-Your Venerable Monks,
-Members of Senate, National Assembly and the Government
-Excellencies, Ladies and Gentlemen,
-Health Ministry’s Officials at Provincial-Municipal, District-Khan, Commune-Sangkat Levels and Representatives of the Voluntary Village Health Agencies,
-Representatives of Donor Communities and NGOs,
Today, it is such a great honor and pleasure for me to participate in the closing forum of the Health Sector Joint Annual Monitoring and the 27th Health Conference. On behalf of the Royal Government of Cambodia and myself, I would like to congratulate and sincerely appreciate all efforts made by the Ministry of Health in organizing the 27th Health Conference together with the Health Sector Joint Annual Monitoring which provided the opportunity for participation from donor communities, NGOs, civil society, the voluntary village health agencies and representatives from the private sector.
I have a strong belief that this health conference is no difference from the previous ones as it is a well-managed process which manifest the real progress and achievement made as well as providing the opportunities that are necessary for the discussion of measures which will be set out in order to promote discussion on necessary policies towards the improvement of people’s healthcare and to ensure the effective and sustainable delivery of health services.
At the same time, in this 27th health conference, there has been an enthusiastic discussion from participants who have also provided crucial recommendations which are beneficial for the development of health sector in Cambodia, especially it provided an opportunity for mutual understanding and to exchange experiences between doctors, pharmacists, officials and all health staffs in order to achieve the humanitarian objective for ensuring the interests for all our people. Another noticeable aspect has been the participation from representatives of commune-sangkat councils and the voluntary village health agencies that have been selected through election. In this sense, representatives of commune-sangkat councils and the voluntary village health agencies, indeed, have opportunities to express their ideas on behalf of customers on the quality of health service as well as deciding on various priority actions.
I believe that the Health Sector Joint Annual Monitoring which we have initiated together with this Health Conference is another new step made by the Ministry of Health in implementing “Sector Wide Approach” in the framework of a joint Prakasmade between the Royal Government and development partners on harmonization dated last December, 2nd 2004 as well as the recent Consultative Group (CG) Meeting in March, 3rd 2006.
Based on the summary report on health related work, in 2005 and the previous years, the health sector has received enormous success toward achieving the MDGs in 2015 as well as contributing in the implementation of the Royal Government’s “Rectangular Strategy”. Taking this great opportunity, I would like to express my sentiment and appreciation for the efforts made by leaders, government officials and all staffs of Ministry of Health, related ministries-institutions, national and international organizations, civil society and the private sector who have been actively participated in improving our people’s health and wellbeing.
For instance, during the last 10 years we have achieved many proud successes including a reduction in infant mortality rate and disease prevention such as HIV/AIDS, malaria, dengue fever tuberculosis and many other diseases listed in the National Vaccination Prevention Program. However, the result in reducing the maternal mortality rate will be clearly made available by the People Health Survey which will be completed by mid-2006. Meanwhile, during 2005 we have achieved many other health related activities as expected and some activities are even more than the annual objective including:
- Disease consultation, hospitalization, particularly the preventive vaccination for children.
- Combating infectious and chronicle diseases such as lung-cancer, tuberculosis, HIV/AIDS, sexual transmitted disease (STD), bird-flu and SARS.
However, we must recognize some of the negative results such as the lack of precise statistic for maternal mortality rate nation wide. Moreover, during the year 2005, some annual objectives have not been achieved such as the lack of basic health check for pregnant women, the delivery of babies by trained nurses and the preventive vaccination for pregnant women. Furthermore, the international aid funding for combating bird-flu has been slow even though we have clear infrastructure in controlling the disease, most aid funding are just promises made by donor communities.
Just after the liberation day, 7 January 1979, the re-establishment of health system is the top priority of the Government among other priorities.
War and instability have resulted in many difficulties for health sector including, the destruction of physical infrastructure and a complete destruction of technical base and supports for health administration, high infection and mortality rates, high birth rate during the period after war, changes in the shape, sexes and age of the people-pyramid, and the mental and physical impacts from war including the disability from mines. These are the negative factor for sustainable development and place Cambodian people in the hard to escapre poverty trap.
I still remember the first Plenary Health Conference across the entire country in December 18, 1979 where we agreed to set three main objectives for health sector in 1980 as fellow:
1. The health sector has a duty and obligation to serve the people.
2. Use prevention as the foundation and use the treatment to enhance prevention.
3. A long with the effort in the mobilization of foreign aids, we must maximize the local resources utilization.
Although, we have subsequently conducted analytical studies to define many strategies and guidelines for health sector, I believe that the above three main guidelines which had been set for more than 27 years ago still remains valuable for the present time. In fact, if we recall the event after the liberation day of January 7, 1979, by starting from the bare hands, there were only 57 doctors and our country, at that time, was in the most difficult situation. Moreover, we had to prevent the return of Pol Pot’s regime on the one hand and faced with the economic and political embargos from the rest of world on the other hand. However, during that period we did try to mobilize and urgently train approximately 2000 medical doctors and nurses /midwives. Ten years later, in 1990s, the number of medical staffs reached 160,000 when 1526 of whom were doctors and 9822 were nurses/midwives. Obviously, this achievement was the valuable heritage of State of Cambodia, which we had rebuilt together since then.
In fact, currently the Royal Government of Cambodia still considers health as a priority sector because good delivery of health services is not only the important factor contributing to the increase in labor productivity, investment and saving through enabling the people to achieve great results from their studies and the attainment of skills to support their living, but most importantly, the treatment for the people is closely related to the fundamental right of human being. In this sense, the Royal Government of Cambodia places the people’s health as the most important agenda in responding to poverty reduction program and the implementations of reform in every sector.
