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Cambodia

Last Updated: May 7, 2012

Senior Program Officer:

Devendra Gnawali, MSc, PhD

Program Activities:

  • December 2008: Senior Program Officer Devendra Gnawali and SIF Program Director Mike McQuestion made introductory visits to Ministry of Health, Ministry of Economy and Finance and GAVI partner agencies.
  • March 2009: Devendra Gnawali visited Ministry of Health counterparts (National Immunization Program, Dept of Budget and Finance, Dept of Planning and Information) and the Deputy Director of Budget Department, Ministry of Economy and Finance. On 12 March, Devendra Gnawali presented the Advocacy Program to a SWAp Technical Working Group for Health meeting.
  • May-June 2009: Devendra Gnawali and Mike McQuestion visited MoH, UNDP (parliamentary strengthening), Rotary and GAVI partner counterparts.
  • October 2009: Devendra Gnawali met with National Assembly members from the the Commission on Public Health, Social Work, Veteran and Youth Rehabilitation, Labor, Vocational Training and Women’s Affairs.
  • February 2010: A six-person delegation, including parliamentarians, Ministry of Health and Ministry of Economy and Finance officials, attended a sub-regional parliamentary briefing on sustainable immunization financing organized by Sabin and UNICEF in Kathmandu, Nepal.
  • April 2010: Sabin SIF and the National Assembly of Cambodia co-host a “Maternal and Child Health and Sustainable Immunization Financing" dissemination meeting in Phnom Penh. Over 120 Cambodian Parliamentarians, government officials and development partners participated as did SIF peer exchangers from Nepal and Sri Lanka.
  • June 2010: SIF peer exchanger Mr. Sok Khorn, Public Finance Department of the Ministry of Economy and Finance, attended a meeting entitled “Countdown to 2015 and Sustainable Immunization Financing: Role of Civil Society Organizations” jointly organized by Sabin Vaccine Institute, Rotary Club and UNICEF Nepal in Kathmandu.
  • July 2010: A five-person delegation, including parliamentarians, parliamentary staff, officials from the Ministry of Health and the Ministry of Economy and Finance, attended the “Second Sub-regional Symposium for Parliamentarians on Sustainable Immunization Financing” on 15-16 July in Colombo, Sri Lanka.
  • October 2010: SIF Sabin and the Cambodian Government hosted the Third Sub-Regional Symposium for Parliamentarians on Sustainable Immunization Financingin Phnom Penh.
  • February 2011: SIF Sabin sponsored Cambodia's first provincial-level briefing on immunization financing. Participants included 20 MPs and counterparts from Ministry of Health and Ministry of Finance and Economy.
  • March 2011: SIF co-sponsored, and Senior Program Officer Devendra Gnawali presented an SIF overview, to the Asian Inter Parliamentary Assembly Seminar on ”Accelerating the Achievement of MDG-5 through the Role of Women Parliamentarians”, in Phnom Penh.
  • August 2011: Senior Program Officer Devendra Gnawali participated in the 32nd ASEAN Inter-Parliamentary Assembly (AIPA) held from 18-24 August, 2011 in Phnom Penh.

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Health Sector Architecture:

  • Public health services in Cambodia are delivered through 76 health districts. The districts prepare annual plans and administer 930 health centers. A cadre of supervisors link the central level with 24 provincial health departments. About 70% of the health budget is spent at central level, 30% at subnational levels. There are no health budgets below provincial level.
  • Cambodia's National Strategic Development Plan (2006-2010) was approved by the National Assembly in 2006. It integrates the MDGs and a national Health Sector Strategic Plan (2008-15). The health plan emphasizes a sectorwide approach, donor alignment, harmonization and results orientation.
  • Cambodia is not yet a SWAp country. (Sector funds are not pooled.) However, as an interim step it has adopted a sector-wide approach to managing its health sector (SWiM).
  • The National Immunization Program is coordinated through an Inter-Agency Coordinating Committee, which acts as a sub-committee of the Technical Working Group for Health. The TWG, which has 74 members, meets the second Thursday of each month.

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Health Financing:

  • In 2007, Cambodians spent US$108 per capita on health. Health accounted for 11% of recurrent government expenditures but only about 1% of GDP. (Source: Countdown to 2015 Report, 2010)
  • In 2008, Cambodia received US$132.5m in Official Development Assistance for health, up from US$53.2m in 2007. (Source: OECD Creditor Reporting System)
  • Highly Indebted Poor Countries (HIPC) Debt Relief:
    Cambodia is not a HIPC-eligible country; however, since January 2006 it has received US$82m in IMF Multilateral Debt Relief. (Source: IDA/IMF HIPC and MDRI- Status of Implementation: September 15, 2009)
  • National Immunization Program:
    • Cambodia's EPI Program began in 1989. In 2001, prior to GAVI funding, the Cambodian Government financed $1.7m of its routine EPI budget, about 16 percent. The 2008-2015 cMYP states that routine immunization costs in 2005 totaled $6.7m, of which the government paid 18 percent (about $1.2m) (Source: cMYP 2006-2010, p32).
    • According to the WHO/UNICEF Joint Reporting Form, government routine immunization program expenditures were US$ 1.4m (17 percent) in 2006, $1.6m (33 percent) in 2007, $2.2m (46 percent) in 2008 and $1.2m in 2009. Until 2009, Cambodia was financing an increasing share of its routine immunization services.
    • An updated cMYP was prepared for 2008-15 (National Immunization Strategic Plan 2008-15). It states that government would finance 46% of routine EPI costs in 2009.
      • Amount spent (USD) by the government of Cambodia on routine immunization per infant (2006 - 2010)Cambodia routine imm spend 2006 2010_0.jpg

