Cambodia's health sector faces multiple financing challenges. Donor support for key health programs is declining. Access to healthcare services remains inequitable, with significant disparities in coverage and quality, and many Cambodians are confronted with high out-of-pocket costs. However, the country has made considerable progress in tackling its concentrated HIV epidemic. In 2017, UNAIDS recognized Cambodia for achieving its “90-90-90” treatment goals three years ahead of schedule and for having the highest treatment coverage in Asia.
Tuberculosis represents a more widespread public health challenge. Cambodia is among the top 30 countries in the world with the highest burden of TB, which causes more than 3,500 deaths each year. Yet, as recently as 2017, more than half of the national TB program budget went unfunded.
Increased domestic investment and better targeting of resources are needed if Cambodia is to achieve its epidemic control goals, including “95-95-95” HIV targets. The country must increase TB detection and treatment rates while identifying undiagnosed cases of HIV and linking these individuals to care. To address health financing challenges, the Cambodian government is advancing reforms, including implementing a social protection policy framework and discussing the need for greater domestic funding for key health priorities.
From 2017 to 2020, HP+ in Cambodia worked to increase sustainable, predictable, and adequate financing for HIV and TB and to improve the implementation of social health protection policies by:
Assisting the Cambodian government to expand social health protection coverage, including using cost and coverage modeling of the impacts of expanding health insurance coverage to inform policy decisions
Working with the National AIDS Authority to implement policies to increase and sustain dedicated government funding for Cambodia’s HIV response
Providing technical assistance to increase domestic financing for HIV-related civil society organizations and community health workers
Generating a framework for integration of HIV into the broader health system, including analyzing HIV-related beneficiary enrollment, benefits, and use of the country’s health equity fund
Developing an investment case for increased government resources for TB, with particular emphasis on drugs, laboratory tests, and case-finding, to inform the National Strategic Plan for Control of Tuberculosis 2021—2030 and Cambodia’s upcoming Global Fund application
Supporting the National TB Program to track and monitor TB program implementation through support and capacity building on use of the TB-Management Information System
Tool Published for Monitoring Social Protection Progress in Cambodia
October 2021 —
From 2017 to 2020, HP+ Cambodia delivered technical assistance and capacity development to advance universal health coverage and the sustainability of key Cambodian health programs. This included supporting the National Social Protection Council Secretariat to implement and monitor the National Social Protection Policy Framework 2016–2025, the government’s long-term roadmap to increase support for vulnerable populations and expand health insurance. The newly published Manual for the Social Protection Monitoring and Evaluation Mechanism, developed over three years of support from HP+, is a monitoring tool to ensure consistency, transparency, and accountability in the framework’s implementation. Approved by the National Social Protection Council in September 2020, the tool is now publicly available in English and Khmer on the GS-NPSC website. Cambodia’s Minister of Economy and Finance acknowledges USAID and HP+ support within the manual, stating, “As the chairman of the National Social Protection Council, I would like to deeply thank and acknowledge the contributions of the technical teams and all stakeholders, especially the Health Policy Plus (HP+) project supported by the United States Agency for International Development (USAID), as well as other development partners including UNICEF, for their active cooperation and valuable inputs to make this M&E mechanism happen.”
Cambodia’s National Social Protection Council Executive Committee Approves Monitoring and Evaluation System Developed with HP+ Support
October 2020 —
On September 14, 2020, Cambodia’s National Social Protection Executive Committee approved the adoption of a new monitoring and evaluation (M&E) system, developed with HP+ support, to enable systematic oversight of social protection results and financing to manage its portfolio, improve accountability and transparency, and inform future investment priorities. HP+ supported the development of the system by creating a logical framework and identifying indicators; drafting an operational manual and legal framework; and providing customized trainings and ongoing coaching to build capacity of a new team with no previous M&E experience. Implementation of the system will support Cambodia’s policy goals of preventing and reducing poverty, vulnerability, and inequality.
