rights and public policy organizations, and--prior to the events of July 1997--the 120-member National Assembly and provincial court system. The Cambodian NGOs supported by USAID under this program have worked to reduce corruption, promote government accountability, and strengthen civil society by introducing internationally recognized fair business and labor practices and by increasing the presence of public defenders in Cambodian courtrooms. NGOs were prominent in supporting preparations for the 1993 elections, and are organizing again to provide voter-education and monitoring for the 1998 parliamentary elections. Prior to the aid suspension, a USAID-supported elections expert was also working with the Cambodian Ministry of Interior helping the government formulate and adopt an internationally acceptable national elections law and create a permanent, independent elections commission.

Description: The majority of funds allocated for FY 1999 under this activity will be used to strengthen the rule of law, governance, government accountability, and respect for human rights. The Asia Foundation, currently the largest grantee under the program, will continue supporting local organizations engaged in protecting human rights, furthering public policy making, improving the capacity of the National Assembly, and implementing a nationwide good governance program focused at the local level. USAID intends to focus its ongoing rule of law program in Cambodia towards its most successful programs, notably the Cambodian Defenders Project, and concentrate on efforts to help end the continuing climate of impunity, including efforts to strengthen the formal legal system. As the post-elections political situation develops, USAID will undertake a sector strategy review preparatory to the development of second generation rule of law programs. Modest funding has been reserved to support local (commune level) elections anticipated in 1999.

Host Country and Other Donors: The United States, France, Australia, and various UN agencies are the major donors working in the democracy sector in Cambodia. Coordination of assistance plans and

activities between the donors in specific areas, e.g., elections and human rights monitoring, has been good. Many donors have indicated interest in supporting the 1998 parliamentary elections, with the European Union (EU) committing 10 million ECU and Japan considering almost as much.

Beneficiaries: Stronger legal institutions, improved rule of law, and free and fair elections will benefit all Cambodians. Beneficiaries directly involved in grant-funded training include eight Cambodian human rights/public policy NGOs and two women's media associations. Beneficiaries of free legal aid include indigent Cambodians accused of crimes and those in need of assistance with civil disputes. Additionally, over five million Cambodians benefit by receiving public service announcements through the media. If current restrictions on direct assistance to the government are lifted, additional beneficiaries will include 120 members of the National Assembly and 75 judges.

Principal Contractors, Grantees or Agencies: The Asia Foundation, the University of San Francisco (USF), the Asian-American Free Labor Institute (AAFLI), the International Human Rights Law Group (IHRLG); the International Foundation for Electorial Systems (IFES), others to be determined.

Major Results Indicators:

Baseline Target
(1996) (1999)

. Democratic multi-party elections whose outcome

-0- 1
reflects the will of the people and result in those
elected taking office;

. A legislative process that is better coordinatedN/A N/A
and more responsive to the expressed needs
of the electorate;

. A National Assembly functioning more independently

N/A N/A
and effectively than at present;

. Increased professionalism and independence of the

3 groups 5 groups
judiciary;

. Increased awareness of human rights and

N/A 65% of populace
democratic processes;

. Greater accountability of military, police and civil
servants under the rule of law.

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ACTIVITY DATA SHEET

PROGRAM: Cambodia
TITLE AND NUMBER: Improved ability of schools and clusters to support quality classroom instruction, 442-SO03
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1999: $4,000,000 (ESF)
INITIAL OBLIGATION: FY 1995 ESTIMATED COMPLETION DATE: FY 2002

Purpose: Improved ability of schools and school clusters to support quality classroom instruction.

Background: A weak and seriously underdeveloped human resource base remains one of the most serious constraints to Cambodia's future development. Under the Khmer Rouge, the education system was dismantled and a large majority of the educated population either killed or forced to flee, with the result that an entire generation of educated Cambodians was lost. Attempts to rebuild the education system during the 1980s, though considerable, fell far short of expectations. Fortunately there is considerably more donor support now; however, extraordinary steps requiring the coordinated efforts of bilateral and multilateral donors as well as NGOs are required to "jump start" the education system so the next generation of Cambodians can learn the basic skills needed to operate in an expanding and dynamic economy.

