EXPERT RESEARCH STUDY ON THE CURRENT STATE SITUATION AND NEEDS IN THE HEALTH SECTOR IN CAMBODIA WITH THE FOCUS ON MOTHER AND CHILD CARE VYPRACOVÁNÍ ODBORNÉ STUDIE ZAMĚŘENÉ NA ANALÝZU POTŘEB V SEKTORU ZDRAVOTNICTVÍ V KAMBODŽI SE ZAMĚŘENÍM NA OBLAST PÉČE O MATKU A DÍTĚ Country: Cambodia NOVEMBER 2017 PETRA NOVAKOVA EM SOVANNARITH June 2017 BERNHARD EDER This Report has been commissioned by the Czech Development Agency (CzDA). The views and opinions are those of the consultants and do not necessarily reflect the views and opinions of the CzDA. CZDA STUDY ON MCH IN CAMBODIA TABLE OF CONTENT TABLE OF CONTENT ......................................................................................................................................... II ABBREVIATIONS ..............................................................................................................................................V SUMMARY .................................................................................................................................................... VII INTRODUCTION ............................................................................................................................................... 9 OBJECTIVES OF THE STUDY ........................................................................................................................................ 9 METHODOLOGY .................................................................................................................................................... 10 PRINCIPLES ........................................................................................................................................................... 10 STEPS .................................................................................................................................................................. 10 LIMITATIONS ........................................................................................................................................................ 11 WORKPLAN .......................................................................................................................................................... 12 OUTLINE OF THE REPORT ......................................................................................................................................... 13 PART I ............................................................................................................................................................ 14 1 LEGISLATIVE REGULATIONS AND PROGRAMMES FOCUSING ON MOTHERS AND CHILDCARE AND CHILD MALNUTRITION ............................................................................................................................................. 14 1.1 OVERVIEW OF THE BASIC FUNCTIONS OF THE MINISTRY OF HEALTH IN CAMBODIA................................................. 14 1.2 RELATED AND RELEVANT LEGISLATIVE REGULATION ........................................................................................ 15 1.2.1 Maternal Health policies and programme inputs ........................................................................... 15 1.2.2 Child health Policies and Programme inputs................................................................................... 15 1.2.3 Nutrition Policies and Strategies ..................................................................................................... 16 1.3 OVERVIEW OF GOVERNMENTAL PROGRAMME PRIORITIES AND STRATEGIES FOR MCH ........................................... 17 1.3.1 Priorities of the GoC in Mother and Child Care ............................................................................... 17 1.3.2 Sources and Health Financing of Government Funding for Health Services ................................... 20 1.4 OVERVIEW OF PROGRAMMES OF FOREIGN DONORS, NGOS AND INTERNATIONAL ORGANISATIONS ......................... 22 1.4.1 Donors supporting the Health Sector .............................................................................................. 22 1.4.2 Two Payment Systems of the SDGs ................................................................................................. 25 1.4.3 Institutional Arrangements ............................................................................................................. 28 1.5 OVERVIEW OF NGOS AND INTERNATIONAL ORGANISATIONS ACTIVE IN MCH AND CHILD NUTRITION ...................... 29 1.5.1 Further externally funded MCH interventions in Cambodia ............................................................ 30 1.5.2 MCH interventions in Kampong Chhnang ....................................................................................... 30 1.6 GEOGRAPHIC FOCUS OF THE PROGRAMMES ................................................................................................... 31 1.6.1 Innovation in MCH and Public Awareness ...................................................................................... 32 1.6.2 Initiatives of Donors / International Organisations / NGOs promoting Birth Certificates .............. 33 1.6.3 Cooperation and Coordination between the various Organisations ............................................... 33 1.7 CONCLUDING REMARKS ............................................................................................................................. 33 2 CURRENT STATUS OF MATERNAL HEALTH AND CHILD HEALTH IN CAMBODIA (PRIMARY DATA) .......... 35 2.1 HEALTH SECTOR IN CAMBODIA ................................................................................................................... 35 2.2 INDICATORS OF MOTHERS’ AND CHILDREN’ HEALTH AND NUTRITIONAL STATUS ................................................... 38 2.3 CONCLUDING REMARKS ............................................................................................................................. 44 3 SYSTEM OF SETTING UP AND FUNCTIONING OF SOCIAL AND HEALTH INSURANCE ............................... 45 3.1 CURRENT SOCIAL AND HEALTH INSURANCE SCHEMES ...................................................................................... 45 3.1.1 Social and Health Insurance Schemes Supported by the RGoC ....................................................... 45 3.1.2 Management and Governance Structure of Health Insurance Schemes ........................................ 46 3.2 HEALTH INSURANCE TYPES ......................................................................................................................... 48 3.2.1 The Community Based Health Insurance ........................................................................................ 49 3.2.2 Health Equity Fund .......................................................................................................................... 50 3.3 ID POOR MECHANISM GOVERNING ACCESS TO HEF ........................................................................................ 51 3.3.1 HEF Funding source ......................................................................................................................... 52 3.3.2 Social and Health Insurance Schemes Supported by Donors, and International Organisations ..... 53 3.3.3 NGOs and other Actors contributing to Social and Health Insurance Schemes .............................. 54 3.4 HEALTH INSURANCE SCHEMES IN KAMPONG CHHNANG ................................................................................... 54 3.5 CONCLUDING REMARKS ............................................................................................................................. 55 NOVEMBER 2017 ii 4 ACCESS TO A HEALTH CARE FACILITY FOR CHILDREN AND ORPHANS AND FOR ETHNIC MINORITIES .... 56 4.1 CURRENT STATUS OF CHILDREN/FAMILIES WITHOUT BIRTH CERTIFICATES ............................................................ 56 4.2 REQUIREMENTS TO OBTAIN A BIRTH CERTIFICATE ........................................................................................... 57 4.2.1 Mechanisms and Realities for Ethnic Minorities in obtaining Birth Certificates in Kampong Chhnang 58 4.3 SITUATIONS OBLIGATORILY DEMANDING BIRTH CERTIFICATES ........................................................................... 59 4.4 PUBLIC AWARENESS CREATION ON THE MECHANISM TO OBTAIN A BIRTH CERTIFICATE .......................................... 59 4.5 INITIATIVES OF DONORS / INTERNATIONAL ORGANISATIONS / NGOS PROMOTING BIRTH CERTIFICATES .................... 59 4.6 BIRTH CERTIFICATE SITUATION IN KAMPONG CHHNANG ................................................................................... 60 4.7 CONCLUDING REMARKS ............................................................................................................................. 60 5 OPERATION AND THE ROLE OF INDIVIDUAL HEALTH FACILITIES (HEALTH CENTER, REFERRAL HOSPITAL) IN MCH-CARE AND CHILD-MALNUTRITION ........................................................................................................ 61 5.1 ROLES AND FUNCTIONS OF THE NATIONAL MOH DEPARTMENT AND NATIONAL PROGRAMMES .............................. 61 5.1.1 Ministry of Health ........................................................................................................................... 61 5.1.2 Municipal and Provincial Health Department - ............................................................................... 61 5.1.3 Operational District Level (First Level) ............................................................................................ 62 5.1.4 Referral