OPERATIONAL MANUAL - Ministry of Health

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 

• 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: admin.hssp@online.com.kh 

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ACRONYMS & ABBREVIATIONS 

3YRP 

ADB 

AFD 

ANC 

AOP 

AusAID 

BCC 

BHEF 

BTC 

CAR 

CBHI 

CDC 

CDHS 

CMDGs 

CNM 

CPA 

CQS 

CSC 

CSES 

DA 

DBF 

DCP 

DDF 

DDG 

DFID 

DG 

DGAF 

DHRD 

DHS 

DIA 

DIC 

Three Year Rolling Plan 

Asian Development Bank 

Agence Francaise de Developpment 

Ante Natal Care 

Annual Operational Plan 

Australian Agency for International Development 

Behavior Change Communication 

Bureau of Health Economics and Finance 

Belgian Technical Cooperation 

Council for Administrative Reform 

Community Based Health Insurance 

Communicable Diseases Control 

Cambodia Demographic and Health Survey 

Cambodia Millennium Development Goals 

National Malaria Center; now renamed as the National Center for 

Parasitology, Entomology, and Malaria Control (NCPEMC) 

Complementary Package of Activities 

Selection based on Consultant Qualifications 

Community Score Card 

Cambodia Socio Economic Survey 

Department of Administration 

Department of Budget and Finance 

Dengue Control Program 

Department of Drugs, Food and Cosmetics 

Deputy Director General 

Department for International Development (U.K.) 

Director General 

Director General of Administration and Finance 

Department of Human Resource Development 

Department of Hospital Services 

Department of Internal Audit 

Department of International Cooperation 

3


DP 

DPHI 

DPM 

EAC 

EMDS 

EOI 

FA 

FMG 

FMIP 

FMM 

GDP 

GGF 

GIS 

GMS 

GTZ 

HC 

HCP 

HCWM 

HE 

HEF 

HIS 

Department of Personnel 

Development Partners 

Department of Planning and Health Information 

Department of Preventive Medicine 

Equity Access Card 

Ethnic Minorities Development Strategy 

Expression of Interest 

Financing Agreement (with the World Bank) 

Financial Management Group 

Financial Management Improvement Plan 

Financial Management Manual 

Gross Domestic Product 

Good Governance Framework 

Geographic Information System 

Greater Mekong Subregion 

Deutsche Gesellschaft fuer Technische Zusammenarbeit 

(German Technical Cooperation Agency) 

Health Center 

Health Coverage Plan 

Health Care Waste Management 

His/Her Excellency 

Health Equity Fund 

Health Information System 

HISSP Health Information System Strategic Plan (2008-15) 

HIV 

HMN 

HP 

HR 

HRD 

Human Immuno-Deficiency Virus 

Health Metrics Network 

Health Post 

Human Resources 

Human Resource Development 

HSP2 Second Health Strategic Plan (2008-15) 

HSSC 

HSSP1 

HSSP2 

IC 

ICB 

Health Sector Steering Committee 

First Health Sector Support Project 

Second Health Sector Support Program 

Individual Consultant 

International Competitive Bidding 

4


IDA 

IFR 

IMCI 

IMR 

IPA 

IPPF 

IU 

JAPA 

JAPR 

JMYR 

JPA 

JPIG 

JQM 

LCS 

LQAS 

M&E 

MBPI 

MEF 

MOH 

MOP 

MOU 

MPA 

MTEF 

MYR 

NCB 

NCD 

NCHADS 

NCPEMC 

NGO 

NHA 

NHC 

NIP 

NIPH 

International Development Association (World Bank) 

Interim Financial Reports 

Integrated Management of Childhood Illnesses 

Infant Mortality Rate 

International Procurement Agency 

Indigenous Peoples’ Planning Framework 

Implementing Unit 

Joint Annual Plan Appraisal 

Joint Annual Performance Review 

Joint Mid Year Review 

Joint Partnership Arrangement 

Joint Partnership Arrangement Development Partners Interface Group 

Joint Quarterly Meeting 

Least Cost Selection 

Lot Quality Assurance Sampling 

Monitoring and Evaluation 

Merit-Based Performance Incentive 

Ministry of Economy and Finance 

Ministry of Health 

Ministry of Planning 

Memorandum of Understanding 

Minimum Package of Activities 

Medium Term Expenditure Framework 

Mid Year Review 

National Competitive Bidding 

Non-Communicable Disease 

National Center for HIV/AIDS, Dermatology, and Sexually Transmitted 

Diseases 

National Center for Parasitology, Entomology, and Malaria Control (formerly 

known as CNM - National Malaria Center) 

