1. health and fitness

Ministry of Health
OPERATIONAL MANUAL
December,
2008
Second Health Sector Support Program, 2009-13
MINISTRY OF HEALTH
No. 151-53, Kampuchea Krom Blvd
Phnom Penh, Kingdom of Cambodia.
HSSP2 Operational Manual
in joint partnership with:
Second Health Sector Support Program
Implementing Units
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Department of Administration
Department of Budget and Finance
Department of Communicable Disease Control
Department of Drugs, Food and Cosmetics
Central Medical Stores
Department of Hospital Services
Department of Human Resources
Department of Internal Audit
Department of International Cooperation
Department of Personnel
Department of Planning and Health Information
Department of Preventive Medicine
National Dengue Control Program (CNM)
Helminths Control Program (CNM)
National Maternal and Child Health Center (NMCHC)
National Nutrition Program
National Reproductive Health Program (NMCHC))
National Immunization Program (NMCHC)
Prevention of Mother to Child Transmission Program (NMCHC)
ARI-CDD-Cholera Program (NMCHC)
National Center for Blood Transfusion
National Center for Health Promotion
University of Health Sciences
Technical School for Medical Care
Regional Training Centers (Battambang, Kampot, Kampong Cham, Stung Treng)
All Provincial Health Departments
All Operational District Offices
MINISTRY OF HEALTH
No. 151-53, Kampuchea Krom Blvd
Phnom Penh, Kingdom of Cambodia.
Tel: 855.(0)23.880.260/880.261 Fax: 855.(0)23.880.262 Email: [email protected]
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ACRONYMS & ABBREVIATIONS
3YRP
Three Year Rolling Plan
ADB
Asian Development Bank
AFD
Agence Francaise de Developpment
ANC
Ante Natal Care
AOP
Annual Operational Plan
AusAID
Australian Agency for International Development
BCC
Behavior Change Communication
BHEF
Bureau of Health Economics and Finance
BTC
Belgian Technical Cooperation
CAR
Council for Administrative Reform
CBHI
Community Based Health Insurance
CDC
Communicable Diseases Control
CDHS
Cambodia Demographic and Health Survey
CMDGs
Cambodia Millennium Development Goals
CNM
National Malaria Center; now renamed as the National Center for
Parasitology, Entomology, and Malaria Control (NCPEMC)
CPA
Complementary Package of Activities
CQS
Selection based on Consultant Qualifications
CSC
Community Score Card
CSES
Cambodia Socio Economic Survey
DA
Department of Administration
DBF
Department of Budget and Finance
DCP
Dengue Control Program
DDF
Department of Drugs, Food and Cosmetics
DDG
Deputy Director General
DFID
Department for International Development (U.K.)
DG
Director General
DGAF
Director General of Administration and Finance
DHRD
Department of Human Resource Development
DHS
Department of Hospital Services
DIA
Department of Internal Audit
DIC
Department of International Cooperation
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DP
Department of Personnel
Development Partners
DPHI
Department of Planning and Health Information
DPM
Department of Preventive Medicine
EAC
Equity Access Card
EMDS
Ethnic Minorities Development Strategy
EOI
Expression of Interest
FA
Financing Agreement (with the World Bank)
FMG
Financial Management Group
FMIP
Financial Management Improvement Plan
FMM
Financial Management Manual
GDP
Gross Domestic Product
GGF
Good Governance Framework
GIS
Geographic Information System
GMS
Greater Mekong Subregion
GTZ
Deutsche Gesellschaft fuer Technische Zusammenarbeit
(German Technical Cooperation Agency)
HC
Health Center
HCP
Health Coverage Plan
HCWM
Health Care Waste Management
HE
His/Her Excellency
HEF
Health Equity Fund
HIS
Health Information System
HISSP
Health Information System Strategic Plan (2008-15)
HIV
Human Immuno-Deficiency Virus
HMN
Health Metrics Network
HP
Health Post
HR
Human Resources
HRD
Human Resource Development
HSP2
Second Health Strategic Plan (2008-15)
HSSC
Health Sector Steering Committee
HSSP1
First Health Sector Support Project
HSSP2
Second Health Sector Support Program
IC
Individual Consultant
ICB
International Competitive Bidding
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IDA
International Development Association (World Bank)
IFR
Interim Financial Reports
IMCI
Integrated Management of Childhood Illnesses
IMR
Infant Mortality Rate
IPA
International Procurement Agency
IPPF
Indigenous Peoples’ Planning Framework
IU
Implementing Unit
JAPA
Joint Annual Plan Appraisal
JAPR
Joint Annual Performance Review
JMYR
Joint Mid Year Review
JPA
Joint Partnership Arrangement
JPIG
Joint Partnership Arrangement Development Partners Interface Group
JQM
Joint Quarterly Meeting
LCS
Least Cost Selection
LQAS
Lot Quality Assurance Sampling
M&E
Monitoring and Evaluation
MBPI
Merit-Based Performance Incentive
MEF
Ministry of Economy and Finance
MOH
Ministry of Health
MOP
Ministry of Planning
MOU
Memorandum of Understanding
MPA
Minimum Package of Activities
MTEF
Medium Term Expenditure Framework
MYR
Mid Year Review
NCB
National Competitive Bidding
NCD
Non-Communicable Disease
NCHADS
National Center for HIV/AIDS, Dermatology, and Sexually Transmitted
Diseases
NCPEMC
National Center for Parasitology, Entomology, and Malaria Control (formerly
known as CNM - National Malaria Center)
NGO
Non Government Organization
NHA
National Health Accounts
NHC
National Health Congress
NIP
National Immunization Program
NIPH
National Institute of Public Health
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NIS
National Institute of Statistics (Ministry of Planning)
NMCHC
National Maternal and Child Health Center
NNP
National Nutrition Program
NRHP
National Reproductive Health Program
NSDP
National Strategic Development Plan (2006-10)
OD
Operational District
ODO
Operational District Office
OPD
Outpatient Department
PAD
Program Appraisal Document
PER
Public Expenditures Review
PFMR
Public Financial Management Reform
PFMRP
Public Financial Management Reform Program
PHD
Provincial Health Department
PIP
Public Investment Plan
PMG
Priority Mission Group
Procurement Management Group
PMM
Pesticide Management and Monitoring
PMR
Performance Monitoring Report
PRC
Procurement Review Committee
PRH
Provincial Referral Hospital
PTWG-H
Provincial Technical Working Group Health
QBS
Quality Based Selection
QCBS
Quality and Cost Based Selection
RGC
Royal Government of Cambodia
RFQ
Request for Quotation
RH
Referral Hospital
RMNCH
Reproductive, Maternal, Newborn and Child Health
RTC
Regional Training Center
SDG
Service Delivery Grant
SFKC
Social Fund of the Kingdom of Cambodia
SHI
Social Health Insurance
SOA
Special Operating Agency
SOE
Statement of Expenditures
SOP
Standard Operating Procedures
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SSS
Single Source Selection
S/T
Short Term (for consultants)
SWiM
Sector Wide Management
TA
Technical Assistance
TSMC
Technical School for Medical Care
TWG-H
Technical Working Group Health
U5MR
Under Five Mortality Rate
UNICEF
United Nations Children’s Fund
UNFPA
United Nations Population Fund
WB
World Bank (International Bank for Reconstruction and Development)
WHO
World Health Organization
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TABLE OF CONTENTS
FOREWORD
13
CHAPTER 1: BACKGROUND
14
1.1 HEALTH STRATEGIC PLAN, 2008-15
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1.2 MOH PLANNING CYCLE: 3 YEAR ROLLING PLANS AND ANNUAL OPERATIONAL PLANS
15
1.3 POOLED AND DISCRETE FUNDS
15
1.4 FINANCING PLAN AND COST ESTIMATES
16
CHAPTER 2: PROGRAM DESCRIPTION
17
2.1 PROGRAM AND PROJECT DEVELOPMENT OBJECTIVES
17
2.2 COMPONENT A: STRENGTHENING HEALTH SERVICE DELIVERY
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2.2.1 SERVICE DELIVERY GRANTS AND INTERNAL CONTRACTING
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2.2.2 STRENGTHENING MANAGEMENT, SUPERVISION AND PUBLIC HEALTH FUNCTIONS AT LOCAL
LEVELS
19
2.2.3 IMPROVING THE HEALTH SERVICE DELIVERY NETWORK
19
2.2.4 INFRASTRUCTURE DEVELOPMENT AND MAINTENANCE PLAN
19
2.2.5 STRENGTHENING EMERGENCY AND REFERRAL SYSTEMS
19
2.3 COMPONENT B: IMPROVING HEALTH FINANCING
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2.3.1 HEALTH EQUITY FUNDS
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2.3.2 SUPPORT TO HEALTH FINANCING POLICIES
21
2.3.3 NATIONAL HEALTH ACCOUNTS
21
2.3.4 BUILDING CAPACITY AT CENTRAL AND LOCAL LEVELS
21
2.4 COMPONENT C: STRENGTHENING HUMAN RESOURCES
21
2.4.1 MERIT-BASED PERFORMANCE INCENTIVE SCHEME
21
2.4.2 STRENGTHENING TRAINING INSTITUTIONS AND PROGRAMS
21
2.4.3 STRENGTHENING HUMAN RESOURCES MANAGEMENT
22
2.5 COMPONENT D: STRENGTHENING STEWARDSHIP AND GOVERNANCE
22
2.5.1 POLICY DEVELOPMENT AND IMPLEMENTATION
22
2.5.2 STRENGTHENING INSTITUTIONAL CAPACITY
22
2.5.3 PRIVATE SECTOR REGULATION AND PARTNERSHIPS
22
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2.5.4 STRENGTHENING COMMUNITY ENGAGEMENT
22
CHAPTER 3: MANAGEMENT AND IMPLEMENTATION ARRANGEMENTS
24
3.1 PROGRAM STRUCTURE AND ORGANOGRAM
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3.2 HEALTH SECTOR STEERING COMMITTEE
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3.3 TECHNICAL WORKING GROUP-HEALTH
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3.4 JOINT ANNUAL PERFORMANCE REVIEW
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3.5 JOINT ANNUAL PLAN APPRAISAL
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3.6 JOINT MID YEAR REVIEW OF THE ANNUAL OPERATIONAL PLAN
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3.7 JOINT QUARTERLY MEETINGS
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3.8 ROLES AND RESPONSIBILITIES OF KEY IMPLEMENTATION UNITS
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3.8.1 CENTRAL DEPARTMENTS
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3.8.2 PROVINCIAL HEALTH DEPARTMENTS
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3.8.3 OPERATIONAL DISTRICTS
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3.9 PROGRAM MANAGEMENT ARRANGEMENTS
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3.10 INTEGRATING HSSP2 SECRETARIAT FUNCTIONS INTO MOH LINE DEPARTMENTS
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3.11 IMPLEMENTING THE GOOD GOVERNANCE FRAMEWORK
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CHAPTER 4: PROGRAM MONITORING AND EVALUATION
42
4.1 PROGRAM AND PROJECT INDICATORS
42
4.2 PROGRAM PERFORMANCE INDICATOR DASHBOARD WITH SPARKLINES
45
4.3 PROGRAM GEOGRAPHIC INFORMATION SYSTEM AND LINKED DATABASES
46
4.4 GENERATING PROGRAM EVIDENCE
46
4.4.1 OVERVIEW
46
4.4.2 HEALTH INFORMATION SYSTEM
46
4.4.3 CENSUS
48
4.4.4 NATIONAL SURVEYS
48
4.4.5 SMALL SAMPLE SURVEYS
48
4.4.6 HEALTH FACILITY ASSESSMENTS
49
4.4.7 CLIENT SATISFACTION SURVEYS
49
4.4.8 COMMUNITY SCORECARDS
49
4.5 PERFORMANCE REPORTING SYSTEM: ROLES, RESPONSIBILITIES, TASKS AND SCHEDULES
49
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4.6 SEMI-ANNUAL PERFORMANCE MONITORING REPORTS
50
4.7 JOINT SUPERVISION VISITS
51
4.8 PROGRAM EVALUATION
51
4.8.1 JOINT ANNUAL PERFORMANCE REVIEW
51
4.8.2 MID TERM REVIEW
51
4.8.3 FINAL EVALUATION
51
4.9 INFORMATION SHARING AND DISSEMINATION
51
CHAPTER 5: COORDINATION AND COMMUNICATION WITH DEVELOPMENT PARTNERS
53
5.1 OVERVIEW
53
5.2 JOINT PARTNERSHIP ARRANGEMENT
53
5.3 JOINT PARTNERSHIP ARRANGEMENT DEVELOPMENT PARTNER INTERFACE GROUP
53
5.4 JOINT QUARTERLY MEETINGS
53
5.5 COMMUNICATION WITH DEVELOPMENT PARTNERS: PROGRAM, TECHNICAL AND FINANCIAL
ISSUES
53
5.6 JOINT SUPERVISION MISSIONS
54
CHAPTER 6: FINANCIAL MANAGEMENT ARRANGEMENTS
55
6.1 FINANCIAL MANAGEMENT MANUAL
55
6.2 FINANCIAL MANAGEMENT IMPROVEMENT PLAN
55
6.3 EXTERNAL AND INTERNAL AUDITS
55
CHAPTER 7: PROCUREMENT PROCEDURES AND ARRANGEMENTS
57
7.1 GENERAL CONSIDERATIONS
57
7.2 PROCUREMENT PROCEDURES
57
7.2.1 PROCUREMENT OF GOODS
57
7.2.2 PROCUREMENT OF WORKS
58
7.2.3. SELECTION OF CONSULTANTS
59
7.2.4 PROCUREMENTS UNDER THE SUB-CATEGORIES OF ‘TRAINING’ AND ‘OPERATING COST’ (AND
OTHER SUB-CATEGORIES EXCLUDING THE SUB-CATEGORIES OF GOODS/WORKS/CONSULTANT
SERVICES)
60
7.2.5. REQUISITION FOR PROCUREMENT
60
7.2.6 METHODS OF PROCUREMENT AND PROCUREMENT THRESHOLDS
61
7.2.7 MINIMUM LEGAL REGISTRATION REQUIREMENT OF SUPPLIERS/CONTRACTORS/SERVICE
62
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PROVIDERS
7.2.8 GENERAL RESPONSIBILITIES OF PROCUREMENT MANAGEMENT GROUP
62
7.2.9 CONTRACT SIGNING AUTHORITY THRESHOLDS
64
CHAPTER 8: INDIGENOUS PEOPLES SAFEGUARDS AND REPORTING
65
8.1 INDIGENOUS PEOPLES PLANNING FRAMEWORK
65
8.2 PROGRAM IMPACT ON INDIGENOUS PEOPLES
65
8.3 SOCIAL ASSESSMENT UNDER HSSP2
68
8.4 INSTITUTIONAL ARRANGEMENTS FOR IPPF
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8.5 MONITORING AND REPORTING ARRANGEMENTS
69
8.6 DISCLOSURE ARRANGEMENTS
70
CHAPTER 9: GENDER SAFEGUARDS AND REPORTING
71
CHAPTER 10: ENVIRONMENTAL SAFEGUARDS AND MANAGEMENT
72
10.1 ENVIRONMENTAL REVIEW AND MANAGEMENT PLAN
72
10.2 HEALTH CARE FACILITY CONSTRUCTION AND REHABILITATION
72
10.3 ASBESTOS
72
10.4 DRINKING WATER QUALITY
73
10.5 HEALTH CARE WASTE MANAGEMENT
74
10.6 PESTICIDE MANAGEMENT AND MONITORING PLAN
75
10.6.1 DENGUE
76
ANNEX
PROGRAM PERFORMANCE MONITORING AND EVALUATION MATRIX
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TABLES AND FIGURES
TABLE 1. KEY GOALS AND OBJECTIVES OF HSP2
14
TABLE 2. FINANCING PLAN
16
TABLE 3. FUNCTIONS AND RESPONSIBILITIES FOR SDGS
18
TABLE 4. PROGRAM PERFORMANCE INDICATOR DASHBOARD
45
TABLE 5. PROCUREMENT OF GOODS
61
TABLE 6. PROCUREMENT OF WORKS
61
TABLE 7. PROCUREMENT OF CONSULTANT SERVICES
61
TABLE 8. PROPOSED PROGRAM RESPONSES TO KEY CONSTRAINTS OF ETHNIC MINORITIES
67
FIGURE 1. HSSP2 FINANCING ARRANGEMENTS
16
FIGURE 2. FLOW OF FUNDS FOR SDGS
18
FIGURE 3. PROPOSED HSSP2 PROGRAM MANAGEMENT AND OPERATIONAL STRUCTURE, PHASE I
24
FIGURE 4. PROGRAM IMPLEMENTATION ARRANGEMENTS, PHASE I (2009-10)
28
FIGURE 5. HSSP2 PROGRAM MANAGEMENT ARRANGEMENTS PHASE II (2011-13)
40
FIGURE 6. PROGRAM M&E CONCEPTUAL FRAMEWORK
43
FIGURE 7 KEY STAKEHOLDERS AND THE FLOW OF INFORMATION
44
FIGURE 8. FLOW OF HEALTH INFORMATION
47
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FOREWORD
The purpose of this Operational Manual is to provide guidance to units implementing the Second
Health Sector Support Program (HSSP2) at all levels regarding HSSP2, its key goals and objectives,
implementation arrangements, financial management procedures and arrangements, procurement
rules and regulations, and the monitoring and evaluation (M&E) system. As such, its emphasis is on the
operational aspects of the Program, and it is expected that implementing units (IUs) will consult the
Manual frequently during Program implementation. Therefore, the aim is to make it readable and
user friendly. To this end, some chapters contain summary information that only provides the minimum
necessary information on the topic, while pointing readers in the right direction for further information.
The annex to the Manual contains further details regarding the M&E system. The Manual also contains
numerous references to other MOH publications and reports that will prove useful to readers, such as
the Service Delivery Grants (SDG) Manual, Merit-Based Performance Incentive (MBPI) Manual, Financial
Management Manual (FMM), and the Royal Government’s Standard Operating Procedures (SOP)
Manual.
Since the Manual covers a great deal of ground, its content draws from a number of publicly
available resources and documents, both domestic and international. In particular, the Manual draws
substantially from the World Bank’s Program Appraisal Document (2008) for HSSP2. Appropriate
citations are made where possible. It should be noted therefore that the Manual makes no claim to
originality and draws heavily from the sources cited.
The Manual should be viewed as a working document which will be revised and updated from timeto-time as modifications are made to the Program’s operational aspects in light of feedback received
from monitoring, review and joint supervision activities; such revisions are subject to the concurrence of
the Joint Partnership Arrangement Development Partners Interface Group (JPIG), and the prior
agreement of the World Bank per the Financing Agreement. Readers are invited to provide
suggestions and comments to improve the usefulness of the Manual, and these may be sent to the
MOH at the address listed on the inside title page of the document.
PROF. ENG HUOT
PROGRAM DIRECTOR
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CHAPTER 1. BACKGROUND
1.1 HEALTH STRATEGIC PLAN, 2008-15
The second Health Strategic Plan, 2008-15 (HSP2) is the guiding framework for all programs and
interventions in the health sector, in succession to the first Health Sector Strategic Plan, 2003-07. It is
the product of exhaustive and close consultation and collaboration among all key stakeholders in the
sector, including the MOH’s development partners. The Plan aims at improving outcomes in three main
program areas over the eight year period that will coincide with both of the Royal Government’s first
and the second National Strategic Development Plans (NSDPs), and the concluding year of the
Cambodia Millennium Development Goals (CMDGs). HSP2 program areas include reproductive,
maternal, newborn and child health (RMNCH); communicable diseases prevention and control (CDC);
and non communicable diseases prevention and control (NCD). These three program areas will be
supported through five cross-cutting strategies aimed at strengthening the health system: provision of
integrated service delivery; ensuring an adequate level and effective use of health financing;
addressing human resource (HR) development needs; improving the health information system; and
strengthening health system governance. The Table below presents the key goals and objectives of
HSP2.
Table 1. Key Goals and Objectives of HSP2
Goal 1: Reduce maternal, new born and child morbidity and mortality with improved reproductive
health
Objective
1
Improve the nutritional status of women and children
2
Improve access to quality reproductive health information and services
3
Improve access to essential maternal and newborn health services and better family
care practices
4
Ensure universal access to essential child health services and better family care
practices
Goal 2: Reduce morbidity and mortality of HIV/AIDS, Malaria, Tuberculosis, and other
communicable diseases
Objective
5
Reduce the HIV prevalence rate
6
Increase the survival of people living with HIV/AIDS
7
Achieve a high case detection rate and maintain a high cure rate for pulmonary
tuberculosis smear positive cases
8
Reduce malaria related mortality and morbidity rate among the general population
9
Reduce the burden of other communicable diseases
Goal 3: Reduce the burden of non-communicable diseases and other health problems
Objective
10 Reduce risk behaviors leading to non-communicable diseases: diabetes,
cardiovascular diseases, cancer, mental illness, substance abuse, accidents and
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injuries, eye care, oral health , etc
11 Improve access to treatment and rehabilitation for NCD: diabetes, cardiovascular
diseases, cancer, mental illness, substance abuse, accidents and injuries, eye care,
oral health, etc
12 Ensure Essential Public Health Functions: environmental health:, food safety; disaster
management and preparedness
1.2 MOH PLANNING CYCLE: 3 YEAR ROLLING PLANS AND ANNUAL OPERATIONAL PLANS
The Three Year Rolling Plan (3YRP) is the MOH’s medium term planning framework. The Plan is built
upon the broader strategy of the HSP2 that sets longer-term goals and objectives. The 3YRP is also
based on the sector’s financing needs and projections of available resource envelope from all sources
(domestic and external). The bottom-up costs and top-down resource envelope are matched in the
context of the annual planning and budgeting process to inform resource allocation decisions on
priorities, both within and across the sector.
The process “rolls forward” every year in order to incorporate changes (changing policy, needs and
resources), and takes into account new priorities as informed by the Joint Annual Performance Review
(JAPR), but not major deviations from the broad strategy or momentum already set. The process thus
contributes to improved allocation and predictability of funding for the health sector and links
allocated resources to improved outcomes of health service delivery. The 3YRP process also assists in
the preparation of the Public Investment Plan (PIP) for the MOH.
Annual Operational Plans (AOPs) are developed with detailed activities, budgets and schedules within
the context of the prevailing 3YRP through which they are linked in turn to the HSP2. Health
management teams at all levels of the health system are required to consult the strategic components
and strategic interventions listed under the program areas within the HSP2, and to use these to frame
their own interventions and activities. This enables a clear and direct link to be established between
the stated goals and objectives enumerated in the HSP2, and those adopted by national and local
budget management centers. This enables the consolidated sector AOPs to better reflect the aims of
the HSP2.
1.3 POOLED AND DISCRETE FUNDS
HSSP2 will support the MOH’s AOPs through a pooled account with common management and
reporting arrangements. The indicative resource envelope available for the pool is US$145 million
(equivalent) over the next 5 years, inclusive of the Royal Government’s contribution. This comprises
US$30 million WB/IDA financing, approximately US$50 million from DFID and an initial allocation of
approximately US$30 million from AusAID for the first two years of Program implementation. UNFPA
and UNICEF have also committed to providing some resources through the pooled account, with
amounts to be confirmed on an annual basis. AFD, BTC, UNFPA, and UNICEF will also channel funds
through discrete or non pooled accounts. The diagram below illustrates the financing arrangements
showing donor contributions to both pooled and discrete funds.
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Figure 1. HSSP2 Financing Arrangements
Government
expenditure
Donor
Donor
Donor
Pool
Public sector
expenditure in health
Defined group of activities
Defined group of
activities
Health Strategic Plan 2008-2015
Program funds complement those provided by Government, which is expected to contribute around
US$557 million over the period 2009-2013.
1.4 FINANCING PLAN AND COST ESTIMATES
Source
AFD
AusAID
BTC
DFID
UNFPA
UNICEF
World Bank (IDA
Credit)
Royal
Government of
Cambodia (RGC)
Total
Table 2. Financing Plan
Amount
€7 Million
AU$37.15 Million
€3 Million
£35 Million
Est. US$8.867 Million (2009 – 2010)
US$4 Million (2009 & 2010)
Estimated US$ Million:
Exchange rate stipulated in
each agreement
10
30
4
50
8.87
4
SDR 18,500 Million
30
US$8 Million
8
144.87
The above Table shows the estimated financing plan of both the RGC and HSSP2 DPs based on
foreign exchange rates stipulated in each agreement. The Financial Management Manual contains
details of counterpart funding requirements and the process of deciding on annual contributions and
their management.
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CHAPTER 2. PROGRAM DESCRIPTION
2.1 PROGRAM AND PROJECT DEVELOPMENT OBJECTIVES
The Program is defined as the wider development partner support provided to the Government for its
implementation of the HSP2. The Program is supported by multiple DPs (both pooling and nonpooling) who have adopted common management arrangements, set out in a Joint Partnership
Arrangement (JPA). In this instance the term “Project” refers more specifically to the WB managed
contributions to the Program.
