Photo by: Heng Chivoan
A woman writhes in pain as she gives birth in a referral hospital in Pursat province last March.
via CAAI News Media
Thursday, 14 January 2010 15:03 James O’toole and Vong Sokheng
Groups say supplement cuts are likely to fuel absenteeism
IN AN overflowing meeting room in Phnom Penh’s Tuol Kork district, NGO and development partner representatives on Wednesday elaborated on their concerns about the government’s recent decision to terminate salary supplement programmes for civil servants, a decision the World Health Organisation (WHO) says could lead to a rise in staff absenteeism and an increased burden on the poor.
At the headquarters of the local health group Medicam, the meeting’s 57 attendees considered their options after a sub-decree that went into effect January 1 banned the supplementation of civil servant salaries by development organisations. Through salary-supplement programmes, NGOs and development partners had been boosting the income of Cambodian civil servants in a range of sectors.
None of those in attendance were willing to be quoted on the record during the gathering, but many said that although they were committed to working with the government, they were unsure whether officials fully grasped the potential impact of the sub-decree.
“I don’t think that the government has adequate information on … the adverse impacts of this decision, because the time is too short,” Medicam director Sin Somuny said following the meeting.
On December 3, Prime Minister Hun Sen signed a sub-decree stipulating that the supplement termination would take effect at the start of this year.
Meanwhile, promotions and salary raises have been suspended for one year, according to a September circular from the Council of Ministers, and the premier has also ordered a 50 percent reduction in contracted and temporary staffers throughout the government. This means that only half of the 29,756 contracted government officials and 11,996 temporary workers requested by government ministries for 2010 can be hired, though Hun Sen granted an exception for 850 health workers and 4,800 teachers.
Some at the Medicam meeting questioned that the health sector would be able to afford those 850 new workers, given the termination of the salary supplements.
In a letter dated December 21 and obtained by the Post on Wednesday, acting World Health Organisation representative for Cambodia Michel Thieren wrote to Minister of Health Mam Bunheng to outline a number of possibly harmful consequences of the supplement termination.
Photo by: Sovan Philong
Students walk out after class at Boeung Trabek high school in Phnom Penh last year.
A rise in absenteeism and “an increase in unregulated private practice by public-sector health providers” is likely, Thieren said, as health professionals look to bolster their reduced income by seeking other sources of revenue. In addition, poor Cambodians may bear an increased financial burden in seeking medical care as government health workers retreat en masse to the more lucrative private sector.
“There may be a reduced range of services for fee-exempted patients in order to get cost recovery for more expensive treatments,” Thieren wrote.
“Health fees can be a huge burden for the poor, as health is often a long-term, large and unpredictable expenditure for households.”
In a December 4 letter to World Bank country director Annette Dixon, Minister of Economy and Finance Keat Chhon explained that the government had made the decision both to deal with the effects of the global financial crisis and to facilitate a broader process of civil service reform.
The issue of fairness was also a factor in the government’s decision. Salary supplements that are not uniformly distributed “cause bad feelings in the workplace and lead to declines in productivity”, Minister of Information Khieu Kanharith said last month.
Hang Chuon Naron, secretary general at the Ministry of Economy and Finance, said Wednesday that the government is scheduled to hold a meeting today to discuss the supplement termination, but declined to comment further. Government officials speaking on condition of anonymity said the meeting would be presided over by Keat Chhon and Prak Sokhon, secretary of state at the Council of Ministers.
A debate that emerged at the Medicam meeting was whether NGOs and development partners in the health sector should be looking for ways to “get around” the sub-decree and continue compensating civil servants at present levels, or whether they should strictly observe the sub-decree and simply monitor its ramifications.
“You can hear two different perspectives, so we don’t know exactly. There is no clear direction on what we are going to do yet,” Sin Somuny said.
Those assembled Wednesday agreed to draft a position paper on the issue and establish a working group to monitor the policy change’s effects, he added.
The Medicam director said many rural health professionals may not yet be aware of the government’s decision, even as they draw most of their wages from salary supplements.
Though perhaps particularly significant for the health sector, the effects of the government’s decision should be monitored across government ministries, Sin Somuny said.
“We need to get more information on other social impacts such as education, rural development, the Ministry of Women’s Affairs and agriculture – many of these key social service delivery sectors,” he said.
On December 17, the Australian and British ambassadors as well as the UN, the Asian Development Bank and the World Bank wrote to Keat Chhon to announce their compliance with the decision, though they also requested a meeting to discuss “how to mitigate the potential adverse impacts of the decision”. Sin Somuny said that as of Wednesday, there had been no response by the government to this request.