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The views expressed in this presentation are the views of the author and do not necessarily reflect the

views or policies of the Asian Development Bank Institute (ADBI), the Asian Development
Bank (ADB), its Board of Directors, or the governments they represent. ADBI does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any
consequences of their use. Terminology used may not necessarily be consistent with ADB official terms.

Trend in Health Policies and Promote


women’s Sexual and Reproductive
Heath in Cambodia

Dr. Teng Srey


Deputy-Director of Communicable Disease Control Department
Ministry of Health, Cambodia
25-26 March 2019
Outline
• Introduction
• Recent change in health and other related policies for
women’s sexual and reproductive health in Cambodia
• Challenges/problem and innovative strategies
• Conclusion
Introduction
• Geographic location:
• Southeast Asian, an agricultural, borders
Thailand (west), the Laos and Thailand to the
north, the Gulf of Thailand to the southwest,
and Viet Nam to the east and the south. Total
land area of 181,035 square kilometers. Laos PDR
• a tropical climate, 2 seasons (dry and rainy
season)
• Demographic characteristics
• The 2014 General Population Census (GPC) :
Pop 15,405,157. 80.5% living in rural areas, 19.5
% urban.
• Divided into 25 provinces, capital Phnom Penh,
165 districts
26 cities.
Introduction (cont.1)
Human Development Index in Cambodia
• Cambodia's HDI value for 2017 is 0.582— which put the country in
the medium human development category—positioning it at 146 out
of 189 countries and territories. Between 1990 and 2017, Cambodia's
HDI value increased from 0.364 to 0.582, an increase of 59.9 percent.

Reference: Cambodia - Human Development Reports – UNDP


hdr.undp.org/sites/all/themes/hdr_theme/country-notes/KHM.pdf
Education level (1)
• By 2011, Progress is on track in improving the ratio of females to males in upper-
secondary education, but not yet for tertiary education.
• Gender parity has been achieved in net primary and lower-secondary enrolment
rates.
• Upper-secondary data indicates a ratio of 83% of girls to boys enrolled, though girls
attended more regularly than did boys.
• Tertiary education data indicates 73% of girls to boys enrolled (compared to 38% in
2000), but only 3-4% of Cambodians aged 15-24 enroll in tertiary education and
most existing enrolments are not in science subjects that could support a medical
career.
• Progress in gender parity in youth literacy is positive, with 96% of women 15-24 to
men literate (compared to approximately 88% in 2000).
• Literacy of adult women (25-44) remains below target at approximately 86% of
male literacy (compared to approximately 78% in 2000), reducing their ability to
achieve equivalent wages to men, access services, or negotiate for what they need
in work or personal relationships. References: Ministry of Planning (2011) Achieving Cambodia’s Millennium Development Goals, update 2011. Phnom Penh: RGC.
Theng P. Current Status of Cambodian Millennium Development Goals (CMDG) 2011; Allson Angkor Paradise Hotel. Ministry of Planning
RGC (2008) Law on the Suppression of Human Trafficking and Sexual Exploitation
Education level (2)
2017-2018
• Participation rate of women in labor market 79%, is the highest rate
in region
• 64% small and medium enterprise owners
• 52.58% completed high school
• 45.9% completed bachelor degree
• 21.6% completed master degree
• And only 5.1% completed PhD degree
(Source: public education statistic of Ministry of Education, Youth and sport 2017-2018)
Recent change in health and other related policies for
women’s sexual and reproductive health in Cambodia
• Total fertility rate for women of reproductive age has sharply declined from 3 in
2010 to 2.7 in 2016 (source: UNFPA teenage pregnancy in Cambodia, Oct; 2015).