The Program’s objective is to support the implementation of Cambodia’s Health Strategic Plan 20082015 that aims to ensure improved and equitable access to, and utilization of, essential quality health
care and preventive services with particular emphasis on women, children and poor. The World Bank
Project’s development objective is to support the implementation of HSP2 in order to improve health
outcomes through strengthening institutional capacity and mechanisms by which the Government and
development partners can achieve more effective and efficient sector performance. A selection of key
indicators from the MOH’s HSP2 M&E framework will be used to evaluate aggregate health sector
performance and track progress towards health outcomes under Program objectives. The Project will
be evaluated through indicators aimed at improved policy, planning and implementation; improved
financing of front line service delivery; use of performance results to improve planning and
management; broad commitment and ownership of the sector wide process; and improved sector
governance (see Annex for the full list of Program and Project monitoring indicators). Wherever
possible, selected key indicators will be disaggregated by age and gender.
2.2 COMPONENT A: STRENGTHENING HEALTH SERVICE DELIVERY
2.2.1 SERVICE DELIVERY GRANTS AND INTERNAL CONTRACTING
The Royal Government has created new opportunities for the management of service delivery and
motivating health care providers through the mechanism of Special Operating Agencies (SOAs). SOA
status is available at all operational levels of the health services including Operating Districts (ODs)
and Provincial Referral Hospitals (PRHs). In accordance with the Decree on SOAs, a management
contract is to be signed between the Director of the SOA and the Minister or representative of the line
Ministry or institution. This is in accordance with the policy of the MOH expressed through HSP2 to use
contracting mechanisms to assist in improving utilization and quality of health services. Thus, Provincial
Health Departments (PHDs) will enter into service delivery contracts with ODs and PRHs (this being
described as “internal contracting” and replacing the existing contracting arrangements with nongovernment organizations (NGOs) from 2009).
Service Delivery Grants (SDGs) will be made to support the objectives of the HSP2 in increasing
utilization of quality health services by the whole population. This is in accordance with broader
government policies to improve service delivery. PHDs will allocate the SDGs to ODs and PRHs in
accordance with their AOPs, and through the mechanism of Service Delivery Performance Contracts.
PHDs, ODs, and PRHs (including those established as SOAs) will also have available to them RGC
legal mechanisms for the improvement of staff incentives – specifically Priority Mission Groups (PMGs)
and, in the case of PHDs, Merit-Based Performance Incentives (MBPIs), although SOAs will need to
finance these from their own resources. Within the limitations and terms described in the management
contract, SOAs will be able to establish employment contracts which can include additional
performance related rewards (“bonuses”).
The MOH will develop policies and strategies required to guide resource allocation and the
mechanisms for resource distribution (including contracting mechanisms). These will include a jointly
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agreed formula for allocation of SDGs, criteria for eligibility to receive SDGs, and mechanisms for
monitoring and auditing the use of SDGs. The MOH will undertake the management of SDGs through
the functions and responsible departments as shown in the Table below.
Table 3. Functions and Responsibilities for SDGs
Function
Responsible Department
Overall Management and Coordination
Department of Planning and Health Information
(DPHI)
Planning, Resource Allocation Formula, and DPHI
Monitoring
Financial Administration, including Budget Department of Budget and Finance (DBF)
Disbursement and Reporting
Performance Monitoring (routine)
Performance Monitoring
results and standards)
MOH/Provincial Health Department (PHD)/DPHI
(verification
Auditing SDGs Expenditures
of Independent Firm/Team (to be selected by MOH)
Department of Internal Audit (DIA); External Audit
PHDs will enter into Service Delivery Performance Contracts with ODs and PRH SOAs based on
agreed service delivery targets and financed in part by SDGs. The role of the PHD will therefore
include situation analysis, understanding the concerns of communities and citizens, assessing the
capabilities of ODs and PRHs, monitoring performance, and managing contractual relationships.
ODs and PRHs will be the immediate providers of services, which will be provided in accordance with
the terms of the contract agreed with the PHD. The Service Delivery Performance Contract will include
all of the sources of funding of the OD/PRH (including SDG derived funds) and articulate any specific
limitations on the use of funds from different sources.
For further details regarding eligible expenditures, key processes and systems, specific requirements
for receiving SDGs, performance management systems, examples of contracts and their content,
contract management and monitoring, financial flows, management and reporting and finally,
performance monitoring, readers are invited to consult the Service Delivery Grants Operational Manual
issued by the MOH’s Department of Planning and Health Information in November, 2008. The figure
overleaf illustrates the flow of funds for SDGs from the central to local levels.
Figure 2. Flow of Funds for SDGs
Provincial Health System
Development Plan
MEF
PG
Annual Budget
Consultation
AOP and Budget Request
MOH
AOP
PHD
Performance Agreement
Service Delivery Agreement/
Pool Fund
Management Contract
Operational District
HC
RH
SP
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HSSP2 Operational Manual
2.2.2 STRENGTHENING MANAGEMENT, SUPERVISION AND PUBLIC HEALTH FUNCTIONS AT LOCAL LEVELS
In provinces not initially receiving SDGs, the Program will support incremental operating costs for
management, public health, integrated supervision, and capacity strengthening activities based on
provincial AOP and guidelines set out in this Manual. It is also expected that support to priority
reproductive, maternal, newborn, and child health (RMNCH) elements of provincial and OD AOPs will
be provided through HSSP2 Pooled and discrete funds until such time as these locations are eligible
for SDGs.
2.2.3
IMPROVING THE HEALTH SERVICE DELIVERY NETWORK
Strengthening health systems will also require improving the health service delivery network. To this
end, the Program will support investments to fill in the gaps identified in the Health Coverage Plan,
2004-2005 (HCP) – a framework document proposing an infrastructure development strategy based
on population and geographic access. As of December 2007, 83 health centers (HCs) were required
to be constructed in order to meet HCP provisions, 184 would be needed by 2010, and a further 89
by 2015. Decentralization of service delivery responsibility to local governments, population growth
and expected increased utilization will fuel demand for expanding the health facility network. The
HSP2 anticipates the need to increase coverage, and projects a need by 2015 of up to 1,700 HCs
and 85 referral hospitals (RHs) in total across the country. The costing study estimates funding needs to
be in the range of US$ 22-47 million by 2015.
The HSP2 proposes to update the MOH’s HCP based on decentralization and deconcentration reform
needs, updated minimum package of activities (MPA) and complementary package of activities (CPA)
guidelines, recurrent financing and HR demands, projected population growth, and service utilization
increases. To assist in quantifying the necessary investment costs, the Program will support (a) the
review and update of hospital and health center designs, (b) finalization of the Health Infrastructure
Development and Maintenance Plan, (c) preparation of a database for standard costs for works and
goods, and (d) strengthened capacity for asset management.
The Program is expected to support significant gaps identified by the HCP for HCs, health posts, RHs
and other public health facilities taking into account existing capacity in both the public and private
sector. This component will also support investments in health service delivery infrastructure stemming
from the emergency medical service strategy calling for strengthening pre-hospital and hospital
emergency services in response of rising traffic injuries, as well as emergency referral systems (e.g.,
emergency obstetric care).
2.2.4 INFRASTRUCTURE DEVELOPMENT AND MAINTENANCE PLAN
In 2009, the Program will carry out a detailed assessment as the basis for the finalization of the draft
Infrastructure Development and Maintenance Plan formulated under the World Bank, ADB, UNFPA
and DFID supported first Health Sector Support Project (HSSP1). This draft plan addresses MPA and
CPA needs in the sector, and excludes national hospitals. Maintenance needs will also be identified as
well as the resources, human, material and financial required to sustain a national and local
maintenance capability.
2.2.5 STRENGTHENING EMERGENCY AND REFERRAL SYSTEMS
This support area responds to the HSP2 strategic interventions of developing and scaling up provision
of comprehensive packages of preventive, curative and promotive health services provided by HCs
and by RHs. The Program will provide support through (a) SDGs; (b) support to strengthen health
services management, supervision, and public health functions at provincial and district level; and (c)
investments to improve, replace, and extend the health service delivery network.
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HSSP2 Operational Manual
2.3 COMPONENT B: IMPROVING HEALTH FINANCING
This component is aligned with the HSP2 health financing strategy that calls for continued policy and
advocacy work, further development of the Strategic Framework of Health Financing 2008, and the
implementation of social protection measures to protect people from catastrophic out-of-pocket health
costs. This component will finance (a) health protection for the poor through the consolidation of Health
Equity Funds (HEFs) under common management and oversight arrangements and expansion of HEF
coverage; and (b) supporting the development of health financing policies and institutional reforms.
2.3.1 HEALTH EQUITY FUNDS
HEFs protect the poor against user fees and other health care related costs. By the end of 2008, there
were 44 ODs with HEFs operating, in addition to 6 national hospitals, covering an estimated 2.9
million poor people. It should be noted that the Royal Government also provides subsidies to the poor
through exemptions from user fees at health facilities. The HEFs also play a purchasing role by being
engaged in improving the quality of care that the poor receive and the accountability of service
providers through capacity and quality assessment tools, contracts and monitoring. These HEFs,
operated by both local and international NGOs, have been supported by a number of DPs through
various projects. The MOH plans to consolidate the HEFs under principles and guidelines outlined in the
national HEF Implementation and Monitoring Framework, the HEF Monitoring Manual, and the HEF
Implementation guidelines; the Bureau for Health Economics and Finance (BHEF) in the Department of
Planning and Health Information (DPHI) exercises the oversight and monitoring of HEFs. Under the
National Health Financing Framework, the HEF system is an intermediate solution that is expected to
be merged into a broader social health protection system which will comprise Social Health Insurance
(SHI) for the formal sector and Government employees, and Community Based Health Insurance (CBHI)
schemes for the informal sector, with Government directly financing the membership of the poor in
these schemes. In the medium term, however, HEFs will continue to be the main health social protection
mechanism for the poor. Once details of the social health insurance arrangements and implementation
plan are made clear, relevant capacity and knowledge transfer mechanisms to respective
management organizations will be developed and included in the HEF operator contracts with the
NGOs. The Government’s HEF policy framework also provides for a national HEF Implementer to
oversee NGOs operating HEFs to improve performance management, and secure common operating
procedures.
The Program will support operating and management costs, and costs associated with the
identification of the poor, outreach and community participation of the NGOs operating HEFs, and the
HEF Implementer. The Program will also finance the HEF Grants managed by eligible NGOs
operating HEFs, financing the direct benefits for the poor, including user fees and associated costs
(such as per diems and funeral as necessary) as defined in the HEF benefit package. The HEF Grants
will be kept, and accounted for, separately from contractual payments for management services.
Efforts will be made, where possible, to seek cooperation via Memoranda of Understanding with DPs
providing parallel financing to support the operating costs of NGOs operating HEFs. This will allow
the Program to cover only the benefits for the poor, which is a core MOH commitment. The HEF grant
funds can also be used to finance membership for those identified as poor who are participating in
CBHI schemes. The Program will also support the HEF monitoring, supervision and oversight role of the
BHEF/DPHI. The estimated cost of HEFs are at US$0.5 per capita which translates into approximately
US$7 million a year if HEFs were fully scaled up. It is expected that the Program will initially sustain
the HEF costs for about 30% of the poor population, with eventual scaling up over the life of the
Program. HEF costs will be included in the AOPs, and contracts with HEF operators in the rolling
procurement plans.
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HSSP2 Operational Manual
2.3.2 SUPPORT TO HEALTH FINANCING POLICIES
In addition to reducing financial barriers at the point of care and developing social health protection
measures, the Program will also support the development of MOH health care financing policies and
institutional reforms. This includes (a) improving the collection of health financing information such as
National Health Accounts (NHAs)and health services costing; (b) integrating health financing
information, costing results and other evidence in health financing policies, including medium-term
planning and budgeting processes; and (c) aligning DP resources with sector priorities.
2.3.3
NATIONAL HEALTH ACCOUNTS (NHAS)
NHAs enable the comprehensive tracking of financial flows and expenditures in the sector, including
both the public and private sectors. The Program will support the development of NHA for the health
sector, and the required capacity to sustain their periodic revisions. Up to this point, NHAs have not
been developed for the health sector, however, the HSP2 calls for their development as a key
strategic intervention under the Health Care Financing Strategy.
2.3.4 BUILDING CAPACITY AT CENTRAL AND LOCAL LEVELS
While significant strides have been made in recent years in strengthening institutional capacity for
designing and implementing health financing policies at the MOH central level, such capacity barely
exists at the provincial levels. The Program will support interventions designed to increase capacity for
implementing health financing policies, including identifying capacity needs, developing an
appropriate training curriculum, and training selected staff at PHD level.
2.4 COMPONENT C: STRENGTHENING HUMAN RESOURCES
The MOH’s Health Workforce Strategic Plan 2006-2015 identifies HR as a major constraint to
improving service delivery outcomes in the health sector. This component will support strategic
interventions necessary to address some of the HR issues identified in the HSP2 through its focus on (a)
strengthening pre- and in-service training, including enrollment in pre-service training where significant
shortfalls exist, (b) strengthening human resource management in the MOH, and (c) supporting the
MBPI scheme for health managers and key technical staff participating in the implementation of HSP2
at central and local levels.
2.4.1 MERIT-BASED PERFORMANCE INCENTIVE SCHEME
The MBPI scheme is a special incentives scheme designed for selected civil servants at central and PHD
levels that harmonizes incentive schemes from different development partners and assures
sustainability, so as to contribute toward the achievement of the goals and objectives of HSP2.
Selection of civil servants under the scheme will be based on job-relevant experience; job-specific
skills and knowledge; relevant professional, vocational and educational qualifications; and training
related specifically to the position requirements. Continued participation in the scheme will be
dependent on demonstrating satisfactory performance against objectives determined as part of the
performance management system. The purpose of the scheme is to ensure that all staff under the MBPI
Scheme devote all of their work time to Ministry duties, and that they improve their work efficiency.
Further details regarding the scheme are contained in the MOH’s Manual for Implementation of MeritBased Performance Incentives (2008).
2.4.2 STRENGTHENING TRAINING INSTITUTIONS AND PROGRAMS
The primary focus of this input will be to support and strengthen training institutions and pre-service
training programs in the Technical School of Medical Care, the Regional Training Centers (RTCs), and
the University of Health Sciences. Options will be explored for improving and revising the pre-service
curriculum, strengthening the link between theory and practice by establishing model practical training
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HSSP2 Operational Manual
sites at the Health Center level linked to RTCs, improving practical training in hospitals, strengthening
the skills and competencies of the trainers, and better coordination of in-service training in RTCs for
improved quality and follow-up at practice sites. The Program will provide support to management
training programs to respond to the needs stemming from decentralization and deconcentration, and
public administration reform.
2.4.3 STRENGTHENING HUMAN RESOURCES MANAGEMENT
Support will also be provided to key HR management areas, including licensing of professionals in
both the public and private sectors, self-regulation of medical professionals, ethics and code of
conduct for health professionals, better alignment and strengthening of human resource planning and
personnel management, and recruitment and deployment of staff, including locally managed
contracted staff.
2.5 COMPONENT D: STRENGTHENING STEWARDSHIP AND GOVERNANCE
2.5.1 POLICY DEVELOPMENT AND IMPLEMENTATION
The Program will strengthen MOH policies and regulations in critical areas identified in HSP2, such as:
(a) contracting and purchasing health services, including institutional arrangements for internal
contracting by the MOH and PHDs, SHI, CBHI, and HEFs; (b) the autonomy of health care providers
and strengthening health care institution governance arrangements in decentralization settings; (c)
staff remuneration reform, focusing on front line clinical staff; (d) detailed design of the
decentralization reforms in the health sector; (e) development, implementation and regulation
enforcement for quality standards and clinical guidelines; and (f) empowering new structures for
increasing local accountability of health care providers to citizens.
2.5.2 STRENGTHENING INSTITUTIONAL CAPACITY
This support area aligns with the HSP2 strategies to strengthen health system governance and
strengthen health information systems. The Program will support MOH policies and regulations in
critical areas identified in the HSP2, including the contracting and purchasing of health services, social
health insurance, community-based health insurance and HEFs; autonomy of health care providers and
health care institutional governance arrangements in decentralized settings; staff remuneration reform,
focusing on front line clinical staff; decentralization reforms in health; development, implementation,
and regulation enforcement across the health sector for quality standards and clinical guidelines; and
empowering new structures for increasing local accountability of health care providers to citizens.
2.5.3 PRIVATE SECTOR REGULATION AND PARTNERSHIPS
The Program will also support the development and enforcement of regulations related to private
sector providers; licensing and accreditation; options for contracting accredited NGOs to provide
capacity building at local levels; and engaging NGO and private sector providers in the AOP
planning processes and the HCP.
2.5.4 STRENGTHENING COMMUNITY ENGAGEMENT
The HSP2 calls for increased community participation, multisectoral responses toward improving
health, and empowering communities to hold health systems more accountable. Decentralization and
Deconcentration policies will require activities associated with preparing community leaders and
political representatives for their increased responsibilities as regards health system management and
oversight. The HSP2 calls for making communities aware of consumer rights and establishing
mechanisms to improve interaction between communities and consumers at the operational level.
Program support will be based on the Strategic Framework on Community Participation of the MOH.
The Program also will implement Community Score Cards (CSCs) to strengthen community
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HSSP2 Operational Manual
empowerment and provider accountability. Further details on CSCs are contained in Chapter 4:
Program Monitoring and Evaluation.
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HSSP2 Operational Manual
CHAPTER 3. MANAGEMENT AND IMPLEMENTATION ARRANGEMENTS
3.1 PROGRAM STRUCTURE AND ORGANOGRAM
The organogram below shows the details of the Program structure with key Implementing Units listed.
FIGURE 3. PROPOSED HSSP2 PROGRAM MANAGEMENT AND OPERATIONAL STRUCTURE, PHASE II
PROPOSED HSSP2 PROGRAM MANAGEMENT AND OPERATION STRUCTURE PHASE II
HSSC
TWG-H
MINISTER OF HEALTH delegates the responsibility
to one Secretary of State (Program Director)
IAD
AUDIT REPORTS
Program Secretariat
DG FOR HEALTH
DIC
H&A
3 YRP
DPHI
PLANNING
HEF
- HEF Planning
- HEF Monitoring
- HEF Reporting
AOP
Joint Appraisal
&
Joint Supervision
DG FOR ADMIN. AND FINANCE
DP
M&E
including
SUPPORT MBPI
ADMINISTRATION
DBF
BUDGET
DISBURSEMENT
SDG Monitoring
(HSMSST)
FM MONITORING
& REPORTS
JMYR
PROCURMENT
PLANS & REPORTS
JAPR
HSP2 MTR
: Accountable for
: Report to
HSP2 ICR
Joint Quarterly Meetings: chaired by Program Director, attended by Program Partners, Director General
(DG)/Deputy Director General (DDG) Adm. And Finance, DG/DDG Health, Dir. of relevant Health Departments (FM
reports, progress reports, audit reports, mission findings)
MBPI: applied to selected Health Departments and National programs ‘ staff implementing AOP
3.2 HEALTH SECTOR STEERING COMMITTEE
The Health Sector Steering Committee (HSSC) is the apex decision making body in the MOH. It is
chaired by His Excellency (HE) the Minister of Health, and its members include Secretaries of State,
Under Secretaries of State, and Directors-General from the MOH, and senior representatives from the
Ministry of Economy and Finance (MEF) and the Ministry of Planning (MOP). It provides leadership,
guidance, oversight, and strategic direction to both the MOH and the health sector as a whole. The
Program Director, a Secretary of State designated by HE Minister of Health, reports to the HSSC and
will have overall responsibility for HSSP2 under the guidance of HSSC for overall Program
implementation and review.
3.3 TECHNICAL WORKING GROUP – HEALTH
The Technical Working Group-Health (TWG-H) is the apex body in the health sector that facilitates
policy dialogue between the MOH and its DPs to improve aid effectiveness, and thus promotes the
MOH’s Sector-Wide Management (SWiM) approach, and improved harmonization and alignment. It
is chaired by HE Minister of Health or his designated representative and co-chaired by a DP
representative and meets regularly on a monthly basis; its minutes are published and disseminated
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HSSP2 Operational Manual
widely across the health sector. Members of the Joint Partnership Arrangement Development Partner
Interface Group (JPIG) are also members of the TWG-H (see section 5.3 for a description of the
JPIG). HSSP2 Program management will provide periodic updates to the TWG-H on Program
implementation as part of sector wide information sharing and dissemination efforts. Provincial TWGHs (PTWG-Hs) have also been established to facilitate closer collaboration between provincial health
departments, local authorities, DPs, and NGOs in Program planning and implementation.
The TWG-H is supported by the TWG-H Secretariat that meets just prior to the TWG-H meetings; HE
Minister or his designated representative chairs, with membership comprising one representative from
bilateral and one from multilateral DPs. The Secretariat supports the functioning of the TWG-H.
3.4 JOINT ANNUAL PERFORMANCE REVIEW
The Joint Annual Performance Review (JAPR) coupled with the National Health Congress is typically
conducted annually in March to assess overall sector performance of the past year and prioritize
interventions and activities for the following year, including setting of national targets for guidance to
local levels. The DPHI prepares a JAPR report which lists key performance indicators and
achievements, and specifies targets for the following year. The JAPR is important for Program
implementation from two perspectives. First, it is the key forum for monitoring sectoral performance
and for agreeing on sector priorities and targets for preparation of the next year’s AOP. Secondly,
JPIG partners have agreed to undertake Joint Program Supervision Missions at this time.
3.5 JOINT ANNUAL PLAN APPRAISAL
A Joint Annual Plan Appraisal (JAPA) process was undertaken for the first time in 2008. The main
purpose of the JAPA is to review and analyze the draft AOPs and to provide feedback on
appropriateness and completeness of the plans and the corresponding funding requests. The process
was jointly conducted by HE Minister of Health, with the active participation of MOH departments,
national programs, central institutions, and DPs.
The rationale for a JAPA arose from the fact that currently there is a disconnect between the
formulation of the MOH’s AOPs which occurs earlier in the year, and financing commitments decided
later in the year. The JAPA now offers a mechanism to identify jointly with DPs how the final
approved budget envelope by the MEF and flexible resources from DPs can be combined, so that all
MOH stakeholders can convert their initially proposed AOPs into an implementable plan based on the
approved JAPA budget indications. The outcome of the JAPA process offers the opportunity to finalize
the AOPs with accurate budget information that forms the basis for implementable work plans that
will be regularly monitored during the year and reviewed at the JAPR. HSSP2 DPs participated in the
first JAPA in 2008, and the JPIG is expected to play a key role in the JAPA over the HSSP2 Program
implementation period.
3.6 JOINT MID YEAR REVIEW OF THE ANNUAL OPERATIONAL PLAN
The Joint Mid Year Review (JMYR) of the sector AOP has been conducted by the MOH since 2007,
and typically occurs midway through the 3rd quarter of the year. It provides the opportunity for the
MOH’s departments, national programs, central institutions and PHDs to jointly review progress on the
implementation of the sector AOP together with DPs, and identify actual and potential constraints to
implementation, and incorporate necessary modifications so that sector targets may be achieved.
Program management, IU and JPIG members actively participate in the JMYR process, which allows
them to conduct a review of program implementation progress and constraints as well. The JMYR
report, including updated information on indicators, will be a major input into HSSP2’s Semi Annual
Performance Monitoring Report for the first semester of the year.
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HSSP2 Operational Manual
3.7 JOINT QUARTERLY MEETINGS
Joint Quarterly Meetings (JQM) between the MOH and JPIG will be conducted to oversee the
allocation of funds to support Program activities funded from the pooled account. These meetings,
chaired by the Program Director, will be conducted on a quarterly basis to review progress reports,
interim unaudited financial reports, semi-annual internal audit reports and annual audits, and
recommend the release of funds from the pooled account against satisfactory financial reports, cash
forecast and any agreed triggers. IUs will be required to prepare and submit Quarterly Work Plans
based on activities in the approved AOP for the year. These work plans will serve as the basis for
review at the JQMs, as well as for routine monitoring by the central level. Participants at the meetings
will be determined by HE Minister of Health and will likely include Directors General, Deputy
Directors General, and Directors of concerned departments. Participants external to the MOH will
include a representative from the MEF, Council of Administrative Reform (CAR), and a representative
from each of the pooling partners. Reference to the JQM is also contained in Chapter 5.
3.8 ROLES AND RESPONSIBILITIES OF KEY IMPLEMENTATION UNITS
3.8.1 CENTRAL DEPARTMENTS
The DPHI will be responsible for (a) building its capacity within a specified timeframe to take over full
responsibility from the HSSP2 secretariat/consultants for Program related monitoring and reporting
(b) organizing the JAPA, JAPR and JMYR (c) conducting capacity assessment and planning for
capacity building of Provinces which will implement SDGs; (d) planning for construction/renovation of
facilities in accordance with HCP; (e) ensuring monitoring of the SDGs including progress being made
against performance targets; (f) mid year review and JAPR reports for MOH and DPs; and (g)
conducting various reviews carried out by MOH, including the mid-term and completion reviews.
