Distinguished National and International Guests,
Ladies and Gentlemen
My warmest greetings to you all!Today is a very important day – and I am truly happy and honored to be here with you all on this auspicious occasion to officially inaugurate the first ever Health Sector Strategic Plan for 2003-2007 (HSP).On behalf of the Royal Government of Cambodia, I congratulate and sincerely appreciate all the efforts made by H.E. Senior Minister, Minister and the staff of the Ministry of Health, the Government’s concerned ministries and institutions, the national and international organizations, the NGOs, the civil society as well as the private sector for their proactive cooperation and technical assistance that helped produce this Health Sector Strategic Plan, 2003-2007.
I strongly believe that the introduction of the HSP for 2003-2007 will serve as a building block of the Royal Government’s social development program, which is part of the Socio-Economic Development Plan II (SEDPII), to improve the health status of Cambodian people aiming at higher economic growth and sustained poverty reduction over the next five years.
Today we officially launch a five-year national plan for the health sector for 2003-2007. The launching the HSP is, by itself, a major achievement – another added to the many successes that our Royal Government has attained so far. HSP proves to us all that we have moved to the next stage of a longer-term development of the health sector in Cambodia. We are marching with confidence, together, on the path to ensuring that our economy shall take off on a higher and faster level of sustained growth into the long term. This is what we need, since higher growth is a basic prerequisite for poverty reduction and prosperity of our nation.
It is the government long-term vision to have a socially connected, highly educated and culturally vibrant Cambodian society without poverty and illiteracy, and free of fatal diseases; providing its every member with equal opportunity to progress on their own. In order for the vision to be realized, it requires healthy citizens and the adherence to the principles of free market, the value of democracy, social justice as well as the development and the implementation of pro-poor economic policies aimed at promoting high growth and social development,-which is an important policy agenda of the Royal Government.
As I have mentioned on many occasions that civil war and political instability over the past three decades had left Cambodia with a weak public sector and poor physical infrastructure, and especially the health sector was affected the most. The Khmer Rouge decimated the national health system in Cambodia, where out of pre-1975 1000 trained doctors only 50 survived the brutal and genocidal regime. In 1979, the rehabilitation of the health system became the utmost priority among the other priorities of the government at that time. The war and political instability inherited Cambodia with innumerable consequences for the health sector. Those include destroyed physical infrastructure, dismantled professional and administrative cadres, very high levels of mortality and morbidity, extremely high birth rate during the post war period, destroyed population pyramid both in term of sex and age, and the emotional and physical trauma resulting from the war, including disabilities due to landmine accidents. All are the unfavorable conditions constraining the sustainable development, which might force Cambodia to fall into the trap of the poverty and difficult to get rid of it.
During the past 20 years, we have done a lot to recover the health sector and thus achieved notable results. The health system has been gradually developed, especially in the urban areas, – cities and towns. Thousands of health students and workers have graduated and assigned to different places throughout the country to provide health care for our people – and that made a huge difference for Cambodia. However, we are still facing a huge burden of the threats from deadly illnesses, especially for people living in the remote villages. I am fully aware that too many of our women die in childbirth while many of our babies do not live to celebrate their first birthday. Too many small children contract life-threatening diarrhea diseases because of polluted water supplies and many of our under-fives children are not vaccinated to prevent serious infectious diseases. Worst of all, one in five children fail to grow because of malnutrition and is severely stunted. Then, among adults, we are facing rising rates of TB, the HIV epidemic, and our old enemy malaria becoming resistant to so many forms of treatment.In this sense, the Royal Government of Cambodia in its second term in office considers the health status of our people as an important policy agenda responding to the policy on poverty reduction and the implementation of reforms in all sectors. Generally, the government has set out new policy agenda on social development whose objectives are to:
- provide basic health services to all people, especially those who are actively involved in the community lives; improve equity and accessibility to basic health and education services with good quality, efficiency and low costs; specifically target women, children, elderly and disabled people; and
- introduce decentralization of financial and administrative functions;
No other mean that is better than the financial one that could accommodate the set of policy targets for developing the health sector. Considerable efforts have been deployed by the RGC to increase investment in this sector by increasing budget allocations for the health ministry, and by mobilizing foreign aid and encouraging contribution from the society to the sector. During the last four years, the budget disbursement for health increased more than threefold from 1998 to 2001. For the next three years, the RGC plans to double the allocation in its effort and commitment to implement the Medium Term Expenditure Framework to meet the needs of people living in rural and remote areas by directly providing them food security.
