The Ministry of Finance agreed on Monday to increase its proposal for next year’s Ministry of Health budget by 33 percent, or 14 billion riel ($3.7 million).
The decision came 10 days after the World Health Organization expressed concern to international donors that more resources were necessary to build an effective health-care system.
If the 82 billion riel ($21.6 million) budget commitment from the Ministry of Finance is approved by the National Assembly, it will be the largest increase for Health in three years.
Health officials interviewed on Sunday had expressed concern for the country’s fragile health network if the Finance Ministry had pushed through its previous 68 billion riel ($17.9 million) proposal, compared to this year’s 62 billion riel ($18.5 million, based on last year’s riel) allocation.
However, Health Ministry officials cautioned that final approval must wait for the new government, which has yet to be formed, and the newly sworn-in National Assembly.
Health officials also stressed that increased commitment from the Finance Ministry would still leave the government health budget at about one-third the international average for “least developed countries,” a term the UN applies to the world’s most impoverished nations.
“They have at least given an indication that they are willing to increase the allocation to health,” said Dr Henk Bekedam, the WHO’s chief technical adviser to the Ministry of Health. “It is as simple as that.”
Dr Mao Tung Ien, director of planning for Health, said the budget increase was a positive step, but noted that the Finance Ministry typically only releases 60 percent to 70 percent of money pledged to his ministry.
Remaining funds are not released because of revenue shortfalls or diverted for other purposes. Through June, the ministry had received only 13 percent of its 1998 budget allotment.
The perceived setback in the preliminary budget proposal prompted a Sept 23 letter to international donors from Dr Georg Petersen, the World Health Organization’s top representative in Cambodia.
“We would appreciate your efforts in providing encouragement to government to highlight their commitment to improving the social sector through increased budget allocations to health,” the letter said.
The letter was addressed to the Asian Development Bank, with copies also sent to the UN Development Program, the UN Children’s Fund, the UN Population Fund and British Ambassador George Edgar.
Health officials say their most serious concerns are expanding the nation’s hospital network and fighting the country’s burgeoning AIDS epidemic.
A Health Ministry document produced for budget talks last month argued that without an expanding budget, “the Ministry of Health will not be able to combat diseases, to open newly built health facilities [and] to deliver adequate health services in already existing health facilities.”
Said the Ministry of Health Cabinet director, Te Kuyseang: “Of course, everything is up to the money. If there is no money, do you think we can achieve our goals? If we get less money [than we requested] we cannot complete our tasks.”
This commitment to 82 billion riel by the Ministry of Finance is about 2.5 billion riel less than the original Health Ministry request.
The allocation, which amounts to $2.07 per capita, would still fall far short of a World Bank target of $12 per capita to run an efficient health-care network. Aid agencies and international donors give $40 million to $50 million to health needs in Cambodia, according to the WHO.
The ministry is aiming to complete an ambitious 72-hospital network supported by hundreds of local health centers by the year 2000. WHO officials have said it could take up to 15 years, however, to complete the system.
Health officials say that Cambodia has about 55 functioning general hospitals, 20 of which can perform emergency surgery “safely” and five of which offer the range of basic services expected of a general hospital in industrialized countries.
The Ministry of Health is two years into the program, which aims to employ a fee structure that excuses the poor from payment.
The structure is also designed to boost the salaries of public health workers, many of whom earn less than $20 per month.
