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Building political ownership and technical leadership Decision-making, political economy and knowledge use in the health sector in Cambodia
Building political ownership and technical leadership Decision-making, political economy and knowledge use in the health sector in Cambodia
Op-Ed: odi.org
6 Recommendations
Based on the findings of the study, the following recommendations can be made for AusAID Cambodia and other international development agencies engaging in the health sector in the country.
6.1 Recommendations for the next phase of programming
At the time of writing, it seems likely that HSSP II will be extended by one year, with the start of 2015 most likely to be the starting point of the next phase of AusAID support to the sector (Pearson, 2012). The following recommendations represent principles and ideas which could help guide the overall approach for this next phase of programming.
6.1.1 Politically savvy programming
1. Effective support for Cambodia’s health sector may involve designing elements of programmes to ‘go with the grain’ of political economy dynamics. This has the potential to have a high impact on health outcomes.
a. Attempting to work with the trend of mass patronage, by encouraging health to be seen as an appropriate ‘gift’ to constituents (e.g. disbursing vaccinations, dietary supplements, medicines), would be likely to garner the required behind-the-scenes approvals and ownership which could see broad, fast and effective roll-out with minimal leakage.
b. This could involve providing funding and/or in-kind resources for relatively top-down, one-off solutions to certain problems – for example, vaccinations, bed nets, or nutritional supplements. Key local government actors (and possibly CPP working groups) should be engaged, and it would be important that there were space for government and/or CPP to claim some credit for handouts. The issues of branding and publicity would need to be carefully considered.
c. Patronage-based distribution helps trickle down resources and allow for services to reach local people to some extent; yet it is far from being systematic and equitable. Complementary activities could be carried out to compensate for the downsides of mass patronage. One important priority would be public education and awareness to make the demand for health services better informed. Mitigation should be made for areas which are under-prioritised by the patronage system, for example through ensuring that NGOs focus service delivery on areas with low political priority.
d. Programmes could limit downsides through making gifts selectively available – for example, on issues where citizen demand is more likely to coincide with good medical advice, and by making the volume of gifts available proportional to the burden of disease or magnitude of the problem.
e. IDPs may want to limit their exposure to risk in such a programme through focusing on impact. Although it may often involve a ‘second best’ response to problems, the nature of handouts means they are suitable for conducting highly rigorous impact evaluations, which would establish improvement in health outcomes attributable to the programme, with a high level of certainty. Full randomised control trials are unlikely to be possible given the (required) lack of control over disbursement; however a variety of quasi-experimental methods should still be able to establish the value of the programme beyond reasonable doubt.
2. It should be recognised that medium- to long-term prospects for sustainability and effectiveness in the sector hinge on whether greater political ownership by the Cambodian government(15) can be built over health service delivery.
a. IDPs should formulate a basic theory of change and some principles and assumptions relevant to Cambodian context about how political ownership can be built in the sector. From that, they should identify strategic entry points or issues on which it is acceptable for them to work, or where their programmes can in some way contribute to health sector programming.
b. Some plausible elements of such a theory could be: increasing the extent to which the CPP sees health as a viable ‘gift’; raising awareness about health ‘gifts’ building expectations for the Government to deliver on the part of Cambodian citizens; increasing the perceived importance of health by key levels of government and the general public; supporting the ability of government to systematically manage and deliver services and health outcomes.
c. As well as potentially targeting programme support around a top-down ‘gift-giving’ dynamic, the other major entry point is the ongoing decentralisation reform, and the way the health system joins up with local government.
d. Goals around government ownership are as important, if not more so, as ‘good governance’ and fiduciary issues, which should be approached with pragmatism (‘good enough governance’ may be the most appropriate mantra). It is likely that successful, visible delivery of health services, combined with an increasingly healthy and able population (over a demographic timescale), are much more likely to lead to long-term transformation, not just in human development indicators, but in the ability and willingness for Cambodians to hold their government to account.
e. Support could work better and donors’ political risk could be more easily managed if programmes revolved around strong outcomes and impact goals, and were realistic and flexible about how these were achieved. The health sector is lucky to be suited to objective assessments of needs and of the impact of programming, and programme design efforts should draw on impact evaluation expertise from an early stage.
