Disillusioned with the public health care sector’s inability to access government funds, Nobel Prize-winning Medecins Sans Frontieres is considering withdrawing from Cambodia and has sent a letter to three ministries stating as much.
The letter cites “the lack of transparency” in the Ministry of Finance’s allocation of money to provinces where MSF is “building up health systems,” and it says the funds “arrive too late, irregularly and incomplete.”
Such problems prompted one of MSF’s country headquarters to request it prepare for a quick handover to another NGO, according to the letter sent in August to the Ministry of Foreign Affairs and copied to the Finance and Health ministries. MSF in Cambodia has section offices in Holland, Belgium and Switzerland.
“I’m very dissatisfied with the way the government resources are being used,” Marits van Pelt, director for MSF here, said. “If it is going to be like this, we are going to throw in the towel.”
MSF has been working to create functioning hospitals in many remote provinces since 1989. The group has brought in essential medicine, and enough money and staff training to get the hospitals up and running. But “the hospitals are empty,” van Pelt said. “It is pretty much a disaster.”
The letter did not give a date for withdrawal, only saying MSF would pull out if the situation does not improve. MSF had a $3 million budget for 1999.
MSF was awarded the Nobel Peace Prize earlier this month. But van Pelt said Thursday: “I’m not proud at all of our accomplishments here. I don’t think we deserve the Nobel in Cambodia.”
The Ministry of Health is aware of the concerns, said Kuyseng Te, director-general of administration and finance, and is addressing this problem with the Finance Ministry. Finance Minister Keat Chhon has “made a commitment to provide a better system” for moving funds from one ministry to another, he noted.
Michael Curtis, the World Health Organization’s budget adviser to the Ministry of Health, said “the current system is ineffective,” but also noted health and finance ministers are reviewing the system and some positive changes are taking effect.
“No doubt what [MSF] says is true,” Curtis said. “But they shouldn’t discount the talks between the ministries.”
But van Pelt said such action has yielded “no concrete results.”
Part of the problem, van Pelt said, is the Ministry of Health, and consequently provincial hospitals, do not have control of their own budgets. Rather than being allocated a specific budget with which to work, hospitals must request equipment and medicine from provincial representatives from the Ministry of Finance.
The current system has little accountability for allocated money, leaving the system open to corruption, van Pelt charged.
Van Pelt did say hospitals are functioning and full of patients in Takeo and Stung Treng provinces. This is due to the cooperation between hospital directors and new provincial governors willing to help them, he said. “But these are rare examples.”
MSF has pulled out of other nations when it thought it was doing more harm than good. In 1996, it left North Korea when the government put strict controls on the organization, effectively disabling it, said Alex Winkler, former MSF director in Cambodia.
“We in effect became an accomplice” to the government, Winkler said. “We hurt the victims.”
If MSF withdraws, Cambodia would be losing an important advocacy voice, said Stephane Rousseau, executive director of Medicam, an NGO comprised of health advocacy groups.
MSF appears to be willing to remain for another year at least.
But for all its work in Cambodia, van Pelt said, it is offset by the current state of budgetary affairs. “It’s like if you make a restaurant with no water,” he said. “It’s useless.”