Implementing decentralization in rural Cambodia's healthcare functions
  • February 02, 2016


February 2, 2016 – The UN Capital Development Fund has completed the "Promoting Local Development through Decentralized Health Service Delivery (LDHSS)" project in Cambodia, with the funding and support of the Australian Department of Foreign Affairs and Trade (DFAT). The project was aimed at supporting the Cambodian Government to improve responsiveness, accountability and budget execution efficiency in planning, financing and delivery of local public health functions.

In operation since 2013, LDHSS has assisted the National Committee for Sub National Democratic Development - Secretariat (NCDD-S) and the Ministry of Health (MoH) to test out financing mechanisms that will enable the transfer of selected healthcare functions across Cambodia.

The project was specifically developed to support the transfer of primary public healthcare functions from central government to the district administrations. It was not designed nor implemented to engage in the technical aspects of healthcare or healthcare personnel. The programme additionally did not examine health sector staff budgets or payrolls.

In pursuit to reach the “last mile,” LDHSS has enabled access to primary healthcare in remote rural areas.  It has done that through assisted functions focused on service provision. Firstly, through the upkeep, maintenance and modernization of district health centers. Secondly, by improving and maintaining physical access to the health centers.  Thirdly, by supporting “24/7” access to public health services through effective and flexible staffing.

Mr. Paul Martin, Regional Technical Advisor at UNCDF, explained: “The LDHSS project illustrates the complex evolution of UNCDFs Local Development solutions in Cambodia. Applying decades of country experience that began as the country emerged from civil war, UNCDF was ideally positioned to assist with the most critical phase of decentralization – the transfer of functions from line ministries to subnational authorities (SNAs). UNCDF brought together all of the financial expertise and fully-tested tools to test and promote the devolution of primary heathcare service responsibility to local governments. The actual results, in terms of the improvement of service provision and access to primary healthcare, has empowered the RGC to scale and speed up the transfer of functions in education, environment and other health functions.  ”

Through the LDHSS pilot initiative, local administrations have been provided with conditional performance-based transfers (grants) to enable them to implement a new functional responsibility for the provision of primary healthcare. Through effective planning and the implementation of dedicated projects, the participating local administrations have demonstrated capacity, not only to maintain levels of service delivery, but to enhance primary healthcare services.

The implemented projects focused directly upon providing year-round access using climate-reliant solutions, providing much needed "24/7" coverage in remote areas and improving local service related infrastructure.

The pilot has proved the feasibility of transferring this function to the SNAs allowing MoH to concentrate on the technical and qualitative issues of primary healthcare.

The LDHSS pilot project was implemented in two provinces, which are Battambang and Pursat, in order to test out the transfer of permissive functions to the SNAs in the health sector. LDHSS subsequently piloted supportive maintenance and physical installation-related projects to enhance service delivery through mechanisms of: (1) localization of budget design-making with citizen participation, (2) improving and maintaining year-long access to district health centers, and (3) providing recurrent budget support to provide “24/7” coverage at the district health centers.

The LDHSS grants were conditional and performance-based in that the district administrations have had to ensure administrative and financial compliance to administer the grants and ensure their correct usage to maintain access to primary healthcare being delivered to their constituents.