Non Government Organization 

National Health Accounts 

National Health Congress 

National Immunization Program 

National Institute of Public Health 

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NIS 

NMCHC 

NNP 

NRHP 

National Institute of Statistics (Ministry of Planning) 

National Maternal and Child Health Center 

National Nutrition Program 

National Reproductive Health Program 

NSDP National Strategic Development Plan (2006-10) 

OD 

ODO 

OPD 

PAD 

PER 

PFMR 

PFMRP 

PHD 

PIP 

PMG 

Operational District 

Operational District Office 

Outpatient Department 

Program Appraisal Document 

Public Expenditures Review 

Public Financial Management Reform 

Public Financial Management Reform Program 

Provincial Health Department 

Public Investment Plan 

Priority Mission Group 

Procurement Management Group 

PMM 

PMR 

PRC 

PRH 

PTWG-H 

QBS 

QCBS 

RGC 

RFQ 

RH 

RMNCH 

RTC 

SDG 

SFKC 

SHI 

SOA 

SOE 

SOP 

Pesticide Management and Monitoring 

Performance Monitoring Report 

Procurement Review Committee 

Provincial Referral Hospital 

Provincial Technical Working Group Health 

Quality Based Selection 

Quality and Cost Based Selection 

Royal Government of Cambodia 

Request for Quotation 

Referral Hospital 

Reproductive, Maternal, Newborn and Child Health 

Regional Training Center 

Service Delivery Grant 

Social Fund of the Kingdom of Cambodia 

Social Health Insurance 

Special Operating Agency 

Statement of Expenditures 

Standard Operating Procedures 

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SSS 

S/T 

SWiM 

TA 

TSMC 

TWG-H 

U5MR 

UNICEF 

UNFPA 

WB 

WHO 

Single Source Selection 

Short Term (for consultants) 

Sector Wide Management 

Technical Assistance 

Technical School for Medical Care 

Technical Working Group Health 

Under Five Mortality Rate 

United Nations Children’s Fund 

United Nations Population Fund 

World Bank (International Bank for Reconstruction and Development) 

World Health Organization 

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TABLE OF CONTENTS 

FOREWORD 13 

CHAPTER 1: BACKGROUND 14 

1.1 HEALTH STRATEGIC PLAN, 2008-15 14 

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 17 

2.2.1 SERVICE DELIVERY GRANTS AND INTERNAL CONTRACTING 17 

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 20 

2.3.1 HEALTH EQUITY FUNDS 21 

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 24 

3.2 HEALTH SECTOR STEERING COMMITTEE 24 

3.3 TECHNICAL WORKING GROUP-HEALTH 24 

3.4 JOINT ANNUAL PERFORMANCE REVIEW 25 

3.5 JOINT ANNUAL PLAN APPRAISAL 25 

3.6 JOINT MID YEAR REVIEW OF THE ANNUAL OPERATIONAL PLAN 25 

3.7 JOINT QUARTERLY MEETINGS 26 

3.8 ROLES AND RESPONSIBILITIES OF KEY IMPLEMENTATION UNITS 26 

3.8.1 CENTRAL DEPARTMENTS 26 

3.8.2 PROVINCIAL HEALTH DEPARTMENTS 27 

3.8.3 OPERATIONAL DISTRICTS 27 

3.9 PROGRAM MANAGEMENT ARRANGEMENTS 29 

3.10 INTEGRATING HSSP2 SECRETARIAT FUNCTIONS INTO MOH LINE DEPARTMENTS 39 

3.11 IMPLEMENTING THE GOOD GOVERNANCE FRAMEWORK 41 

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 68 

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 

14


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. 

15


Figure 1. HSSP2 Financing Arrangements 

Government 

expenditure 

Donor 

Donor 

Donor 

Pool 

Public sector 

expenditure in health 

Health Strategic Plan 2008-2015 

Defined group of activities 

Defined group of 

activities 

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 

Table 2. Financing Plan 

Source Amount Estimated US$ Million: 

Exchange rate stipulated in 

each agreement 

AFD €7 Million 10 

AusAID AU$37.15 Million 30 

BTC €3 Million 4 

DFID £35 Million 50 

UNFPA Est. US$8.867 Million (2009 – 2010) 8.87 

UNICEF US$4 Million (2009 & 2010) 4 

World Bank (IDA 

Credit) 

SDR 18,500 Million 30 

Royal 

Government of US$8 Million 8 

Cambodia (RGC) 

Total 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. 