3. Efforts to tackle systemic issues of corruption and rent-seeking in the sector need to be informed by the findings of this study (and ideally, further and more focused work). The findings indicate that issues of corruption and rent-seeking are small in the health sector compared to other sectors. Possible implications include:
a. It is imperative that IDPs make clear and explicit decisions about the extent to which they are aiming to promote governance and institutional change, and the extent to which their focus is on promoting health outcomes for poor Cambodians.
b. In the authors’ opinion, a realistic approach would jettison any hopes of making inroads to broader systemic trends around rent-seeking or issues around politics and accountability, from what is a marginal sector. It should recognise the fact that these issues are comparatively small in health, compared to other sectors. It would also understand the limits of technocratic governance and accountability reforms pushed by external actors in the absence of any strong domestic demand for this in the near future, or stronger government ownership of effectiveness in health.
c. Rent-seeking and corruption can be tackled in the sector, but a flexible, opportunistic and responsive approach is needed. Rather than making a series of non-negotiable demands and conditions, IDPs could prepare to change focus if it appears that vested interests and behind-the-scenes deals block the way in one area. Achievable institutional and governance goals are incremental rather than idealistic, recognising the likelihood of policies which appear ‘perfect’ on paper but lack resonance in local context.
d. An ‘outcomes-based’ funding mechanism could put in place a beneficial incentive for reforms, given the importance of donor funding to the sector. A menu of desired changes could be laid out with associated budgetary tranches to be released in response to not only policy changes but actual indicators of outcomes and behaviour change. This could be used as one tool for donor coordination, with different partners assigning different levels of funding to different options, according to their own priorities and fiduciary risk tolerance.
6.1.2 Embedding knowledge-policy links
4. IDPs should improve financial support for building a sustainable model for evidence-informed policymaking in the sector. This could help deepen and embed the required capacities, practices and structures of professional sector management, to go along with (hoped for) increases in government ownership and funding. This could revolve around three main elements:
Cambodian overseas absentee voting viewed by PM Hun Sen and HE Sam Rainsy
Political Paradigm of Pragmatism from the Khmer Youth part 55
This part (55), Mr. Sophan Seng articulated on the CEROC or Committee for Election Rights of Overseas Cambodians on recent news of Prime Minister Hun Sen and H.E. Sam Rainsy regarding Cambodians overseas absentee voting.
PM Hun Sen used the excuse of not allowing Cambodians overseas to vote in Cambodia elections because of election system in Cambodia is proportional representation which is different from USA, and he continued to comment on different time such daytime in Cambodia is nighttime in America. With this matter, Mr. Sophan described that it is just a small piece of technical issues that they are not complicate to resolve. Thailand has operated proportional representation, and their overseas voters casted ballots to vote with no problem at all. Thailand has no problem of allocating them, or jurisdiction, or residency at all when overseas citizens registered to vote. To avoid conflicting time of night and day, and especially to avoid pressure on voter, they have arranged “advance vote” by giving more time to both domestic voters and overseas absentee voters to caste their ballots.
Regarding letter to the Phnom Penh Post by H.E. Sam Rainsy, Mr. Sophan described that it depends on how the election committee agrees to solve such technical issue. It is not beyond the ability and capacity to solve the issues whenever Cambodian overseas absentee ballots and voting are counted and facilitated.
From Post-Conflict Reconstruction to Economic Transformation
From Post-Conflict Reconstruction to Economic Transformation
Op-Ed: diva-portal.org
Given that Cambodia has left behind its post-conflict status, how should we characterize the current period of continuing change? In this study, we coin the term “economic transformation” to describe the current context. This economic transformation represents a visible change in the level and nature of economic activities from the 1990s to the 2000s. Although a slowdown is expected as a result of the global financial crisis, and may limit or reverse some of the political implications of economic success, it will not erase the transformations wrought over the past five years. Some statistics give an indication of the empirical dimensions of this transformation. The economy has grown at an average of almost ten per cent per year over the past five years.
The value of exports has tripled, while the flow of foreign direct investment has increased 12-fold since 2004. Poverty has fallen and human development indicators have improved. At the same time, according to the World Food and Agriculture Organization, Cambodia lost almost a third of its primary tropical forests between 2000 and 2005,13 and severe inequality has emerged and is growing, especially in terms of landholdings. A recent estimate by the Land Coalition put the proportion of landless people at 20 per cent of the rural population, and the proportion of land-poor people at 25 per cent. This is a figure that is considered to be rising, in view of the rash of forced evictions from disputed land that have taken place over the past three or four years.