Building Consensus for Policy Recommendations to Improve Healthcare Quality
October 2020 —
In Cambodia, General Secretariat for the National Social Protection Council (GS-NSPC) leadership reached consensus on five actionable policy recommendations to ensure high-quality health services are delivered under national Universal Health Coverage schemes. The recommendations, which include adoption and optimization of a strategic purchasing approach as well as the integration of monitoring and key progress indicators into the annual performance-based budgeting process, were documented in a peer-reviewed article developed with HP+ input, Improving Health Service Quality in the Kingdom of Cambodia: A Policy Perspective, published in the Asia Pacific Journal of Public Health in September 2020.
Decentralizing Implementation of Sustainable Financing for HIV in Cambodia
October 2020 —
In support of the Government of Cambodia’s implementation of a policy to decentralize health sector leadership to subnational and provincial levels, HP+ supported the National AIDS Authority (NAA) to facilitate an advocacy workshop in the province of Kampong Speu on August 31. Fifty participants—hailing from the provincial government, operational districts, NAA, and the National Center for HIV/AIDS, Dermatology, and STIs—reviewed policy measures and discussed implementation plans and roles. Decentralized implementation of this policy will enable the province to directly manage health resources and make decisions with regard to health planning, monitoring, and policy prioritization.
Government of Cambodia Enrolls 129,000 New Households in the Health Equity Fund
September 2020 —
Since July, over 129,000 new households have been enrolled in Cambodia’s largest social health protection scheme, the Health Equity Fund, which entitles families to receive free healthcare—including family planning services. This accelerated rollout follows publication of a secondary analysis, conducted by HP+, which found that 36 percent of Cambodians living under the national poverty line do not hold an equity card, making them ineligible to benefit from the fund. The study was cited by a Deputy Secretary of State of the Ministry of Economy and Finance in the rationale to accelerate national rollout of the system, which will benefit an additional 47,785 households.
Embracing an Evidence-to-Action Agenda in Cambodia’s Universal Health Coverage Journey
Building Capacity in Cambodia’s Tuberculosis Response
September 2020 —
HP+ and Cambodia’s National Center for Tuberculosis and Leprosy (CENAT) conducted assessments and provided on-site support for the Tuberculosis (TB) Prevention Therapy module in three provinces. The assessments follow a June training that HP+ and CENAT provided to TB supervisors on use of the TB management information system at public health facilities. The recent assessments revealed that TB supervisors’ knowledge and use of the module was either “excellent” (80%) or “very good” (20%), demonstrating strengthened skill competencies. In October 2020, CENAT will lead in providing module trainings and follow-up visits to the remaining 23 provinces and 86 operational districts.
Improving Government Accountability and Transparency in Cambodia
July 2020 —
HP+ supported the development of a National Social Protection (NSPC) Monitoring and Evaluation system in Cambodia to facilitate the collection, analysis, and use of service and beneficiary statistics; budget and expenditure data; and payment and administrative information to monitor key performance indicators. HP+ trained NSPC staff on use of the system dashboard, which generates key performance metric visuals; a soft launch by September is planned. The monitoring system is expected to improve accountability and transparency between line ministries and the Ministry of Economy and Finance; strengthen social protection scheme management and decision making; inform the annual budget; and increase public transparency and accountability.
Supporting the Government of Cambodia’s COVID-19 Response
July 2020 —
On June 24, the Prime Minister of Cambodia officially launched a new cash transfer program to offset the impacts of COVID-19 on the country’s poor and vulnerable that will begin with the transfer of about US$50 million to 560,000 poor households. HP+ had supported Cambodia’s General Secretariat for the National Social Protection Council (GS-NSPC) to develop a monitoring and evaluation (M&E) concept note for the program and provided technical assistance to the GS-NSPC team and GIZ contractor implementing COVID-19 M&E activities, improving accountability among local authorities. In Cambodia, health service disruptions related to COVID-19 could potentially result in 559,900 individuals being unable to access contraceptives.