• The CDHS 2014 reports extremely low levels of sexual activity in unmarried
adolescent girls so the increase in adolescent births is in married girls. The
percentage of girls 15-19 who were married increased from 10% in 2010 to 15.4%
in 2014. The increase in married adolescents has been in older adolescents, with
child marriage (by age 18) staying constant (18.4% and 18.5% of women 20-24 in
2010 and 2015 respectively). The percentage married by age 20 has risen from
37.3% to 40.8% in 2014.
• The highest increase in adolescent pregnancy is in adolescents with no education,
where the percentage who have begun childbearing has increased from 17% to
37.1%, and in those adolescents in the lowest two wealth quintiles. Most of the
increase is in adolescent girls bearing children at age 18 or 19. Only a small
percentage of girls gave birth at age 15 or 16 (approximately 4.4%). This recent
analysis of CDHS 2014 data is essential in helping to focus the national reproductive
health programme on these particular groups of adolescents.
• In 2013
• the population at marriageable age (18-30 years old) was 3.9 millions (26.6% of the
total pop) of which 2.1 million had not bee married (53.2%).
• The suggests high demands for health care of youth, especially reproductive health
and family planning for both married and unmarried youth.
• Only 7.4% of the pop aged 15-64 years old (9% among men and 5.8% among women
of the same ages) finished upper secondary education, vocational training and college
education.
• The % of pop aged 15-64 finishing upper secondary education, vocational training and
college education differs significantly by place of residence.
• Urban: total 19.3% male 23.5% female 15.3%
• Rural: total 3.3% male 4.2% female 2.5%
• Need for key policy directions, measures and actions in order to reduce the above
gender and geographic disparities.
• Promote the use of modern birth spacing methods of family planning among youth
and women to reduce unmet need for family planning
• Improve women’s access to education health care service and social and legal
protection
Reference: Ministry of Planning: National population policy 2016-2030, continue to improve the quality of life and well being of the people, General Secretariat for population and development
• In 2013
• Accelerate further reduction of the maternal mortality ratio, child mortality rate and
infant mortality rate
• Realize all the adolescent youth and couple’s reproductive needs and fertility
intentions are met and accelerate the pace of pop stabilization.
• Reduce the prevalence of HIV/AIDS and decrease the spread of malaria, Tuberculosis
and other diseases towards the total elimination of spread.
Overview of Cambodia’s recent health and other relevant inter-
ministerial policy changes for women’s sexual and reproductive health
: up to date domestic policy developments as well as the progress on
recent mul-tilaterial and bilaterial assistance programs for women’s
sexual and reproductive health
Gender context in Cambodia
• Cambodian Millennium Development Goals 2003, National Population Policy, Rectangular Strategy
2004, National Strategic Development Plan 2009, and the 5 years Strategic Plan for Gender Equality and
the Empowerment of Women in Cambodia 2009-2013 or ‘Neary Rattanak III (Ministry of Women's
Affairs (MoWA)) with relevant partners
• National Action Plan to Combat Violence Against Women; the National Program on the Promotion of
Social Morality, Women and Khmer Family Values; the Social Security Policy and National Social
Protection Strategy for the Poor and Vulnerable; the Strategic Plan on Women, Girls and HIV/AIDS; and
sectoral Gender Mainstreaming Action Plans.
• Cambodian National Council for Women (CNCW), an inter-ministerial council comprised of secretaries
of state of line ministries and relevant institutions; the Technical Working Group on Gender (TWG-G),
established within the framework of the Government-Donor Consultative Committee (GDCC) to support
improved aid effectiveness; Gender Mainstreaming Action Groups (GMAGs) established in line
ministries, including the Ministry of Health (MOH); and Women's and Children's Consultative
Committees (WCCCs), established at sub-national government levels.
• Gender Mainstreaming Strategic Plan MOH 2006-2010
• Gender Mainstreaming Strategy and Action Plan for the Ministry of Health Cambodia (2014-2018)
The four objectives are to:
• improve gender responsiveness of MOH financing;
• strengthen equality of opportunity in MOH recruitment, training and promotion;
• increase the responsiveness of MOH programmes and service delivery to gender issues;
• strengthen the capacity of GMAG to address gender responsiveness within MOH.
Policy 1 of health sector priority:
• Improve reproductive health, reduce maternal, newborn and
child mortality and malnutrition among women and children.
Strategy level: strategic priority focuses on health service delivery
system that is a core business of the whole health system, to ensure
that all population has access to and utilization of quality, safety and
effective health services in equitable manner through:
• Expanding the coverage of and access to improved quality health
services across geographical areas throughout the country; and
• Increasing the coverage social health protection mechanisms for
all Cambodians, regardless their socio-economic conditions.
• Health Equity Funds
1. Health Equity Funds for the poor
2. Health Equity Funds for informal workers and other groups target
Non-Independent Workers, District / Khan Councils, Commune / Sangkat, Village Chiefs, Vice-Chairmen,
CMAC, Moto, Cyclo ... with the right associations are guaranteed
• Subsidy Scheme from Facilities
• National social security funds for formal workers/employees
1. (The government's budget revenues through the Ministry of Economy and Finance provide the National
Security Fund with a 1% base of basic salary, of which 0.5% is the responsibility of the Royal Government
and 0.5% is the responsibility of the person. But now, the government has replaced the civil servants
2. Income from the employer is based on the contribution rate of the employer 2.6% of the average wage
involved (200,000 to 1,200,000 Riel) (enterprise, worker))
• More support for maternity:
• Women workers under the provisions of the Labor Law are funded by the Royal Government for a one-child
birth:
- One child is 400,000 Riels
- Two children are 800,000 Riels
- Three children are 1200,000 Riel
• Outsourced workers and other members
• Outsourced Workers District / Khan Councils Commune / District Chiefs / Vice-Presidents, CMAC Artists,
Motorbikes, Motorcycles, Cyclists ... Women, and whose names are in the correct contacts, are provided by
the Royal Government for the same maternity To the workers under the provisions of the Labor Code.
• Female public officials
• Women's public officials, including the Royal Cambodian Armed Forces (RCAF)
One child is 800,000 Riels, two children, 1,600,000 Riels and 2,400,000 Riels, which the Ministry of the Institution provides.
• National strategy for reproductive and sexual health in Cambodia 2017-2020, 2013-2016,
2006- 2010, to ensure an effective and coordinated response to reproductive and sexual
health needs in the country: focus on increase coverage and service quality especially at 6
domain areas : Kampong Cham, Kampong Chhnang, Kratie, Phnom Penh, Prah Vihear and Stung
Treng in high demand group (age group 15-24 years old , 40-49 Years old , in rural area, poor,
and low education) increase capacity of provider in counselling and provide long term and
permanent contraceptive methods services.
• Increase service providers' ability to provide counseling, increase long-term and permanent
contraceptive methods services at hospital, and ensure Health Equity Funds fund pay for post-
delivery family planning services and after abortion.
• Ensure availability of emergency contraception and dual protection (e.g. Condom plus for
entertainment workers and at Opportunistic Infection/ART sites..)
• Increasing men's participation in interventions, outreach and behavior change in dual protection
/ birth spacing
• Increase 4 ANC and addressing anemia and parasite effectively, increasing access to and
utilization of services in those areas that coverage are still slow, as well as among the vulnerable
groups
• Provide incentive for midwives who deliver babies in health facilities and increasing coverage of
health financing projects for promote access to health services and increase community demand
level.
• Increase midwives at HC level (2 persons/HC) especially at Prah Vihea, Stung Treng, Mondulkiri,
Rattanakiri
Challenges/problem and innovatives strategies