USAID Role and Achievements to Date: From September 1994 to July 1997, USAID worked closely with the Ministry of Education, Youth and Sports (MoEYS) to develop and refine the government's investment plan for the education sector. This action was necessary to ensure that USAID's in-service teacher training activities (which began in earnest during the fall of 1996) were coordinated with related activities undertaken by other donors and NGOs. The methodology used under the USAID program built upon pilot activities pioneered by the MoEYS, with assistance from UNICEF, in teacher training and cluster school development. USAID's assistance combined elements of these programs in an effective, low cost fashion than enhanced the likelihood that MoEYS would be able continue skills development on its own after the termination of USAID assistance. Alternatives to the use of school "clusters" were also being explored for the more remote, sparsely-populated areas. Studies were also being conducted to examine constraints to the participation of girls in primary school and develop strategies to increase their participation.

Description: Assuming USAID will be able to resume this activity after the 1998 parliamentary elections, USAID, the implementing NGO consortium, and the MoEYS will work together to select school clusters and then train all primary school teachers in these clusters in improved pedagogic practices for math and Khmer language. (Over the life of this activity, USAID plans to retrain nearly all primary school teachers and administrators in Cambodia). The course of study comprises a series of two three-week workshops, two four-day workshops, weekly tutorials, and weekly classroom observation over the course of an entire academic year. For cluster school development, technical assistance and training will be provided to each new school cluster for a period of two years. Together, these two forms of assistance will provide teachers with improved skills and a community-based support structure to support the primary education system generally. These efforts will be combined with targeted assistance at the central level to make education planning and policy better coordinated and implemented.

Host Country and Other Donors: USAID's assistance to the primary education system builds upon government initiatives to enhance teacher skills and develop school clusters. It is complementary to other assistance being provided by UNICEF, the Asian Development Bank, the European Union, UNESCO, Japan, Australia, Great Britain, and France, as well as various NGOs providing a range of assistance in cluster schools, curriculum, textbooks, capacity building, teacher training, and language. By being dynamic and recognizing that change will occur throughout the life of the activity, the USAID

activity articulates well with these other programs. For instance, new textbooks being developed and published with financing from other donors will require constant modification of the teacher training curriculum being used under the USAID activity. Mechanisms are in place to ensure that these modifications are incorporated as new textbooks come on line.

Beneficiaries: The beneficiaries of USAID assistance under this activity are many. First are Cambodia's children, who will be better able to learn through improved teaching techniques taught by more qualified teachers and through better access to quality teaching materials. Girls of school age will also benefit as studies are conducted, and strategies developed and implemented to increase their participation in primary education. Finally, selected Ministry of Education staff will benefit from hands-on training in data collection and public policy analysis.

Principal Contractors, Grantees, or Agencies: Prior to the aid suspension teacher training and cluster school development activities were implemented through a consortium made up of World Learning (as lead institution), World Education, and Save the Children. Capacity building in education policy was partially provided through the Global Bureau's Advancing Basic Education and Literacy II activity (ABEL2). Grants to these organizations have been suspended pending the holding of parliamentary elections in July 1998.

Major Results Indicators:

Baseline Target
(1997) (1999)
(Targets are subject to resumption of this activity
after elections; FY 1999 target level is 70% for all indicators)

. Schools and clusters able to support quality classroom

N/A 70%
instruction (i.e., improved teacher knowledge and
practice; reduced constraints on teachers' planning
and performance; improvements in communication
among and between teachers, schools, and parents;
and improvements in decision-making and problem-solving
by teachers, schools and clusters);
    
. Effective teacher training (improved math and KhmerN/A/ 70%
competency; increased use of student-centered
teaching methodologies; and increased access to
teaching resources);

. Effective school clusters (increased interaction between

N/A 70%
teachers, schools, clusters, and PTAs; resource centers
set up and functioning; and increased community
involvement); and

. Appropriate primary education policies.

TBD TBD

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ACTIVITY DATA SHEET

PROGRAM: Cambodia
TITLE AND NUMBER: Improved maternal child health, 442-SO04
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1999: $4,500,000 (ESF)
INITIAL OBLIGATION: FY 1995 ESTIMATED COMPLETION DATE: FY 2000

Purpose: To improve Cambodia's reproductive health and child survival profile by increasing modern method contraceptive prevalence from 7% to 17%; by decreasing in infant mortality from 115 per thousand to 100 per thousand; and by decreasing under-five mortality rates from 181 per thousand to 155 per thousand.

