Key themes are emerging from IHP+Results data collection in Cambodia.  Our Country Representative David Wilkinson interviewed as many IHP+ signatories as possible, with most engagement from Development Partners and Civil Society. I have outlined our key initial findings below*:

• Commitments show increased funding and increased predictability of funding, but there are some concerns about whether these commitments will be met. Most agencies presented increasing funding for 2007-10, but concerns were raised about the uncertainty of funding from agency headquarters, the impact of the financial crisis, changes in the aid environment including increased flow/allocation of funds to the Global Fund, direct budget support and/or SWAps.  Most agencies reported having agreed and met a disbursement schedule with the Ministry of Health (MoH).

• Partners are committed to Harmonisation & Alignment, and efforts predate the IHP+.  Cambodia does not yet have a full IHP+ Country Compact, although many of the elements are in place, for example the Joint Partnership Arrangement (JPA), signed by 7 major health partners (WB, DFID, AusAid, BTC, AFD, UNICEF and UNFPA).  Partners raised concerns that progress should not be attributed to the IHP+ if not appropriate, and mixed views exist about the added-value of a compact, although most partners seem willing to sign if the RGoC and partners develop one.

• Country systems are being used, but with some constraints. All agencies interviewed reported funding in line with the Health Sector Strategic Plan (HSP2), corroborated by civil society, although it was noted that the plan needs to be better prioritized and supported by better costing processes.  All agencies felt that Government procurement systems were too weak for them to use. and alternative procedures are in place whilst a reform process is implemented; agencies described their intention to use government systems when Public Financial Management reforms are satisfactory.  The HSP2 Monitoring & Evaluation (M&E) plan is used by all JPA signatories, but parallel M&E frameworks exist, often driven by agencies’ corporate accountability and attribution needs.

• There are different interpretations of results-based financing.  Most agencies reported some form of results-based financing. A number of challenges in the use of results were identified: the perception that Government risks losing funds if results are bad, or indeed if results are very good; different agencies define results in different terms, some are more process driven, others are more impact oriented; delays in reporting mean decisions are based on results achieved about 2 years earlier.

• Mutual accountability mechanisms exist, but effectiveness varies.   Technical working groups bring together government and development partners and form an accountability mechanism.  Higher level accountability is provided via the Government Donor Coordination Committee which discusses results, and then the Cambodian Development Cooperation Forum, a high-level policy body.  JPA partners are mutually accountable for performance, including through independently facilitated self-evaluation process.  It was also noted that it is less easy to hold non-JPA partners to account. UNAIDS reported that members of the Joint UN Team on HIV/AIDS (JUNTH) are also assessed on achievement of results.  Civil society noted that Development Partners are accountable through a monthly Health Partners meeting. 

• Civil Society is engaged, but there is room for improvement.  Civil Society (through MEDiCAM) is represented on the TWGH Secretariat, which acts as the focal point for the Country Health Sector Team. Getting the full engagement of NGO/CSO members is sometimes challenging as the NGO community itself is not unified. The MoH is more open to engagement with Civil Society than many other sectors in Cambodia.  Civil Society representatives noted IHP+ support to strengthen Civil Society engagement in the health sector. 

Are these key messages reflected in your experiences? Do you have any other themes to add, or contradictory experiences?  Sign up to leave us a comment and let us know what you think.  For more early findings please see our blogs on Zambia and Mozambique.

*This overview does not reflect the perspective of the Royal Government of Cambodia (RGoC), nor comprehensively review all of the data collected.   A full progress report will be available in early 2010.