        • Sources:
        1. WHO Vaccine Preventable Disease Monitoring System, 2008. Immunization Profile: Cambodia. Data derived from the WHO/UNICEF Joint Reporting Form as follows:
        a: C_6450. This % excludes any external financing from donors.
        b: C_6490. This % includes all recurrent, immunization-specific spending financed solely with government funds. This includes vaccines, injection supplies, salaries, and per diems of health staff working full-time on immunization, transport, vehicles, and cold chain maintenance, training, social mobilization, and monitoring and surveillance. "NA" indicates data not available.

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        Budgeting:

        • The Ministry of Economy and Finance reviews the country's macroeconomic situation in March. In April the MoEF issues a circular to the line ministries to prepare their budgets and programs. Budget negotiation with the line ministries happens in August. The consolidated budget and program is submitted to the Council of Ministers in October. The Council of Ministers submits the government’s policy, program and budget to the Parliament in November. After discussion and possible amendments, the Parliament submits the budget to the Senate for approval in December.

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          Budget Flows and Reporting:

        • Actual government expenditures for EPI were US$1.2m in 2008. (Source: Johnston 2010)

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          Budget Performance:

          • In 2008, Cambodia's routine EPI Program immunized 331,646 children with DTP3 and spent around $17 per DTP3 immunized child (US$5,655,081 total), down from $26 per DTP3 immunized child in 2005. (Source: GAVI Annual Progress Report, 2009 and GAVI Annual Progress Report, 2005)
          • Country Policy and Institutional Assessment: The World Bank 2007 CPIA gave Cambodia's budget and financial management systems (Indicator #13) a score of 3.0, up from 2.5 in 2005. (mean 2007 score for all IDA countries: 3.2) Read more here.
        • Open Budget Index: Cambodia scored 11% out of a possible 100% on the Open Budget Index 2008. This indicates that the government provides scant budgetary information to the public. Read more here.

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          Parliamentary Notes:

          • Cambodia’s government is a constitutional monarchy. The parliament is bicameral. The National Assembly has 123 members, representing 24 constituencies. The Senate has 61 members. Current NA members were elected in September 2008 to five-year terms. Senators were elected to six-year terms in 2006. The Cambodian People’s Party dominates both houses.
          • The NA approves the prime minister and council of ministers with a minimum 2/3 vote.
          • The Senate and NA have identical committee structures. Each NA commission has nine members, each senatorial commission five. With 26 line ministries, each of the nine standing commissions oversees many government programs. Immunization falls under the jurisdiction of the Public Health, Social Affairs, Veteran, Youth Rehabilitation, Employment, Vocational Training and Women Affairs Commissions. Budget oversight is done by the Commissions on Economy, Finance, Banking and Audit.
          • The constitution prohibits MPs from introducing Private Member Bills. All legislation to date has originated with the government.
          • MPs do not have electorate allowances that would pay their travel expenses to their respective constituencies.
          • In 2009, in collaboration with the Inter-Parliamentary Union, the Cambodian Senate performed a self-evaluation. Among the recommendations are strengthening the Senate's ties to subnational governments (league of comune/sangkat councils), particularly for implementing the country's decentralization program. A series of regional fora is proposed for this purpose. A second recommendation is for specialized commissions to strengthen their relations with national institutions, civil society organizations and external partners.
          • The next parliamentary election will be held in July 2011 (Source: ElectionGuide).
          • Chapter VI, Article 72 of Cambodia’s 1993 constitution states: “(1) The health of the people is to be guaranteed. The State gives full consideration to disease prevention and medical treatment. Poor citizens receive free medical consultation in public hospitals, infirmaries, and maternities“.
          • One Kraw, dated 17 June, 1996 (“Management of pharmaceuticals”), gives the government authority to regulate vaccines. It also permits retired health officials to administer vaccines.

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            Immunization Performance Indicators:*

            Percent of districts reporting at least 80% coverage (DPT3), 2008*: 81%
            % of districts with />= 80% DPT3 Coverage

            *Source:
            WHO Vaccine Preventable Disease Monitoring System, 2008. Immunization Profile: Cambodia. Data derived from the WHO/UNICEF Joint Reporting Form, Indicator GSA17ap. "NA" indicates data not available.

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            Disease Burden:

            Population (2008): 14,562,000
            Births (2008): 361,000
            U5 Deaths (2008):
            - total 32,000
            - preventable by routine EPI: 4,4801
            - preventable by routine EPI and new vaccines: 8,0002

            (Source: UNICEF "State of the World's Children" 2009 )

            1 Assumes use of BCG, DPT, polio, and measles vaccines prevent 14% of U5 deaths.
            2 Assumes use of BCG, DPT, polio, measles, HepB, Hib, yellow fever, and pneumococcal antigen-containing vaccines prevent 25% of U5 deaths.

            Note: Vaccine preventable death estimates assume that force of infections, individual susceptibility, and probability of exposure are constant at all mortality levels.

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            Useful Links:

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