16


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 2008- 

2015 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 

17


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. 

Function 

Overall Management and Coordination 

Planning, Resource Allocation Formula, and 

Monitoring 

Financial Administration, including Budget 

Disbursement and Reporting 

Performance Monitoring (routine) 

Performance Monitoring (verification of 

results and standards) 

Auditing SDGs Expenditures 

Table 3. Functions and Responsibilities for SDGs 

Responsible Department 

Department of Planning and Health Information 

(DPHI) 

DPHI 

Department of Budget and Finance (DBF) 

MOH/Provincial Health Department (PHD)/DPHI 

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 

MOH 

Pool Fund 

Consultation 

MEF 

AOP 

Performance Agreement 

Development Plan 

Annual Budget 

PG 

AOP and Budget Request 

PHD 

Service Delivery Agreement/ 

Management Contract 

Operational District 

HC 

RH 

SP 

18


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. 

19


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. 

20


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 Merit- 

Based 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 

21


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 

22


empowerment and provider accountability. Further details on CSCs are contained in Chapter 4: 

Program Monitoring and Evaluation. 

23


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 

DG FOR HEALTH 

Program Secretariat 

DG FOR ADMIN. AND FINANCE 

DIC DPHI DP 

DBF 

H & A 

PLANNING 

HEF 

M & E 

including 

SUPPORT MBPI 

ADMINISTRATION 

BUDGET 

DISBURSEMENT 

3 YRP 

AOP 

- HEF Planning 

- HEF Monitoring 

- HEF Reporting 

SDG Monitoring 

(HSMSST) 

JMYR 

FM MONITORING 

& REPORTS 

PROCURMENT 

PLANS & REPORTS 

Joint Appraisal 

& 

Joint Supervision 

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 

24


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 TWG- 

Hs (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 3 rd 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. 

25


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. 

26


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. 

27


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 


Assistants x 2 

Accounting Assistants x 6 

ADB/GMS Accountant x2 

Accounting Assistant 

(DBF secondment) 

Procurement Officers x 3 

Procurement Officer 


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) 

International Financial 

Management Adviser 

International Procurement 

Adviser 

International Health Sector Monitoring 

and Evaluation Adviser 

DEPARTMENT OF BUDGET AND FINANCE 

DEPARTMENT OF PLANNING AND 

HEALTH INFORMATION 

28


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. 


• 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; 

29


• 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. 


• 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. 

3.9.4 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. 


(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 

30


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. 


• 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 

3.9.4 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. 


• 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. 


• 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 

31



3.9.5 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. 


• 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. 


• 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. 

3.9.6 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. 


• 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 

32


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. 


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. 

33



• 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. 


• 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. 


• 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; 

34


• 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. 


• 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 


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. 


• 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. 


• 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. 

35



• 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. 


• 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. 


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; 

36



• 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. 

• 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. 


• 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. 

37



• 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. 


• 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. 


• Master's degree in management, economics, business administration, engineering or any 

related field; 

38


• 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. 

39


FIGURE 5. PROGRAM MANAGEMENT ARRANGEMENTS PHASE II (2011-13) 


Program Coordinator 

FINANCE UNIT 

PROCUREMENT UNIT 

PROGRAM ADMINISTRATION UNIT 

Chief Financial Management 

Officer 

Chief Procurement Officer 

Chief Program Administrator 

Senior Pool Fund Financial 


Assistant x 2 

Senior Discrete Account Financial 


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 

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 

Accounting Assistant 


Procurement Officer 


HSSP2 Secretariat by 2011 under 


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 

Financial Management Advisor 

International Procurement 

Adviser 

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


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. 

41


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. 