The Department of Budget and Finance will be responsible for (a) building its capacity to take over
management of Program funding from the HSSP Secretariat/consultants within a defined timeframe;
(b) releasing Grants to PHDs on the basis of the Joint Program Management Group decisions; (c)
helping to build financial management capacity of PHDs; (d) providing quarterly and annual financial
management reports, including disbursement rates of Government budget, Program funds from DPs,
and financial expenditures reports; and (e) producing quarterly financial monitoring reports.
The Procurement Unit will be responsible for (a) building its capacity, within a specified timeframe, to
take over responsibility from the HSSP Secretariat/consultants for Program-related procurement; (b)
preparing Program procurement plans for procurement which will be handled through Standard
Operating Procedures (SOP) for discrete accounts, or by the International Procurement Agent (IPA) or
other arrangement as agreed between the World Bank and the RGC (c) following-up on Program
procurement activities with stakeholders; and (d) providing quarterly reports on Program procurement
status for the JQMss.
The Department of Personnel will be responsible for (a) providing administrative and technical support
to the MOH MBPI Committee (b) supporting MBPI recruitment and (c) conducting MBPI performance
M&E.
The recently established Department of International Cooperation (DIC) in MOH, with a mandate to
implement the Paris Declaration on Aid Effectiveness, has the role of facilitation, coordination, and
improving transparency in the Ministry by putting information relating to Program support on the
Ministry’s web site. They are expected to be a “one-stop shop” where interested parties can obtain
information relating to all the support being provided to the health sector, in order to strengthen
transparency and accountability through enhanced oversight.
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HSSP2 Operational Manual
3.8.2 PROVINCIAL HEALTH DEPARTMENTS
Provinces with SDGs are required to implement their interventions in accordance with the rules and
regulations contained in the SDG Manual. This will pertain to contract management as well, for those
contracts they will execute with their ODs and RHs which have SOA status. These PHDs will also be
required to develop, with facilitation by an NGO contracted by MOH for this purpose, a capacity
building plan. Fiduciary responsibilities for these PHDs are contained in the Financial Management
Manual which should be referred to for guidance. Provinces not receiving SDGs will implement their
AOPs as appraised and approved. AOPs will be required to integrate all sources and levels of
funding so as to present as comprehensive a picture in this regard.
Both groups of PHDs will be required to submit Quarterly Reports in the approved format, and with
the required content. The Financial Management Improvement Plan (FMIP) will be implemented across
both groups, and technical audits will also be conducted for both groups of PHDs.
3.8.3 OPERATIONAL DISTRICTS
ODs receiving SDGs will be held accountable for implementation of activities in line with the provisions
contained in the SDG Manual. Contracted staff will be recruited to fill existing vacancies, as required.
Activities in these ODs will be implemented in accordance with Program policy as amended from time
to time, as well as in accordance with the provisions contained in the SDG Manual, the HEF Manual,
and the MBPI Manual. ODs not receiving SDGs will be required to implement their AOPs as approved.
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HSSP2 Operational Manual
FIGURE 4. PROGRAM MANAGEMENT ARRANGEMENTS, PHASE I (2009-10)
Program Director
Program Coordinator
FINANCE UNIT
PROCUREMENT UNIT
PROGRAM ADMINISTRATION UNIT
Chief Financial Management
Officer
Chief Procurement Officer
Chief Program Administrator
Senior Pool Fund Financial
Management Officer
Assistants x 2
Senior Discrete Accounts Financial
Management Officer
Assistants x 2
Accounting Assistants x 6
ADB/GMS Accountant x2
Procurement Officers x 3
Administrative Group
Administrative Officer/Secretary to
TWG-H Sec
IT/Communications Officer
Senior Secretary (for HSSP2 Sectt)
Office Clerk
Secretary (for ADB-CDC/GMS office)
Drivers x 10
Management Group
Pooled Fund Management Officer
AFD/BTC Management Officer
UNFPA/UNICEF Management Officer
Management Assistant
ADB-CDC/GMS Assistant Manager
GAVI Assistant Manager
Monitoring and Support Group
Internal Contracting Monitoring Officer
ADB-CDC/GMS Consultants x 4
Infrastructure Development Coordinator
Monitoring and Evaluation Officers x 3
Training Management Officer(S/T)
Accounting Assistant
(DBF secondment)
Procurement Officer
(DBF secondment)
International Financial
Management Adviser
International Procurement
Adviser
DEPARTMENT OF BUDGET AND FINANCE
International Health Sector Monitoring
and Evaluation Adviser
DEPARTMENT OF PLANNING AND
HEALTH INFORMATION
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HSSP2 Operational Manual
3.9
PROGRAM MANAGEMENT ARRANGEMENTS
3.9.1
PROGRAM DIRECTOR
Executive oversight on overall Program implementation will be the responsibility of a Program
Director, who will be a Secretary of State nominated by the Health Sector Steering Committee.
He/she will have the principal responsibility to lead on both technical issues on health, and on
administrative, procurement and monitoring aspects to ensure timely and efficient execution of the
Program.
3.9.2
PROGRAM COORDINATOR
The Program Coordinator of the HSSP2 will be a senior official of the MOH and have at least 5
years of experience in managing external, large multi-donor assisted projects in the health sector.
He/she will have delegated authority to sign for expenditures under the Program up to US$50,000
and in line with approved plans. He/she will report to the Program Director in all aspects of the
Program, and manage the day-to-day operations of the Program Secretariat.
Key responsibilities
•
•
•
•
•
Coordinate the preparation of HSSP2 work plans, as directed by the Program Director;
Carry out decisions of the Health Sector Steering Committee, as conveyed by the Program
Director;
Ensure close liaison between MOH Departments, National Programs, PHDs, and other
agencies;
Manage the Program Secretariat; and
Manage day-to-day HSSP2 operations.
Key qualifications
Should be a senior official of the MOH with at least 5 years of experience in managing external,
large multi-donor assisted projects in the health sector.
3.9.3
CHIEF PROGRAM ADMINISTRATOR
This is a full-time senior position in HSSP2. He/she will report to the Program Coordinator, with the
main responsibilities of providing both technical and management support to the Program
Coordinator.
Key responsibilities
•
•
•
•
•
•
•
Coordinate in the development/update of Program Operational Manual and other
administrative and technical manuals as required for the Program;
Assist in the coordination of planning and monitoring of Pooled funds and Discreet accounts
and help to integrate into overall planning for the sector;
Monitor implementation of Program activities for compliance with conditions of the
Financing/Legal Agreements and Joint Partnership Arrangement;
Ensure that all IUs are aware of rules and procedures related to financial management and
procurement;
Monitor Program implementation in accordance with the Operational Manual;
Develop administrative policy, guidelines, and procedures for the flow of information,
personnel and logistics management;
Prepare technical assistance plan, terms of reference for individual consultants and firms, and
assist the Program Coordinator in recruiting consultants and arranging for signing of contracts;
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HSSP2 Operational Manual
• Manage and monitor knowledge and skill transfers within the Program, the MOH, and public
organizations that are involved in Program implementation;
• Monitor performance of individual consultants and consulting firms;
• Assist in gradually integrating management functions into the existing MOH structure in
accordance with MOH decisions;
• Monitor implementation of the Good Governance Framework (GGF) and other Program
policies;
• Act as secretary for the Joint Quarterly Meetings and other essential Program meetings and
Joint Program Supervision Missions, including assuming responsibility for development and
finalization of the agenda and for writing and distributing minutes; and
• Perform other tasks as assigned by Program Director and/or Program Coordinator.
Key qualifications
•
•
•
•
3.9.4
Master’s degree in management, business administration, or public health;
At least five years experience in administration of donor assisted project(s);
Familiarity with MOH management structures and processes; and,
Fluency in English and Khmer.
ADMINISTRATIVE OFFICER/SECRETARY TO TWG-H SECRETARIAT
This is a full-time domestic consultant position appointed by the MOH, and reporting to the Chief
Program Administrator and Program Coordinator for HSSP2 Administration, and to the Chairman of
the TWG-H Secretariat for its secretarial affairs.
Key responsibilities
(i) HSSP2 Administration
•
•
•
•
•
•
•
•
•
•
•
Overall administrative affairs within the HSSP2 Secretariat to ensure a proper flow of
information and documents for concerned Implementing Units, as specified in the Operational
Manual;
Preparing correspondence in Khmer and English for communication within the Ministry, with
other ministries and agencies, and DPs;
Assisting in maintaining contracts, Agreements to Pay for Work, and Memoranda of
Understanding (MOUs) for both local and expatriate staff, and IUs;
Maintaining the filing/record keeping system for the Secretariat, including the maintenance of
all documents;
Assisting in the recruitment and selection of consultants, including preparation/drafting of TOR,
and recruitment, selection reports, renewal of staff contracts, and staff leave records;
Assisting in keeping up-to-date with new developments in management information systems
and HSSP2 personnel and other relevant policies and procedures;
Organizing meetings and appointments and arranging transportation for WB, ADB/GMS,
DFID, UNFPA, UNICEF, BTC, AusAID, AFD and Program staff;
Assisting in the production of Program documents, including Semi-Annual Performance
Monitoring Reports and other publications;
Overseeing the implementation of administrative policies, guidelines and procedures
governing the Program;
Overseeing the maintenance and inventory of office/telecommunications/computer equipment
for the HSSP2 Secretariat; and
Handling any other tasks which may reasonably be assigned by the HSSP2 Program
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HSSP2 Operational Manual
Coordinator or Chief Program Administrator.
(ii) TWG-H Secretariat
•
•
•
Providing technical and administrative support for the development and implementation of the
TWG-H work plan;
Supervising all day-to-day administrative and secretarial matters of the TWG-H and its
Secretariat, including drafting of minutes for TWG-H and TWG-H secretariat meetings; and
Drafting the TWG-H Progress Report, in collaboration with relevant institutions/agencies, for
approval and submittal to the Council for Development of Cambodia.
Key qualifications
•
•
•
•
•
3.9.4
Minimum Bachelor’s degree in IT, management, business, or related field;
At least 2 years junior administrative experience working on similar donor funded project(s);
Strong IT skills, particularly in design and operation of database systems, and maintenance of
computer networks;
Fluency in English and Khmer; and
Willingness to work long hours, when required
MANAGEMENT OFFICERS (3 TO 4 OFFICERS)
The Management Officers include the Pooled Fund Management Officer, the UNICEF and UNFPA
Management Officer, and the AFD and BTC Management Officer. The incumbents will report to the
Program Coordinator through the Chief Program Administrator.
Key responsibilities
•
•
•
•
•
•
•
•
•
•
•
•
Assisting IUs in preparing draft AOPs, progress reports and budgets for HSSP2;
Tracking the progress of AOP indicators for each IU;
Resolving implementation problems and reporting to the Program Coordinator/Chief Program
Administrator, as appropriate;
Working with disbursement and procurement staff to ensure efficient and effective
implementation;
Working closely with other MOH and Program officers to liaise, when necessary, with other
ministries in the Government, particularly MEF;
Assisting in producing Semi-Annual Performance Monitoring Reports for the relevant Program
component;
Facilitating communication between DPs and Government counterparts and IUs;
Advising IUs on policy issues arising from Program activities;
Monitoring the capacity development of MOH staff as defined by the Program;
Monitoring progress of implementation of GGF and other Program policies;
Acting as Secretary and Assistant to the HSSC; and
Carrying out such specific tasks as may be assigned by the Program Coordinator/Chief
Program Administrator from time to time.
Key qualifications
•
•
•
•
Medical, public health, or related degree;
At least 3 years administrative experience on similar donor funded project(s);
Knowledge and experience of MOH and principal donor budgeting procedures;
Familiarity with MOH structures and administrative procedures; and
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HSSP2 Operational Manual
•
3.9.5
Fluency in English and Khmer.
MONITORING AND EVALUATION OFFICERS (3 OFFICERS)
Monitoring officers will be responsible for monitoring all Program activities, and preparing
Performance Monitoring Reports. They will report to the Chief Program Administrator.
Key responsibilities
•
•
•
•
•
•
•
•
•
Assisting in the development of the monitoring framework for HSSP2 in line with the monitoring
system of the MOH;
Making regular visits to all IUs to monitor implementation progress, and submit reports in the
required format to the Program Coordinator;
Making regular unannounced spot visits to Program area PHDs, ODs, HCs and RHs to assess
whether staff are present and providing services, and whether supervision visits are being
made by PHDs and ODs in accordance with established MOH policies and procedures on
integrated supervision;
Providing data for regular updating of Program database regarding HC development by
OD;
Overseeing the implementation of integrated supervision checklists for use by PHDs in the
supervision of PRHs and ODs, and for use by ODs for supervision of RHs and HC;
Providing on-the-job training in use of the checklists and monitoring that supervision is
conducted as scheduled, and funds are correctly used;
Following up on processing of approved requests (MOUs, procurement of supplies, etc.) and
collaborating with procurement and financial units for smooth flow of supplies and
disbursements;
Monitoring AOP implementation at provincial level, and submitting reports in required format,
and
Carrying out other tasks as may reasonably be assigned by the Chief Program Administrator.
Key qualifications
•
•
•
•
•
•
3.9.6
University degree in medicine, public health or related field;
Familiarity with MOH national health policies, structures and procedures;
Previous experience with MOH health services delivery in rural areas;
Previous experience with monitoring and evaluation of health services;
Excellent health and willingness to undertake extensive field travel under harsh conditions;
able to spend at least 50% of time away from home in the field; and
Excellent interpersonal skills.
INTERNATIONAL HEALTH SECTOR M&E ADVISER
This position is located at the DPHI, with the main responsibility of providing technical assistance to the
Department, and through the Department to other IUs, in developing and implementing the health
information system (HIS), and the M&E of the sector HSP2, 3YRPs, and AOPs. He/she will also provide
technical assistance on the M&E of HSSP2 implementation.
Key responsibilities
•
Developing, updating and implementing plans for the phased introduction of the new HSP2
M&E system based on: (i) the HIS, through use of information technology and rationalization of
the surveillance system; (ii) Health Facility Assessments; (iii) existing personnel, financial and
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HSSP2 Operational Manual
•
•
•
•
•
•
•
•
•
•
•
•
•
essential drug databases; and (iv) other surveys, such as small sample surveys, community
scorecards and client satisfaction surveys;
Coordinating the integration of national program(s) M&E (initially the HSSP2 M&E) with the
HSP2 M&E system to the extent possible;
Facilitating linkages between the HSP2 M&E framework and other Government M&E
frameworks, such as for the National Strategic Development Plan (NSDP), Medium-Term
Expenditure Framework (MTEF), Public Expenditures Review (PER), Public Investment Plan (PIP)
and Public Financial Management Reform (PFMR);
Establishing the framework for the HSSP2 M&E/Reporting system acceptable to the JPIG, and
establishing and periodically updating HSSP2 Program, Project, and AOP M&E frameworks
and indicators to facilitate trend analysis of sector performance;
Assisting the DPHI to prepare Semi-Annual Performance Monitoring Reports in a format and
frequency acceptable to the MOH and the JPIG;
Building the capacity of DPHI staff to manage HSSP2 monitoring and progress reporting
requirements from 2011 onward;
Facilitating the Semi-Annual Joint Review of HSSP2 progress, including once during the JAPA
and once in conjunction with the JAPR of HSP2;
Determining the implications at central, provincial, OD and facility levels in terms of
procedures, personnel, equipment and training requirements for strengthening M&E activities
in the health sector;
In collaboration with other technical assistance, identifying appropriate training institutions and
organizing training programs for MOH, Provincial and OD staff;
Assisting the DPHI, and especially the BHIS, in the phased implementation of the Health
Information System Strategic Plan (HISSP), 2008-15;
Reviewing existing computer systems and networks at central, provincial and OD levels and
designing a strategy for the phased upgrading of this system in line with the needs of the
M&E framework;
Supporting the DPHI in the design and implementation of the JAPR and the JAPA processes,
and the Joint Mid-Year Review through compilation of indicator frameworks, reviewing past
sector performance, and setting targets for the next 3YRP and AOP periods;
Collaborating with other technical assistance (TA) to contribute to the design and
implementation of national surveys, such as the Cambodia Demographic Health Survey (CDHS)
and the annual Cambodia Socio Economic Survey (CSES); and
Handling any other tasks which may reasonably be assigned by the Program Coordinator,
and/or Director, DPHI.
Key qualifications
The TA should have M&E specialist skills with substantial experience of working on health sector M&E
systems in developing countries. The TA will also need to have demonstrated skills in the design and
implementation of computerized database systems and experience in the design, planning,
implementation and analysis of sample surveys.
3.9.7 IT AND COMMUNICATIONS OFFICER
This position will be responsible for publishing Program information on the website, in the Program
bulletin and other Program publications, and assisting the HSSP2 M&E unit in establishing, maintaining,
updating, and managing the Program’s computerized database.
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HSSP2 Operational Manual
Key responsibilities
•
•
•
•
•
•
Working in close collaboration with relevant stakeholders to collect and update Program
data;
Preparing Program bulletins, web content and other regular publication materials, including
designing the layout, drafting and editing of content;
Establishing and maintaining hard copies and electronic copies for the Program Secretariat of
key documents and reports, including Government Decrees and Sub-Decrees, minutes of the
HSSC meetings, Program Semi-Annual Performance Monitoring Reports, field monitoring
reports, Program correspondence, etc);
Assisting the Program’s M&E unit in the design, development, maintenance and management of
the Program’s information database on a routine basis;
Assisting in managing Program computer networks, and providing hands-on technical
assistance to Program staff, or requesting external assistance as required;
Handling any other tasks, which may reasonably be assigned by the Program Coordinator.
Key qualifications
•
•
•
•
•
University Degree in Computer Sciences;
Minimum 3 years experience in communications and publications, preferably in the public
sector;
Experience in the development of MS Access databases for similar donor funded project(s);
High proficiency in English as a critical asset; and
Strong computer skills in the design and publication of high quality documents and reports.
3.9.8 CHIEF FINANCIAL MANAGEMENT OFFICER
This position is a national position whose incumbent will report to the Program Director through the
Program Coordinator.
Key responsibilities
•
•
•
•
•
•
•
•
•
•
Managing Program funds according to the Financial Management Manual (FMM) and the
requirements of the MEF and HSSP2 DPs;
Assisting in consolidating Program annual budget plan of Pooled funds and Discrete accounts;
Reviewing expenses and records to ensure transparency and eligibility in accordance with the
FMM;
Ensuring sound financial control, documentation and the flow of information for all Program
expenditures;
Cross-checking the occurrence of activities and market prices to ensure efficiency in using
Program funds;
Ensuring proper authorization and accounting of operating costs which will be classified by
nature of expenses and sources of funding and by categories;
Preparing withdrawal applications for submittal to respective DPs through MEF if applicable,
and following-up on payments;
Managing all accounting staff and assist to develop a clear responsibility for each staff to
avoid overlapping task and to ensure achievement of best performance;
Managing Program fixed assets in compliance with Government and DPs policies;
Producing regular Interim Financial Reports (IFRs) and other reports/data for the JPIG and
MEF on the status of HSSP2;
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HSSP2 Operational Manual
•
•
•
Providing training to Program accounting staff at all levels and conducting regular supervision
visits;
Assisting internal and external auditors to conduct audits by furnishing them appropriate
documents, assisting in identifying location of assets and facilitating communication with
concerned IUs for audit purposes; and
Performing other tasks as assigned by the Program Director and/or Program Coordinator.
Key qualifications
•
•
•
•
Bachelor’s degree in accounting or finance;
At least 5 years experience in financial management of similar donor assisted project(s);
Familiarity with accounting software programs; and
Fluency in English and Khmer.
3.9.9 SENIOR FINANCE OFFICERS (ONE FOR POOLED FUNDS AND ONE FOR DISCRETE ACCOUNTS)
They will have day-to-day responsibility for the management and implementation of the Pooled Funds
component and Discrete Accounts of HSSP2, with special emphasis on keeping the Program on
schedule and meeting its stated objectives. They will report to the Chief Financial Management
Officer.
Key responsibilities
•
•
•
•
•
•
•
•
•
•
•
Managing accounts of his/her designated responsibility, Pooled Funds or Discrete Accounts;
Preparing annual action plans of the Program in line with the AOP of the sector, progress
reports and budgets;
Cross-checking requests from IUs to ensure eligibility and adherence to financial management
policies;
Tracking progress of expenditures;
Resolving implementation problems, and reporting problems to the Chief Financial
Management Officer as appropriate;
Liaising with other Government ministries and agencies, when necessary, particularly with the
MEF;
Supporting production of regular Interim Financial Reports (IFR) and other reports/data for
JPIG and the MEF on the status of HSSP2;
Liaising with the MOH, JPIG, and IUs on issues relating to Program implementation;
Assisting in capacity development of MOH staff in financial management;
Conducting financial control activities at all IUs and reporting on their performance to the
Program Director; and
Carrying out any other tasks as may reasonably be assigned by the Program Director and/or
the Program Coordinator.
Key qualifications
•
•
•
•
Bachelor’s degree in accounting or finance;
Experience in financial management of similar project(s) for at least 4 years;
Conversant with accounting software programs; and
Fluency in Khmer, with good English language skills.
3.9.10 ACCOUNTING ASSISTANTS (6 POSITIONS)
This is a full-time position which will report to the Chief Financial Management Officer, and will be
based at the MOH, and require extensive travel to the provinces.
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HSSP2 Operational Manual
Key responsibilities
•
•
•
•
•
•
•
•
•
Keeping accounting files regularly updated following HSSP2 accounting procedures;
Following-up disbursements by financing institutions and of Government counterpart
contributions;
Assisting the Senior Finance Officers with preparation of documents related to the payments to
staff, IUs, and other concerned agencies;
Checking bill of quantities of civil work contractors and preparing payments based on
completion following the terms of the contracts;
Reconciling bank accounts with bank statements;
Reconciling petty cash accounts;
Drafting applications for withdrawals for direct payments or replenishments;
Conducting regular visits to provinces to cross-check and control financial reports; and
Any other accounting tasks that may reasonably be assigned by the Chief Financial
Management Officer or Program Coordinator.
Key qualifications
•
•
•
•
•
Bachelor’s or intermediate degree in accounting or finance;
At least 2 years experience working on similar donor assisted project(s);
Knowledge of Government financial and accounting procedures;
Willingness to travel to provinces at least 50% of the time; and
Fluency in Khmer, with good English language skills.
3.9.11 FINANCIAL MANAGEMENT ADVISER
The Financial Management Adviser will work with the Program Secretariat and the Department of
Budget and Finance (DBF) of the MOH to improve the financial management system, and financial
management capacity at the MOH. This position is an international position and will report to the
Program Director through the HSSP2 Financial Management Group on Program related activities and
to the Director of DBF of the MOH on the activities related to the National Budget.
Key responsibilities
A. Health Sector Support Program
• Reviewing and revising the FMM to reflect actual implementation and the newly
adopted Standard Operation Procedures for externally assisted Programs;
• Providing advice on the proper financial reporting format in compliance with the
requirements of DPs;
• Supervising performance of the Financial Management Group to ensure eligible
expenditures in accordance with financial management and budget plan; and
• Building capacity of MOH staff to manage HSSP2 financial requirements from 2011
onward.
B. National Budget
•
Helping the MOH on priority financial issues, including the roll out of the Public
Financial Management Reform Program (PFMR) as it relates to the MOH, preparation
of the next Medium-Term Expenditure Framework (MTEF), Program Budgeting, revised
Budget Classification and Chart of Accounts, Public Investment Plan (PIP), and other
relevant documents as required;
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HSSP2 Operational Manual
•
•
•
•
•
•
Assisting in monitoring and improving the timeliness of disbursement of counterpart
funds, especially to the SDG ODs;
Maintaining and updating the financial database developed by the previous Adviser;
Providing quarterly updates to the Program Secretariat and DPs;.
Working closely with the Financial Management Improvement Plan (FMIP) team to
improve financial management at PHD and OD levels;
Building capacity of MOH staff through on-the-job and regular financial management
training; and
Preparing monthly reports on the progress of National Budget disbursement, and
other relevant matters for the Director, DBF.
Key qualifications
•
•
•
•
Recognized graduate level qualifications, with tertiary qualification in financial
management or accountancy;
At least 7 years experience in the financial management of similar donor assisted
project(s);
Good communications skills in English; and
Good knowledge of relevant computer software applications for financial
management.
3.9.12 CHIEF PROCUREMENT OFFICER
He/she will report to the Program Coordinator. His/her main responsibilities are to ensure that goods
and services are procured in a timely fashion in a highly competitive, transparent and fair manner,
and in compliance with Program procedures and guidelines of the World Bank and the MEF. He/she
will supervise the work of the HSSP2 Procurement Officers, and liaise closely with all HSSP2
consultants. He/she will be responsible for procurement from all funding sources, including Pooled
funds and Discrete accounts per MOH rules and regulations.
