1. High Level Policy Dialogue – Cambodia Towards a Strong and Sustainable Health Sector Development ( Health Strategic Plan)
24 June, 2015
Cambodia

2. Towards a strong and sustainable health sector development
Proposed agenda
Introduction (20 minutes)
Brief welcome by the Minister (MOH)
Purpose and introduction (WPRO-Regional Director)
Current situation and challenges (40 minutes)
Presentation (WHO)
Discussion
The way forward (60 minutes)
Discussion (start with remarks by WPRO-RD)

3. Outline Current situation and challenges
Cambodia’s significant progress in improving population health
Health system challenges and donor funding
The way forward
Increase domestic funding
Use the funding more efficiently

4. Current situation and challenges

5. Cambodia’s achievements
Cambodia is on track to achieving all MDG goals (improvement in Maternal and child health, HIV, TB and Malaria)
Life expectancy increased 55 years to 72 years between 1990 and 2013
Measles elimination - Immunization coverage of measles reached 93% (2014)
Skilled-birth attendants reaching 89% (CDHS, 2014)

6. Health MDGs scorecard for LMICs in the Western Pacific Region (2014)

7. Overview of health financing
Sources of funding, 2012
Health expenditure per capita - USD 70
Total health expenditure as % of GDP - 7.2%
High out-of-pocket payment
Heavy reliance on donor funding
Low government spending on health
Source: Cambodia NHA Report 2014

8. Total health expenditure (%) GDP selected countries, 2012
Note: OOP = out-of-pocket health expenditure; GGHE = General Government Health Expenditure
Source: Cambodia NHA Report 2014, WHO Global Health Expenditure Database (WHO, 2014)
* For Cambodia, GGHE does not include donor funding. Donor funding is included in ‘other%GDP’.

9. Donor funding contributed to better health outcomes
Donor funding has been critical for Cambodia to address population health:
The control of communicable diseases (HIV, TB, malaria)
Maternal and child health
Immunization coverage
Helping the poor to access services (Health Equity Funds)
Expenditure share by donor category, 2012
Source: Cambodia NHA Report 2014

10. Donor funding on health to Cambodia
The nature of donor funding
Volatile and unpredictable
Often operated as vertical programs
Affected by socio-economic and political factors
May not always align with recipient country’s priorities
Difficult to make long-term commitment
Source: Cambodia NHA Report 2014, WHO Global Health Expenditure Database (WHO, 2014)

11. Donor funding poses challenges
Risk of fragmentation
Donor funding, if skewed towards certain diseases or specific programs, may not always reflect the country’s priorities
Certain donor funded programs operate separately with their own mechanisms
Endangers sustainability
Donor funding is about the same amount as government spending from domestic source
Global Fund, GAVI and Gates Foundation accounts for one-fourth of total donor funding, the decrease in funding will have big implications on sustainability of these programs

12. Government spending on health is among the lowest in Asia countries
Government expenditure on health as a % of General Government Expenditure, 2012
Government expenditure on health as a % of Total Health Expenditure, 2012
Note: GGHE = General Government Health Expenditure; GGE = General Government Expenditure; THE = Total Health Expenditure
* For Cambodia, GGHE does not include donor funding. Donor funding is included in ‘other%GDP’.
Source: Cambodia NHA Report 2014, WHO Global Health Expenditure

13. Out-of-pocket expenditure on health is among the highest in the region
OOP expenditure as % of THE, 2012
The components of OOP, 2013
Note: OOP stands for out-of-pocket.
Source: Cambodia NHA Report 2014, WHO Global Health Expenditure; Lao NHA.
Source: Cambodia Socioeconomic Survey, 2013

14. Limited resource on prevention and other priority areas (eg.NCDs)
Prevention expenditure as a % of total health expenditure
Distribution of health expenditure by diseases
Source: WHO Global Health Expenditure database, 2014
Source: Cambodia NHA Report 2014

15. Private sector provides large quantity of services and draws substantial resources
Service utilization by providers [%]
Distribution of health expenditure by providers
Source: Cambodia Socio-economic Survey (CSES) 2012
Source: Cambodia NHA Report 2014

16. Quality of health services is low in both public and private facilities
Source: World Bank Study on health care quality, 2013

17. Summary of the challenges
Heavy reliance on donor funding with vertical approaches
High out-of-pocket payments paid for poor quality of services
Low government spending on health from domestic sources
Large private and informal sector with limited regulatory mechanisms
Low quality of services in both public and private sectors

18. The way forward

19. Reshape and re-orient health system NOW
Economic growth gives the government the means to invest in its people’s health
Reshape and re-orient the health system:
To improve integration and coordination among programs and different level of health services
Take strong ownership and align donor funding with national strategy and priorities
Improve transparency and accountability
Enhance people’s trust in public services

20. Increase government spending on health from domestic sources and use it efficiently
The amount of government spending on health matters
Efficient use of resources with greater transparency and accountability is crucial
More domestic funding will strengthen the national ownership
More domestic funding allows government to address the country’s health priorities and to work towards long-term sustainability

21. Rebalance budget allocation towards prevention and primary care
More resource for sub-national levels, especially health centres and district hospitals
Ensure maintenance of equipment and regular supply of quality medicines and other essential commodities at the primary level
Bring compensation and motivation of health workers at the primary level facilities to the adequate level
Introduce appropriate interventions to encourage retention of health workers in the rural areas and at the primary level facilities

22. Improve safety and quality of service in both public and private sectors
Strengthen regulatory capacity and reinforce implementation of legislations
Develop and update clinical standards based on evidence and improve compliance
Strengthen the registration, licencing and accreditation mechanisms
Improve quality of medical education and create opportunities for continued professional development
Further develop systems for monitoring and oversight of health services

23. Minimizing out-of-pocket payment and make services more affordable
Increase prepayment
Balance the supply side and demand side subsidies
Health Equity Funds should focus on providing vulnerable populations access to a well-defined package of good quality essential services
Leverage private sector through contracting and payment methods (financial incentives) for public benefit

24. discussion