42


FIGURE 6. PROGRAM M&E CONCEPTUAL FRAMEWORK 

Political and 

Administrative 

System 

3 Year Rolling Plan 

EXTERNAL 

CONTEXT 

Functional Outputs 

Sustainability 

Institutionalization 

Organizational 

Resources 

RGC Contribution 

Annual Operational Plan 

Service Outputs 

Knowledge, 

Attitudes, Demand, 

and Practices 

Reduced Incidence 

of Endemic and 

Emerging Diseases 

Service Utilization 

Pooled Funds and 

Discrete Accounts 

Implementation of 

Activities 

Reduced Maternal, 

Infant and Child 

Mortality 

INPUTS PROCESS OUTPUTS OUTCOMES IMPACT 

43


FIGURE 7 KEY STAKEHOLDERS AND THE FLOW OF INFORMATION 

HEALTH SECTOR STEERING COMMITTEE 

JPIG 

JOINT QUARTERLY MEETING/ JOINT SUPERVISION MISSION 

EXTERNAL AUDIT/ TECHNICAL & FINANCIAL REPORT 

PROGRAM DIRECTOR 

INTERIM FINANCIAL REPORT/ PERFORMANCE MONITORING REPORT 

DG/ADMINISTRATION & FINANCE 

• ADMINISTRATION 

• BUDGET AND FINANCE 

• HUMAN RESOURCE 

DEVELOPMENT 

• INTERNAL AUDIT 

• PERSONNEL 

QUARTERLY REPORT 

PROGRAM COORDINATOR 

PROGRAM SECRETARIAT 

INTEGRATED PROGRAM DATABASE 

NATIONAL INSTITUTES/CENTERS 

REGIONAL TRAINING CENTERS 




DG/HEALTH 

• COMMUNICABLE DISEASES CONTROL 

• DRUGS AND FOOD 

• INTERNATIONAL COOPERATION 

• PREVENTIVE MEDICINE 

• HOSPITAL SERVICES 

• PLANNING AND HEALTH 

INFORMATION 


PROVINCIAL HEALTH DEPARTMENTS 

HIS 

CLIENT SATISFACTION SURVEYS, HIS AND HEALTH FACILITY SURVEYS 

OPERATIONAL DISTRICTS 

PROVINCIAL REFERRAL HOSPITALS 

CLIENT SATISFACTION SURVEYS, HIS AND HEALTH 

FACILITY SURVEYS 

REFERRAL HOSPITALS 

HIS 

HEALTH CENTERS 

COMMUNITIES 

LOCAL AUTHORITIES 

COLLABORATING MINISTRIES AND AGENCIES 

COMMUNITY SCORE CARDS AND SMALL SAMPLE SURVEYS 

44


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. 

TABLE 4. PROGRAM PERFORMANCE INDICATOR DASHBOARD 

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 TRENDS 

Incidence Rate per 

1,000 pop. 9.5 15 12.4 12.3 11.4 9.6 8.6 10.26 7.5 5.5 7.2 4.2 

Case Fatality Rate 0.69 0.51 0.44 0.64 0.47 0.41 0.41 0.37 0.38 0.4 0.39 0.40 

45


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. 

46


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 1 st 

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 Flow of 8. Health FLOW OF Information HEALTH INFORMATION 

Dept of 

Planning and 

Health 

Information 

National Programs 

20 th day 

Provincial Health Departments 

PRO4 Report 

(Aggregated DO3 Reports) 

Central Institutions 

National Hospitals 

Dept of CDC 

Pasteur Institute 

10 th day 

OD Office 

DO3 Report 

(Aggregated HO2 and HC1) 

5 th day 

Referral Hospital 

HO2 Form 

5 th day 


HC1 Form 


HC1 Form 

Report 

Feedback 

Page 1 

47


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. 

48


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 

49


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. 

50


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 

51


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. 

52


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 

53


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. 

54


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 

55


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. 

56


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. 

57


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 Category Description 

Number 

1 Service Delivery Grants 

2 Health Equity Fund Grants 

3 MBPI-related payments 

4 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. 

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) 

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. 

60


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 

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 

International Competitive All contracts estimated to cost above US$ 300,000 

Bidding 

National Competitive Bidding All contracts estimated to cost above US$ 40,000 and 

below US$ 300,000 

Shopping With Advertising All contracts estimated to cost above US$ 5,000 and below 

US$ 40,000 

Shopping Without Advertising All contracts estimated to cost below US$ 5,000 

Community Participation 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 


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 

61



Threshold 

Least Cost Based Selection (LCS) Contract for external audit of HSSP 2 from Year 2010 

onwards 

Selection Based on the 

Consultant’s Qualification (CQS) 

Sole-Source Selection (SSS) – 

Firm, and Single-Source 

Selection (Individual Consultant) 

Selection of Individual 

Consultant (IC) 

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.’ 

62


• 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. 

64


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. 

65


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 

1 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. 

66


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. 