Key responsibilities
•
•
•
•
•
•
•
•
•
•
•
•
•
Preparing Annual Procurement Plans of the Program;
Preparing and keeping updated current procurement schedules according to plan;
Preparing tender documents/contracts, organization of public tendering or shopping of
Goods, Works and Services;
Finalizing Technical Specifications for Goods Works;
Receiving bid submittals and preparing tables for record of bid opening proceedings;
Organizing public tendering for Goods, Works and Services to be procured under the
Program;
Preparing draft reports on bid evaluations;
Monitoring performance of Contractors in complying with the Terms of Contracts;
Resolving any procurement issues that interfere with efficient Program implementation and if
not possible, informing the Program Director through the HSSP Secretariat;
Assisting in the training of Procurement Assistants, Departments and National Program staff on
procurement procedures;
Preparing requests for quotes, bid comparison sheets, Purchase Orders, Contract and
Acceptance Letters;
Organizing files, keeping archive documents and procurement reports; and
Carrying out any other tasks as may reasonably be assigned by the Program Director,
Program Coordinator, or Procurement Adviser.
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HSSP2 Operational Manual
Key qualifications
•
•
•
•
Bachelor’s degree in business administration, or other related fields;
At least 5 years experience in managing procurement of externally assisted project(s);
Familiarity with specifications of medical equipment; and
Fluency in Khmer and English.
3.9.13 INTERNATIONAL PROCUREMENT ADVISER
This position will be based at the Program Secretariat and will report to the Program Director through
the Program Coordinator.
Key responsibilities
•
•
•
•
•
•
•
•
•
•
•
Advising the Program team at all stages of the procurement cycle to ensure that correct
procedures are followed;
Assisting in the preparation of bid advertisements, pre-qualification documents, bidding
documents, evaluation reports, requests for proposals for consulting services, and draft
contracts following applicable Program procurement procedures;
In cases where bidding and evaluation are required to be conducted by agencies, provide
technical advice on pre-tender and post-tender activities (bidding and evaluation) including
contracts management of the procurement packages.
Providing continuous on the job training (including other necessary capacity building measures)
as required on procurement and related contract management procedures to local
procurement consultants/officers, MOH procurement staff, and other members of the Program
implementation/management team on a regular basis, so that all the staff are oriented
towards organizing/conducting procurement activities in accordance with correct procedures
as part of the Government's strategy to build up capacity within Ministries. The training should
focus on measures to improve institutional capacity for procuring goods, equipments, drugs
and services;
At the Ministry’s specific request and in coordination/consultation with competent ministerial
staff, conducting an initial assessment of training and capacity building needs and developing
a training strategy with quantified requirements for staff to be trained through on the job
training (learning by doing) and/or short-term in-country upgrading sessions and/or external
training (as considered necessary);
Assisting the staff to update the procurement plan every three months or at periodic intervals,
and to set in place a monitoring system for procurement activities;
Reviewing procurement procedures that have been implemented and suggesting improvements
in procedures in subsequent bidding/tender operations;
Assisting the MOH to resolve any procurement and contract management-related issues,
including complaints from contractors, suppliers, and consultants;
Supervising and providing guidance to national consultants/officers;
Preparing communications and coordinating between the MOH and HSSP2 DPs on
procurement and contract management related document clearance, and other procurement
and contract management related activities; and
Assisting in preparation of Program Semi-Annual Performance Monitoring Reports.
Key qualifications
•
Master's degree in management, economics, business administration, engineering or any
related field;
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HSSP2 Operational Manual
•
•
•
•
•
•
Familiarity with public procurement procedures of multi-lateral development institutions,
including the World Bank/ADB, and significant hands-on demonstrated experience as Team
Leader/Coordinator/Procurement Specialist for development projects;
At least 10 years working experience in public procurement in developing countries
(preferably experience in more than one country);
Excellent communication skills, including speaking and writing in English;
Willingness to train junior staff and to work as part of a team;
Good working knowledge of computer programs such as Word, Excel, etc.; and
Work experience in Cambodia, with basic knowledge of Khmer language as an added asset
3.10 INTEGRATING HSSP SECRETARIAT FUNCTIONS INTO MOH LINE DEPARTMENTS
Program management functions will be progressively integrated into the respective MOH line
departments under respective Directors General. Meantime, capacity on financial management,
procurement, M&E, and internal audit will be built for related departments with clear time frames and
strict monitoring. By 2011, Program management functions will be delegated to assigned staff of line
departments and administrative support for HSSP2 will be provided by a smaller Program
Secretariat. To ensure smooth transfer of program management functions, the MOH will develop a
transitional plan to prepare for the transfer of functions by June 30, 2009. Figure 5 overleaf shows
the Program management arrangements for the period 2011-2013.
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HSSP2 Operational Manual
FIGURE 5. PROGRAM MANAGEMENT ARRANGEMENTS PHASE II (2011-13)
Program Director
Program Coordinator
FINANCE UNIT
PROCUREMENT UNIT
PROGRAM ADMINISTRATION UNIT
Chief Financial Management
Officer
Chief Procurement Officer
Chief Program Administrator
Senior Pool Fund Financial
Management Officer
Assistant x 2
Senior Discrete Account Financial
Management Officer
Assistant x 2
Accounting Assistants x 6
ADB/GMS Accountant x2
Procurement Officers x 3
Administrative Group
Admin. Officer / Sec. to TWGH Sec.
IT/ Communications Officer
Senior Secretary (for HSSP2 Sec.)
Office Clerk
Secretary (for ADB-CDC/GMS office)
Drivers x 10
HSSP2 Secretariat by 2011 under
Program Director
Accounting Assistant
(DBF secondment)
Procurement Officer
(DBF secondment)
Financial Management Advisor
International Procurement
Adviser
Management Group
ADB-CDC/GMS Assistant Manager
AHICPEP Assistant Manager
Pool Fund Management Officer
AFD/BTC Management Officer
UNFPA/UNICEF Management Officer
Management Assistant
GAVI Assistant Manager
Monitoring and Support Group
Internal Contracting Monitoring Officer
ADB-CDC/GMS Consultants x 4
Infrastructure Development Coordinator
Monitoring and Evaluation Officers x 3
Training Management Officer
International Monitoring and Evaluation Adviser
By 2011 moved to
DEPARTMENT OF BUDGET AND FINANCE
By 2011 moved to
DEPARTMENT OF PLANNING AND HEALTH INFORMATION 40
HSSP2 Operational Manual
3.11 IMPLEMENTING THE GOOD GOVERNANCE FRAMEWORK
The GGF which was developed and approved during the appraisal stage will be implemented and
reported regularly through Joint Quarterly Meetings, and Joint Program Supervision Mission Aide
Memoires. The relevant departments will be assigned to monitor implementation and monitoring of the
GGF. The Program Secretariat will be responsible for consolidating reports of progress.
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HSSP2 Operational Manual
CHAPTER 4. PROGRAM MONITORING AND EVALUATION
4.1 PROGRAM AND PROJECT INDICATORS
A selection of key Program indicators have been drawn primarily from the HSP2, since there is broad
agreement between the MOH and HSSP2 DPs on the importance of adopting a single, common,
results and monitoring framework that reflects the MOH’s priorities in the sector. They will be used to
evaluate aggregate performance of the health sector and track progress towards health outcomes.
The list of all Program indicators is contained in the Annex.
While the Program will use the HSP2 framework, the Project’s impact on overall strategy
implementation will be evaluated through indicators aimed at (a) improved policy, planning and
implementation; (b) improved financing of front line service delivery; (c) use of performance results to
improve planning and management; (d) broad commitment and ownership of the sector wide process;
and (e) improved sector governance. These are presented in the Annex.
The indicators have been selected on the basis that they can be monitored regularly through the
Health Information System (HIS), or socio-economic surveys (CSES) currently being carried out on an
annual basis. Support will be provided to strengthen the HIS on the basis of the Health Information
System Strategic Plan, 2008-15 developed in cooperation with the Health Metrics Network.
Monitoring of the AOPs will take place through the JAPR conducted by the MOH with JPIG
participation. Further details are provided in the sections below.
For indicators which the HIS cannot track, or which cannot be covered through the JAPR, rapid small
sample surveys will be supported; this mechanism will also be used on an ad hoc basis to verify the
validity of the HIS data. Performance indicators will be included in the Performance Agreements
signed between the various parties, and independent monitoring of these indicators will be carried out
to verify performance. Further details appear in the sections below.
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HSSP2 Operational Manual
FIGURE 6. PROGRAM M&E CONCEPTUAL FRAMEWORK
Political and
Administrative
System
EXTERNAL
CONTEXT
3 Year Rolling Plan
Sustainability
Functional Outputs
Institutionalization
Organizational
Resources
Annual Operational Plan
Service Outputs
Knowledge,
Attitudes, Demand,
and Practices
Reduced Incidence
of Endemic and
Emerging Diseases
RGC Contribution
Service Utilization
Pooled Funds and
Discrete Accounts
INPUTS
Implementation of
Activities
PROCESS
Reduced Maternal,
Infant and Child
Mortality
OUTPUTS
OUTCOMES
IMPACT
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HSSP2 Operational Manual
FIGURE 7 KEY STAKEHOLDERS AND THE FLOW OF INFORMATION
HEALTH SECTOR STEERING COMMITTEE
JPIG
JOINT QUARTERLY MEETING/ JOINT SUPERVISION MISSION
PROGRAM DIRECTOR
EXTERNAL AUDIT/ TECHNICAL & FINANCIAL REPORT
INTERIM FINANCIAL REPORT/ PERFORMANCE MONITORING REPORT
PROGRAM COORDINATOR
DG/ADMINISTRATION & FINANCE
•
•
•
•
•
ADMINISTRATION
BUDGET AND FINANCE
HUMAN RESOURCE
DEVELOPMENT
INTERNAL AUDIT
PERSONNEL
PROGRAM SECRETARIAT
QUARTERLY REPORT
DG/HEALTH
QUARTERLY REPORT
INTEGRATED PROGRAM DATABASE
NATIONAL INSTITUTES/CENTERS
QUARTERLY REPORT
REGIONAL TRAINING CENTERS
QUARTERLY REPORT
•
•
•
•
•
•
COMMUNICABLE DISEASES CONTROL
DRUGS AND FOOD
INTERNATIONAL COOPERATION
PREVENTIVE MEDICINE
HOSPITAL SERVICES
PLANNING AND HEALTH
INFORMATION
QUARTERLY REPORT
PROVINCIAL HEALTH DEPARTMENTS
CLIENT SATISFACTION SURVEYS, HIS AND HEALTH FACILITY SURVEYS
HIS
PROVINCIAL REFERRAL HOSPITALS
OPERATIONAL DISTRICTS
CLIENT SATISFACTION SURVEYS, HIS AND HEALTH
FACILITY SURVEYS
REFERRAL HOSPITALS
HIS
HEALTH CENTERS
COMMUNITY SCORE CARDS AND SMALL SAMPLE SURVEYS
COMMUNITIES
LOCAL AUTHORITIES
COLLABORATING MINISTRIES AND AGENCIES
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4.2 PROGRAM PERFORMANCE INDICATOR DASHBOARD WITH SPARKLINES
Program and Project Indicators as jointly agreed to per the FA will be reported on in the Program’s Semi-Annual and Annual Performance Monitoring
Reports in the form of a Program Performance Indicator Dashboard with Sparklines. The inclusion of sparklines is intended to aid in presentation of trends
and variations for performance indicators in a form that can be quickly and easily comprehended. An example of the dashboard for trend data for two
key Malaria Program indicators is shown below.
1996 1997
TABLE 4. PROGRAM PERFORMANCE INDICATOR DASHBOARD
1998 1999 2000 2001 2002 2003 2004 2005
Incidence Rate per
1,000 pop.
9.5
15
12.4
12.3
11.4
9.6
8.6
10.26 7.5
Case Fatality Rate
0.69
0.51
0.44
0.64
0.47
0.41
0.41
0.37
0.38
2006
2007 TRENDS
5.5
7.2
4.2
0.4
0.39
0.40
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4.3 PROGRAM GEOGRAPHIC INFORMATION SYSTEM AND LINKED DATABASES
The Program Secretariat will house the Program database to be maintained by the Program
IT/Communications Officer. The database will be maintained in MS Access format, and will contain
indicators and reports relevant to the Program. The Program Secretariat working in close
collaboration with individual departments and national programs will design reporting forms that will
enable a seamless integration of IU reports into the database. Where necessary, the HIS data for
selected indicators will be compiled from the HIS Bureau and selected national programs. The intent of
the database is not to introduce a parallel information system to that of the MOH’s constituent units,
but to compile an integrated database that contains all of the information necessary for monitoring
Program performance and progress, including Program, Project, and AOP indicators. The existence of
the integrated database will also enable trend analysis to be conducted from time to time that will
inform the content of the PMRs. Over the first year of the program, provincial and OD level data and
geographic coordinates for facilities constructed or renovated by the Program will also be integrated,
permitting more rigorous monitoring of Program performance. The M&E unit of the Program
Secretariat will work closely with the HIS Bureau and the Program’s IT/Communications Officer to
ensure the integration of the additional geographic information system (GIS) data. It should be noted
that the HIS Bureau staff have already been trained in the use of GIS, and that they maintain a
simple database for the periodic updating of the Health Coverage Plan. Selected PHD and OD staff
have also been trained in the use of GIS techniques under HSSP1, and this training will also be
expanded under HSSP2.
4.4 GENERATING PROGRAM EVIDENCE
4.4.1 OVERVIEW
This section provides details of the sources of information and the methods the Program will employ to
generate evidence for M&E of Program progress and achievements. As can be seen, there are a
number of sources including first and foremost, the HIS. These data will be supplemented by other
sources of information including Census data, national surveys, small sample surveys, health facility
assessments, client satisfaction surveys, and community scorecards.
4.4.2 HEALTH INFORMATION SYSTEM
The HIS was first launched in 1992 when the MOH began to develop a new information system to
serve its needs, with technical and financial support from UNICEF. It was gradually phased in through
implementation in a few provinces starting in May 1994. Complete nationwide coverage was
achieved by February 1995. Subsequently, the HIS underwent revisions in 1996, 1999, 2003 and
most recently, in 2008. The 2008 revision was carried out to incorporate additional indicators
required for sector-wide M&E, and to generate age and sex-disaggregated data. A hallmark of the
revision process, as for those in the past, is the consultative and participatory approach employed,
involving all key stakeholders. The figure overleaf shows the information flow with reporting forms
and monthly schedule as applied within the routine HIS.
From the earliest, the MOH has sought to develop a computerized HIS to cover the OD and PHD
levels. In 1997 an Access based computerized system was adopted which for a number of reasons fell
into disuse by 2000, most prominently the lack of IT support at central and local levels. In 2006, with
the recruitment of one IT staff at central level, the DPHI modified the HIS database developed by
GTZ at provincial level and introduced it from OD level upwards. Although this system worked well at
first, the inability of one IT staff member at central level to provide IT support to 24 PHDs and 77
ODs on a sustained and regular basis led to the development of serious problems, including the
generation of unreliable and invalid data.
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In 2008, with HSSP1 support and following the latest revision of HIS forms, DPHI employed a short
term HIS database consultant to design a new HIS database with a couple of new features:
generation of both age and sex disaggregated data, as well as core HSP2 monitoring indicators at
central and local levels. Training of DPHI and HSSP staff will be completed in December, 2008 and
training of PHD and OD staff in data entry and use of the HIS database will begin from the 1st
quarter of 2009. HSSP2 will support this training, as well as the acquisition of additional equipment to
make the HIS database fully functional. It is expected that the computerized HIS database will be
expanded to cover all referral hospitals and health centers in a phased manner, and HSSP2 will
support this activity as well.
In 2008 after a year long process, and with support from the Health Metrics Network, the DPHI
developed the HIS Strategic Plan (HISSP), 2008-15 to coincide with the HSP2 implementation period.
A sector-wide consultative process was employed for the purpose, with the additional participation of
the Ministries of Interior and Planning. After a detailed assessment, the HISSP identified a set of
components of the HIS for development and strengthening. These include: (i) HIS policy and resources
(ii) health and disease records, including surveillance (iii) health service administration and support
systems (iv) census, civil registration and surveys, and (v) data management, dissemination, and use.
For each component, a set of activities has been specified, some of which are developmental in
nature, and some routine, and therefore, recurring. The Plan has also been costed. HSSP2 will support
activities under all five components of the Plan, as requested by IUs through their AOPs.
FIGURE
8. Health
FLOW OF
HEALTH INFORMATION
Flow of
Information
Dept of
Planning and
Health
Information
National Programs
20th day
Central Institutions
National Hospitals
Dept of CDC
Pasteur Institute
Provincial Health Departments
PRO4 Report
(Aggregated DO3 Reports)
10th day
5th day
OD Office
DO3 Report
(Aggregated HO2 and HC1)
Referral Hospital
HO2 Form
5th day
Health Center
HC1 Form
Health Center
HC1 Form
Report
Feedback
Page 1
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4.4.3 CENSUS
The third national Census was conducted in March, 2008. As of December, 2008 only preliminary
results had been released by the National Institute of Statistics (NIS), Ministry of Planning consisting of
national and provincial population estimates. The full results are likely to be released in mid 2009,
and these will be critical for HSSP2 in two respects. First they are likely to provide estimates of the
maternal mortality ratio, and infant and child mortality rates. Since these will update the estimates
from the last CDHS in 2005, they will be used as the baselines for these indicators for the Program.
Second, Census results will provide total population and sex disaggregated estimates for health
facility catchment areas, and ODs, and this will help in calculation of more precise coverage rates
than has been the case so far. Detailed Census results will also prove useful in the updating of the
Health Coverage Plan which will be supported by the Program.
4.4.4 NATIONAL SURVEYS
The next CDHS is expected to be conducted in 2010 which will be roughly mid-way through the
Program. Results from the CDHS will inform the Mid Term Review of the Program scheduled for 2011.
In addition, the Program will utilize findings from the Cambodia Socio Economic Survey (CSES) which is
now scheduled to occur on an annual basis for some of the indicators included in the M&E framework.
For this purpose, since the CSES is conducted by the National Institute of Statistics (Ministry of
Planning), close liaison will need to be maintained to ensure that the required questions are
incorporated into the questionnaires annually.
4.4.5 SMALL SAMPLE SURVEYS
The Program will support the use of small sample surveys for data validation, and for the
measurement of Program and Project monitoring indicators which either cannot be measured through
the existing HIS, or require data from other sources, such as the private commercial sector and nonprofit sector. Two types of small sample surveys will be supported by the Program, including Lot
Quality Assurance Sampling (LQAS), and 30 Cluster Surveys.
LQAS is a random sampling approach and analysis tool that originated in industry as a quality
assurance method, and is now increasingly applied in international health programs to monitor service
coverage, quality of care, and client satisfaction, among other uses. It is a management tool that
enables managers at provincial and operational district levels to track their performance and that of
the sub-units under their charge, and observe movement toward set objectives and targets. The key
advantage of the LQAS approach is the small sample size required, typically only 19 respondents in
a particular service delivery area, such as a health center catchment area. Total sample size for an
OD will thus depend on the total number of health centers in the OD. Aggregating across health
center catchment areas can also provide parameter estimates for the OD as a whole. The 30 cluster
survey typically involves a sample size of 300 respondents, with 10 respondents each spread over 30
clusters (villages in rural areas). The disadvantage of the 30 cluster survey approach lies in the fact
that it cannot generate parameter estimates below OD level, unlike LQAS. Nevertheless, 30 cluster
surveys may be more efficient in cases where an OD has more than 15 health centers, at which point
LQAS samples become prohibitively large.
The Program will support the use of small sample surveys to validate and supplement HIS data at
local levels. This will involve technical assistance and funding support for training and implementation
of the surveys. Training materials for both LQAS and 30 cluster surveys that are adapted to local
conditions were developed under HSSP1, and M&E staff were trained in their use. It is expected that
the application of small sample surveys will first be employed under internal contracting arrangements
with annual population based surveys to determine if the contracting unit has achieved its agreed
targets. Later, the Program will support the use of small sample surveys by other PHDs and ODs to
evaluate AOP achievements.
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4.4.6 HEALTH FACILITY ASSESSMENTS
The Program will support the implementation of Health Facility Assessments to be conducted by PHDs
and ODs to assess service provision and the quality of care at health centers and referral hospitals.
Particular emphasis will be placed on those facilities either constructed or renovated through Program
support, as a means of determining Program impact. Instruments for such assessments have been
prepared by the Department of Hospital Services (DHS) and these will be employed for the purpose.
The instruments will focus on all four components of an HFA, including facility inventory, observation of
service providers, health worker interviews and client exit interviews. HFAs will initially be introduced
on an annual basis in the internally contracted ODs, and then be gradually phased in across other
ODs. The DHS will arrange to conduct TOT of PHD staff for the purpose, who will arrange to train
other PHD and OD staff for the purpose. Findings from the HFAs will be incorporated into the relevant
PMRs on Program progress, placed on the Program web site and reported in the newsletter from time
to time.
4.4.7 CLIENT SATISFACTION SURVEYS
A key emphasis of the Program is on ensuring client satisfaction through improvements in the quality of
care provided at public health facilities. The Program will support the periodic implementation of
surveys to measure client satisfaction, and provide monitoring information. GTZ has developed
appropriate context relevant tools for this purpose and has piloted their use in their provinces. The
Program will support the introduction of these tools in other provinces in a phased manner. Initially,
their use will be encouraged in the internally contracted ODs, and the Program will support training of
staff in the implementation of such surveys.
4.4.8 COMMUNITY SCORECARDS
Community scorecards are tools for participatory monitoring with an emphasis on promoting
accountability and the empowerment of communities. It is both a process and a product, and the way
in which the process is conducted is as important as the final product i.e., “the score.” Essentially the
scorecard involves both the community which is being served by a health facility and the service
providers at that facility coming together to discuss mutual assessments of provider and facility
performance, and to highlight areas for improvement. It thus increases community voice in the facility’s
functioning. It may be used for inputs or expenditure tracking (e.g., availability of drugs), monitoring
of quality of care, generating benchmark performance criteria for resource allocation and budgetary
decision making, or performance comparison across facilities. In the process, it strengthens citizen voice
and community empowerment.
The Program will support the application of community scorecards at health center level. For this
purpose, the Program will support the preparation of a simple input tracking scorecard, the
performance scorecard, the self-evaluation scorecard, and guidelines for facilitating the interface
meeting between the community and health center staff. Due care will be given to developing
culturally appropriate instruments for this purpose, particularly since there is always the danger that
the interface meeting can become confrontational. This can be avoided by employing skilled
facilitators, and framing questions appropriately. The Program’s M&E unit will work closely with DPHI,
DHS and the selected PHDs and ODs to develop appropriate scorecards for piloting in an internally
contracted OD. Instruments will be modified based on community and provider feedback before the
process is scaled up across other ODs.
4.5 PERFORMANCE REPORTING SYSTEM: ROLES, RESPONSIBILITIES, TASKS, AND SCHEDULES
All IUs receiving Program support will be required to submit quarterly reports indicating AOP
activities conducted, outputs produced, planned budget, actual expenditures incurred, constraints
encountered, and plan of action to overcome the constraints in the approved reporting format. The
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reports will be submitted to the relevant Management Officer within the Program Secretariat who will
arrange to have the required information entered into the integrated Program database by the
IT/Communications Officer, and then forward the report to the Finance unit within the Program
Secretariat for their review and approval. Release of funds to IUs for the next quarter will be
contingent on the submittal of a complete quarterly report in the required format. Data from the
quarterly reports will be compiled by the Program Secretariat for the preparation of the Program’s
Semi-Annual Performance Monitoring Reports to be submitted to JPIG and Joint Supervision Missions.
They also will form the basis of discussions during the Joint Quarterly Meetings (JQMs).
HIS data required for the tracking of Program and Project monitoring indicators will be collected by
DPHI’s HIS Bureau based on the computerized data files submitted by PHDs every month. These will
be merged into the HSSP2 database maintained by the IT/Publications Officer and used for
calculation of indicators for semester reporting for the PMRs. In addition, quarterly reporting on AOP
indicators by IUs will also be merged into the database. Findings from small sample surveys, health
facility assessments, client satisfaction surveys, and aggregated community scorecards will be entered
into the database as and when such information becomes available.
The DPHI will be responsible for conducting monitoring visits to internally contracted PHDs, and these
PHDs in turn will monitor the Management Contracts executed with SOAs such as ODs and PRHs within
their jurisdictions. External validation of performance indicators will also be supported by the
Program. Further details regarding these arrangements including selection of monitoring indicators are
contained in the Internal Contracting Manual and the SDG Manual.
