Catalog

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p. 14 of 21 BACK | NEXT Executive Summary I. Background II. Overview of Development Issues III. External Development Assistance IV. Priority Sectors for ADB's Future Operations A. Strategic Thrust B. Guidelines for ADB Interventions in Cambodia C. Priority Area One: Rural Economic Development D. Priority Area Two: Human Resource and Social Development E. Priority Area Three: Private Sector Development V. ADB Strategy in Operation

Country Operational Strategy - Cambodia : IV. Priority Sectors for ADB's Future Operations

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D. Priority Area Two: Human Resource and Social Development

115. The second priority area is human resource and social development. It will include investments in basic education, basic health, and water supply and sanitation to directly reduce poverty and empower the poor to participate in economic development. In addition, ADB will provide key capacity building assistance to government agencies involved in ensuring that the needs of women and vulnerable groups are being addressed. The guiding theme is to improve the quality and efficiency of and equitable access to these social services. Key constraints to improvement of the Government's delivery of these basic social services are the (i) inadequacy of budgetary support for investment and recurrent expenditures, (ii) inefficient use of allocated funds, and (iii) poor quality of the civil service. Key areas of reform are the functional review and reorganization of relevant ministries and the rationalization of the civil service, including salaries. An operational consideration in this area is the Social Sector Working Group established in 1999 for improved aid coordination and collaborative policy dialogue with the Government.

1. Education Sector

116. In response to a request from the Government, ADB will facilitate strengthened government-aid agency partnership mechanisms in education sector development. A significant cluster of policy, planning, and institutional TAs in recent years, including the 1999 Secondary Education Investment Plan TA,²⁵ positioned ADB to fill this role. Despite significant aid agency involvement in primary education, the net enrollment rate (NER)²⁶ for primary education remains low at less than 80 percent. Marked disparities in access to primary and secondary schooling exist by geographic region, socioeconomic status, and gender. Although primary schools exist in every district, distance remains one of the major obstacles to universal access to primary education. The high opportunity costs of sending children to school constitute another major obstacle since about 80 percent of the population reside in farm households, which depend largely on the use of their own child labor. Female labor, in particular, is highly valued in household chores. Females account for 45 percent, 40 percent, and 25 percent of the total enrollments in primary, lower secondary, and upper secondary education, respectively.

117. Basic education (primary plus lower secondary) suffers from low quality. This is a result of outdated curricula, inadequate instructional hours, lack of a quality assurance system, limited coverage and access to textbooks, the prevalence of unqualified teachers, the large number of students per teacher particularly at the primary level, and low teacher morale because of low teacher salaries. Resulting largely from the problem of low quality of education, internal efficiency as measured by students' performance is low. The extremely high repetition rates (25 percent for primary and 10 percent for lower secondary education) and high dropout rates indicate significant resource wastage. Poverty is a factor in the high dropout rates experienced in Cambodian schools. Another constraint to sustainable sector development is limited capacity within the Ministry of Education, Youth and Sports (MOEYS) for medium- and long-term planning, management, and delivery of quality education services.

118. ADB's 1994 Education Sector Strategy Study presented policy and strategic frameworks for education development especially at the basic education level. ADB further supported the development of the Basic Education Investment Plan (1995-2000) that was endorsed by the Government and funded by external agencies. The plan identified policy and strategy reforms needed for basic education as well as investment priorities. The top priority was to improve the efficiency and quality of basic education (reducing repetition and dropout rates, revising curriculum, increasing coverage and access to textbooks, and teacher training), followed by equitable access to primary education linked to the gradual expansion of lower secondary school enrollment.

119. ADB's strategy for the education sector in Cambodia will be to promote and facilitate a comprehensive approach to education development, led and owned by the Government. Within the overall sector policy framework, ADB will continue to focus on improving efficiency, quality, and equitable access to basic education, especially for the rural poor and girls. ADB's immediate strategy will be to consolidate and extend policy and strategy development, in coordination with other aid agencies. This approach will address policy needs in decentralization, quality improvement, and financial management and efficiency, as well as legislative and regulatory reforms. It is anticipated that a strategic and program framework, including prioritized support requirements, will be completed in early 2001. It will form the basis for an ADB-supported education development program in 2001. A follow-up project is envisioned in 2004.