To date, studies of Cambodia’s economic trajectory have been largely confined to analyses by the international financial institutions (IFIs) that engage with Cambodia as “development partners,” or by research institutes focused on the specifics of particular industries or indicators. There is broad agreement within these studies as to the nature of the economic transformation that has occurred, and its limitations. For example, there is widespread agreement that while economic growth in Cambodia has been high, it has been narrowly based. Over the period from 1996 to 2006, the economy as a whole grew by an average of 8.7 per cent per year. Disaggregated by sector, the picture looks less promising. Manufacturing grew by 18.1 per cent per year over this period: within the manufacturing sector, garment production grew by 34 per cent. Construction grew by 12 per cent. These industries are confined to a small geographical area: particularly the area around Phnom Penh and Tak Khmau, and the corridor along National Route 4 to the main port of Sihanoukville. However, the garment industry in particular has proved flexible and relatively durable in response to changes in the nature of the global trading regime of which it is a part. The industry survived the end of the Multi-Fibre Agreement which guaranteed Cambodian exporters privileged access to US markets, and brokered a new deal which claimed a niche for Cambodian garments on the basis of their “ethically produced” status. The extent to which the ethical claims made are real is debatable, but the strategy worked, up until 2008, in securing markets for Cambodian goods.
Services performed well, growing at an average of 8.5 per cent, a performance particularly boosted by the 12.5 per cent growth in the tourism sector which saw the number of tourists increase from 289,524 in 1998 to 2,015,128 in 2007. Again, tourism is narrowly concentrated in the town of Siem Reap, gateway to the ancient Angkor temple complex, and a recent study has found that tourism has little effect on poverty reduction in Cambodia, since revenues do not reach the poor. Across the rest of the country, although agriculture remains the main occupation of 55 per cent of the population, it grew only slowly over this period, at less than 5 per cent per year, and some of this growth was driven by the expansion of the sub-sector of industrial agriculture, which grew by 10 per cent per year The subsistence agriculture sector upon which the rural population largely depends remained poor. Consequently, the numbers of people leaving the land altogether and making a living in manufacturing or service industries increased sharply. The percentage of the (expanding) labour force employed in industry and services increased from 4 to 12 per cent and 20 to 25 per cent respectively between 1994 and 2004.
Read the entire text of Cambodia Economic Transformation in pdf file
Briefing on the meeting with NEC’s officials on 19 March 2016
Political Paradigm of Pragmatism from the Khmer Youth part 54
This part (54), Mr. Sophan Seng elaborated about the meeting with NEC’s officials on February 19, 2016. Mr. Sophan Seng who is the leader of the CEROC, was honored to meeting H.E.Kuoy Bunroeun, Deputy of NEC at the head office to discuss the right to vote of Cambodians overseas.
The meeting was anticipated by two permanent members and two deputy secretaries of the current NEC. The discussion is summarized following:
Mr. Sophan Seng highly valued the new NEC that is better and more independent than before including the high expectation of its performance for this upcoming commune election 2017 and national election 2018. Precisely, he addressed the need to allow and facilitate access for Cambodians overseas to vote in Cambodia elections (inclusiveness). The CEROC’s objectives are: – to organize suggestions, petitions, and participation of all Cambodians overseas, and – to produce paper work on mechanism, technical and comparative studies through researches and academic gatherings.
Solution: H.E. Kuoy Bunroeun welcomed the tasks of research and recommended to submit petition through a right channel. NEC is implementing in accordance to the existing laws solely.
- In the future, the NEC shall prepare high ranking officer(s) to visit Khmers diaspora to interact with them about the progress of the NEC.
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H.E. Kuoy Bunroeun debriefed the advantage and disadvantage points of the new NEC following:
Advantage Points:
- Institutionalized into Cambodia Constitution
- Procedures, mechanism, and implementation of the NEC
- Election laws: new voter registration using fingerprint, photos and computer database etc.
- Able to make all decision makings
Disadvantage points:
- Population database and identity matching are under limit
- Ability of NEC’s staffs especially in each voting booth (PSO) is under limit
- Infrastructure such as electricity is very limited
- Etc.