The Program’s M&E unit will be responsible for conducting regular site visits per approved schedule to
all IUs to monitor AOP implementation progress and preparing reports in required format for
Program management. This will involve making unannounced spot visits to PHDs, ODs, RHs, and HCs to
assess whether staff are present and providing services, and whether supervision visits are being
conducted by the PHDs and ODs in accordance with established MOH policies and procedures on
integrated supervision. The unit will retain principal responsibility for data collection and analysis for
the preparation of the Semi-Annual Performance Monitoring Reports and for this purpose will hold
quarterly meetings with Management Officers to confirm receipt of and check the validity of Program
data from IUs.
4.6 SEMI-ANNUAL PERFORMANCE MONITORING REPORTS
The Program Secretariat will arrange to compile Semi-Annual Performance Monitoring Reports (PMRs)
on Program progress based on quarterly reports received from IUs. Each such report will be submitted
to the JPIG by March 31 and September 30 for the First and Second Semesters respectively. While
the detailed outline and format of the PMRs will be decided mutually between the MOH and JPIG
within the first quarter after effectiveness, they will report on all Program and Project indicators per
the agreed Performance M&E framework, as well as individual AOP indicators at input, process, and
output level contained in the AOPs of IUs. Draft PMRs will be presented to the JPIG in advance of the
Joint Supervision Visits which will occur in March and September of each year, and will form part of
the basis for the review by the MOH and HSSP2 DPs of Program progress. Each PMR will also contain
detailed financial information on Program expenditures, Program physical progress, detailed reports
on each component and sub-component of the Program, procurement progress, and reports on any
internal and external audits (including technical audits) that may have been conducted in the previous
period. Copies of the Reports will be made available to the MOH’s other health partners (i.e., those
not part of the JPIG), and other key stakeholders, and will also be placed on the Program’s web site
for access to by the public and the media, as part of the Program’s information sharing and
dissemination efforts.
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4.7 JOINT SUPERVISION VISITS
Joint Supervision Visits will be conducted by the JPIG twice a year in March and September. Draft
PMRs will be prepared by the Program Secretariat in advance of these visits with full reporting on
Program progress for the previous period. The Program Secretariat will arrange site visits, and
individual or group meetings between JPIG and IUs per the agreed schedule. The Secretariat will also
arrange to widely disseminate the final Aide Memoire issued by the JPIG to all key stakeholders
including non-JPIG health partners, and arrange to place it on the Program web site for easy access
by members of the public and the media. The Secretariat will arrange to follow up on the issues
raised in the Aide Memoire with the relevant IUs and facilitate an appropriate response, including
any additional data collection as required.
4.8 PROGRAM EVALUATION
4.8.1 JOINT ANNUAL PERFORMANCE REVIEWS
The Joint Annual Performance Review (JAPR) coupled with the National Health Congress is typically
conducted annually in March to assess overall sector performance of the past year and to prioritize
interventions and activities for the following year, including setting of national targets for guidance to
local levels. The DPHI will prepare the JAPR report for that year listing key performance indicators
and achievements (including those selected as Program indicators), and specify targets for the
following year. The JAPR is important for Program implementation from two perspectives. First, sector
priorities and targets are finalized and guidance issued to all budget management centers for
preparation of the next year’s AOP. Secondly, this forum provides the JPIG partners with an
opportunity to carry out their Joint Program Supervision Mission to review sector performance along
with the performance of individual IUs in light of Program objectives, and to propose appropriate
modifications.
4.8.2 MID TERM REVIEW
The Mid Term Review of the Program will occur in 2011, and will be based on the findings from the
CDHS 2010, and the annual CSES. The design for the Mid Term Review will be prepared by DPHI
and submitted to JPIG for review and approval in the first quarter of 2009, after which it will be
shared with IUs for their information.
4.8.3 FINAL EVALUATION
The final evaluation of the Program will occur in the first and second quarters of 2014 with the final
report submitted to all partners by September 30, 2014. The final evaluation report will include the
findings from all methods of data collection employed for the purpose. The design for the final
evaluation will be prepared by DPHI and submitted to JPIG for review and approval in the first
quarter of 2009, after which it will be shared with IUs for their information.
4.9 INFORMATION SHARING AND DISSEMINATION
Information sharing and dissemination about Program activities and progress will be ensured through
a wide variety of methods. The Program Secretariat will include an IT/Communications Officer whose
main tasks will include maintenance of the Program database and web site, and the preparation of a
six monthly Program newsletter, based on the information contained in the latest Semi-Annual PMR.
Copies of the Semi-Annual Report will be shared with all key stakeholders in the sector, including non
JPIG health partners. Financial and procurement information including procurement notices, and the
civil works plan will be available through the web site and published in the newsletter as well. All of
the above sources of information will be placed on the MOH web site which is maintained by DIC. The
Program will explore appropriate means of bringing Program relevant information directly to
communities in collaboration with the National Center for Health Promotion, and IUs at local levels. The
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Program’s IT/Communications Officer will be tasked with maintaining copies of all Semi-Annual PMRs,
Program newsletters, and individual and group consultancy reports at the Program Secretariat for
ready access by key stakeholders as required.
A Compendium of Program and Project Indicators and Reporting Formats, Forms and Tables are
included in the Program M&E Plan.
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CHAPTER 5. COORDINATION AND COMMUNICATION WITH DEVELOPMENT PARTNERS
5.1 OVERVIEW
Coordination and communication with DPs is key to the success of the Program. Several institutional
arrangements will be instituted under the Program to facilitate this objective. Key among these include
the Joint Partnership Arrangement (JPA), the Joint Partnership Arrangement Development Partner
Interface Group (JPIG), Joint Quarterly Meetings, and Joint Supervision Missions, each of which is
described in detail below.
5.2 JOINT PARTNERSHIP ARRANGEMENT
The JPA signed by the HSSP2 DPs and Government articulates the harmonized management
arrangements agreed to for the Program. The JPA covers the roles and responsibilities of each party,
and includes sections on: (a) contributions and responsibilities of DPs and Government; (b) consultation,
information, coordination and decision making; (c) annual planning processes; (d) disbursements and
financial management; (e) procurement; (f) reporting (g) mechanisms for additional DPs to join; (h)
mechanisms to amend the partnership arrangements; and (i) withdrawal from the partnership
arrangements.
5.3 JOINT PARTNERSHIP ARRANGEMENT DEVELOPMENT PARTNER INTERFACE GROUP
The JPIG has been established to assure smooth and efficient running of the Program, and to agree on
partners’ joint positions on issues arising in the Program. The main roles are to (i) discuss and agree on
the JPIG’s position on substantive and emerging issues related to HSSP2, including agreeing a common
position for communication with RGC and other partners by the members of the JPIG; (ii) encourage
engagement of other health partners as part of overall harmonization and alignment efforts in the
sector; and (iii) facilitate the regular review of the JPIG working arrangements to ensure effectiveness,
efficiency, and make improvements as necessary. The JPIG Chair’s main role is facilitating JPIG’s
work, leading the JPIG in program matters, and overseeing the sharing of information and distribution
of tasks within the JPIG. Designated JPIG technical leads will advise JPIG partners on issues in the
technical area concerned, and lead in technical interactions with the RGC and other partners.
Communications on operational aspects of the Pooled funds will flow through the World Bank Task
Team Leader with a copy to the JPIG chair and consultation among JPIG partners. The detailed roles
and functions of the Group are described in the TOR for JPIG.
5.4 JOINT QUARTERLY MEETINGS
For purposes of Program monitoring and to ensure proper planning, coordination and implementation
of the Program, MOH will convene JQMs to facilitate exchange of information and dialogue among
Program partners and the RGC on all matters related to the Program. The JQM will be chaired by
the Program Director and will include key representatives of the MOH and Program partners. The
MOH will be responsible for preparation of the agenda. Program partners may make proposals for
items to be included on the agenda and, whenever necessary, call for an interim meeting. The JQM
will review semi-annual PMRs, quarterly IFRs, progress reports, audits and Mission findings, endorse
AOP requests for funds, review funding release triggers, monitor disbursements, and make
recommendations on release of Program funds. JQMs will be convened in May, August, November
and February, after the quarterly IFRs are available.
5.5 COMMUNICATING WITH DEVELOPMENT PARTNERS: PROGRAM, TECHNICAL AND FINANCIAL ISSUES
Management officers of the HSSP Secretariat will be responsible for facilitating communication with
HSSP2 DPs including arrangement of meetings with MOH officials and technical departments, seeking
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information from MOH officials, technical departments, and PHDs/ODs as required by HSSP2 DPs,
facilitating HSSP2 DPs field trip supervision, facilitating policy decisions, and consolidating and
submitting regular required reports on implementation progress.
5.6 JOINT SUPERVISION MISSIONS
The timing of the joint implementation reviews of the Program by JPIG partners will align with MOH
planning and review cycles so as to maximize the goal of harmonization and alignment. A Program
launch workshop will set the stage for a clear understanding of the various arrangements, including
fiduciary aspects, by all IUs. The first review of each year will be undertaken in March to coincide
with the health sector JAPR during which a post review of accomplishments from the previous year’s
activities will be undertaken. The second review of the year will be carried out in September, when
the MOH appraises the sectoral AOP through the JAPA and adjusts, as necessary, the Plan to ensure
compliance with articulated priorities prior to submittal to the Royal Government for approval. The
JPIG partners will also attend the JQMs.
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CHAPTER 6. FINANCIAL MANAGEMENT ARRANGEMENTS
6.1 FINANCIAL MANAGEMENT MANUAL
The Program’s Financial Management Manual contains common financial management procedures,
rules, and regulations required to be observed by all IUs whether activities are financed from pooled
or discrete funds, and may be referenced for such details.
6.2 FINANCIAL MANAGEMENT IMPROVEMENT PLAN
Since 2005, the Ministry of Economy and Finance (MEF) has been implementing a comprehensive
Public Financial Management Reform Program (PFMRP) in support of the Government’s National
Strategic Development Plan (NSDP). A sector wide approach has been adopted with an overall
strategy being articulated and agreed to between the RGC and its key stakeholders, including
Development Partners.
The PFMRP utilizes a step wise reform methodology based on the so called Platform Approach. The
first stage has involved implementation of actions designed to improve Budget Credibility (Platform
1). During the April 2007 Annual PFMRP retreat, stakeholders agreed that good progress had been
made towards achievement of the Platform 1 goal of Budget Credibility, and further agreed to
commence planning for implementation of stage 2 (Effective Financial Accountability). The introduction
of Financial Management Improvement Plan (FMIP) in each line ministry therefore is a substantial
undertaking that is required to achieve the goals of Platform 2.
The MOH still has weaknesses at national and local levels in Financial Management procedures and
practices that may impact negatively on Implementation of HSSP2 and therefore need to be
addressed. To mitigate this risk and provide support to PFMRP Platform 2, the Directorate General of
Administration and Finance (DGAF) has started a concerted effort to improve its financial
management programs, practices and processes. One of these activities is the development of the
“Financial Management Improvement Plan (FMIP).” The FMIP identifies the DGAF’s highest priority
strategic goals and lays out the series of activities necessary to accomplish them. Key DGAF
executives, leaders and staff developed the plan in June 2008 in cooperation with the Department of
Planning and Health Information (DPHI), HSSP secretariat, and JPIG partners. Thus, the FMIP is a part
of the reform program, and aims at strengthening the MOH's financial management systems and
internal financial control systems based on an initial assessment.
The Program will support the objective of the FMIP in strengthening and building capacity at central,
PHD, OD, RH and other parts of the program within the current limitations in the financial management
system of the MOH in both financial management capacity of externally financed projects/programs,
and government’s existing public financial management system through its phased implementation
over the life of the Program.
6.3 EXTERNAL AND INTERNAL AUDITS
An Internal Audit Department (DIA) was established in the MOH two years ago, which presently has
approximately 30 staff. The Department reports to HE Minister of Health. Its work program will cover
activities of the Program which are aimed at strengthening systems and controls. As part of the
assistance provided under the Program, an International Adviser will be recruited three months after
effectiveness to build the capacity of the DIA. Staff will be trained in enhanced internal controls and
how to apply such techniques to the Program, and will provide their findings to the Program on a
semi-annual basis. The findings will be made available to the Program Director and HSSP2 partners
and will be discussed during the JQMs and the semi-annual Joint Supervision Missions. The Program
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Director/Coordinator will be responsible for ensuring that all recommendations from the internal audit
are implemented at various implementation levels.
For the purposes of an external financial audit, an independent audit firm, acceptable to the JPIG,
will be appointed by MOH by Program effectiveness. The firm will conduct continuous (quarterly), and
a year-end financial audit. The auditors will operate under extended terms of reference, and the
methodology shall include providing quarterly audits acceptable to all participating DPs which are
structured in such a way that every level of implementation is audited. The main focus will be on (a)
compliance with the relevant (SDG, HEF, MBPI, FM) manuals (b) verification of Interim Financial
Reports (IFRs); (c) due attention to fraud and corruption (ISA 240); and (d) physical verification of
assets, and a reasonable check on outputs achievement. The auditors will provide MOH management
and the JPIG with an opinion on compliance and integrity of a representative sample of expenditures
included in the IFRs and provide recommendations, if any, for improvements in internal controls. It is
expected that the auditors would highlight instances where acquittals are outstanding, and guide
MOH management in decisions on further release of funds to delinquent implementing agencies. The
IFRs shall be furnished to the JPIG within 45 days of the end of the quarter being reported on, and
the audit report of these IFRs will be provided for review within 90 days after its quarter end, prior
to submittal of the following IFRs. The annual financial statements and audit report shall be furnished
to the JPIG by June 30 of the following year.
An annual technical audit will be carried out by an independent firm or a team of consultants
contracted out and its timing determined in close collaboration with Program partners. Program
partners will jointly agree on the TOR and the selection process will be subject to the World Bank’s
prior review. Based on the outcomes of such audits, Program partners may jointly agree with the MOH
on any corrective measures considered necessary.
Program partners will, to the extent possible, refrain from initiating unilateral audits of Program
supported activities. In the event that a Program partner is required to conduct a special audit as part
of its supervision, it will, to the extent possible, advise other Program partners, and the MOH. The
RGC will offer all reasonable support to facilitate such special audits. The cost of such audits will be
covered by the initiating Program partner through separate arrangements.
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CHAPTER 7. PROCUREMENT PROCEDURES AND ARRANGEMENTS
7.1 GENERAL CONSIDERATIONS
As of the date of formulation of this HSSP2 Operational Manual, the Royal Government of Cambodia
has mandated that certain procurement activities (including tendering and evaluation of bids) under
Selected World Bank Projects are to be carried out by an International Procurement Agent (IPA).
Consequently, until such time as such a mandate is rescinded, the IPA will carry out the required
procurement activities on behalf of the Procurement Management Group (PMG). The mandate of the
IPA also requires adherence to the Royal Government of Cambodia’s Standard Operating Procedures
(SOP) for Externally Assisted Projects, and Procurement Manual. Changes/modifications in the IPA’s
mandate (if any) will be formally communicated to the MOH (by the Ministry of Economy and Finance)
and any amendments to the Operational Manual that arise as a result will be incorporated
accordingly.
7.2 PROCUREMENT PROCEDURES
The purpose of the following section is to provide a general overview of the procurement process
expected to be followed under the HSSP 2. It is not intended to be an exhaustive manual on
procurement.
In accordance with the agreements reached with the World Bank and other Development Partners
contributing to the pooled funds, all procurement under the HSSP 2 pooled funds will be conducted in
accordance with the World Bank’s “Guidelines: Procurement under IBRD Loans and IDA Credits” dated
May 2004, revised October 2006 (hereinafter referred to as “Guidelines), and “Guidelines: Selection
and Employment of Consultants by World Bank Borrowers” dated May 2004, revised October 2006
(hereinafter referred to as “Consultant Guidelines). For activities financed from the discrete donor
funds, procurement will be in accordance with the SOP and Procurement Manual. The Royal
Government of Cambodia’s SOP and Procurement Manual, subject to the stipulations listed in the
Annex to the Financing Agreement (FA), are the basic manuals governing the national competitive
bidding (NCB) and Shopping methods and procedures.. Copies of these documents are available in
the HSSP Secretariat and specifically with the Procurement Management Group.
All procurements of goods, works or services expected to be carried out in a particular financial year
are required to be covered under the budgets specifically indicated in the approved Annual
Operating Plan (AOP) for the year concerned.
The proposed procurements are also expected to be listed in the approved Procurement Plan for the
year concerned. In case where an eligible item requested for procurement is not covered in the AOP
or the Procurement Plan (for any reason whatsoever), it would have to be justified in writing (possibly
followed through by a re-allocation of budgets, and further approved by the Project Coordinator
/Project Director and the DPs/MEF) before actual procurement action can be initiated. Subsequently
the AOP and the Procurement Plan should be amended to include the items under consideration.
Modifications to the Procurement Plan may be required from time to time and therefore modifications,
if any, should be incorporated in the Procurement Plan every quarter. The Revised Procurement Plan
shall be forwarded to the DP for review/comments/approval.
7.2.1 PROCUREMENT OF GOODS
Goods procured under the HSSP 2 would primarily (but not limited to) include: office furniture, office
equipment, drugs, medical instruments and equipment, and vehicles.
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Contracts for goods estimated to cost more than US$100,000 shall be procured through the
International Competitive Bidding (ICB) method and the procedures set forth in the World Bank’s
Procurement Guidelines and will use the World Bank’s applicable Standard Bidding Documents.
Contracts for goods estimated to cost less than US$100,000 equivalent per contract may be procured
through the NCB method and the procedures, including standard bidding documents, set forth in the
Sub-decree 14 on Promulgating of the Standard Procedure for Implementing the World Bank and the
Asian Development Bank Assisted Projects dated February 26, 2007, and relevant provisions of the
Royal Government of Cambodia Externally Assisted Project Procurement Manual for Goods, Works and
Services, subject to the stipulations listed in the Annex to the FA.
Contracts for goods estimated to cost less than US$20,000 equivalent per contract may be procured
through the Shopping method and the procedures, including standard bidding documents, set forth in
the aforesaid Sub-decree and Procurement Manual.
Certain types of goods including drugs, vaccines, medical instruments and equipment, and vehicles
(including ambulances), estimated to cost less than US$100,000 equivalent per contract, may be
procured from UN Agencies such as World Health Organization, UNICEF, UNOPS, in accordance with
the provisions of paragraph 3.9 of the Guidelines.
Specialized drugs and vaccines such as for Dengue Fever and ARV drugs that are manufactured to
international quality standards by only a limited number of manufacturers may, with the World Bank’s
prior concurrence, be procured under the Limited International Bidding method.
Contracts for the replacement, on an emergency basis, of items of medical supplies and instruments
originally procured as part of the annual medical equipment kits package, and estimated to cost less
than US$200 per contract and not to exceed an aggregate amount of US$5,000 per Province over
the life of the Program may be procured through the Direct Contracting Method.
7.2.2 PROCUREMENT OF WORKS
Works procured under the HSSP 2 would, inter-alia, include construction and rehabilitation of Referral
Hospitals/Health Centres/Health Posts/OD Pharmacies/Training Centers/Other Health Facility
Buildings.
Contract for works estimated to cost more than US$300,000 equivalent per contract shall be
procured through the ICB method and the procedures set forth in the Guidelines and using the World
Bank’s applicable Standard Bidding Documents.
Contract for works estimated to cost less than US$300,000 equivalent per contract may be procured
through the NCB method and the procedures, including standard bidding documents, set forth in the
aforesaid Sub-decree and Procurement Manual, and subject to the stipulations listed in the Annex to
the FA.
Contract for works estimated to cost less than US$40,000 equivalent per contract may be procured
through the Shopping method and the procedures, including standard bidding documents, set forth in
the aforesaid Sub-decree and Procurement Manual.
Procurement of works through Community Participation (as defined in the Guidelines) is currently not
provided for in the FA. However, should special circumstances justify the need for use of these
procurement methods, special clearance will need to be obtained from the World Bank (or other
applicable DP) prior to undertaking such procurement.
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7.2.3. SELECTION OF CONSULTANTS
Consultant services are, inter-alia expected in the following areas: Civil Works Design & Construction
Supervision, External Independent Auditor, Financial Management, Procurement Management, Project
Management, Health Equity Funds Implementers and Operators, and Contractual Staff for Health
Service Delivery. Other services that may be required for institutional development, program
evaluations/surveys/assessments etc. will also be covered.
Services requiring hiring of firms would generally be procured through Quality-and Cost-based
Selection (QCBS) method.
Assignments of a complex or specialized nature meeting the circumstances described in paragraph
3.2 of the Consultant Guidelines may be procured through the Quality Based Selection (QBS) method.
Assignments estimated to cost less than US$50,000 equivalent per contract may be procured through
Selection Based on Consultants' Qualifications (CQS).
External Audit assignments may be procured through the Least Cost Selection (LCS) method. Other
assignments of a routine nature estimated to cost less than US$50,000 equivalent per contract may
also be considered for procurement through the Least Cost Selection (LCS) method.
Services for tasks under circumstances which meet the requirements of paragraph 3.10 of the
Consultant Guidelines may, with the World Bank's prior agreement, be procured through the Single
Source Selection (SSS) method.
Services requiring the hiring of individual consultants may be procured in accordance with the
provisions of Section V of the Consultant Guidelines, whereas Sole Source Selection of individual
consultants may be done only with the World Bank’s prior agreement and under the circumstances
described in paragraph 5.4 of the Consultant Guidelines.
Contractual Staff for health service delivery will also be hired under the procedures for selection of
individual consultants until such time that specific selection procedures, consistent with the Consultant
Guidelines and satisfactory to IDA, for hiring of these staff are developed and incorporated in the
Operational Manual.
Shortlists of consultants for consulting services estimated to cost less than US$100,000 equivalent per
contract may be composed entirely of national consultants.
Subject to such procurement being covered under the AOP, the procurement shall be carried out and
accounted under the applicable disbursement category of the Financing Agreement (FA) of HSSP 2.
The disbursement categories in the FA are:
Category
Number
1
2
3
4
Category Description
Service Delivery Grants
Health Equity Fund Grants
MBPI-related payments
Goods, Works, Services, Training, Operating Cost
Note: The above is not intended to be an exhaustive listing of all disbursement categories under the
HSSP 2 funding agreement(s) under the various discrete sources of funding.
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7.2.4 PROCUREMENTS
UNDER THE SUB-CATEGORIES OF
‘TRAINING’
AND
‘OPERATING COST’ (AND
OTHER SUB-
CATEGORIES EXCLUDING THE SUB-CATEGORIES OF GOODS/WORKS/CONSULTANT SERVICES)
Procurements of goods or services under the ‘Training’ sub-category or ‘Operating Cost’ sub-category
(or any other category other than the sub-categories related to ‘goods’, ‘works’ and ‘services’) shall
also be carried out in line with the procedures stipulated in the Royal Government of Cambodia’s SOP
and Procurement Manual. However the current mandate of the IPA does not cover procurement of
these items and therefore these will be carried out under the oversight of the PMG. Under the Training
sub-category, the common items anticipated for procurement, inter-alia are: Printing of
Documents/Posters/IEC Material/Procurement of T-Shirts, Caps, Banners, Buntings, Portfolio
Bags/Office Consumables/Translation Services/Production of Video Spots/Hiring of Venues for
Workshops. Under the Operating Cost sub-category, the common items are: equipment rental and
maintenance, vehicle operation, maintenance and repair, office rental and maintenance, materials
and supplies and utilities, media information campaigns and communications’ expenses, etc. While
procurements under the ‘Training’ category or ‘Incremental/Operating Cost’ category will not be
subject to the IDA’s Prior Review or Post Review, such procurements will be subject to review by the
auditors during audit of project financial statements and may be subject to DP scrutiny as part of the
Statement of Expenditures (SOE) Review.
Procurement of Services related to Broadcasting/Public Announcements etc on TV/Radio
/Newspapers may normally be carried out on the basis of Single Source contracting (with specific TV
and Radio Channels/Newspapers) keeping in view the specific nature of the broadcasting/public
announcement and target audience for such services. A competitive selection process may not be
appropriate for such services. However, it requires price quotations from the major broadcasting
agencies that meet the required coverage criteria to be approved by funding partners.
7.2.5 REQUISITION FOR PROCUREMENT
Request for initiation of procurement action for goods/works/consultant services shall be initially
prepared by the requesting department (either at the central, provincial or OD level). This request
must be received in writing and should include some basic information on the type of
goods/works/services required (as well as some basic information on quantity, basic specifications,
type of service etc). The authorized representative of the requesting department must sign the request
letter.
Based on the written request for purchase, the Procurement Requisition Form will be initiated and
completed by the appropriate section in the Program Secretariat (i.e. Program Management,
Administration, or Financial Management). The PMG may also initiate the procurement through use of
the Procurement Requisition Form.
The Procurement Requisition Form must clearly indicate the estimated cost and disbursement category
of the items being requisitioned for procurement.
The completed Procurement Requisition Form must be countersigned by all the officials (as indicated in
the form) and is required to be appropriately approved by the Program Coordinator and or the
Program Director.
Following completion of the signature process, each completed Procurement Requisition Form will be
provided with a Procurement Reference Registration by the PMG, to ensure that all required
procurements are carried out through the proper channels of the PMG.