As I have indicated earlier, the human factor is a cornerstone of the government policies. All Cambodians regardless of their sex and age, and wherever they live, their health status is the priority of the government. The Royal Government is firmly committed to invest in the social development and especially in the health sector. That could be seen of the government strong commitment in increasing the allocation for the health sector though the resources are still inadequate to response to the needs for health services of our people. Therefore, I would like to appeal to all the governments of friendly countries, the national and international organizations and other development partners to take this strategic plan as an investment plan, and increase the funding for the Cambodia’s health sector.
Together with the government, we make improvement of the health status of the people, and at the same time help to reduce the poverty and contribute to the social and economic development in Cambodia. I have followed the report and the presentation of the HSP by H.E. Senior Minister and Minister of Health about its strategies, objectives and the targets. Initially, we focus on the delivery of health services, changed behavior of the service providers, the quality of the service, human resource development, financing the health sector and the institutional reform and development. I recognize that the document is very well prepared with great care reflecting the challenges and specific needs of our country. I was very proud when Cambodia was declared polio-free in 2001. The success in eradicating polio was due to the strong commitment and active political participation of the Royal Government, technical and financial support from all partners, and the effective mass media campaigns and especially the participation by the local authorities and the communities. I also wish to appreciate the success in the treatment of TB and malaria, the reduction in new cases of HIV and AIDS.
A good health system would positively contribute to the economic development, as it is a determining factor for improved productivity that leads to more investment and more savings. This is because, with good health, people would get good results in their education a well as in their job, and also the changes in demography. Experiences of countries in the region show the improvement in health is one of the key factors enabling the “East Asia miracle” of the economic growth, though it alone could not be a sufficient driving force for high level of economic growth. Thus, I wish to indicate that the government policy on health does not take into consideration only the economic rationales, but also focus on the well-being of our people as a whole.Fully aware of the needs and the current health status and to reduce the gap of health standards with countries in the region, the Royal Government in its HSP for 2003-2007 has set out targets as follows:
First, reduce the proportion of underweight children aged less than 5 years from 45% to 31%.
Second, reduce infant morality from 95 to 84 deaths per 1,000 live births, and for under-five mortality from 125 to 111 deaths per 1,000 live births.
Third, reduce the ratio of maternal mortality from 437 to 305 deaths per 100,000 live births.
Fourth, increase modern contraceptive prevalence rate from 19% to 35% among women aged 15-49 years.
Fifth, Reduce HIV infection rate from 2.8% to 2.1% among those aged 15-49 years.Sixth, Reduce incidence of malaria from 11% to 8% and mortality from 10% to 7%.
The HSP 2003-2007 presents strategies for the health sector, which is an important prerequisite for realizing the policies on high growth and sustained poverty reduction of the Royal Government of Cambodia. The plan is aimed for managing the changes and implementing reforms for the health development. The HSP 2003-2007 includes the following essential core strategies:
- Health service delivery: further improve coverage and access to health services especially for the poor and other vulnerable groups through planning the locations of health facilities; strengthen the delivery of quality basic health services through health centers based on minimum package of activities; strengthen the delivery of quality care, especially for obstetric and pediatric care, in all hospitals through measures such as the complementary package of activities;
- Behavioral change: change for the better the attitude of health providers sector wide to effectively communicate with consumers especially regarding the needs of the poor through sensitization and building interpersonal communication skills;
- Quality improvement: introduce and develop a culture of quality in public health, service delivery and their management through the use of Ministry of Health quality standards;
- Human resource development: increase the numbers of midwives through the basic training and strengthen the capacity and skills of midwives already trained through continuing education;
- Health financing: ensure regular and adequate funds to the health sector especially for service delivery through advocacy to increase resources and strengthening financial management; and
- Institutional development: organizational and management reform of structures, systems and procedures in the Ministry of Health to respond effectively to changes.
To take this opportunity, I wish to call on to the Ministry of Health of the followings:
- Intensify capacity building for our entire workforce, wherever they live and work; encourage them to serve the poorest people in the remote areas; and find ways to reward them with incentives according to their performance; Work more closely with other concerned ministries especially the Ministry of Economy and Finance to improve the disbursement of funds to the provinces and Operational Districts where are of higher demand;
- Ensure the transparency and the ownership in implementing the plan with other sectors as well as the private sector;
… May I take this opportunity to elaborate further (on point three) by expressing my sincere appreciation to HE Hong Sunhuot, Senior Minister and Minister of Health, and other leaders in the Ministry for having made a good model in implementing the supply program. We have allowed four institutions to conduct public auctions. They are the Ministries of Health, Education, Youth and Sports, Rural Development and Agriculture, Forestry and Fisheries. But we can say that the Ministry of Health has proven to be a model in its implementation and its experience could be replicated for application in other state institutions where there is sufficient cash. In just a few public auctions, the state has earned/saved about US$ 2 million. This clearly proves that there are reform and transparency.