Costs are 

unaffordable. 

Lack of 

participation in 

health development. 

Health workers 

absent from 

facilities. 

Health workers are 

not from local 

communities. 

Poor quality 

services. 

Introduction of health 

posts and/or mobile 

services. 

Ensuring that the 

poor are not 

charged. 

Indigenous 

community 

participation in 

designing and 

making decisions 

about primary 

health care. 

Strategy to retain 

health workers in 

highland areas. 

Recruiting personnel 

from local 

communities. 

Health workers 

trained to offer 

MPA. 

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. 

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. 

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. 

MOH will introduce management and quality improvements 

and financial incentives for good performance. Program will 

support nurse and midwife training of indigenous people. 

Development of a primary nurse and midwife training course 

tailored to the needs local communities. Targeted recruitment 

from local communities. 

Training in specific modules of MPAs based on needs 

assessment. 

67


Constraints 

Identified by 

Ethnic minorities 

Language and 

cultural barriers 

Remedial Measures 

Proposed by 

Stakeholders 

Strategy to provide 

culturally 

appropriate 

information and 

services 

Program Plans in Mondulkiri , Ratanakiri, Stung Treng and 

Kratie and other areas where large populations of ethnic 

minorities live 

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; 

68


(b) 

(c) 

(d) 

(e) 

Improving delivery of appropriate targeted information and behavior change 

communication; 

Local ethnic minority participation in designing and monitoring health development 

plans; 

Monitoring, evaluation and the annual sector review process; and 

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 programs 6 

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 

6 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. 

69


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. 

70


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. 

71


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 

72


• 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. 

73


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 

74


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 PESTICID E MANAGEMENT AND MONITORING PLA N 

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 

75


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 

76


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 

PERFORMANCE 

INDICATOR 

BASELINE 

VALUE AND 

YEAR 

SOURCE OF 

DATA 

FREQUENCY REPORTING RESPONSIBILITY DESCRIPTION AND 

FORMULA 

I 

Impact and 

Outcome 

Indicators 

(Total: 14) 

1 Infant Mortality Rate 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 


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 


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 

BASELINE 

VALUE AND 

YEAR 

SOURCE OF 

DATA 


FORMULA 

4 Maternal Mortality Ratio 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 


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 

Anthropometric 

Survey 

Socio-Economic 

Survey 

` 

5 years 

2008 

2009 

NIPH/NIS 

NIS/Ministry of 

Plannig (MOP) 

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 


FORMULA 

below the new WHO 

growth standards / Total 

number of children under 

5 x 100 


with acute undernutrition: wasted 

(per new WHO growth 

standards)* 

7.3 

2005 

CDHS 


Survey 


Survey 

5 years 

2008 

2009 

NIPH/NIS 

NIS/MOP 

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 





standards, and are 

considered acutely 

undernourished. 


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 


who are underweight (per new 

WHO growth standards)* 

35.6 

2005 

CDHS 


Survey 


Survey 

5 years 

2008 

2009 

NIPH/NIS 

NIS/MOP 

NIS/MOP 

NNP 


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 


FORMULA 

chronic undernutrition. It 

refers to the proportion 

of children under 5 years 

whose weight-for-age Z 

scores are below minus 2 





standards. 


5 years whose weightfor-age 

is below minus 2 

standard deviations of 


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 

Anthropometrics 

Survey 

5 years 

2008 

NIS/NIPH 

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 


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 


Survey 

5 years 

2008 

NIPH/NIS 

NIS/MOP 

NNP 


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/m 2 . Any woman 

of reproductive age with 

a BMI of 18.5 kg/m 2 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 

0.9 

2007 

CDHS 

HIV/AIDS 

Sentinel 

Surveillance 

5 years 

2-3 years 

NIS/NIPH 

NCHADS 

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 

12 TB death rate per 100,000 75 National Center Annual CENAT CENAT 

It refers to the estimated 

number of deaths due to 

6

NO. 