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It will be the responsibility of the signatories to ensure that the item/s being requisitioned are eligible
for procurement under HSSP2 and meets the ‘fiduciary’ requirement for procurement under HSSP2.
7.2.6 METHODS OF PROCUREMENT AND PROCUREMENT THRESHOLDS
All procurements are required to be carried out in accordance with the provisions of the FA with the
World Bank, and the latest version of the Royal Government of Cambodia’s SOP for Externally
Assisted Projects and Procurement Manual as approved by the Royal Government of Cambodia and
issued through Sub-Decree. Unless otherwise amended, the following procurement thresholds will
apply:
Method of Procurement
International Competitive
Bidding
Limited International Bidding
National Competitive Bidding
Shopping With Advertising
Shopping Without Advertising
Direct Contracting
Method of Procurement
International Competitive
Bidding
National Competitive Bidding
Shopping With Advertising
Shopping Without Advertising
Community Participation
Table 5. Procurement of Goods
Threshold
All contracts estimated to cost above US$100,000
Only when specifically allowed under the Project’s legal
agreements or specifically non objected by the IDA and
MEF on an exceptional basis.
This method may be used when there only a limited number
of supply sources for the items concerned (e.g., ARV Drugs
Prequalified by WHO)
All contracts estimated to cost above US$20,000 and below
US$ 100,000
All contracts estimated to cost above US$5,000 and below
US$20,000
All contracts estimated to cost below US$5,000
Only when specifically allowed under the Project’s legal
agreements or specifically non objected by the IDA and
MEF on an exceptional basis
Table 6. Procurement of Works
Threshold
All contracts estimated to cost above US$ 300,000
All contracts estimated to cost above US$ 40,000 and
below US$ 300,000
All contracts estimated to cost above US$ 5,000 and below
US$ 40,000
All contracts estimated to cost below US$ 5,000
Currently not provided for in the World Bank FA for HSSP2.
Therefore can only be considered for use if specifically nonobjected by the IDA and MEF on an exceptional basis.
Table 7. Procurement of Consultant Services
Method of Procurement
Threshold
To obtain Expressions of Interest (EOI), advertisement/notification for a request for EOI for each
contract for consulting services shall be made in the national newspaper or in an electronic
portal of free access. In addition, all Consultant Procurement Contracts estimated to cost above
US$ 200,000 shall also be advertised in UNDB online and in dgMarket. All Consultant Contracts
must be advertised in accordance with the Consultant Guidelines.
Quality-Cost-Based Selection
All contracts estimated to cost above US$ 50,000
(QCBS)
Quality Based Selection (QBS)
Only for Contracts estimated to cost above US$ 50,000
(provided such complex or specialized assignments meet the
circumstances described in Para 3.2 of the Consultant
Guidelines
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Method of Procurement
Least Cost Based Selection (LCS)
Selection Based on the
Consultant’s Qualification (CQS)
Sole-Source Selection (SSS) –
Firm, and Single-Source
Selection (Individual Consultant)
Selection of Individual
Consultant (IC)
Threshold
Contract for external audit of HSSP 2 from Year 2010
onwards
All contracts below US$ 50,000
Only when specifically allowed under project’s legal
agreement (FA) and specifically non objected by the IDA
and MEF on an exceptional basis
For selection of Individual Consultants.
7.2.7 MINIMUM LEGAL REGISTRATION REQUIREMENT OF SUPPLIERS/CONTRACTORS/SERVICE PROVIDERS
All national suppliers/contractors/service providers (except Individual Consultants) who are engaged
for provision of Goods/Works/Services are required to be appropriately registered as a legal entity
with the applicable statutory authority. If no information is available (or made available after a
specific request is made) about the legal registration status of an agency, then such an agency should
not be considered for any contract even if their quoted price is the lowest.
All international suppliers/contractors/service providers (except Individual Consultants) are required
to be appropriately registered as a legal entity in their respective country of origin. If no information
is available (or made available after a specific request is made) about the legal registration status of
an agency, then such an agency should not be considered for any contract even if their quoted price is
the lowest.
7.2.8 GENERAL RESPONSIBILITIES OF PROCUREMENT MANAGEMENT GROUP
According to the current arrangement, the IPA will be responsible for carrying out all procurement
contracts financed by IDA and the Procurement Management Group (PMG) will be responsible for
preparation of the Procurement Plan, detail specifications, and monitoring of contracts. However,
subject to the possible change of the procurement arrangement at MOH as indicated in the letter from
MEF dated 15 December 2008, the text outlines that the PMGs will be applied only for all
procurement of IC, hiring of NGO, Direct Contracting, SSS, Procurement of goods estimated to cost
less than US$50,000, and Procurement of works estimated to cost less than US$100,000.
The general responsibilities of the PMG include:
• Prepare the Program’s general procurement notice (GPN) updating it on an annual basis, and
submitting it through the Program Director/Program Coordinator for national and
international publication.
• Collate by area of expertise all expressions of interest received in response to the GPN.
• Quantify the goods works and services required by the Program.
• Group the goods works and services required into packages so that they will attract the
maximum of competition
• Prepare the overall Program procurement plan.
• Update the overall Program procurement plan at the end of each month.
• Prepare specific bidding documents, using agreed standard bidding documents.
• Prepare and issue through the Program Director/Program Coordinator specific procurement
notices
• When the DP’s prior review of the bidding document is required, submit the document through
the Program Director/Program Coordinator to the relevant DP for its review and ‘no
objection.’
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•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Distribute copies of the Invitation for Bids to all relevant firms that expressed interest in
response to the General Procurement Notice.
Distribute the bidding documents to all firms purchasing the same.
Through the Program, acting as purchaser/client/employer to receive and respond to all
clarification requests received during the bidding period.
Ensure that the venue for bid opening is adequate and that all logistical arrangements are in
place.
Receive all bids and proposals ensuring their secure storage.
With the supervision of Program Director/Program Coordinator undertake the public opening
of bids.
Review and pass all bid securities to the Financial Officer for secure storage, recording
amounts and validities ensuring that validities do not expire prior to notification of award and
requesting extensions as and when required.
Under the guidance of the Procurement Review Committee undertake preliminary evaluation
of all bids and proposals received.
Facilitate with the assistance of the Technical Officer and any other available resources such
as consultants, the technical evaluation of all bids and proposals received.
Through the Program Director/Program Coordinator seek clarifications to bids and proposals
as required to complete the evaluation
Draft the Bid Evaluation Report for review and approval by the Procurement Review
Committee
Respond, through the Program Director/Program Coordinator, to any queries raised on the
evaluation report from oversight agencies or DPs.
Draft contracts in accordance with the recommendation for award contained in the ‘no
objection’ evaluation report and in the case of consultants services, in accordance with the
minutes of contract negotiation.
Ensure that the relevant oversight agencies are provided with copies of contracts and in the
case of prior review submitting copies of draft contracts to the reviewing agency with a
request for ‘no objection’.
Issue the notification of award to the winning bidder/consultant/contactor requesting the prerequisite performance and advance payment securities.
With the assistance of the Financial Officer draft the documentary requirement for any letter
of credit to be issued in favor of a supplier/contractor/consultant.
Monitor, with the support of the Technical Officer and any other resources available such as
consultants, suppliers/contractors/consultants performance against the contract.
Review all payment requests received from a supplier/contractor/consultant confirming (or
otherwise) that the contractual payment is due, obtaining validation and approval of the
payment request as necessary, and confirming that the conditions of contract triggering the
payment have been met.
Ensure that either the performance security or retention monies are in place to adequately
protect the Government for the period of the supplier’s warranty period, or a contactor’s
defects liability period.
In the event that the period for contractual performance is extended or the amount of the
contract changed, ensure that any performance securities held are amended to reflect the
change in the conditions of the contract
Ensure that all performance securities and retention monies are passed to the supplier or
contractor upon the satisfactory expiry of their contractual obligations.
Act as Secretary to the Procurement Review Committee.
Compiling pre and post contract files in accordance with RGC’s Procurement Manual
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Larger Programs with significant amounts of procurement may include one or more procurement
assistants. The procurement assistant is to work under the direct supervision of the Procurement
Adviser/Chief Procurement Officer and provide assistance with the tasks set out above as directed by
the Chief Procurement Officer.
7.2.9 CONTRACT SIGNING AUTHORITY THRESHOLDS
All contracts valued at US$50,000 or less can be signed by the Program Coordinator as the
authorized representative of HSSP2.
All contracts valued at over US$50,000 must be signed by the Program Director as the authorized
representative of HSSP2.
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CHAPTER 8. INDIGENOUS PEOPLES SAFEGUARDS AND REPORTING
8.1 INDIGENOUS PEOPLES’ PLANNING FRAMEWORK
HSSP2 is expected to have a positive impact on the lives of people throughout Cambodia by
improving their access to, and utilization of, effective and efficient health services. Since the Program
will be supporting activities nationwide, it will affect ethnic minorities. Accordingly, the Program will
be implemented in a manner consistent with World Bank Operational Policy on Indigenous Peoples
(OP 4.10), which is designed to ensure that indigenous people are afforded opportunities to
participate in, and benefit from, the Program in culturally appropriate ways. The policy requires that
a process of free, prior, and informed consultation be undertaken with the affected indigenous
peoples’ communities, and that such consultations establish that there is broad community support for
the Program.
HSSP2 builds on the earlier HSSP1 Project, for which a social assessment was undertaken and for
which an Ethnic Minorities Development Strategy (EMDS) was prepared. Though similar in most
respects, HSSP2 extends Program coverage to predominantly ethnic minority provinces (Mondulkiri
and Ratanakiri) previously covered under the Project as part of other donors’ projects. Also, HSSP1
was prepared under an earlier Bank policy pertaining to indigenous peoples (OD 4.20).
To ensure compliance with OP 4.10 for HSSP2, a two step consultation process was designed. The first
step of this consultation process was completed during Program preparation, and the second step will
take place during the first year of Program implementation. This Indigenous Peoples Planning
Framework (IPPF) has been prepared to guide the consultation process. In short, the IPPF will help to
identify health care priorities and constraints in ethnic minority communities, and to ensure that
Program designs and targeted health care improvements are culturally appropriate and inclusive in
both gender and intergenerational terms. The consultations are designed to be consistent with the
newer OP 4.10 requirement that consultations be “free, prior and informed,” and are the method of
assessing whether there is broad community support for the Program.
8.2 PROGRAM IMPACT ON INDIGENOUS PEOPLES
Previous studies, including a social assessment undertaken for the preparation of HSSP1 have shown
that ethnic minorities face particular challenges in accessing health services and tend to be particularly
vulnerable to poor health. Many minority groups live in rough-terrain highland and border areas that
are hard to reach, and are generally poorer than average. The sheer physical geography of these
settings poses special challenges, as well as costs, in terms of accessing, providing and maintaining
health care services. Geographic isolation coupled with language and cultural barriers, and generally
poorer human development indicators, make reaching these groups a particular challenge.
The RGC recognizes the Hill Tribes and the Khmer Cham as Cambodian minorities. The Hill Tribes are
mainly concentrated in the northeastern provinces, where they comprise the majority of the population
in both Ratanakiri (66%) and Mondulkiri (75%) and less than 10% in the adjoining provinces of Kratie
and Stung Treng. The Cham, who speak Khmer, constitute about half of the ethnic minority groups and
are widely distributed throughout the country. The Cambodian definition of ethnic minorities does not
include Vietnamese, Chinese and other groups who are considered “migrants,” even though they have
lived in Cambodia for generations. With a wider definition of “ethnic” groups also including Cham,
Lao, Vietnamese and Chinese, the proportion of ethnic minorities is approximately 6%. Many of the
Vietnamese are fishermen living along the rivers and on the Tonle Sap Lake, while artisans and
traders are found in all large towns.
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The hill tribes in Mondulkiri and Ratanakiri are among the poorest groups in the country.1 Literacy
rates in these provinces are less than one third of the national average. Women are even less likely to
be literate or to speak Khmer. This creates extra barriers for women, who have a high need for
reproductive health, birth-spacing, and child health services. Furthermore, infant and child mortality
are particularly high in this easternmost region of the country. The percentage of infants reported
smaller than average is 26.6% in Mondulkiri and Ratanakiri, compared to 14.5% for the nation as a
whole.2
In general, health indicators for ethnic minorities are low compared to the rest of the country, although
it is difficult to develop an accurate understanding of health status as Cambodia does not collect
disaggregated data by ethnicity. Statistics on ethnic groups are scarce and mainly based on
estimates.3 Key constraints identified by ethnic minorities in accessing health care include:4
•
•
•
•
•
Poor physical access to health services: Only a third of Cambodians live within 10 km or a twohour walk of a public health centre. The situation is worse in the remote northeast areas, home
to many ethnic minorities, where the population is relatively small but dispersed over a large
area. Many minority groups live in remote highland areas with rough-terrain highland which
makes both access and provision of health services challenging.
Costs are unaffordable: High out of-pocket expenses are for many Cambodians unaffordable
and impoverishing. Given that poverty rates tend to be high among ethnic minorities, costs are
particularly unaffordable for these groups. As health costs can be large and involve
unforeseen expenses, many families find they do not have enough money to pay for the care
they need.5
Health workers absent from facilities and poor quality services: Absent health workers, limited
opening hours and generally poor quality services make health facilities a less desirable
option, offering low-value for money, and wastes scare household resources.
Health workers are not from local communities: In cases when health workers are not from the
local communities, language can become an issue as different ethnic groups speak different
languages and thus have a hard time communicating. Also, cultural difference may reduce
trust in the health workers and the health workers may have a weak understanding of the
communities’ cultural norms and practices, and vice versa.
Lack of participation in health development: Limited indigenous community participation in
designing and making decisions about health care may result in the health care offered not
fully reflecting the communities’ needs, and limit the communities’ ownership of the health
services being offered.
In addition, consultations with indigenous peoples’ communities in Ratanakiri, Mondulkiri and Kratie
provinces as part of HSSP2 Program preparation identified the following:
•
•
•
Maternal and child health are key areas of need.
Communicable diseases such as HIV, TB and malaria are areas of concern, and there is a
general sense that not enough information is available about these diseases or their
prevention.
Non-communicable diseases and injuries are also important areas of concern, with a particular
emphasis on injuries sustained by men working in mining or commercial logging activities.
HSSP2 aims to ensure improved and equitable access to essential health care and preventive services.
The Program is national in coverage and the target beneficiaries are mothers, children, and the poor,
but the Program is envisioned to improve access to health care for all Cambodians. Given the
For more information see, Report on the Health Status of Ethnic Minorities in Cambodia. Helen Pickering. DFID Health
Systems Resource Centre. 2002. The report was commissioned as input to the design of HSSP1.
2 In-Depth Analysis Report on the 2005 Demographic Health Survey for Cambodia. Kingdom of Cambodia. December
2007.
3 Reproductive Health of Ethnic Groups in the Greater Mekong Sub-region. UNFPA. 2008.
4 Health Sector Support Project. Ethnic Minorities Development Strategy. World Bank. 2002.
5 Study on Ethnic Minorities and Access to Health Care in Kratie Province, Cambodia. Partners for Development. 2002.
1
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Program’s focus on maternal health, women of reproductive age in particular are expected to benefit
from the Program. By extending the health network, the Program is also envisioned to have a positive
impact on ethnic minorities who tend to live in remote areas with limited access to services.
Program financing will be used to support the development of the health sector in areas that are
home to ethnic minorities, including Mondulkiri, Ratanakiri, Stung Treng and Kratie as well as other
areas in the country. When non-ethnic minorities live in the same area with ethnic minority, the
Program will attempt to avoid creating unnecessary inequities between poor and marginal social
groups.
The Table below gives a preliminary picture of how the Program will address key constraints
identified in earlier consultations with ethnic minorities. The approach, however, will likely differ in
different locations reflecting the particular needs and challenges facing the different ethnic groups (as
determined, in part, through the participatory stock-taking exercise to be undertaken in the first year
of implementation).
Table 8. Proposed Program Responses to Key Constraints of Ethnic Minorities
Constraints
Identified by
Ethnic minorities
Remedial Measures
Proposed by
Stakeholders
Program Plans in Mondulkiri , Ratanakiri, Stung Treng and
Kratie and other areas where large populations of ethnic
minorities live
Physical access.
Introduction of health
posts and/or mobile
services.
Health posts, and flexibility for health service providers to
design appropriate outreach services which are likely to
include mobile services (such as motorbike and boat). Access
can also be improved by creating a communication network
via radio between the Health Center and remote villages in
the catchment area.
Costs are
unaffordable.
Ensuring that the
poor are not
charged.
Options under consideration include health service providers
obliged to either provide completely free services, or
introduce equity funds to exempt the poor. The Program
plans to scale-up equity funds to cover increased proportion
of the poor population.
Lack of
Indigenous
participation in
community
health development. participation in
designing and
making decisions
about primary
health care.
Research will form the basis for participatory local health
planning and monitoring. In some areas, research on health
seeking behavior and local perspectives has already been
undertaken (such as Mondulkiri, Stung Treng, and Ratanakiri)
and the Program will utilize this information in its design. In
other cases, new research may have to be conducted. Health
service providers are obliged to foster and support
community participation in planning and monitoring service
delivery. Frameworks for community participation are
already in various stages of operation, and the Program
should incorporate lessons from this work into Program
design.
Health workers
absent from
facilities.
Strategy to retain
health workers in
highland areas.
MOH will introduce management and quality improvements
and financial incentives for good performance. Program will
support nurse and midwife training of indigenous people.
Health workers are
not from local
communities.
Recruiting personnel
from local
communities.
Development of a primary nurse and midwife training course
tailored to the needs local communities. Targeted recruitment
from local communities.
Poor quality
services.
Health workers
trained to offer
MPA.
Training in specific modules of MPAs based on needs
assessment.
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HSSP2 Operational Manual
Constraints
Identified by
Ethnic minorities
Remedial Measures
Proposed by
Stakeholders
Program Plans in Mondulkiri , Ratanakiri, Stung Treng and
Kratie and other areas where large populations of ethnic
minorities live
Language and
cultural barriers
Strategy to provide
culturally
appropriate
information and
services
Develop behavior change communication strategies and
outreach materials that take into account the specific needs
of ethnic minorities. Consider using local translators in health
facilities, and during outreach activities.
Similar to HSSP1, two approaches will be taken to address social development issues: targeted
assistance and mainstreaming. The Program will target primary stakeholders by:
(i)
(ii)
(iii)
strengthening health services in particularly poor and disadvantaged geographical areas to
increase access affordability and quality;
introducing social protection measures to safeguard the most vulnerable from the cost of
health care; and
supporting national health programs that most benefit the poor and disadvantaged.
With regard to mainstreaming, the principles of client-centeredness, pro-poor, social inclusion, gender
equality, and stakeholder participation will be mainstreamed through the Program’s support to sector
reform and institutional development.
The Program will build particularly on earlier activities in Mondulkiri and Ratanakiri (which were more
intensive than in Kratie and Stung Treng). The Program’s institutional development activities will
strengthen capacity for lesson learning across the sector, and this will be particularly relevant for
replicating good practices vis-à-vis ethnic minorities.
8.3 SOCIAL ASSESSMENT UNDER HSSP2
A social assessment was conducted for HSSP1, informing preparation of the Ethnic Minority
Development Strategy. The social assessment has been updated for HSSP2, to reflect modifications to
program objectives and procedures, as well as changes in the Cambodian regulatory framework and
DP policies. The updated social assessment takes into account consultations with MOH officials,
Development Partners and NGOs (such as MEDICAM); recent analytic work on equity, gender issues
and ethnic minorities; evaluations and monitoring of HSSP1; and analytic work commissioned for
HSSP2, including a study analyzing the health situation of ethnic minorities in Cambodia, and a more
targeted study of health seeking behaviors and constraints accessing health services of ethnic minority
groups in selected areas. Both these studies included consultations with and visits to ethnic minority
communities. In addition, consultations with selected indigenous people’s communities were undertaken
during Program preparation. These consultations were “free, prior and informed,” and demonstrated
that broad community support exists for the Program.
8.4 INSTITUTIONAL ARRANGEMENTS FOR IPPF
The Program’s institutional development activities will strengthen capacity for lesson learning across
the sector, and this will be particularly relevant for replicating good practices vis-à-vis ethnic
minorities. Integrated into the institutional development and capacity building activities of the Program
are measures to enhance attention to, and the inclusion of ethnic minority concerns. The mainstreaming
of safeguards across the sector is necessary to support the targeted interventions in the four
northeastern provinces, but also to capture and respond to the interests of vulnerable ethnic minorities
living in other parts of the country. Pathways for mainstreaming are:
(a)
Strengthening the social assessment capacity of the MOH;
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HSSP2 Operational Manual
(b)
Improving delivery of appropriate targeted information and behavior change
communication;
(c)
Local ethnic minority participation in designing and monitoring health development
plans;
(d)
Monitoring, evaluation and the annual sector review process; and
(e)
Human resource development.
Language differences are a significant barrier to health care access for ethnic minorities. Lack of
information and educational materials in the languages of ethnic minorities is a major constraint to
health education and promotion. The Program will through its support for key national programs6
ensure that behavior change communication (BCC) strategies and materials take into account the
specific needs of ethnic minorities, and that communication approaches and materials are developed
that are appropriate for the needs of target minority groups. This will require increased
understanding of the health beliefs that influence ethnic minorities in order to design appropriate
materials. NGOs are already using a range of BCC approaches and materials in their work with
ethnic minorities, and this is an important resource that needs to be better used by MOH. Where
appropriate, consideration will need to be given by MOH and PHDs to sanctioning the use of local
translators in health facilities, and during outreach activities.
Participation of ethnic minority communities will be encouraged through the development of more
participatory planning and monitoring processes at local, district, provincial and the national level. The
Program will support the MOH’s efforts to strengthen the planning process to be more responsive and
participatory. This will include strengthening the participation of a diverse range of the community,
including ethnic minorities, and undertaking an analysis of the health situation and needs of the
catchment population at the local level. NGO participatory planning experience is valuable and
provides examples of workable methodologies in Cambodia that could be adapted and scaled up.
The presence of NGOs in particularly disadvantaged areas working with difficult to reach social
groups, such as ethnic minorities is also a resource for local health managers.
The MOH is committed to increasing the participation of all sections of society in monitoring services as
a means of enhancing public accountability. The Program will support this objective by undertaking
research to inform the design of participation mechanisms, developing mechanisms in consultation with
target social groups, and monitoring the effectiveness of different forms of consumer participation. In
all of this work, attention will be given to ethnic minority groups and communities.
In the four northeastern provinces, participatory approaches are likely to take different forms than in
the rest of the country where ethnic minority populations are less concentrated. To raise the profile of
ethnic minorities in planning and monitoring processes throughout the country, the planning and
monitoring frameworks will include specific questions on ethnic minorities, training to implement the
revised methods will include attention to the health of ethnic groups and methods to promote their
inclusion, and guidelines for establishing consumer participation will include representatives of ethnic
minorities where they are present in the local population.
8.5 MONITORING AND REPORTING ARRANGEMENTS
The Program will assist the MOH reform of sector wide M&E to include civil society participation in the
process, and to address social variables such as ethnicity and gender. As part of Program mid-term
review and final evaluation, social issues (including social safeguard issues such as indigenous peoples
and resettlement) will be reflected. Annual reviews of sector performance will aim to disaggregate
National Programs include: Maternal and Child Health Program, including reproductive health, immunization, child
health and newborn care, and nutrition; Communicable Disease Program, including HIV/AIDS, tuberculosis, and
malaria; and Non-communicable Diseases Prevention Program.
6
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HSSP2 Operational Manual
achievements in accessibility, public and client satisfaction, and health utilization by ethnicity, as well
as by gender, as this would significantly increase knowledge on the health and access to health care
of ethnic minorities. The Program will support capacity building within the MOH to better gather,
analyze and use data disaggregated by sex and ethnicity.
8.6 DISCLOSURE ARRANGEMENTS
The MOH will make the social assessment report and draft IPPF available to the affected Indigenous
People’s communities in an appropriate form, manner, and language.
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CHAPTER 9. GENDER SAFEGUARDS AND REPORTING
The Program will support the Gender Mainstreaming Strategic Plan of the MOH (2006-2010), and is
committed to mainstream gender concerns. It will attempt to ensure that the health system takes into
account the cultural and biological differences between men and women. It will support a variety of
interventions and reforms that will benefit both women and men, including efforts to increase
affordability and access to health services. In addition, the Program will introduce a number of
changes that will target women specifically. Examples of targeted support include:
•
Implementation of the MPA will significantly increase access to reproductive health services for
women of reproductive age.
•
Training a significant number of women health workers, to ensure that women are adequately
represented in the health system. Female heath workers will be trained in the MPA and CPA,
to ensure that more women can be attended to. Nurses and midwifes will be recruited and
trained.