Background: Cambodia has one of the highest maternal and child mortality rates in the world, the region's highest population growth rate, and one of the fastest growing HIV/AIDS epidemics anywhere. According to some estimates fewer than 50% of rural Cambodians have access to any health care. Surveys continually highlight the high priority Cambodians place on access to essential health services, particularly those related to family planning and child survival. Recognizing the urgency of the situation, the Cambodian Government and has designated maternal child health as a top priority. Major reforms undertaken by the Ministry of Health (MOH) include instituting a minimum package of services at the lowest level of the health care system, introducing pilot cost recovery schemes, and testing innovative public-private partnership models of service delivery.

USAID Role and Achievements to Date: Building on the Agency's comparative advantage in the health sector, the USAID program in Cambodia works with the MOH, local NGOs, and the private sector to improve the health of Cambodians. USAID is a leader in the maternal-child health sector in Cambodia and has recorded a number of important achievements at a variety of levels. At the policy level, USAID has contributed directly to the elaboration and implementation of policies for reproductive health, specifically for birth spacing and HIV/AIDS testing and prevention; in child survival, through the integration of Vitamin A activities into national systems and the development of a Dengue Hemorrhagic Fever program at the MOH; and in improved sustainability through the introduction of community participation schemes at the lowest levels of the system, the launching of the first private sector reproductive health center in Cambodia, and the introduction of social marketing programs. Programs aimed at improved service delivery have reached over 165,000 women with reproductive health services, sold over 10.5 million condoms annually for the prevention of STDs and HIV and for contraception, and trained hundreds of health care workers in the basic elements of reproductive health and child survival services.

Description: USAID's maternal-child health program focuses on developing a leadership role of the MOH in the policy arena, improving service delivery in the public and private sectors, and increasing access to quality MCH commodities in the public and private sectors. Technical areas include birth spacing, STD/HIV management and prevention, safe motherhood, and child survival with a focus on diarrheal diseases, acute respiratory infections, micronutrient deficiencies, and immunization.

Host Country and Other Donors: With assistance from Japan and World Health Organization (WHO), UNICEF supports the national immunization program. UNICEF and other bilateral donors also support the essential drug system. The United Nations Population Fund (UNFPA), Japan, and Germany are partners with USAID in the area of reproductive health. WHO provides technical advisors to the MOH, with particularly strong support from ODA, in health systems planning, human resources, and management information systems. Both the Asian Development Bank and the World Bank have funded large projects to improve health infrastructure and the management of health services. In HIV/AIDS the World Bank is the major donor, with smaller programs funded by UN agencies and by the European

Union. The Cambodian government supports MOH salaries, selected institutional costs, and principal reform efforts.

Beneficiaries: Primary beneficiaries include an estimated 2.1 million children under the age of five and 2.6 million women of reproductive age. Secondary beneficiaries, particularly for STD and HIV interventions, include 2.7 million men of reproductive age.

Principal Contractors, Grantees or Agencies: USAID/Cambodia implements its MCH and HIV/STI prevention activities through U.S., international, and local NGOs, the Ministry of Health, and centrally-managed (USAID/W-based) cooperating agencies. Grantees include CARE, Helen Keller International, Medicins Sans Frontieres, Partners for Development and Population Services International. Global Bureau partners include AVSC International, John Snow, Inc. (through SEATS) and Partnership for Child Health, Inc. (through BASICS).

Major Results/Indicators:

Baseline Target
(FY 1999 Target)(1995) (1999)

By the year 2000:

. Increase in modern method contraceptive prevalence

6.9% 15%
rate from 7 to 17%.

. Decrease in infant mortality from 115 to 100 per

115 103
1,000 live births.

. Decrease in under-five mortality from 181 to 155

181 158
per 1,000 live births.

. Key policies in place for reproductive health, child

1 4
survival and program sustainability.

.    Increase in the proportion of children under the<10% 40%
age of 5 who have received oral rehydration
therapy when they had diarrhea.

.    Increase in the percent of service providers

0 0%
in target areas who are correctly managing
STDs from 0 to 40%.

. Increase in the percent of service providers in

<10%
target areas who are correctly managing
diarrhea cases in children under five from 0 to 80%.

. Increase in percent of births attended by trained

38.8% N/A
health personnel from 38% to 50%.