Building Cambodia’s Domestic Capacity to Address Tuberculosis
June 2020 —
HP+ continues to build Cambodia’s domestic capacity to manage its tuberculosis response by supporting the roll-out of the new Tuberculosis Prevention Therapy (TPT) training modules to the National Center for Tuberculosis and Leprosy’s tuberculosis management information system (CENAT TB MIS). In May 2020, HP+ facilitated a three-day training-of-trainers for 16 technical staff from CENAT and partners. The training, which prepared participants to provide the training nationwide, covered data entry protocols, roles and responsibilities, and best practices for troubleshooting. CENAT staff can now execute TB-MIS trainings with limited HP+ oversight and support, extending the frequency and reach of the trainings throughout all provinces.
Supporting Integrated Systems to Enable Social Health Insurance Reforms in Cambodia
May 2020 —
HP+ is supporting Cambodia’s General Secretariat for National Social Protection Council (GS-NSPC) to implement integrated systems to enable social health insurance reforms. Following an April launch by the Prime Minister of an inter-Ministerial Technical Working Group to oversee linking of health insurance reimbursement systems, HP+ is collaborating with the GS-NSPC and the Asian Development Bank to design an interoperability demonstration project to support harmonization. These efforts to boost effectiveness, transparency, and accountability will improve the operation and effectiveness of the Health Equity Fund, which includes long-acting reversible and permanent contraceptive methods, and National Social Security Fund schemes that cover nearly 5 million beneficiaries.
HP+ Assessment Aids Cambodian Government to Improve Private Sector Engagement in the HIV Response
May 2020 —
HP+ supported Cambodia’s National AIDS Authority to conduct a legal and regulatory assessment of private sector provision of HIV services. The assessment concluded that, while the private sector can legally provide HIV services, these services are insufficiently regulated and reported. Findings informed private sector engagement strategies for the five-year National Health Sector Strategic Plan for HIV. If these strategies are adopted, Cambodia can expect to see higher-quality HIV services provided by the private sector, and the government will be able to use more reliable data to program resources.
International Social Security Review Publishes HP+ Cambodia Article
April 2020 —
An original article authored by HP+ in coordination with a research team at Cambodia’s Ministry of Economy and Finance’s General Secretariat for the National Social Protection Council was published in the International Social Security Review. The research, which assesses current coverage potential, gaps, and social equity considerations with regard to the expansion of social health protection in Cambodia, is being used to inform a comprehensive policy proposal to expand coverage to about 5.7 million financially vulnerable people, improve healthcare quality, and strengthen institutional systems within Cambodia.
Monitoring Plans to Promote Social Protection Advance, Adjust During Cambodia’s COVID-19 Response
April 2020 —
In Cambodia, HP+ supported the Ministry of Economy and Finance and the National Social Protection Council (NSPC) to develop a monitoring and evaluation (M&E) operations manual and indicators to monitor progress on social protection in Cambodia. Included is an indicator on rates of contraceptive prevalence. Due to COVID-19-related social distancing measures, HP+ has facilitated rapid transition of this activity to an online platform to validate indicators with 11 line ministries. In addition, HP+ developed an online course catalogue that offers 27 free, online social protection courses for colleagues to pursue self-study while working remotely.
Advancing a Social Health Protection Policy Agenda in Cambodia
March 2020 —
In January 2020, Cambodia’s Ministry of Economy and Finance’s inter-departmental health working group accepted 32 recommendations crafted by the National Social Protection Council. The recommendations, which include expanding coverage to dependents and raising the income threshold for premium contributions, came from HP+-generated evidence aimed at advancing the government’s social health protection agenda by promoting ownership and empowering key influencers to effectively advocate for policy change. The recommendations, which the government will begin to implement over the coming year, could significantly benefit Cambodia’s most vulnerable citizens by expanding social health insurance to 3.8 million family dependents and 3.1 million vulnerable people, who will gain improved access to long-acting and reversible and permanent family planning methods to be reimbursed under the HEF benefits package
Building the Case for Increased Funding to End Tuberculosis in Cambodia
March 2020 —
In Cambodia, the National Center for Tuberculosis and Leprosy Control (CENAT) is using evidence generated by an investment case and recommendations from a joint program review to advocate for greater funding for the tuberculosis (TB) response. HP+ is providing technical support to CENAT to employ the TB TIME model to analyze a variety of scenarios of programmatic impact against potential investment requirements. HP+ found that scaling up active case finding and contact investigation and improving the diagnostic algorithm could result in a 33% reduction in the number of TB incident cases and a 27% reduction in costs borne by individuals from 2019 to 2025.