•
Equal opportunity for women to receive training is essential and the Program will ensure that
women will receive training at least in proportion to their numbers in health system, with the
ultimate goal of at least 40% of trainees being women.
•
Institutionalize a gender-disaggregated M&E system.
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CHAPTER 10. ENVIRONMENTAL SAFEGUARDS AND MANAGEMENT
10.1 ENVIRONMENTAL REVIEW AND MANAGEMENT PLAN
The intent of an Environmental Management Plan is to recommend feasible and cost-effective
measures to prevent or reduce significant adverse impacts to acceptable levels. For purposes of the
HSSP2 for which environmental impacts are expected to be limited gauging from the HSSP
experience, particular attention will be given to outlining best management practices and design
measures which should be put in place to ensure that environmental impacts are minimized during civil
works activity and that human health and environmental concerns are fully addressed on an ongoing
basis during Program implementation. Best management practices and mitigation measures are
detailed by activity in the following sections.
10.2 HEALTH CARE FACILITY CONSTRUCTION AND REHABILITATION
Although health care facility construction and rehabilitation to be undertaken as part of the HSSP2
does not require environmental assessment, best practices will still be followed to avoid potential
adverse environmental impacts. Environmental checklists developed by the SFKC and the Ministry of
Environment provide a comprehensive basis for identifying any environmental impacts of civil works
projects. The SFKC’s Checklist of Likely Environmental Impacts Arising From School and Health Care
Projects will be used/adopted during the design stage for each referral hospital and health center
planned under the HSSP2. The checklist covers:
• Environmental effects related to Program location and design including natural habitat and
wildlife, land use and settlement, drainage, water quality, traffic congestion, noise, and health
and safety, and
• Environmental effects related to Program construction/operation including natural vegetation,
land use and settlement, health and safety, drainage pattern, water quality, noise and dust,
and traffic congestion.
Available preventive and mitigation measures for potential negligible and moderate impacts include:
• Design consideration in health centers and hospitals to ensure that adequate water system,
incineration and wastewater treatment system are included in the design and construction
package. This approach has been found and proven to be effective under the first phase and
therefore should be continued in the second phase
• Consultation with the local community regarding site selection
• Design specifications that provide for minimization of disruption of natural vegetation and
terrestrial and aquatic habitats
• Design modifications for flood prone areas
• Supervision and monitoring of construction (e.g., restricting work to daylight hours, limiting
noise and dust emissions, safe traffic control, occupational health and safety).
• In areas where old and derelict buildings or existing health care facilities are being removed
for the new construction or refurbished the site should be cleaned and decontaminate before
any construction starts.
• Appropriate waste disposal plan should be identified and implemented where hospital or
hazardous waste exists.
• In case required appropriate protective gear should be provided for the construction workers
to ensure their health and safety while working at the health care facility construction. This
may specially be an issue of relevance for areas where the new construction or refurbishing is
to take place in old and derelict health care facility sites or within the compound of an
existing health care facility; and
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HSSP2 Operational Manual
•
In areas where construction is to take place within an existing health centre or hospital
compound appropriate measures must be taken to ensure minimum disturbance and impact to
the hospital. This could be in the form of enclosures for the construction site, low noise, vibration
and smoke producing machines. The construction plan should also be discussed with the health
care facility management to ensure minimum disturbance.
10.3 ASBESTOS
Potential risks associated with fiber-concrete building materials containing asbestos will be considered
in planning health care facility rehabilitation. Recommended mitigation measures to avoid or minimize
occupational health risks associated with asbestos exposure are:
• Survey of all building structures (i.e., both existing health care facility and buildings to be
demolished before any new construction) by qualified and experienced building inspectors to
determine whether asbestos is present in structures.
• Adherence to best practices to ensure construction worker protection during renovation and
demolition activities. Occupational exposure can be avoided by controlling dust emissions and
through use of effective respiratory protective equipment.
• Workers involved in asbestos removal should be properly trained.
• Ensuring that demolition waste is disposed of at secure landfills or handled by a reputable
hazardous waste management facility.
• Prohibiting procurement of asbestos-containing building materials, and
• Close supervision and monitoring of all demolition and construction activities.
10.4 DRINKING WATER QUALITY
Ensuring the safe supply of water to health care facilities as part of the HSSP2 is of paramount
concern. Microbial water quality represents the most serious human health threat in Cambodia with
infectious diseases caused by pathogenic bacteria, viruses and protozoa or by parasites representing
a common and widespread health risk associated with drinking water. Microbial water quality is of
most concern for untreated surface waters and shallow groundwater obtained from open wells – hand
pump wells commonly used to tap aquifers at depths of greater than 15m are generally considered
to provide water that is safe from a biological perspective, if the wells are properly drilled and
maintained.
Available water quality data indicates that chemical water quality, particularly for surface waters, is
generally very good in Cambodia, but that groundwater in certain areas of the country contains
levels of chemicals that could pose problems for human health. The most important of these chemicals
is arsenic which has been found to exceed the WHO’s recommended limit of 10 µg/l in some HSSP2
provinces – most notably Kampong Thom and Kratie. Although water chemistry sampling has yet to be
undertaken in all HSSP2 provinces, elevated arsenic levels are predicted for Krong Pailin and Preah
Vihear based on geological evidence.
Based on available information on groundwater arsenic levels in the provinces, a water quality
monitoring program will be included as part of Program implementation to confirm that water supply
to health care facilities will meet WHO guideline values – particularly for microbial quality and
arsenic content. Although data exist for some of the rural communities to be served by the health care
facilities, the high spatial variability of groundwater arsenic necessitates that drinking water supply
be tested at all existing and planned health care facilities as the only certain way of determining its
potability. Routine follow up monitoring of water supply will also be undertaken to ensure that water
continues to meets drinking water guidelines. Provision of simple testing kits and delivery of basic
training to MOH and PHD staff will enable their involvement in monitoring of water quality on an
ongoing basis.
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Available mitigation and remedial measures to ensure microbial quality of surface waters include
(WHO, 1993):
• Pre-treatment of surface waters through impoundment in reservoirs. Microbial quality can be
improved considerably as a result of sedimentation and the effect of ultraviolet content of
sunlight.
• Use of slow sand filtration or an activated carbon system are simple and effective methods
for removing pathogenic bacteria, viruses, and parasites.
• Disinfection, typically through chlorination, provides an effective barrier to transmission of
waterborne bacterial and viral diseases.
Available mitigation and remedial measures when high arsenic levels are found in drinking water
sources include:
• Investigate possibility of digging deeper wells to access groundwater from below alluvial
areas. Hand pump wells are typically 30m deep compared to deep aquifers at 70-120 m
depths.
• Extending water supply to health care facilities from proven water sources such as municipal
water systems or pumping from other safe wells.
• Substitution of alternative low-arsenic sources of drinking water such as rainwater or potable
surface water where available and appropriate. Alternative water supplies such as surface
water should be tested to ensure compliance with drinking water guidelines (e.g., microbial
water quality).
• Segregation of water use within health care facilities. Water containing elevated arsenic is
reserved for non-drinking purposes such laundry and sanitary uses. Water from safe wells,
surface water sources or bottled water purchased from commercial suppliers is used exclusively
for consumption by patients and health care facility staff, and
• Treatment of water supply to remove arsenic. Considered the least preferable option due to
installation costs and high maintenance requirements.
10.5 HEALTH CARE WASTE MANAGEMENT (HCWM)
Guidelines have been developed by the MOH for use by health care facilities in handling and
disposal of health care waste. These guidelines are intended to supplement WHO’s comprehensive
HCWM guidelines (WHO, 2000; 1999a) and focus on practical aspects of safe hospital waste
management, including waste minimization, collection, segregation, storage, transportation, and
disposal. Additional guidelines on injection safety have also been developed by the MOH to provide
specific guidance to facilities on the distribution, use, collection and safe destruction of disposable
syringes and safety boxes. Feedback from WHO and UNICEF safe injection experts obtained in
completing the Environmental Review indicated that the guidelines reflect best practices, but that
attention should be given to ensuring their proper application by health care facilities. Recommended
follow up activities in support of HSSP2 implementation by the MOH include detailed review of both
sets of guidelines to ensure that they are consistent with WHO guidelines, and that additional
technical content be added as required. Capacity building will also be provided to health care
facility staff under the HSSP2 to build awareness of occupational health and environmental risks
posed by health care waste, and to increase knowledge of best management practices.
Notwithstanding the availability of HCWM guidelines, it is apparent that there is considerable scope
for adopting more rigorous HCWM practices in health centers and referral hospitals. Of particular
concern is uneven application of guidelines regarding proper waste handling and disposal. To
address this weakness capacity building will be provided to improve site-specific waste management
practices at health care facilities. Capacity building will comprise both training and technical support.
Training in best health care handling and disposal practices is expected to create more awareness of
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HSSP2 Operational Manual
HCWM issues and foster responsibility among health care facility staff in an effort to prevent
occupational exposure to hazardous health care waste. Training materials will be drawn from WHO’s
(Pruss and Townsend, 1998) Teacher’s Guide on Management of Wastes from Health Care Activities
and the MOH’s own HCWM and injection safety guidelines. Training will be provided to all health
care facility staff – both health care personnel and auxiliary and support staff. Recognizing that
sustaining adequate waste management practices at health care facilities ultimately depends on
auxiliary staff, waste management responsibilities will be clearly defined and linked with
performance based M&E.
Adequate waste handling and disposal infrastructure and management systems will be put in place at
health care facilities. A standard HCWM package intended to improve health care waste handling
at health care facilities will encompass: (i) color-coded waste plastic bags and containers; and (ii)
safety boxes for disposal of syringes. Additional assessment of available health care waste disposal
options is required before finalizing recommended disposal practices. Preliminary findings of the ER
suggested that incineration and disposal to landfills are preferred disposal options. However, it is
necessary to fully evaluate the appropriateness of all disposal strategies within the context of the
overall HCWM in finalizing guidance to health care facilities concerning best practices. The
segregation of waste at source to minimize mixed waste must be practiced as it would improve the
waste disposal system. Therefore, an appropriate system and management will be put in place to
ensure waste segregation at the point of generation itself.
Safe disposal practices for wastewater as specified in the MOH’s Waste Management Guidelines will
be followed in handling of sanitary wastes from health care facilities. Specific mitigation measures to
ensure environmentally-safe disposal of wastewater from health care facilities are also described in
WHO (1999a). Recommended practices include:
• Where possible, hospitals should be connected to municipal WWTP.
• Hospitals that are not connected to municipal WWTP should install compact on-site sewage
treatment (i.e., primary and secondary treatment, disinfection) to ensure that wastewater
discharges meet applicable permit requirements.
• Health care facilities in remote locations should provide for minimal treatment of wastewater
through affordable means such as lagooning; the system should comprise two successive
lagoons to achieve an acceptable level of purification, followed by infiltration of the effluent
to the land.
• Sewage from health care facilities should never be used for agricultural or aquacultural
purposes.
• Sewage should not be discharged into or near water bodies that are used for drinking water
supply or for irrigation purposes (i.e., infiltration to soil must take place outside of the
catchment area of aquifers).
• Convenient washing and sanitation facilities should be available for patients and their
families, and health care facility staff to minimize the potential for unregulated wastewater
discharge, and
• Where septic tanks are used for the treatment and disposal of toilet waste it should be
ensured that the septic tanks do not leak and appropriate management systems are identified
for them. The septic tanks should also be of appropriate size to handle all the waste they are
supposed to receive.
10.6
PESTICIDE MANAGEMENT
AND
MONITORING PLAN
The intent of this Pesticide Management and Monitoring Plan (PMMP) is to summarize mitigation
measures and best management practices with a view to minimizing or avoiding any potential
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HSSP2 Operational Manual
adverse human health or environmental effects that have been identified for malaria and dengue
vector control programs to be funded under the Program.
Recognizing that all pesticides are toxic to some degree, it is paramount to ensure that proper care
and handling practices form an integral part of any program involving their use. In formulating
management practices, it is necessary to take into account both the nature of the pesticides being used
(i.e., their formulation and the proposed methods of application) and any existing safeguards that
have been incorporated into programs to address potential occupational safety and environmental
concerns. Guidelines and training materials have already been developed for both malaria and
dengue programs in Cambodia, and few improvements are considered necessary to ensure the
continued safety of these activities. Existing best management practices and recommended
enhancements are detailed in the following sections by activity.
10.6.1 DENGUE
Larviciding programs inherently pose fewer occupational health and environmental risks due to the
pesticide formulations used, their controlled application, and the lower potential for exposure of
health care workers involved in program implementation. Notwithstanding these factors, extensive
safeguards have been developed by the National Malaria Center (CNM) and WHO to minimize or
avoid potential human health and environmental problems.
Dengue programs undertaken in Cambodia are scheduled to coincide with the peak transmission
period occurring during the rainy season. Two applications of Temephos are made each year in
targeted provinces; in May-June, and repeated in July-August. In preparation for field distribution,
approximately 160 metric tons of Temephos is procured annually by the MOH for use in dengue
programs. Purchased Temephos is securely stored in a government warehouse until immediately prior
to program implementation at which time casual workers are employed to pre-package the granular
product into 20g satchels. Pre-packaging is intended to facilitate field activities (i.e., addition of a
20g satchel of Temephos to a standard 200 liter water jar or two satchels to the alternative 400 liter
container size provides the required dosage), and to increase the efficacy of the chemical when
placed in water containers. Although some safety precautions (e.g., children are not allowed to be
involved or to be present) are taken in the packaging of Temephos, these safeguards will be
strengthened to address potential occupational health concerns. Specifically, strict precautions will be
taken in handling the chemical such as: ensuring adequate building ventilation; wearing protective
gloves to avoid dermal contact; wearing protective masks to avoid inhalation of chemical dust; and
washing of hands after handling.
Comprehensive guidelines have been developed by the CNM for Temephos larviciding programs to
address potential human health and environmental concerns during field operations. Safeguards
include:
• Tiered supervision by CNM, provincial and district health departments to closely track all
aspects of inventory and distribution of stocks.
• Daily supervision of all field activities to ensure proper handling and household coverage.
• Water containers that are used frequently and those holding fish and other aquatic life are
not treated.
• Households are educated on proper procedures for care and handling of water containers to
which Temephos has been added (e.g., remove Temephos before washing containers), and
• First aid procedures are explained for use if Temephos is accidentally ingested.
Safeguards developed by the CNM for dengue programs in Cambodia are considered to represent
best available practices. With the exception of the need to strengthen occupational health practices
during pre-packaging of Temephos into satchels, available guidelines are comprehensive and
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inclusive. Provision will be made for: (i) regular delivery of training to PHD and OD staff involved in
program implementation to ensure that each person knows precisely what their responsibilities are;
and (ii) ongoing M&E to ensure compliance with safeguards.
Information on the proper management, storage and usage of pesticides will be given to the health
workers involved in the program to ensure that minimum contamination and toxicity of the environment
and in the health care facility. An appropriate waste disposal system will also be identified for the
waste generated from the pesticide program. This waste would largely consist of the pesticide
containers and pesticide dispensers.
77
ANNEX. PERFORMANCE MONITORING AND EVALUATION MATRIX
A. PROGRAM INDICATORS
NO.
TYPE OF
INDICATOR
I
Impact and
Outcome
Indicators
(Total: 14)
PERFORMANCE
INDICATOR
1 Infant Mortality Rate
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
RESPONSIBILITY
DESCRIPTION AND
FORMULA
66
2005
CDHS
5 years
National Institute of
Statistics
(NIS)/National
Institute of Public
Health (NIPH)
National Maternal
and Child Health
Center (NMCHC)
It measures the
probability of dying
between birth and the
first birthday.
Number of infant deaths
/ Total number of live
births x 1,000
2 Neonatal Mortality Rate*
28
2005
CDHS
5 years
NIS/NIPH
NMCHC
It measures the
probability of dying
within the first month of
life.
Number of neonatal
deaths / Total
number of live births x
1,000
3 Under 5 Mortality Rate
83
2005
CDHS
5 years
NIS/NIPH
NMCHC
It measures the
probability of dying
between birth and the
fifth birthday.
Number of under 5
deaths / Total number of
live births x 1,000
1
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
4 Maternal Mortality Ratio
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
RESPONSIBILITY
DESCRIPTION AND
FORMULA
472
2005
CDHS
5 years
NIS/NIPH
National
Reproductive Health
Program (NRHP)
It measures the obstetric
risk associated with each
live birth. A maternal
death is defined as any
death that occurred
during pregnancy,
delivery or within two
months after birth or
termination of a
pregnancy, and includes
all deaths during the
specified period.
Note that this definition
conforms to the one used
in the CDHS, both 2000
and 2005, and differs
slightly from the
international definition
which refers to 42 days,
and only includes deaths
from pregnancy,
delivery, and abortion
complications.
Number of pregnancy
related deaths / Total
live births x 100,000
5 Total Fertility Rate*
3.4
2005
CDHS
5 years
NIS/NIPH
NRHP
It is the sum of the agespecific fertility rates for
women 15 to 49 years.
The total fertility rate
(TFR) is the average
number of children that
would be born to a
2
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
RESPONSIBILITY
DESCRIPTION AND
FORMULA
woman by the time she
ended childbearing if she
were to pass through all
her childbearing years
conforming to the agespecific fertility rates of
a given year. The TFR
sums up, in a single
number, the fertility of all
women at a given point
in time.
Number of births /
Number of women 15-49
x 1,000
6 Percent of children under 5
with chronic undernutrition:
stunted (per new WHO growth
standards)
37.3
2005
CDHS
`
5 years
NIPH/NIS
Anthropometric
Survey
2008
NIS/Ministry of
Plannig (MOP)
Socio-Economic
Survey
2009
NIS/MOP
National Nutrition
Program (NNP)
It refers to children under
5 years who are stunted.
It is a height-for-age
index that measures
linear growth retardation
and cumulative growth
deficits. It refers to the
proportion of children
under 5 years whose
height-for-age Z-scores
are below minus 2
standard deviations from
the mean of the
reference population per
the new WHO growth
standards.
Number of children under
5 years whose heightfor-age Z-scores are less
than or equal to 2
standard deviations
3
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
RESPONSIBILITY
DESCRIPTION AND
FORMULA
below the new WHO
growth standards / Total
number of children under
5 x 100
7 Percent of children under 5
with acute undernutrition: wasted
(per new WHO growth
standards)*
7.3
2005
CDHS
5 years
NIPH/NIS
Anthropometric
Survey
2008
NIS/MOP
Socio-Economic
Survey
2009
NIS/MOP
NNP
It refers to the proportion
of children under 5 years
who are wasted. It is a
weight-for-height index
that measures current
nutritional status. Children
under 5 whose Z-scores
are below minus 2
standard deviations from
the mean of the
reference population per
the new WHO growth
standards, and are
considered acutely
undernourished.
Number of children under
5 years whose weightfor-height Z-scores are
below minus 2 standard
deviations of the new
WHO growth standards
/ Total number of
children under 5 x 100
8 Percent of children under 5
who are underweight (per new
WHO growth standards)*
35.6
2005
CDHS
5 years
NIPH/NIS
Anthropometric
Survey
2008
NIS/MOP
Socio-Economic
Survey
2009
NIS/MOP
NNP
It refers to children under
5 years who are
underweight. It is a
weight-for-age index
and a composite
indicator that accounts
for both acute and
4
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
RESPONSIBILITY
DESCRIPTION AND
FORMULA
chronic undernutrition. It
refers to the proportion
of children under 5 years
whose weight-for-age Z
scores are below minus 2
standard deviations from
the mean of the
reference population per
the new WHO growth
standards.
Number of children under
5 years whose weightfor-age is below minus 2
standard deviations of
the new WHO growth
standards / Total number
of children under 5 x
100
9 Proportion of breastfed
children 6-8 months of age who
are fed three and more food
groups daily and are receiving
age-appropriate frequency of
meals (%)*
33
2005
CDHS
5 years
NIS/NIPH
Anthropometrics
Survey
2008
NIS/MOP
It refers to the number of
infants 6-8 months old
who are continuously
breastfed and given
complementary foods
from 3 and more food
groups at least twice a
day expressed per 100
infants 6-8 months of
age who are breastfed
Number of infants 6-8
months old who are
continuously breastfed
and given
complementary foods
from 3 and more food
groups at least twice a
day/ Total number of
5
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
RESPONSIBILITY
DESCRIPTION AND
FORMULA
infants 6-8 months old
who are breastfed x
100
10 Women of reproductive age
with low Body Mass Index (%)*
20.3
2005
CDHS
5 years
NIPH/NIS
Anthropometric
Survey
2008
NIS/MOP
NNP
It refers to the proportion
of women of
reproductive age with
low Body Mass Index
(BMI). Body mass index is
defined as weight in
kilograms divided by
height squared in meters
i.e., kg/m2. Any woman
of reproductive age with
a BMI of 18.5 kg/m2 is
classified as having low
BMI.
Number of women of
reproductive age with
low BMI / Total number
of women of
reproductive age x 100
11 HIV prevalence rate among
adult 15-49
12 TB death rate per 100,000
0.9
2007
75
CDHS
5 years
NIS/NIPH
HIV/AIDS
Sentinel
Surveillance
2-3 years
NCHADS
National Center
Annual
National Center for
HIV/AIDS,
Dermatology, and
STDs (NCHADS)
It refers to the
prevalence of HIV
among adults 15-49
years, both male and
female.
Expected number of
adults 15-49 years who
are HIV+ / Total number
of adults 15-49 years x
100
CENAT
CENAT
It refers to the estimated
number of deaths due to
6
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
population
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
2007
for Tuberculosis
and Leprosy
Control (CENAT)
FREQUENCY
REPORTING
RESPONSIBILITY
DESCRIPTION AND
FORMULA
tuberculosis within the
population. Includes
deaths from all forms of
TB, including pulmonary
(smear positive and
negative), and extra
pulmonary as well as
deaths from TB in people
with HIV.
It is calculated for
countries through an
analytic process led by
WHO where TB mortality
= incidence x proportion
of incident cases that die
expressed per 100,00
population
13 Malaria case fatality rate per
1,000 population
0.36
2007
National Center
for for
Parasitology,
Entomology and
Malaria Control
(CNM)
Annual
CNM
CNM
It refers to deaths of
malaria inpatients in
public health facilities
and includes both
uncomplicated and
severe malaria cases.
Number of deaths due to
malaria among inpatients
in public health facilities
/ Total number of
malaria inpatients in
public health facilities x
100
14 Percentage of deaths due to
road traffic accidents
NA
Department of
Preventive
Medicine (DPM)
Annual
DPM
DPM
It refers to the proportion
of deaths among patients
hospitalized due to road
7
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
RESPONSIBILITY
DESCRIPTION AND
FORMULA
traffic accidents.
Number of deaths due to
road traffic accidents
among inpatients / Total
number of inpatients
admitted due to road
traffic accident injuries x
100
II
Program
Development
Objective
Indicators
(Total: 10)
1 Percent of births attended by
trained health personnel
44
2005
46
2007
2 Percent of births attended by
trained health personnel at
health facility
22
2005
CDHS
5 years
NIS/NIPH
NRHP
Socio-Economic
Survey
Annual
NIS/MOP
DPHI
HIS
Annual
Health Information
System Bureau
(HISB)/Department
of Planning and
Health Information
(DPHI)
DPHI
It refers to the proportion
of deliveries that were
attended by trained
health personnel
including physicians,
medical assistants,
midwives and nurses, but
excluding traditional
birth attendants.
Number of deliveries
attended by trained
health personnel /
Expected pregnancies x
100
CDHS
5 years
NIS/NIPH
NRHP
Healh
Information
System (HIS)
Annual
HISB/DPHI
DPHI
It refers to the proportion
of all deliveries that
occurred at health
facilities.
Number of deliveries that
occurred at health
facilities / Expected
pregnancies x 100
8
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
3 Percent of currently married
women using a modern
contraceptive method
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
RESPONSIBILITY
27
2005
CDHS
5 years
NIS/NIPH
NRHP
HIS
Annual
HISB/DPHI
DPHI
DESCRIPTION AND
FORMULA
It refers to the use of
modern methods of
contraception among
married women of
reproductive age.
Note that the HIS will
underestimate the
contraceptive prevalence
rate because it covers
only those who use public
sector facilities
Number of married
women of reproductive
age using modern
methods / Total number
of married women of
reproductive age x 100
4 Percent of children under 1
year fully immunized
60
2005
CDHS
5 years
NIS/NIPH
NIP
HIS
Annual
HISB/DPHI
DPHI
Full immunizations refers
to receipt of BCG, 3
doses of OPV, 3 doses of
DPT, 3 doses of Hepatitis
B, and 1 dose of measles
vaccine before the first
birthday.