.    Increase in annual sales of Number One condoms

5 million 12 million
from 0 (in 1994) to 12 million.

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ACTIVITY DATA SHEET

PROGRAM: Cambodia
TITLE AND NUMBER: Enhanced assistance for war and mine victims, 442-SpO01
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1999: $2,500,000 (ESF)
INITIAL OBLIGATION: FY 1993 ESTIMATED COMPLETION DATE: FY 2001

Purpose: To increase access to quality rehabilitation services and strengthen institutions for long term service provision.

Background: Cambodia has an alarmingly high number of citizens who suffer from grinding poverty and physical and mental impairments related to 25 years of war. Given the country's poor economy and low human resource capacities, it is not currently possible for Cambodia to care for these victims, nor will it be for years to come. Yet these men, women, and children have much to contribute to the country's reconstruction and development if only they can be provided with basic rehabilitative services. Many local community groups and institutions are willing to provide these and other services but lack the financial means and technical/management know-how to do so effectively.

USAID Role and Achievements to Date: In 1997 USAID grants to Cambodian and U.S. NGOs enabled the provision of prosthetic limbs, orthotic devices, and physical therapy to 1,972 mine and polio victims; mental health care and treatment to 1,252 patients; vocational skills training to an estimated 656 orphans, amputees, and very poor widows; and general social services to 5,107 other individuals. In addition, 41,866 farmers, widows and other community members were provided training and resources in rural community-based approaches to health, savings and credit and agriculture. Just as importantly, capacity-building training was provided to local NGOs and individuals to improve their ability to provide sustainable and cost-effective quality care.

Description: USAID will support the efforts of our international and local NGO partners in meeting the needs of war and mine victims, including social and psychiatric counseling, credit, job skills, prosthetics/orthotics, and increased personal empowerment.

Host Country and Other Donors: The Cambodian Government funds and staffs 20 orphanages around the country and, through its line ministries, supports programs for women, mental health care training, and, with the assistance of international NGOs, prosthetics and vocational training for the disabled. Donors such as Japan, the United Kingdom, Germany, Canada, the European Union, World Food Program, UNICEF, the International Committee of the Red Cross, International Labor Organization (ILO), and the United Nations High Commissioner for Refugees support modest programs (often implemented by NGOs) that target war and mine victims.
Beneficiaries: It has been estimated that over 200,000 children in Cambodia are orphans; 158,000 Cambodians are disabled (landmines continue to claim 150-200 civilian victims every month); and 2% of the population suffers from acute mental illness, with many more thought to suffer debilitating depression or anxiety disorders. Approximately 600,000 women are widows, and 35% of the country's households are headed by women. As a result, women often lack sufficient (male) labor to help with farming tasks and often end up joining the ranks of the very poor, which comprise about 36% of the population.

Principal Contractors, Grantees, or Agencies: USAID implements these through US, international and local NGOs, working collaboratively with the ministries of Social Action; Health; Women's Affairs; and Rural Development. Grantees include the American Red Cross, the Harvard School of Public Health, the Vietnam Veterans of American Foundation, Salesian Missions, and Participating Agencies Collaborating Together (PACT).

Major Results Indicators:						Baseline	Target
									 (1995)	(1999)  

 Mental health treatment provided					  1,917	 2,552
 Non-formal education made available for orphans & disabled	     200	    700
 Number of coordinating mechanisms in place			      -0-	      10
 Availability of practitioners proficient in recognizing and
    treating trauma cases               					      -0- 	      50  

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ACTIVITY DATA SHEET

PROGRAM: Cambodia
TITLE AND NUMBER: Reduced Transmission of STIs and HIV/AIDS in High Risk Populations, 442-SpO02
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1999: $1,500,000 (ESF)
INITIAL OBLIGATION: FY 1998 ESTIMATED COMPLETION DATE: FY 2002

Purpose: To reduce HIV and STI transmission in commercial sex workers and their clients in order to slow down the HIV epidemic.

Background: Although HIV infection was first detected in Cambodia in 1991, with the first diagnosed AIDS cases in late 1994, Cambodia has the most serious HIV/AIDS epidemic in Asia and may become one of the worst affected countries in the world. Recent surveys estimate that between 100,000-120,000 people are infected with HIV, and 1997 seroprevalence data indicate an infection rate nationally at nearly 40% of commercial sex workers, 6% of police, over 7% of military and 3.2% of pregnant women, the latter nearly double last year's rate. .

