Health Equity and Quality
                                                                                                           Improvement Project
                                      IN CAMBODIA


Background
Health remains an important challenge as well as a development priority for Cambodia. On one hand,
Cambodia is one of the few countries globally that achieved both of the MDG targets of maternal and
child mortality. On the other hand, 32% (or approximately 0.5 million) of children under five are stunted
even today. The maternal mortality ratio decreased from 472 in 2005 to 170 in 2014 (number per
100,000 live births), but still remains high. Similarly, the under-five mortality rate decreased from 83 per
1,000 live births in 2005 to 35 per 1,000 in 2014. Despite these dramatic improvements in maternal and
child health, inequities in health outcomes persist among different socioeconomic statuses,
geographical area, and between urban and rural populations. The government recognizes the need to
go beyond improved survival rates to maximizing the potential of the country’s human capital.

For over 15 years, the World Bank has supported the health sector with its own financing as well as that
of other development partners pooling funds through the World Bank. This has led to joint ownership,
shared success and strong coordination among development partners and with the government, which
is a unique feature in Cambodia and was instrumental in the rapid improvement in coverage and quality          Location: The project covers the
of health care services. The emphasis of past projects has been to improve access to health services           whole country.
while improving the results-based focus of financing through innovative instruments such as Health
Equity Fund and Service Delivery Grants, with the specific goal of improving the quality of health service      Financiers:
delivery and utilization of services by the poor.                                                                Royal Government of Cambodia:
                                                                                                                   US$94.2 million;
                                                                                                                 The World Bank (International
                                                                                                                  Development Association) :
                                                                                                                  US$30.00 million;
                                                                                                                 Free-standing Multi-donor Trust
                                                                                                                  Fund (MDTF) Program with
                                                                                                                  contributions from the
                                                                                                                  Government of Australia
                                                                                                                  (through the Department of
                                                                                                                  Foreign Affairs and Trade- DFAT),
                                                                                                                  Government of Germany
                                                                                                                  (through Kreditanstalt fur
                                                                                                                  Wiederaufbau- KfW) and the
                                                                                                                  Government of Republic of
                                                                                                                  Korea (through the Korea
                                                                                                                  International Cooperation
                                                                                                                  Agency- KOICA), amounting to
                                                                                                                  US$50 million,
                                                                                                                 Government of Japan through
                                                                                                                  the Policy and Human Resources
                                                                                                                  Development Trust Fund: US$1.0
                                                                                                                  million.
About the Project
The project development objective is to improve access to quality health services for the target                Implementing Agency:
population. It will be achieved by:                                                                             Ministry of Health
   Increasing the number of health centers that exceed a quality assessment score of 60 percent .
   Protecting households against falling into poverty due to the cost of health services t by reducing         Approval Date:
     the share of households that experienced high levels of health spending, and reducing out of
     pocket health expenditure as percentage of the total health expenditure.
                                                                                                                May 19, 2016
   Providing service delivery grants to support the quantity and quality of service delivery by the
     health facilities and to strengthen the management of the provincial health departments and                Closing Date:
     district. Operations.                                                                                      June 30, 2021
   Ensuring sustainable and responsive Health Systems.
                                                                                                                Contact:
Each year, the HEF system supports free access to over 2 million outpatient visits and over 100,000             Mr. Somil Nagpal
hospital admissions for the poorest people in Cambodia, nationwide and across all public health                 World Bank Task Team Leader
facilities in the country. Payments for these services provided to the poor, as well as additional fixed
and performance-based grants to health facilities, are deposited electronically and in a timely manner          E-mail: snagpal@worldbank.org
into the bank accounts of the health facilities. This has changed the empowerment and accountability
paradigm, as resource availability at the most peripheral level of the health system has allowed facility-
level decision making and vital funding that supports maintenance and repair of equipment and
infrastructure and emergency shortages of drugs and consumables.
                                                                                                                     www.worldbank.org
The project uses a multipronged approach to strengthening health systems, especially to support
improvements in quality of care, by focusing on enhancing provider knowledge through both pre-
service and in-service training, improved availability of critical infrastructure and strengthening public      www.youtube.com/worldbank
financial management (PFM). Significantly, the project uses government systems for its
implementation arrangements, and is predominantly financed through results-based instruments.
                                                                                                                www.twitter.com/worldbank
Beneficiaries and Location
The project beneficiaries are the population of Cambodia, particularly the poor and vulnerable, and
health care providers working in the public health sector. The project covers the whole country.               www.facebook.com/worldbank