1. Gender equity ((e.g. gender-based violence, pregnancy/childbirth, HIV risk)); Gender-based


violence (GBV)
2. human rights and empowerment
3. The knowledge, skill, capacity and confidence of the female health staff through the participation of
the female health staff in both in-country and overseas training is limited.
4. The opportunity, encouragement and enabling conditions for the female health staff to hold the
decision-making position in order to close the gap between male and female health staff in making
decisions is limited.
5. Multisectoral partnerships: Key ministries include the Ministry of Social Affairs (MoSA), Ministry of Women’s Affairs
(MoWA), Ministry of Education, Youth and Sport (MoEYS), Ministry of Information, Ministry of Interior, and Ministry of
Rural Development (MoRD). Key MOH departments include Personnel (PD), Human Resource Development (HRD),
Planning and Health Information (DPHI), Human Resources Development (HRD), Drugs, Food & Cosmetics (DDF),
and Central Medical Stores (CMS). Key programmes and disciplines include the National Centre for Health Promotion
(NCHP), National Maternal and Child Health Centre (NMCHC), Child Survival Partnership (CSP), National Nutrition
Programme (NPP), National Aids Authority (NAA) and National Centre for HIV/AIDS, Dermatology, and STIs
(NCHADS).; NGOs, and private sector.
Challenges/problem and innovatives strategies

6. Authority (NAA) and National Centre for HIV/AIDS, Dermatology, and STIs (NCHADS).
7. , linkages, and community involvement
8. evidence based programming
9. Lack of budget for :
 increase the knowledge of gender at all levels of the health sector;
 monitor and evaluate all programmes and activities of the MoH to ensure that every programme
and activity responds to gender needs.
 Implement national strategy for reproductive and sexual health in Cambodia 2017-2020 effective
and coordinated response and action required.
10. Human resources for revise Gender mainstreaming strategy and action plan for MOH (previous 2014-
2018)
11. effective health workforce for universal access (recruitment and training,)
12. Another barrier is that fewer Cambodian women want to become midwives
Conclusion
1. Need policy and strategy
2. Gender mainstream strategy is crucial for each program to implement
3. Need to have Gender mainstream strategy for guidance the implementation
4. Need resources available for operational strategy effective (human
resources, fund, supplies, logistic)