Key contributing factors to the explosive epidemic are political conflict, migration, high levels of sexually transmitted infections (STIs), an unregulated and permissive environment, poverty, a cultural demand for commercial sex and a vigorous sex industry. Unless effective interventions begin immediately, indirect costs to the Cambodian economy by the year 2006 are estimated conservatively at $2 billion! Recognizing this, the Cambodian National AIDS Program led a review in 1997 which contributed a critical anaysis to better understand the epidemic and required response. Findings were presented in a national strategic planning workshop with broad participation of government, NGOs, international organizations and donors, results of which are a National Strategic Plan for STDs/HIV/AIDS for the years 1998-2000. The plan will act as the national framework for action and coordination for all partners contributing to the HIV/AIDS prevention effort.

USAID Role and Achievements to Date: USAID has been active in the area of reproductive health (including STIs/HIV) in Cambodia since 1993, supporting condom social marketing and diagnosis and treatment of STIs in NGO clinics as a part of integrated reproductive health care. By 1995 when it appeared that the epidemic was growing particularly rapidly in Cambodia, USAID brought its comparative advantage to launch a number of activities which examined the epidemiology of the epidemic, the response of the government and donors and made recommendations for effective assistance. Among the activities were HIV sentinel surveillance -- which not only provided a better understanding of the epidemic but also helped the MOH use the data for policy change; behavioral sentinel surveillance which provided essential information concerning reported behaviors relative to sexual practices which enable better targeting of interventions and a useful tool to measure program effectiveness; critical research on STIs which identified drug resistance patterns in order to better inform treatment protocols for nationwide use; and support to the MOH in the elaboration of national counseling and testing policy and guidelines. Based on analysis of the epidemic, USAID opted for a dual approach in its HIV prevention support: first, to continue HIV and STI prevention activities through the maternal and child health program to reach the general population, and second, a new strategy for HIV prevention activities in high-risk populations -- the commercial sex workers and their clients who sustain and increase the epidemic.

Description: Through work at the policy level, communication efforts directed specifically towards commercial sex and special service delivery in selected provinces to reach sex workers and their clients, the HIV/AIDS Special Objective will reduce HIV transmission. Substantial support will be provided for research and monitoring efforts to include forrmative research to inform interventions, pilot

studies to test service delivery models and continued surveillance activities to monitor the epidemic and its trends.

Host Country and Other Donors: The RGC's National AIDS Program works closely with UNAIDS to plan and coordinate major international donors and organizations which make a significant contribution to HIV/AIDS/STI prevention and care. Significant donors include the European Union, UNICEF, WHO, Australia, France, Germany and the United States. A coordination committee of host government, donor, international and implementing organizations meets regularly for joint planning, programming and monitoring.

Beneficiaries: The primary target groups are female commercial sex workers (CSWs) -- both direct and indirect --and their clients. A direct CSW works at an establishment that specializes in selling sex, i.e., a brothel. An indirect CSW works at an establishment that ostensibly has a primary function other than selling sex (e.g., a bar or restaurant). Two primary target groups are chosen because both CSWs and their clients engage in risky sexual practices and are key to the epidemic. The secondary target group is composed of those who derive financial gain from CSWs -- brothel owners, restaurant owners, police, taxi drivers, etc.).

Principal Contractors, Grantees, or Agencies: USAID works with the National AIDS Program, UN agencies, other donors and U.S., international and local PVOs/NGOs to plan and implement its HIV prevention program. Major implementation partners include Family Health International and its partners in the IMPACT project, Population Services International and the HIV/AIDS Alliance.

Major Results/Indicators: Performance targets to be set in February 1988 once action plan is complete, activities defined and target areas identified. Baseline figures given are from a variety of studies in Cambodia.

*    Increased condom use by commercial sex workers with non-regular partner in most recent sex act. (Baseline range is 11.5% to 89.4%.)

*    Increased condom use by clients of commercial sex workers with non-regular partner in most recent sex act. (Baseline range is 39.2% to 84.8%.)

*    Decreased STI prevalence rate in commercial sex workers in target areas. (Baseline range is 36% to 58.6%.)

