More than four months after the government’s salary reform measures put an end to bonuses for civil servants working on donor-funded projects, the Global Fund, one of the main donors in the country’s health sector, said that healthcare services have deteriorated to the point that it will take steps to try and reinstate the bonuses.
Chiv Bunthy, secretary manager for the Global Fund’s Country Coordination Committee, said the fund would suggest reinstating civil servant bonuses for its programs at a meeting with the Ministry of Health, international donors and civil society on Friday.
“During this meeting we will propose the offer of the Global Fund,” Mr Bunthy said, adding that the fund would seek the support of the other participants, particularly other donor organizations, for its decision to reinstate the bonuses.
The Global Fund is a public/private funded international institution that is the largest international funder of programs to combat Aids, malaria and tuberculosis, having disbursed more than US$ 19.3 billion since 2002.
Mr Bunthy said the fund decided to take action “because the Global Fund is concerned after more than three months since the end of [donor] payments for healthcare services [staff].”
In early December, the government surprised many by banning the longtime practice of allowing donor organizations to provide project-related salary supplements to civil servants. But on January 21, the government told donors they were again allowed to pay some of the bonuses.
The donors however, have so far declined to resume payments because of the confusion, choosing to wait for the government to clarify its position on the salary supplements.
The cessation of supplementary payments has led to fears of a crisis in the low-paid public sector, while civil servants have complained of straitened economic circumstances.
Mr Bunthy said the Global Fund feared the lack of bonuses has already reduced the quality of services for patients dependent on its programs-which focus on the treatment and prevention of HIV/Aids, malaria and tuberculosis-and the loss of healthcare staff as workers migrate to the private sector.
“Some staff that work for the Global Fund, they resign and go out to another sector,” he said.
Recipients of the fund’s aid, including the government’s National Aids Authority, the National Malaria Program and the National Tuberculosis Program, have said they would like to see salary supplements restored for their staff, Mr Bunthy added.
Tia Phalla, vice chairman of the National Aids Authority, yesterday outlined the likely impact of terminating incentive payments for workers on HIV/Aids programs.
The lack of bonuses “would clearly affect the quality of service delivery through absenteeism, reduced working hours and loss of motivation” and create “a loss of the most highly qualified staff to the private and NGO sectors,” he said during a presentation at a healthcare conference at the Phnom Penh Hotel yesterday.
The reduction in the quality of healthcare service could lead to delays in treatment of HIV/Aids patients with anti-retroviral drugs, increased patient drop-out rates, poor adherence to treatment, and higher mortality, he said.
“There is a real risk that huge gains made in Cambodia in the last 15 years might be reversed if staff remuneration is inadequate,” Dr Phalla said, adding, “It is critical…that an early and satisfactory solution to the problem of salary supplementation is found.”
Speaking by telephone later, Dr Phalla said the Ministry of Health and donors would discuss how to tackle the salary supplement issue at Friday’s donor meeting.
“The options will be forwarded to the royal government for a decision,” he added.
Sin Somuny, executive director of Medicam, an umbrella organization for NGOs working in healthcare, welcomed the Global Fund’s initiative to try and reinstate the salary supplements for health workers on its programs.
“We have been advocating a transitional plan,” he said, adding that donor-supported healthcare programs could not wait until the government completes its civil servant reform policy in July.
“Until [this policy] is developed we have to implement the [salary supplements] similar to the situation prior to 2010,” he said, explaining that the lack of supplementary incentives for workers might otherwise severely weaken the healthcare system.
(Additional reporting by Neou Vannarin)