To meet this demand and need the Royal Government has eventually increase the national and international budget as well as continuously encouraging the private sector to invest more in health sector. Obviously, from the year 2005 public health expenditure was approximately $172 Millions USD, which amounted to $12.7 per person, 33% of which was government expenditure and 67% was coming from aid. Health sector expenditure for 2005 has almost an equal value to the recommendation made by the Macroeconomic-Health Committee of the WHO which allocated $14 USD for one person living in developing countries by 2007.
I would like to take this opportunity, based on my understanding that the cooperation between Ministry of Health and development partners are jointly reviewing the mid-term of Strategic Health Plan 2003-2007 in order to prepare the Strategic Health Plan for 2006 – 2010 to align with the National Strategic Development Plan 2006 – 2010, I would like to offer some recommendations for preparing this strategy as follows:
First: The health sector seems to be increasing toward imbalanced proportion of human resource. There was a worrying trend during 2000-2005 where the staff ratio of midwives/nurses per 1000 people has declined from 0.95 to 0.82, particularly numbers of midwife has decreased by 14% during the same period. The most important and urgent issue is that currently there are more than 200 health centers without midwives. I know for a fact that in 2005, the Ministry of Health has announced job recruitment of more than 100 midwives; however, only 60 graduates applied for the positions. This is such a worrying trend which can lead to the lack of trained professionals to take care of patients directly at hospitals and provide services at health centers or at local level where there are doctors that can only provide general diagnose and issue prescriptions or provide technical services at hospitals, especially in the cities and populated areas.
Taking this opportunity, I would like to express my appreciation for development partners, especially, the Royal Government of Japan, the French government, Asian Development Bank and UNFPA for noticing these problems on time and provided aid to train more midwives and nurses, especially the one-year primary midwife training program which had be abandoned for many years. Hence, it has changed back to the modern intensive training method as in the Cambodian State Regime. Meanwhile to solve all problems related to the declining number of nurses and midwives, I would like to appeal for the cohesive cooperation between all stakeholders including the State Secretariat of Public Function, Ministry of Education Youth and Sport and the Council for Administrative Reform.
Second– More than $172 Millions USD of national budget which has been used in the health sector since 2005 is a crucial opportunity among all other opportunities provided to the health sector. Thus we should raise a question that by what proportion and how much of the above budget ought to be used for some of the delayed health programs notably the reduction of the maternal mortality rate which we, the Government, and donor communities agree that this is a priority issue in which we have an efficient method to deal and with the clear operational structure of the Ministry of Health, it is the National Center of Maternal and Child Support.
On other hand, according to the study prepared by the WHO on the cost of the public health services, the supply of the primary health care services to the poor as stated in the CMDGs, in the year 2015, Cambodia probably needs an additional $45 Millions USD per annum to expand the strategies that used to show that it would be significant in contributing to the poverty reduction, for instance the strategies for boosting local health services and the cooperation with the NGOs in the form of contracting etc. With the above expenditure of $172 Millions USD, which part of it can be transferred to spend on these efficient priority strategies? This is a strategic question to which the Ministry of Health, the relevant institutions and development partners have to address together for the next 5 years.
Third– As the health sector is a sector which is implementing the process of “Sector Wide Approach”, I would like to remind that there are 2 major factors for this process, the leadership and ownership, particularly the ownership on the aid management as I have mentioned at the beginning that 68% of the health expenditure comes from aid. Would the leadership exist if the decisions of the leaders did not derive from the rationalization process, for example a promotion which is only based on political party quota instead of looking over the real demand, capacity, talented officials who should be promoted. Can ownership on the use of aid exist when the officials with no knowledge and suitable experience have been assigned as direct executor responsible for negotiation and international corporation and project management.
Fourth– In the framework of hospital development, ministry has to balance between the capability of recent resources and the needs for developing the modern technology, so that we can achieve our priority goals in which the promotion and encouragement of the private sector to participate in this work is necessary. Meanwhile, although there are sufficient and enforceable laws for health sector, the management in private health sector is still in the process of solving many controversial issues such as fake medicines, illegal medical service and false advertisement, etc. All of these are the problems that all related institutions have to cooperate with each other in order to effectively enforce the existing regulations as well as creating new regulations and advices necessary for strengthening law enforcement and effective legal documents aiming at ensuring the quality health service provided to our people.
Fifth– At the same time, Ministry of Health must continue to promote more new works such as extending decentralization in the form of contracting public health service as highlighted in the National Strategic Development Plan 2006-2010, the strategy to enhance equity by reducing the personal spending on health care by the poor and enhancing the public health service for them. For the expansion of equity fund, we should think of the sustainability and the ability to connect to the arrangement of health insurance mechanism.
Sixth– For the traffic accident and nutrition, especially child malnutrition, are the issues that have not been clearly and satisfactorily addressed. I acknowledge that the solution for these two problems requires the cooperation of inter-sectors that government’s institution and many other related international organizations have participated; however, related institutions should discuss with each other in order to identify their precise responsibilities. For example, Ministry of Health must be the leading ministry in guiding the action of educating parents to feed infants and children, while other institutions must help in ensuring the security, enhancing the local awareness and family revenue.
Before I come to the conclusion, once again, on behalf of Royal Government and myself, I would like to highly appreciate the Ministry of Health, line ministries-institutions, national and international organizations, civil society as well as private sector that are trying hard in the sake of improving the health sector, promoting welfare for citizens that is the tremendous and genuine contribution for reducing poverty in Cambodia.
At last, may I wish Excellencies, Lady and Gentlemen who are the member of the conference, and national and international honorable guests with the Five Gems of Buddhist blessing. May I now announce the closing of this 27th Health Conference and the Health Sector Joint Annual Monitoring.