… May I place an appeal today for local enterprises — both private and state ones – producing medicaments to fulfil the norms placed by the Ministry of Health and the World Health Organization (WHO.) It is true that these enterprises have been permitted by the Ministry of Health to take part in public auctions so as to gain market access. What is more important, however, is that they have to guarantee an acceptable quality and affordable prices. We also have to reinforce the law used in sector. This is very important and HE Hong Sunhuot has had some discussions with me already.
… We have private sectors involved in many areas but if they do not have communications and relations with institutions specialized in management we may come to an unpredictable problem. It is therefore obligatory that private hospitals and clinics have to have regular reports sent to the Ministry of Health. This could be useful starting from sharing the registered number of patients, decease, etc. This sort of information has to be shared otherwise the state and private sectors operating in the field would stay out of each other’s knowledge. This could foresee a disaster that might be caused by physicians treating hundreds of diseases.
… In our country a doctor/physician treats patients from hundreds of different health problems, to put it plainly, they are more qualified than those physicians/doctors in Japan, Germany or France. But I demand that this issue be looked at seriously. It is also my wish to see physicians/doctors respect their professional ethics and refrain from committing prolonged treatments for their own benefits. I am saying this because some patients have not been given proper treatments and therefore prolonged treatment sucks them dry. Some patients have therefore requested for change of physicians, but their medical records are not given to them. So measures have to be taken in relation to private medical services...
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- Effectively monitor and evaluate the performance of the plan making sure that the targets are met while responding to the overall objectives of the government.
… I wish to make an appeal from this forum to the national and international communities to kindly offer all sorts of assistance to this important sector as Cambodia is making its efforts in overcoming various difficulties – both drought and flood. The health institution is obliged to provide assistance and service at the closest possible to those calamity-affected areas. As of now we already have the provinces of Stoeungtreng, Kratie and Kompong Cham under flood already. On the contrary, we also have certain parts of land uncultivated because of lack of water. While we are starting to put into practice the five-year plan for socio-economic development as well as the five-year plan for the health sector, we have encountered with problems already. We have difficulties from the onset of implementing our plan. So I instruct all of officials coming to this meeting from Stoeungtreng, Kratie, and Kompong Cham provinces to return to their works immediately after the closure of the meeting.
… That is why I told a foreign dignitary that I could not travel abroad because I have to stay managing the situation that drought and flood are causing threats. Absence of leader in such a situation is no good. My presence is very important. That is why I have canceled my plan to participate in the summit meeting in South Africa, the UN National Assembly session and various other forums. To say in short I could not neglect the constant threats of the natural disasters. As of now I advise that we have to identify areas that are prone to threats and in need of medical help. Urgent assistance has to be provided. As far as flood is concerned, the flood level for Phnom Penh is still manageable, though we have three provinces up north flooded.
… We could perhaps now say that we have three consecutive floodings in 2000, 2001 and 2002, whereas the 2002 situation is the most severe. Cambodia in 2002 has got flooded and drought-affected areas – where we have water, we have it too much and where we do not have water, we have drought. It is predictable that there will be diseases that the receding flood would cause. So I make my appeal once again to our medical staff to please help rescue our people in time of difficulty with the Royal Government and other development partners…
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The important task that needs to be implemented is the system to monitor the implementation of HSP (2003-2007). The main inadequacy we found earlier from our experience was the lack of a mechanism to monitor and assess the progress in implementing the plan. Thus, the Ministry of Health shall pay attention on establishing an effective monitoring and evaluation mechanism in close cooperation with all the concerned institutions.
Therefore, I call on all the international partners and the NGOs to support the Ministry of Health, and work together on the setting up of an HSP (2003-2007) monitoring and evaluation system. In addition, I wish to call for attentions on capacity building for the health personnel and staff in planning, monitoring and evaluation of the implementation of the HSP.In closing, I wish to thank all government ministries and institutions, civil society and the private sector, key international organizations partners and the NGOs for the active participation and support of the formulation of the plan. I hope that all of you will continue to actively support and participate in implementing this first Health Sector Strategic Plan, and in formulating the next HSP.
Let me end by wishing success for the implementation of the HSP 2003-2007, and extending to you all, Excellencies, Ladies and Gentlemen, the five gems of Buddhist wishes and my personal wish for your prosperity and happiness.