In the framework of the Action for Global Health (AFGH) network, the European Parliamentary Forum on Population and Development (EPF) brought a four-member Parliamentary delegation from Belgium, Spain, Lithuania and Germany to Phnom Penh for a week-long field visit on Global Health hosted by KHANA, the Khmer HIV/AIDS NGO Alliance from 22-28 August 2010.

The EPF delegation visit focused on the achievement of health-related Millennium Development Goals (MDGs) in Cambodia (MDG 4 on child mortality; MDG 5 on maternal mortality and universal access to reproductive health and MDG 6 on HIV/AIDS, tuberculosis and malaria). EPF delegates met with representatives from ministries, relevant national authorities and UN agencies and visited projects on the health MDGs run by major Cambodian and international NGOs. Briefings also included a development partners’ roundtable on health held at the EU delegation to exchange on best practices and coordination mechanisms between European development agencies to ensure the de facto implementation of the Accra agenda for Action on Aid Effectiveness (AAA) and of the International Health Partnership and related initiatives (IHP+). The activities have enabled delegation participants to discuss and learn about the challenges of health MDGs@10 but also about the latest developments and new ideas on the frontline of healthcare in developing countries and finally about the implications of the economic and financial crisis on ODA spending for health in Cambodia.

A journey into rural Cambodia
The EPF Delegation also had the opportunity to visit rural areas such as the Takeo Province, south of Phnom Pen, to see the living conditions and health situation of the local population. This journey into agricultural Cambodian villages affected by a record lack of rain and water led participating parliamentarians to meet and engage with staff and beneficiaries from local NGOs on the improvement of their lives and their remaining needs as well as will local health and administrative authorities on their service delivery capacities and funding needs.

Meeting vulnerable groups left behind
Despite the fact that the Cambodian constitution stipulates that poor people shall have access to health services (art. 72 on the right to health including free access for the poor and on the role of the State in disease prevention, medical treatment and rural outreach) and despite that a health insurance scheme (Cambodian Health Equity Fund) has been introduced to guarantee access to primary health services for the poorest population in Cambodia (estimated in around 30% of the population), this remains a distant reality for marginalized and most vulnerable groups in Cambodia. In the absence of safety nets, economic crisis disproportionately affects the poor population. Just as an example of the effect of the financial crisis in developing countries, the shutdown of many industrial and manufacturing plants has driven many young girls and women into prostitution (in Phnom Penh alone, the number of sex workers increased from 17000 to 37000 between 2008 and 2009).

The EPF parliamentary delegation witnessed how marginalized people are not covered by any social insurance despite the introduction of a so-called equity fund. In reality, they have to pay fees from $0.50 to $12, depending on the necessary treatment which is a considerable amount for the average industrial worker who earns 61 $/month and is the only breadwinner of the family. For vulnerable groups, underage and dependent people, this is an insurmountable barrier for accessing health services. The visit to KHANA's implementing partners' projects addressing local street-based underserved groups such as drug-users (who upon testing might suffer a HIV/AIDS prevalence of up to 60%), orphans and vulnerable children (OVC) including children living with AIDS have shown how access to primary health services is seriously hampered by user fees and the lack of comprehensive protection schemes. Those NGOs can hardly cope with the important number of victims of poverty. In addition, the donors-supported Cambodian Health Equity Funds still do not cover more than 30 % of the national territory.
Engaging with stakeholders and decision-makers

In a health donor roundtable, kindly hosted by the EU delegation in Cambodia, Parliamentarians were able to learn about the different health programmes in place in Cambodia operated mainly by the German, British and French cooperation (DFID, GTZ and AFD respectively). The meeting offered valuable insights into the health-related development aid EU member states are delivering and plan to deliver in Cambodia. This fruitful 3 hours meeting helped participants share concerns about the prospects of withdrawal from DFID and foreseen cuts in GTZ budget (2013) which were later shared with Cambodian parliamentarians as they hold a joint press conference within the premises of the Palace of Parliament.

In a declaration endorsed by the delegation, participating Members of Parliament further committed to investigate and report upon return home on the health development cooperation budgets and programmatic plans of their respective governments.

“Health solutions for Cambodian people are within reach. Present action must nevertheless be complemented by a supportive political, legislative and financial environment to ensure long-term results and effectiveness. We must advance, implement and protect the human rights of the Cambodian people and in particular of Cambodian women and girls.”