*    Decreased proportion of commercial sex workers in target areas who are paid by the month. (Baseline range is 15% to 64.6%.)

*    Appropriate regulatory policies defined and implemented in order to reduce HIV transmission     in commercial sex workers.    

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ACTIVITY DATA SHEET

PROGRAM: CAMBODIA
TITLE AND NUMBER: IMPROVED NGO CAPACITY TO MANAGE NATURAL RESOURCES, 442-SpO03
STATUS: New
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1999: $1,000,000 (ESF)
INITIAL OBLIGATION: FY 1999 ESTIMATED COMPLETION DATE: FY 2002

Purpose: To promote and improve community environmental awareness and constituency building through NGO training and support for NGO community environmental protection activities.

Background: While Cambodia has embarked on the path of democratic governance and a free market economy, the environmental impact of the country's development has been largely ignored. The impact of continuing resource extraction is most pronounced for forestry and fisheries. In the early 1970s forests covered 74% of the land area, but today this totals less than 35%, of which less than half is primary forest. The loss of tree cover from logging is destroying fish habitat and spawning grounds and, in the northern part of the country, is contributing to an increased siltation of the Tonle Sap lake and the surrounding wetland ecosystem. Uncontrolled gem mining, disposal of solid waste and sewage into rivers, and biodiversity destruction are additional serious problems.

In recognition of the growing serious of the country's environmental problems, in 1994 the government established the Ministry of Environment. With assistance from a number of donors, it has been actively involved developing its staff, formulating environmental policies and regulations, assessing critical environmental issues, and improving its ability to influence the policies and programs of other ministries to incorporate environmental concerns and safeguards. However, the ministry has a long way to go, both institutionally and programmatically, before it can credibly lead participatory environmental management policy and provide leadership for development and implementation of a regulatory framework. This is largely due to the dearth of qualified staff and a very limited budget. Since the July 1997 political events, uncontrolled logging and exploitation of natural resources has increased, with serious downstream impacts. The ministry's difficulties are compounded by lack of a public constituency, poor public awareness of the seriousness of current problems and their long term impact, and lack of serious political will to deal with the problems.

USAID Role and Achievements To Date: USAID has provided support to the fledgling Ministry of Environment since 1996. The principal focus has been to develop MoE's institutional capacity to deal with Cambodia's environmental problems, principally through staff training, assessment of environmental problems, and development of a National Environmental Action Plan. Prior to the aid suspension, assistance to the MoE under the Cambodia Environmental Management Project (CEMP) was being provided through grants to a consortium of U.S. environmental NGOs headed by CARE International as prime grantee. The program was halted as part of the aid suspension announced in July 1997.

At the time of suspension, a National Environmental Action Plan (NEAP) had been completed and a comprehensive multi-donor strategy for protected areas prepared. Planning of specific conservation activities in Ratanikiri Province had been completed and implementation of improved management plans for Kirirom and Virachey National Parks were had begun. CEMP had also assisted in establishing a community forestry network composed of staff from the community forestry units of Ministry of Agriculture, Forestry and Fisheries, the MoE, and several NGOs supported by CEMP were expanding community team-building toward the establishment of community forestry programs. An environmental awareness campaign and participation campaign to integrate the efforts of local and provincial governmental departments, communities, and local NGOs had also been developed and put into motion. A pesticide information and education campaign for farmers had also been developed and piloted in collaboration with provincial departments of agriculture and health and NGOs. Finally, CEMP had improved collaboration among key players at the local level, raising environmental awareness as

a result of support provided to provincial environment departments. Strategic planning had been strengthened in all six MoE departments, the drafting of a five-year strategic plan for the Ministry itself had been initiated, a restructuring plan had been completed for the MoE's planning and legal affairs department, and a number of provincial Ministry staff and decision makers had been trained in water pollution assessment and abatement in collaboration with a number partners.
    
Just before the July 1997 aid suspension the CEMP activity had updated its program plan and was on the verge of conducting a number of assessments, studies, and training activities aimed at developing baseline data and improving MOE's capacity to manage and monitor the country's natural resource base. Planned activities included remote sensing GIS training, pesticide management, fuelwood and water quality assessments, and pilot biodiversity and protected areas management activities. These activities were halted along with the rest of the CEMP program as a result of the aid suspension announced in July 1997.     

