Catalog

Health Services in Cambodia

The feasibility and effectiveness of having nongovernment organizations (NGOs) deliver health services, as an alternative to the Government providing such services, was studied under an ADB-financed project by the Cambodia Government’s Ministry of Health. The research conducted in 2001 and 2002 tested two models: contracting out, where contractors had complete responsibility for services delivery, and contracting in, where the contractors worked within the government system (see http://www.adb.org/Documents/Periodicals/ADB_Review/2001/vol33_2/cam.asp).

An independent evaluation, including repeat household and health facility surveys, showed that coverage of health services in contracted districts resulted in significant improvements in a short time. Contracted districts consistently outperformed the control districts with respect to the predefined coverage indicators. The contract-out model outperformed the contract-in model.

Contracted districts experienced an impressive increase in the use of reproductive health services, child health services, and curative health services. NGO-contracted services were generally more effective in reaching the poor, both in absolute and relative terms. Also, there was a significant decline in the per capita private out-of-pocket expenditure in the contracted districts, especially for the poor.

The Cambodia case study suggests that it is feasible and beneficial for government to contract NGOs to provide health services. Contractors delivered interventions to reduce infant, child, and maternal mortality to more people more quickly than had conventional government service delivery mechanisms. The pilot study suggests, moreover, that efficiency gains in providing health services do not come at the expense of equity. Rather, improved efficiency appears to have also led to better access to health services by the poor, easing the burden of health care expenditures.

Nutritional Security

Plant breeding offers the opportunity to create an international public good that has public health significance and will provide comprehensive benefits to producers and consumers.

Based on encouraging prospects for enriching rice germ plasm with trace minerals, ADB approved a project and organized a donor consortium to support biofort- ification, which is research for breeding iron- and zinc-dense rice as a low-cost, sustainable approach to reducing iron-deficiency anemia and zinc deficiencies in Asia.

The broad objectives of ADB’s Rice Breeding to Reduce Anemia in Asia project are to develop high-yield, high-profit, iron-dense rice germ plasm adapted to growing environments in Bangladesh, Indonesia, Philippines, and Viet Nam; demonstrate bioavailability of the extra iron in poor adult women and young children; support economic research to demonstrate feasibility and cost-effectiveness of the plant-breeding strategy; and organize the institutions and financing necessary for generating a flow of nutrient-improved rice technologies to Asian farmers.

The project targets the poor and will reduce poverty in several ways. Women and children from the poorest households suffer most from inadequate dietary quality. Treating anemia in women and children in poor households through enriched cereal diets will lower the risk of maternal mortality during pregnancy and childbirth, increase their capacity to perform chores, and improve the cognitive abilities and health of children.

Encouraged by ADB’s project, the Consultative Group on International Agricultural Research (CGIAR) approved the Biofortification Challenge Program for its centers. The collaborating institutions in ADB’s and CGIAR’s projects are International Food Policy Research Institute; International Rice Research Institute; the University of Adelaide, Australia; and the national agricultural research systems of the four countries.