2. Health Sector

120. Decades of war and internal strife have destroyed much of the institutional and physical infrastructure of the basic health care system in Cambodia. With a small amount of government budget allocated to health services each year (about $2 per capita per year or 17 percent of the World Bank's recommended government spending on health services for low-income countries), the country has been left with some of the worst health conditions in Asia. There is a shortage of clinics, and few clinics outside of Phnom Penh have running water, adequate ventilation, or light. Low salaries drive most of the Government's poorly trained and supervised health care personnel to private practice and to the selling of pharmaceuticals on the side. Many charge fees for services that are supposed to be free. The Government lacks the ability to regulate the private market where fraud and misdiagnosis are common. Poor health and illness aggravate poverty.

121. The Ministry of Health's (MOH's) 1994 Health Policy and Strategy Guidelines set national health policies and strategies for improving health care. The first priority was the improvement and extension of primary health care services, especially to people living in remote villages, followed by providing special health needs to those who suffered from the conflict, including women, children, the disabled, displaced and homeless people, and returning refugees. MOH's 1999-2001 plan identifies the following areas as priorities: (i) providing a cost-effective minimum package of health activities (MPA) in rural areas; (ii) improving the health of women and children through safe motherhood and child nutrition; (iii) reducing the incidence of diseases that are the primary causes of mortality: diarrhea, acute respiratory infection (ARI), malaria, tuberculosis, and HIV/AIDS; (iv) improving the quality of hospital services in Phnom Penh and in provincial hospitals; (v) strengthening institutional capacity to underpin the reforms; (vi) ensuring adequate supplies of drugs in all community health centers; and (vii) increasing private sector providers. Included in the MPA are prenatal care, immunization, birth spacing, prevention of micronutrient malnutrition, and treatment of ARI and diarrhea.

122. A large number of international agencies provide assistance-much of it in grant funds-in the areas of basic health, disease control, and capacity building. Nearly 30 percent of planned public investment disbursements over the period 2000-2002 are in the health sector. Yet, in part because of the paucity of local funds, health indicators do not as yet appear to be improving. Indeed, there have been increased infant and child mortality rates since the early 1990s due to the high rates of diarrhea and pneumonia associated with poor immunization coverage and Vitamin A supplementation. It must be recognized, however, that substantial investments in basic health provision took place after the latest indicators were compiled.

123. Even considering the large level of planned assistance, this is potentially an area of great need and offers a wide scope for poverty reduction, as well as opportunity to address gender issues and the needs of vulnerable groups. It is therefore important for ADB to clearly identify its role in this sector prior to further investment. Contingent upon satisfactory review of the ongoing basic health project and assessment of ADB's potential strategic role in the health sector, ADB will maintain financial, institutional, and policy support in basic health with targeted technical assistance for HIV/AIDS prevention. ADB's strategy will still emphasize extending coverage of basic health services in rural areas, consistent with MOH's health sector plan. ADB's strategy would focus on safe motherhood and child nutrition, reproductive health, preventive and curative care of major causes of mortality-particularly HIV/AIDS-and increasing use of private providers.

3. Water Supply and Sanitation

124. Because of antiquated water supply systems, poor sanitation, and inadequate pollution control, poor living conditions contribute to the general conditions of poor health as well as constrain the development of provincial towns as economic growth poles to anchor rural development in the surrounding regions. In Phnom Penh, households obtain 53 percent of drinking water from protected sources; in other urban areas, the percentage is 31. Typically, sewer systems double as storm water runoff systems. There are usually no treatment facilities and the sewers are in disrepair. In Phnom Penh, 75 percent of households use inside toilets compared with 26 percent in other urban areas. Assuredly, for both water supply and sanitation, rural household access is even lower than urban access.

125. The Government's strategy includes formulation of a water supply and sanitation policy (WSSP) framework within the broader framework of a water resource management policy. The WSSP will emphasize financial autonomy of suppliers, cost recovery, private sector participation, aid agency coordination, and clear demarcation of regulatory responsibilities. The World Bank is expected to play a major facilitative role in assisting government leadership of sector development, including policy dialogue and investment.

126. Ongoing ADB assistance in this area includes the 1996 Phnom Penh Water Supply and Drainage Project and the 1999 Provincial Towns Improvement Project. The latter is an important element of ADB's efforts to support geographically balanced growth through development of infrastructure in key provincial towns. ADB involvement in this sector will also provide further support for policy dialogue in conjunction with efforts to facilitate improvement in water resource management. Because the 1999 project emphasizes provincial town water supply provision, a follow-up project that focuses more on provincial town sanitation systems is possible in 2003. However, given the World Bank's expected role, careful assessment of need will be required prior to further investment.

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