TYPE OF 

INDICATOR 

PERFORMANCE 

INDICATOR 

BASELINE 

VALUE AND 

YEAR 

SOURCE OF 

DATA 


FORMULA 

population 2007 for Tuberculosis 

and Leprosy 

Control (CENAT) 

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 


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 

CDHS 


Survey 

HIS 

5 years 

Annual 

Annual 

NIS/NIPH 

NIS/MOP 

Health Information 

System Bureau 

(HISB)/Department 

of Planning and 


(DPHI) 

NRHP 

DPHI 

DPHI 


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 

2 Percent of births attended by 

trained health personnel at 

health facility 

22 

2005 

CDHS 

Healh 

Information 

System (HIS) 

5 years 

Annual 

NIS/NIPH 

HISB/DPHI 

NRHP 

DPHI 


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 

BASELINE 

VALUE AND 

YEAR 

SOURCE OF 

DATA 


FORMULA 

3 Percent of currently married 

women using a modern 

contraceptive method 

27 

2005 

CDHS 

HIS 

5 years 

Annual 

NIS/NIPH 

HISB/DPHI 

NRHP 

DPHI 

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 


year fully immunized 

60 

2005 

CDHS 

HIS 

5 years 

Annual 

NIS/NIPH 

HISB/DPHI 

NIP 

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 


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 DTP- 

HepB3* 

75.5 

2005 

82 

2007 

CDHS 

HIS 

5 years 

Annual 

NIS/NIPH 

HISB/DPHI 

NIS/NIPH 

NIP 


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/ 


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 


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 


9 Proportion of children aged 6– 

59 months who received vitamin 

A supplement within the last 6 

months* 

34.5 

2005 

76 

2007 

CDHS 

HIS 

5 years 

Annual 

NIS/NIPH 

HISB/DPHI 

NIS/NIPH 

HISB/DPHI 


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 


FORMULA 

Number of children aged 

6–59 months who 

received a high-dose 

vitamin A supplement 

within the last 6 months/ 


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 

69 

2007 

CDHS 

HIS 

5 years 

Annual 

NIS/NIPH 

HISB/DPHI 

NIS/NIPH 

HISB/DPHI 


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 


FORMULA 

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 


among the total 

population and among 

children under 5 years. 

• All consultations 

0.51 

2007 

HIS 

Annual 

HISB/DPHI 

MOH 

• Total OPD 

consultations (new 

cases) for all cases 

/ Total population 

• Children under 5 years 

1 

2007 

HIS 

Annual 

HISB/DPHI 

MOH 

• Total OPD 

consultations (new 

cases) for children 

13

NO. 

TYPE OF 

INDICATOR 

PERFORMANCE 

INDICATOR 

BASELINE 

VALUE AND 

YEAR 

SOURCE OF 

DATA 


FORMULA 

under 5 years / 

Total children under 

5 

4 Percent of pregnant women 

attending at least 2 antenatal 

care consultations 

60 

2007 

68 

2007 

CDHS 

HIS 

5 years 

Annual 

NIPH/NIS 

HISB/DPHI 

NRHP 

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 C- 

section 

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 

BASELINE 

VALUE AND 

YEAR 

SOURCE OF 

DATA 


FORMULA 

(+) pulmonary TB (%) 2007 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 (

NO. 

TYPE OF 

INDICATOR 

PERFORMANCE 

INDICATOR 

BASELINE 

VALUE AND 

YEAR 

SOURCE OF 

DATA 


FORMULA 

Health Facility 

Survey on quality 

of case 

management of 

childhood 

illnesses (to be 

developed in 

2009) 

2 years CDCD/MOH CDCD/MOH public health provider. 


5 years with ARI who 

were treated by a public 

health provider / Total 

number of children under 

5 with ARI x 100. 


years with diarrhea who 

received ORT 

58 CDHS 

Health Facility 

Survey on quality 

of case 

management of 

childhood 

illnesses (to be 

developed in 

2009) 

5 years 

2 years 

NIPH/NIS 

CDCD/MOH 

CDCD (IMCI) 

CDCD/MOH 


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 


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 


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 


FORMULA 

thus reported alongside 

is prevalence, not 

incidence. However, DPM 

will provide incidence 

data by the 1 st quarter 

of 2009 after which the 

matrix will be updated. 

12 Percent of essential drugs at 

HCs that faced stock-outs 

12.07 

2007 


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 


of Operational Districts 

18

NO. 

TYPE OF 

INDICATOR 

PERFORMANCE 

INDICATOR 

BASELINE 

VALUE AND 

YEAR 

SOURCE OF 

DATA 


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 Community- 

Based 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 


FORMULA 

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 


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 

1 Ratio of MOH secondary 

midwives per 10,000 population 

per location: 

This is a composite 

indicator that refers to 

the availability of 

secondary midwives in 

the country and its 

provinces. 

