Improving Access to Quality Health Services for Cambodia's Poor

MANILA, PHILIPPINES (22 November 2002) - Health service quality and coverage will be improved for about 5 million mostly poor people in Cambodia, with the help of an Asian Development Bank (ADB) loan approved for US$20 million equivalent.

The loan for the Health Sector Support Project will improve access to quality health services in nine of the country's poorest provinces, particularly for the poor and disadvantaged, including ethnic minorities, women, and children.

The project will provide basic health services, upgrade commune health centers and district referral hospitals, and improve the skills of health care workers.

It is part of a program for 21 provinces being cofinanced by the United Kingdom Department for International Development (DFID) and International Development Association (IDA).

The project aims to:

• Boost the planning, finance, and management capacity of the health sector;
• Develop affordable quality, basic health services for the population;
• Increase health service utilization;
• Control and mitigate the effects of infectious epidemics and malnutrition.

About 4.6 million of the 5 million beneficiaries will be from rural areas. The project is also expected to improve health services for 2.5 million women, through strengthened motherhood services and improved antenatal care and emergency obstetric services.

Although there has been considerable improvement in the last five years, the quality of Cambodia's public and private health services remains generally poor. Many districts still lack properly equipped buildings and face staff shortages, particularly in remote areas.

Also, the capacity of the Ministry of Health to plan, manage, and finance health services remains weak.

As a result, health indicators in Cambodia are among the worst in the Asian and Pacific region. Average life expectancy at birth is estimated at only 56.4 years and the infant mortality rate is at about 95 per 1,000 live births.

The project will tackle these issues through three components to improve health service delivery, support health programs, and strengthen institutional capacity:

• Health services delivery will focus on constructing and renovating health centers, hospitals, etc., and providing medical and auxiliary equipment, and drug kits.
• Health programs support will finance national campaigns to control and prevent communicable diseases including HIV/AIDS, malaria, and tuberculosis.
• Institutional capacity strengthening will focus on management, planning, and evaluation at the national, provincial, and district levels, including training of hospital managers, planning improvements, and setting up of monitoring and evaluation systems.

"Poverty and health are closely interrelated in an often vicious cycle, with one being the cause or consequence of the other," says Indu Bhushan, ADB Senior Project Economist. "Improving health care is thus important to the prospects for economic growth and poverty reduction."

The total cost of the project, is estimated to be US$77 million equivalent. IDA will provide US$27 million in cofinancing and DFID will supply a grant of about US$22 million, of which ADB will administer US$10.4 million. The Government will provide counterpart funds of US$4.63 million equivalent for the ADB-administered part.

ADB's loan comes from the Asian Development Fund with a 32-year term, including a grace period of eight years. Interest is 1.0% per annum during the grace period and 1.5% per annum subsequently.

The executing agency for the project, which is to be carried out over five years to December 2007, is the Ministry of Health.

More at adb.org/media