Description: Given he seriousness of environmental issues in Cambodia, USAID intends to resume limited assistance if and when current aid restrictions are lifted. USAID will work with international and local NGOs for public awareness and education for environmental constituency building, support for continued assessment and awareness of critical environmental issues such as deforestation and
pesticide use, and support assessments and community action aimed at resolving specific community-level environmental problems.

Host Country and Other Donors: Various donors continue to provide institutional and programmatic support to the MoE, including UNDP, the European Union, UNESCO, the Asian Development Bank, and the World Bank. USAID will work with and coordinate activities with the other donors, including key International and local NGOs and district and community organizations. No support will be provided directly to the MoE, but activities will be coordinated with them.

Beneficiaries: The primary beneficiaries will be the local NGOs and communities who will receive training and other support to improve their capacity to plan and manage environmental awareness and improvement activities. Secondary beneficiaries will be the broader Cambodian population, who will benefit from activities that identify environmental problems and take action to alleviate those problems.

Principal Contractors, Grantees, or Agencies: USAID plans to enter into cooperative agreements with U.S. and local NGOs to implement the environmental activities.

Major Results Indicators:

This a new SO to be implemented in FY99 baseline and targets will be established during spring 1998 country strategy review.

.    Improved community environmental awareness, education, and analysis of environmental issues and problems.

.    Increased number of community pilot projects which address specific environmental problems.

.    Improved capacity of local environmental NGOs.

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ACTIVITY DATA SHEET

PROGRAM: CAMBODIA
TITLE AND NUMBER: EXPANDED ACCESS TO SUSTAINABLE FINANCIAL SERVICES, 442-SPO04
STATUS: New
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1999: $500,000 (ESF)
INITIAL OBLIGATION: FY 1999 ESTIMATED COMPLETION DATE: FY 2002

Purpose: To expand access to financial services and credit to the poor in Cambodia, especially to women.

Background: Over 50% of the Cambodian population is under 15 years of age, and approximately 85% of the population resides in rural areas, where many households are headed by women. Access to financial services in the rural areas is very limited: it is estimated that effective credit demand in the rural areas alone could amount to $66-97 million in the medium term, equal to 25-35% of the value of agricultural inputs. In the long term, the credit demand possibly will increase as high as 50% of the value of inputs. The current high cost and scarcity of credit to the rural poor retards growth and hinders productivity. Female-headed households comprise over 25% of total rural households, and women comprise the largest percentage of microenterprise operators. Thus, , women would be the major beneficiaries of improved and expanded financial services.

USAID Role and Achievements To Date: USAID has provided assistance to international and local NGOs for poverty-based lending and village banking, with women being the primary beneficiaries. With USAID funding support, World Relief has established 272 banks serving 7,356 women. Catholic Relief Services' (CRS) Village Banking Project has worked through local NGO partners to establish 116 village banks serving 5,124 women clients. USAID also provides a small grant to the local Association of Cambodian Local Economic Development Agencies (ACLEDA) under the Global Bureau's PRIME activity. ACLEDA now works through 11 provincial branches serving approximately 46,000 clients, the majority of whom are women.

Description: In concert with the International Finance Corp. (IFC) and the United Nations Development Fund ( UNDP), USAID proposes to provide technical assistance to help ACLEDA become a specialized microfinance bank in 1998. We will also continue to work with World Relief and CRS to continue expanding sustainable financial services for the rural poor, particularly women. World Relief plans to have 500 banks by 1999 serving 15,000 women. CRS plans to establish 121 village banks serving 9,165 women members by 1999.

Host Country and Other Donors: USAID will work with key international and local NGOs to implement this special objective.

Beneficiaries: Beneficiaries will include rural households and micro and small entrepreneurs. Special attention will be focused on the needs of women, who head over a quarter of farm households. Secondary beneficiaries will be NGO and local community staff, who will benefit from training and technical support activities aimed at increasing local capacity to deliver financial services.

Principal Contractors, Grantees, or Agencies: USAID plans to enter into cooperative agreements with U.S. and local NGOs and cost sharing agreements with the UNDP and IFC to implement this special objective.

Major Results Indicators:

This is a new SO and baseline and targets will be established during spring 1998 country strategy review.

• Improved access to and utilization of sustainable financial services; and

• Transformation of ACLEDA into a formal specialized microfinance bank.

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