For CDHS:
Number of children
12-23 months who were
fully immunized before
their first birthday /
Total number of children
12-23 months x 100;
9
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
RESPONSIBILITY
DESCRIPTION AND
FORMULA
For HIS:
Number of children who
were fully immunized
before their first
birthday/ Total number
of children under 1 year
x 100
5 Proportion of infants under 1
year immunized with DTPHepB3*
75.5
2005
CDHS
5 years
NIS/NIPH
NIS/NIPH
82
2007
HIS
Annual
HISB/DPHI
NIP
It refers to the proportion
of infants under 1 year
of age who have
received three doses of
DPT and Hepatitis B
vaccines
Number of infants under
1 year of age who have
received three doses of
DPT and Hep B vaccines/
Total number of children
under 1 year of age x
100
6 Percent of HIV+ pregnant
women receiving ART for PMTCT
11.2
2007
Prevention of
Mother To Child
Transmission
(PMTCT)
Annual
NMCHC
NMCHC
It refers to the proportion
of HIV+ pregnant women
who received
antiretroviral therapy for
prevention of mother to
child transmission of HIV.
Number of HIV infected
pregnant women
receiving ART for PMTCT
/ Estimated number of
HIV+ pregnant women x
10
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
RESPONSIBILITY
DESCRIPTION AND
FORMULA
100
7 TB cure rate (%)
>85
2007
CENAT
Annual
CENAT
CENAT
It refers to the proportion
of smear positive TB
cases registered that
were cured.
Number of smear
positive TB cases that
were cured / Total
number of estimated
number of smear positive
TB cases x 100
8 Number of malaria cases
treated at public health facilities
per 1,000 population
7.2
2007
CNM
Annual
CNM
CNM
It refers to the number of
malaria cases (simple
and severe) that were
treated at public health
facilities expressed per
1,000 population.
Number of malaria cases
(simple and severe)
treated at public health
facilities expressed per
1,000 population
9 Proportion of children aged 6–
59 months who received vitamin
A supplement within the last 6
months*
34.5
2005
CDHS
5 years
NIS/NIPH
NIS/NIPH
76
2007
HIS
Annual
HISB/DPHI
HISB/DPHI
It refers to the number of
children aged 6–59
months who received a
high-dose vitamin A
supplement within the last
6 months expressed per
100 children aged 6-59
months
11
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
RESPONSIBILITY
DESCRIPTION AND
FORMULA
Number of children aged
6–59 months who
received a high-dose
vitamin A supplement
within the last 6 months/
Total number of children
aged 6-59 months x
100
Note: HIS data will refer
to Round 1 and/or Round
2 supplementation
10 Proportion of pregnant
women receiving iron folate
supplementation (at least 60
tablets), %*
57.4
2008
CDHS
5 years
NIS/NIPH
NIS/NIPH
69
2007
HIS
Annual
HISB/DPHI
HISB/DPHI
It refers to the number of
pregnant women who
took (or received) at
least 60 tablets of iron
folate tablets
Number of pregnant
women who took (or
received) at least 60
tablets of iron folate
tablets / Total number of
pregnant women x 100
III
Performance
Indicators
(Total: 25)
Component A: Strengthened
Health Service Delivery
1 Percent of population with
access to full MPA services
NA
HISB/DPHI
Annual
HISB/DPHI
MOH
It refers to the proportion
of the total population
that lives within the
catchment area of HCs
12
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
DESCRIPTION AND
FORMULA
RESPONSIBILITY
providing full MPA
services.
Total number of persons
residing in catchment
areas of HCs providing
full MPA services / Total
population x 100
2 Percent of population with
access to at least CPA2 services
NA
HISB/DPHI
Annual
HISB/DPHI
MOH
It refers to the proportion
of the total population
that lives within the
catchment area of RHs
providing at least CPA2
services.
Total number of persons
residing in catchment
areas of RHs providing
at least CPA2 services /
Total population x 100
3 OPD consultations (new cases)
per person per year:
It refers to the utilization
of outpatient services at
public health facilities
among the total
population and among
children under 5 years.
•
All consultations
0.51
2007
HIS
Annual
HISB/DPHI
MOH
•
Children under 5 years
1
2007
HIS
Annual
HISB/DPHI
MOH
•
Total OPD
consultations (new
cases) for all cases
/ Total population
•
Total OPD
consultations (new
cases) for children
13
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
RESPONSIBILITY
DESCRIPTION AND
FORMULA
under 5 years /
Total children under
5
4 Percent of pregnant women
attending at least 2 antenatal
care consultations
60
2007
CDHS
5 years
NIPH/NIS
NRHP
68
2007
HIS
Annual
HISB/DPHI
NRHP
It refers to the use of
antenatal care services
and measures access and
utilization of health care
during pregnancy.
Number of pregnant
women with 2 or more
ANC consultations /
Expected pregnancies x
100
Note: HE Minister’s newly
announced Fast Track
Initiative for RMNCH
prescribes a norm of at
least 3 ANC visits per
pregnancy. Indicator will
be updated as and when
the new protocol is
issued.
5 Percent of deliveries by Csection
1.8
2007
HIS
Annual
HISB/DPHI
MOH
It refers to the proportion
of all births that were
delivered through
Cesarean section.
Number of deliveries by
C section / Expected
pregnancies x 100
6 Case detection rate of smear
65.4
CENAT
Annual
CENAT
CENAT
It refers to the rate at
14
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
(+) pulmonary TB (%)
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
RESPONSIBILITY
2007
DESCRIPTION AND
FORMULA
which TB is diagnosed in
a patient and is reported
within the national
surveillance system, as
against the total
estimated number of new
cases of smear positive
TB.
Number of new smear
positive TB cases for the
reporting period /
Estimated number of new
smear positive TB cases
for the reporting period
x 100
7 Percent of families living in high
malaria endemic areas (<1km
from forest) of 20 provinces have
sufficient (1 net per 2 persons)
treated bed nets (LLIT/ ITN)
64
2007
CNM
Annual
CNM
CNM
It refers to the proportion
of families living in high
malaria endemic areas
(20 provinces) who had
sufficient treated bed
nets.
Number of families living
in high malaria endemic
areas (<1 km from
forest) with sufficient
treated bed nets / Total
number of families living
in high malaria endemic
areas x 100
8 Percent of children under 5
years with cough or difficult
breathing who sought treatment
by public health provider
48
2005
CDHS
5 years
NIPH/NIS
Communicable
Disease Control
Department (CDCD)
(IMCI)
It refers to children under
5 years with acute
respiratory illnesses (ARI)
who were treated by a
15
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
9 Percent of children under 5
years with diarrhea who
received ORT
BASELINE
VALUE AND
YEAR
58
SOURCE OF
DATA
FREQUENCY
REPORTING
RESPONSIBILITY
Health Facility
Survey on quality
of case
management of
childhood
illnesses (to be
developed in
2009)
2 years
CDCD/MOH
CDCD/MOH
CDHS
5 years
NIPH/NIS
CDCD (IMCI)
Health Facility
Survey on quality
of case
management of
childhood
illnesses (to be
developed in
2009)
2 years
CDCD/MOH
CDCD/MOH
DESCRIPTION AND
FORMULA
public health provider.
Number of children under
5 years with ARI who
were treated by a public
health provider / Total
number of children under
5 with ARI x 100.
It refers to children under
5 with diarrhea who
received oral
rehydration therapy
(ORT) to prevent
dehydration and
associated deaths. ORT
includes solutions
prepared from oral
rehydration salts (ORS),
prepackaged ORS
packets, and
recommended home
fluids (RHF).
Number of children with
diarrhea who received
ORT / Total number of
children with diarrhea x
100
Note: CDCD/IMCI has
split this indicator into
two, following issue of
revised protocols for
treatment: (i) Percent of
children under 5 years
with diarrhea who
received ORT without
16
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
RESPONSIBILITY
DESCRIPTION AND
FORMULA
zinc and (ii) Percent of
children under 5 years
who received ORT with
zinc.
10 Percent of disease outbreaks
responded to in a timely manner
90
2008
CDCD
Annual
CDCD
CDCD (Surveillance)
It refers to the proportion
of disease outbreaks that
have been investigated
and responded to in a
timely manner.
Number of disease
outbreaks that were
timely investigated and
responded to / Total
number of disease
outbreaks x 100
11 Incidence of diabetes
reported from public health
facilities
2
2007
DPM
Annual
DPM
DPM (Sentinel site
surveillance)
It refers to the new cases
of diabetes among
adults as reported from
public health facilities
during the given period.
Number of new diabetes
cases among adults as
reported from public
health facilities during
the given period
Note: Currently DPM
reports prevalence
based on sentinel site
surveillance, since the
HSP2 monitoring
indicator refers to
prevalence. The baseline
17
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
RESPONSIBILITY
DESCRIPTION AND
FORMULA
thus reported alongside
is prevalence, not
incidence. However, DPM
will provide incidence
data by the 1st quarter
of 2009 after which the
matrix will be updated.
12 Percent of essential drugs at
HCs that faced stock-outs
12.07
2007
Department of
Budget and
Finance (DBF)
Annual
DDF
DDF
It refers to the
availability of essential
drugs at health centers.
Number of essential
drugs (15 listed) that
experienced stock-outs at
health centers / 15 x
100
Component B: Strengthened
Health Financing and Protection
of the Poor
1 Percent of Government health
expenditure at provincial level
and below
27
2007
DBF
Annual
DBF
DBF
This indicator refers to
the proportion of the
provincial national health
budget spent on PHDO,
ODO, RHs, and HCs.
Total expenditures on
PHDO, RHs and HCs /
Total national health
budget x 100
2 Percent of ODs with Health
Equity Fund
57
2008
DPHI
Annual
Health Equity Fund
Bureau (HEFB)/DPHI
DPHI
It refers to the proportion
of Operational Districts
18
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
RESPONSIBILITY
DESCRIPTION AND
FORMULA
operating Health Equity
Funds within their
jurisdictions.
Number of ODs with a
Health Equity Fund /
Total number of ODs x
100
3 Number of persons covered by
Health Equity Funds
2,886,876
2008
DPHI
Annual
HEFB/DPHI
DPHI
It refers to the The
estimated number of
poor persons who are
eligible for HEF support
in areas covered by
HEFs.
The sum of the estimated
number of HEF eligible
persons of all areas
covered by HEFs. For
pre-identified areas this
will be the number of
persons with an EAC, for
areas which have not yet
been pre-identified the
poverty figures of the
most recent SES will be
used.
4 Percent of ODs operating
Community-Based Health
Insurance schemes
11.7
2007
DPHI
Annual
HEFB/DPHI
DPHI
It refers to the proportion
of ODs that are
operating CommunityBased Health Insurance
(CBHI) schemes within
their jurisdictions
Number of ODs with a
19
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
DESCRIPTION AND
FORMULA
RESPONSIBILITY
CBHI scheme / Total
number of ODs x 100
5 Number of persons covered by
Community-Based Health
Insurance schemes
100,671
2007
DPHI
Annual
HEFB/DPHI
DPHI
It refers to the total
number of members of
CBHI schemes in the
country.
Total number of members
of CBHI schemes
6 Government health
expenditure per capita (USD)
6
2007
Department of
Budget and
Finance (DBF)
Annual
DBF
DBF
It refers to government
health expenditures
expressed per person in
the country.
Government health
expenditures / Total
population
Component C: Strengthened
Human Resources
This is a composite
indicator that refers to
the availability of
secondary midwives in
the country and its
provinces.
1 Ratio of MOH secondary
midwives per 10,000 population
per location:
•
Country ratio
0.55
2007
Personnel
database
Annual
Department of
Personnel (DP)
DP
•
Number of
secondary midwives
expressed per
10,000 population
for the country as a
20
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
DESCRIPTION AND
FORMULA
RESPONSIBILITY
whole
•
Provincial average
0.64
2007
•
Provincial median
0.57
2007
NA
2 Number of HCs with staffing
levels recommended by MPA
guidelines
Annual
DP
DP
•
Provincial average
of ratio of
secondary midwives
per 10,000
population
Personnel
database
Annual
DP
DP
•
Provincial median of
ratio of secondary
midwives per
10,000 population
Personnel
database
Annual
DP
DP
It refers to the proportion
of health centers with
staff per MPA guidelines.
Personnel
database
Number of HCs with staff
per MPA guidelines /
Total number of HCs x
100
Note: Personnel
Department has advised
that since the MPA and
CPA guidelines were
revised with new staffing
levels only in 2008, the
baseline figure is under
calculation and will be
made available in 1st
quarter, 2009.
21
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
3 Number of RHs with staffing
levels recommended by CPA
guidelines
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
RESPONSIBILITY
DESCRIPTION AND
FORMULA
NA
Personnel
database
Annual
DP
DP
It refers to the proportion
of RHs with staff per CPA
guidelines.
Number of RHs with staff
per CPA guidelines /
Total number of RHs x
100
Note: Personnel
Department has advised
that since the MPA and
CPA guidelines were
revised with new staffing
levels only in 2008, the
baseline figure is under
calculation and will be
made available in 1st
quarter, 2009.
Component D: Strengthened
Health Sector Stewardship and
Institutions
1 Percent of external funds for
health included in 3YRPs and
AOPs
66
2007
DIC Database
Annual
DPHI
Department of
International
Cooperation DIC)
It refers to the proportion
of external funds for
health included in the 3
Year Rolling Plans, and is
a measure of the
comprehensiveness of
these Plans. It is
expressed as a percent.
Total amount of external
funds included in the
3YRPs / Total amount of
external funds available
22
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
RESPONSIBILITY
DESCRIPTION AND
FORMULA
in the health sector x 100
It is a composite indicator
that refers to the
proportion of Referral
Hospitals, Operational
District offices, and
Provincial Health
Departments equipped
with a computerized
Health Information
System.
2 Percent of RHs, ODOs and
PHDs offices with computerized
HIS:
•
•
•
RHs
ODOs
PHDs
3 (Number) Percent of functioning
HCMCs
0
2007
100
2007
PHDs
Annual
PHDs
DPHI
Number of RHs with
computerized HIS / Total
number of RHs x 100
PHDs
Annual
PHDs
DPHI
Number of ODOs with
computerized HIS / Total
number of ODOs x 100
PHDs
Annual
PHDs
DPHI
Number of PHDs with
computerized HIS / Total
number of PHDs x 100
PHDs
Annual
PHDs
National Center for
Health Promotion
(NCHP)
100
2007
46
2007
It refers to Health Center
Management Committees
that are functioning, and
is an indicator of the
level of community
participation in the
delivery of health
services.
Number of functioning
HCMCs / Total number
23
NO.
TYPE OF
INDICATOR
PERFORMANCE
INDICATOR
BASELINE
VALUE AND
YEAR
SOURCE OF
DATA
FREQUENCY
REPORTING
DESCRIPTION AND
FORMULA
RESPONSIBILITY
of HCMCs x 100
This composite indicator
refers to the proportion
of private entities that
are licensed.
4 Percent of private entities that
are licensed:
•
Polyclinics
70
2007
Department of
Hospital Services
(DHS)
Annual
DHS
DHS
•
Consultation cabinets
52
2007
DHS
Annual
DHS
DHS
•
Pharmacies
47.8
2008
Department of
Drugs and Food
(DDF)
Annual
DDF
DDF
•
Number of
polyclinics that are
licensed / Total
number of
polyclinics x 100
•
Number of
consultation cabinets
that are licensed /
Total number of
consultation cabinets
x 100
•
Number of
pharmacies that are
licensed / Total
number of
pharmacies x 100
24
B. PROJECT MONITORING INDICATORS
NO.
1
INDICATOR
BASELINE VALUE
AND YEAR
SOURCE OF
DATA
FREQUENCY
RESPONSIBILITY
REPORTING
COMMENTS
AOP process improves HSP2
sector outcomes as reported in
JAPRs (27 Core indicators)
0
2007
JAPR Report
Annual
Policy, Planning,
and Health Sector
Reform Bureau
(PPHSRB)/DPHI
DPHI
It refers to the new AOP process
based on program budgeting
and improved monitoring and
evaluation that is expected to
contribute to improvements in
sector outcomes as reflected in
the core indicators reported on at
the Joint Annual Performance
Review.
Number of HSP2 Core Indicators
that achieved targets / Total
number of HSP2 Core Indicators x
100
2
Number of MOH implementing
units preparing 3YRPs
consistent with the MEF
Strategic Budget Plan
guidelines
0
2008
Central and
Provincial 3YRPs
Annual
PPHSRB/DPHI
DPHI
It refers to MOH implementing
units at central and provincial
levels that prepare 3 Year Rolling
Plans that are consistent with the
Ministry of Economy and Finance’s
Strategic Budget Plan guidelines.
Number of MOH implementing
units (central and provincial
levels) preparing 3YRPs consistent
with MEF Strategic Budget Plan
guidelines
3
Number of PHDs allocating
budgets based on AOPs
100
2007
Provincial AOPs
and Budgets
Annual
PPHSRB/DPHI
DPHI
It refers to whether PHDs have
allocated their annual budgets
based on their AOPs.
Sum of PHDs allocating their
budgets based on their AOPs.
25
NO.
4
INDICATOR
Percentage of external funds
for health sector included in
3YRPs and AOPs*
BASELINE VALUE
AND YEAR
SOURCE OF
DATA
FREQUENCY
RESPONSIBILITY
REPORTING
COMMENTS
66
2007
DBF Reports
Annual
DBF
DBF
It refers to the proportion of
external funds for health included
in the 3 Year Rolling Plans, and is
a measure of the
comprehensiveness of these Plans.
It is expressed as a percent.
Total amount of external funds
included in the 3YRPs / Total
amount of external funds
available in the health sector x
100
5
AOP resource allocation
reflecting HSP2 and JAPR
priorities (1. MCH; 2. CDs; and
3. NCDs)
RMNCH: 27
2009
Sector AOP
Annual
PPHSRB/DPHI
PPHSRB/DPHI
It refers to the allocation of
financial resources within the
sector AOP to the three key
program areas of RMNCH, CDC,
and NCDs. It is expressed as
percent of the total AOP budget
for each of the program areas.
DBF
Annual
DBF
DBF
It refers to the proportion of the
approved budget for DP pooled
funds and Government funds that
are expended in a given year. It
is expressed in percent.
CDC: 31
2009
NCD: 3
2009
6
Rate of Program execution for
both pooled DP and
Government funds
RGC: 91
2007
DP (HSSP1): 85
2007
Percent of approved Government
budget spent / Total approved
Government budget x 100
7
Percentage of Government
and AOP expenditure at
RGC: 27
2007
DBF
Annual
DBF
DBF
This indicator refers to the
proportion of the provincial
26
NO.
INDICATOR
BASELINE VALUE
AND YEAR
SOURCE OF
DATA
FREQUENCY
RESPONSIBILITY
REPORTING
COMMENTS
national health budget spent on
PHDO, ODO, RHs, and HCs.
provincial level*
AOP: 29
2007
Total expenditures on PHDO, RHs
and HCs / Total national health
budget x 100
8
Share of operating cost budget
reaching contracting ODs
NA
DBF reports
Annual
DBF
DBF
It refers to the receipt of the
operating cost budget by
internally contracted ODs in a
given year. It is expressed in
percent.
Operating cost budget received /
Total operating cost budget x
100
9
Proportion of ODs
implementing SDGs and
internal contracting meeting at
least 80% of their
performance targets
NA
External technical
audit reports
Annual
HEFB/DPHI
DPHI
It refers to the proportion of ODs
that are implementing SDGs and
internal contracting arrangements
that have achieved at least 80%
of their performance targets. It is
expressed in percent.
Number of SDG and internally
contracted ODs that achieved at
least 80% of their performance
targets / Total number of SDG
and internally contracted ODs x
100
10
Coverage of HEFs (by OD and
beneficiaries)*
ODs (%): 57
2008
DPHI
Annual
HEFB/DPHI
DPHI
It refers to the proportion of
Operational Districts operating
Health Equity Funds within their
jurisdictions.
Number of ODs with a Health
27
NO.
INDICATOR
BASELINE VALUE
AND YEAR
SOURCE OF
DATA
FREQUENCY
RESPONSIBILITY
REPORTING
COMMENTS
Equity Fund / Total number of
ODs x 100
Beneficiaries:
152,213
2007
DPHI
Annual
HEFB/DPHI
DPHI
It refers to the number of HEF
eligible patients who are clients
and received HEF support during
the reporting period.
Total number of HEF beneficiaries
is the sum of the reported
numbers of HEF supported
patients/clients during the
reporting period by all existing
HEFs.
11
Percentage of staff covered by
agreed and aligned incentive
scheme*
0
2008
Personnel
database (DP)
Annual
DP
DP
It refers to the proportion of staff
participating in the Merit Based
performance Incentive (MBPI)
scheme. It is expressed in percent.
Number of staff participating in
MBPI / Total number of staff x
100
12
Financial Management
Improvement Plan developed
and implemented
NA
DBF reports
Annual
DBF
DBF
It refers to the development and
implementation of the Financial
Management Improvement Plan
(FMIP) that is designed to
strengthen the MOH’s financial
management systems.
FMIP developed and
implemented
13
(Increased) Number of ODs
and PHDs using health
PHDs: 24
2008
JAPA
Annual
PPHSRB/DPHI
DPHI
It refers to the number of PHDs
and ODs that use health
28
NO.
INDICATOR
BASELINE VALUE
AND YEAR
SOURCE OF
DATA
FREQUENCY
RESPONSIBILITY
REPORTING
COMMENTS
indicators to prioritize
interventions in their AOPs.
indicators for prioritization in
their AOPs
ODs: 77
2008
AOPs
Annual
PPHSRB/DPHI
DPHI
Number of PHDs using health
indicators to prioritize
interventions in their AOPs
Number of ODs using health
indicators to prioritize
interventions in their AOPs
14
Government health sector
expenditure in line with NSDP
and MTEF targets
1.0% GDP
2007
MEF report
Annual
DBF
DBF
It refers to whether government
health expenditures expressed as
a proportion of GDP meets the
recommended targets contained
in the RGC’s NSDP and MTEF.
Total government health
expenditures / GDP x 100
15
Annual health planning summits
(JAPR and JAPA) conducted
with wide stakeholder
participation
Yes
2008
JAPR and JAPA
reports
Annual
HISB/DPHI
DPHI
It refers to the holding of the
JAPA and JAPR with wide
stakeholder participation.
JAPR and JAPA conducted with
wide stakeholder participation
16
Number (proportion) of HSP2
indicators have baselines and
annual reporting
80
2008
HSP2 M&E
Framework
Annual
HISB/DPHI
DPHI
It refers to the proportion of
HSP2 M&E indicators that have
baselines and that are reported
on annually.
Number of HSP2 indicators that
have baselines and are reported
o annually / Total number of
HSP2 indicators x 100
29
NO.
INDICATOR
BASELINE VALUE
AND YEAR
SOURCE OF
DATA
FREQUENCY
RESPONSIBILITY
REPORTING
17
Selected key HSP2 indicators
disaggregated by gender and
location
0
2008
HSP2 M&E
Framework
Annual
HISB/DPHI
DPHI
COMMENTS
It refers to the number of core
HSP2 indicators that are
disaggregated by sex and
location. It is expressed in
percent.
Number of core HSP2 indicators
disaggregated by sex and
location / Total number of core
HSP2 indicators x 100
18
Percent of performance
agreements between the MOH
and PHDs meeting target
performance indicators
0
2008
External technical
audit reports
Annual
HEFB/DPHI
DPHI
It refers to the proportion of PHDs
that have met their annual
performance targets as contained
in their performance agreements.
It is expressed in percent.
Number of PHDs achieving annual
performance targets per their
performance agreements / Total
number of PHDs with performance
agreements x 100
NOTE:
*These indicators were not anticipated to be tracked in the World Bank HSSP2 Program Appraisal Document.
30
This Program Operational Manual was produced by an MOH Team internally led by Dr. Char
Meng Chuor, Deputy Director General for Health/MOH and Project Coordinator/HSSP1 with the
following members:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Dr. Lo Veasnakiry, Director/DPHI
Dr. Mey Sambo, Director/DP
Dr. Sao Sovanratnak, Deputy Director/DPHI
Dr. Sok Kanha, Deputy Director/DPHI
Ms. Khout Thavary, Deputy Director/DBF
Dr. Khol Khemrary, Chief/HISB/DPHI
Dr. Uy Vengky, Executive Administrator/HSSP1
Dr. Ou Vun, Chief/World Bank Operations Unit/HSSP1
Dr. Khuon Vibol, Coordinator/UNFPA/HSSP1
Mr. Pheav Chin Lay, Chief Financial Management Officer/HSSP1
Ms. Leng Sok Heng, Procurement Officer/HSSP1
Mr. Krang Makol, Accountant/HSSP1
Dr. Seng Bundeth, Health Contracting Monitor/HSSP1
Ph. Chea Sok Meng, Health Management Monitor/HSSP1
Ph. Chan Phal, Health Management Monitor/HSSP1
Mr. Kiv Sonissay, Executive Administrator Assistant/HSSP1
Mr. Vijay Rao, Health Sector M&E Adviser/HSSP1
Mr. Deb Majumdar, Procurement Adviser/HSSP1
Mr. Myo Min, Financial Management Adviser/HSSP1
A number of IUs assisted with inputs, and HSSP2 DPs reviewed drafts and provided extensive
comments.