• Country ratio 0.55 

2007 

Personnel 

database 

Annual 


Personnel (DP) 

DP 

• Number of 

secondary midwives 

expressed per 


for the country as a 

20

NO. 

TYPE OF 

INDICATOR 

PERFORMANCE 

INDICATOR 

BASELINE 

VALUE AND 

YEAR 

SOURCE OF 

DATA 


FORMULA 

whole 

• Provincial average 

0.64 

2007 

Personnel 

database 

Annual 

DP 

DP 

• Provincial average 

of ratio of 

secondary midwives 

per 10,000 

population 

• Provincial median 

0.57 

2007 

Personnel 

database 

Annual 

DP 

DP 

• Provincial median of 

ratio of secondary 

midwives per 


2 Number of HCs with staffing 

levels recommended by MPA 

guidelines 

NA 

Personnel 

database 

Annual DP DP It refers to the proportion 

of health centers with 

staff per MPA guidelines. 

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 1 st 

quarter, 2009. 

21

NO. 

TYPE OF 

INDICATOR 

PERFORMANCE 

INDICATOR 

BASELINE 

VALUE AND 

YEAR 

SOURCE OF 

DATA 


FORMULA 

3 Number of RHs with staffing 

levels recommended by CPA 

guidelines 

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 1 st 

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) 


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 


FORMULA 

in the health sector x 100 

2 Percent of RHs, ODOs and 

PHDs offices with computerized 

HIS: 

It is a composite indicator 

that refers to the 

proportion of Referral 

Hospitals, Operational 

District offices, and 

Provincial Health 

Departments equipped 

with a computerized 


System. 

• RHs 

0 

2007 

PHDs 

Annual 

PHDs 

DPHI 

Number of RHs with 

computerized HIS / Total 

number of RHs x 100 

• ODOs 

• PHDs 

100 

2007 

100 

2007 

PHDs 

PHDs 

Annual 

Annual 

PHDs 

PHDs 

DPHI 

DPHI 

Number of ODOs with 


number of ODOs x 100 

Number of PHDs with 


number of PHDs x 100 

3 (Number) Percent of functioning 

HCMCs 

46 

2007 

PHDs Annual PHDs National Center for 

Health Promotion 

(NCHP) 

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 


FORMULA 

of HCMCs x 100 

4 Percent of private entities that 

are licensed: 

This composite indicator 

refers to the proportion 

of private entities that 

are licensed. 

• Polyclinics 

70 

2007 


Hospital Services 

(DHS) 

Annual 

DHS 

DHS 


polyclinics that are 

licensed / Total 

number of 

polyclinics x 100 

• Consultation cabinets 

52 

2007 

DHS 

Annual 

DHS 

DHS 


consultation cabinets 

that are licensed / 

Total number of 

consultation cabinets 

x 100 

• Pharmacies 

47.8 

2008 


Drugs and Food 

(DDF) 

Annual 

DDF 

DDF 


pharmacies that are 

licensed / Total 

number of 

pharmacies x 100 

24

B. PROJECT MONITORING INDICATORS 

NO. INDICATOR BASELINE VALUE 

AND YEAR 

SOURCE OF 

DATA 

FREQUENCY RESPONSIBILITY REPORTING COMMENTS 

1 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


AND YEAR 

SOURCE OF 

DATA 


4 Percentage of external funds 

for health sector included in 

3YRPs and AOPs* 

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 

CDC: 31 

2009 

NCD: 3 

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. 

6 Rate of Program execution for 

both pooled DP and 

Government funds 

RGC: 91 

2007 

DP (HSSP1): 85 

2007 

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. 

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


AND YEAR 

SOURCE OF 

DATA 


provincial level* 

AOP: 29 

2007 

national health budget spent on 

PHDO, ODO, RHs, and HCs. 

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


AND YEAR 

SOURCE OF 

DATA 


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


AND YEAR 

SOURCE OF 

DATA 


indicators for prioritization in 

their AOPs 

ODs: 77 

2008 

AOPs Annual PPHSRB/DPHI DPHI 

indicators to prioritize 

interventions in their AOPs. 

Number of PHDs using health 


interventions in their AOPs 

Number of ODs using health 


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


AND YEAR 

SOURCE OF 

DATA 


17 Selected key HSP2 indicators 

disaggregated by gender and 

location 

0 

2008 

HSP2 M&E 

Framework 

Annual HISB/DPHI DPHI 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.

OPERATIONAL MANUAL - Ministry of Health

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