Mobilizing Government Funding for HIV from Non-Health Sectors in Cambodia
March 2020 —
In recent months, HP+ has supported Cambodia’s National AIDS Authority to identify and budget for HIV-related activities for the coming year in coordination with non-health line ministries. Using the National Strategic Plan for a Multi-Sectoral, Comprehensive HIV/AIDS Response (2019-2023) as guidance—a strategic plan for coordinating the country’s HIV response, produced with HP+ support—the ministries committed approximately US$500,000 to fund HIV-related activities in Cambodia. This commitment supports progress toward achieving the vision of government funding of 50% of the HIV response by 2023 (up from 24% in 2017).
Prime Minister Approves Financing Action for Cambodia’s Integrated HIV/AIDS Response
February 2020 —
Cambodia took a major policy implementation step in its national HIV/AIDS response this month when the Prime Minister approved a resolution directing operational funding for the response and other key advancements, notably the eligibility of all people living with HIV to receive a Health Equity Card and recognition of the important role played by civil society organizations. The resolution also guides the Ministry of Health to amend policies for health center and hospitals to use their own funds for HIV/AIDS activities, in addition to Ministry’s national budget. This achievement represents the culmination of an extensive effort by HP+ Cambodia and its health advisors, who are embedded at the National AIDS Authority (NAA), to advance health financing policy implementation for people living with HIV. This effort included sensitization and capacity building with the NAA leadership and ongoing support for the entire policy advocacy process including the drafting of the board resolutions and proposal to the Prime Minister’s office. Moving forward, the Prime Minister’s directive calls for the Supreme National Economic Council to further study the fiscal space to ensure implementation of the commitments and to sustainably mainstream the HIV/AIDS response through strengthened human resources, procurement, supply chain management, and health information systems. HP+ will continue to support the NAA in implementation of the new guidance.
HP+ Advocacy Prompts Increased Government Funding for ARVs in Cambodia
February 2020 —
As a result of HP+ advocacy support to Cambodia’s National AIDS Authority, the country’s Ministry of Economy and Finance (MEF) agreed to significantly increase funding for antiretroviral drugs (ARVs) over the next three years. The annual increases in funding—from the current allocation of US$1.5 million to US$5 million by 2023—will allow the Global Fund to reallocate resources to critical, underfunded HIV prevention activities. The MEF’s decision supports progress toward achieving the country’s national strategic plan directive that 50 percent of HIV response funding be derived from domestic sources by 2023 and sets a new contribution floor for government ARV funding.
2020 Prince Mahidol Award Conference
February 2020 —
Representatives from HP+ Cambodia and Indonesia teams participated in the Prince Mahidol Award Conference 2020, adding to discussions on universal health coverage with case studies on HIV financing, social protection, and private sector engagement. HP+ collaborated with USAID to host a well-attended satellite session entitled Harnessing the Private Sector for UHC through Smart Policy, with participation by Elaine Menotti and Pellavi Sharma of the Office of Population and Reproductive Health.
Cambodia’s National AIDS Authority Commends HP+ Support
November 2019 —
Health Policy Plus Cambodia received an appreciation award from Cambodia’s National AIDS Authority at its Annual Congress Meeting on November 6, 2019, in Phnom Penh. HP+ Cambodia engaged with the National AIDS Authority on evidence generation, capacity building, policy advocacy, and technical dialogue to drive policy change for a more sustainable and domestically financed HIV response. A success of the engagement has culminated in the prime minister approving a policy circular to increase allocation of resources for HIV. Read our brief for more information.
