All together now: Extending social protection in Cambodia

A new National Social Protection Council convenes the right players

Cambodian mothers bring their children for health checks

Until recently there was no overarching platform for coordinating social protection schemes across ministries and agencies in Cambodia. With support from Germany and the United States, the General Secretariat of the National Social Protection Council is now playing this role. What did it take to get there and does it make a difference to poor people's lives?

A healthy start to life

Earlier this year when the Royal Government of Cambodia launched a new conditional cash transfer scheme for poor pregnant women and young children, it had women like Yin La in mind. Yin La is 17 years old and has just become a mother for the first time. She and her husband are among the 2.4 million Cambodians who are classified as poor through the national poverty identification programme, ID Poor. For the young couple the arrival of a baby daughter is both cause for joy and an added responsibility.

To help women like Yin La to eat well and to take good care of themselves and their babies during pregnancy and the first two years of life, the Cambodian government has started making a series of cash payments to poor women when they attend antenatal check-ups, deliver their babies at health facilities, and bring their infants for health checks and immunisations. Since June 2019, when the programme was launched, more than 40,000 poor women across Cambodia have benefitted from the scheme.

Yin La with her newborn daughter and her ID Poor card

Many different elements need to come together behind the scenes for social assistance schemes such as this one to work smoothly for recipients. When Yin La arrived at the Kampot Referral Hospital to give birth, she had never heard of the cash transfer scheme. But when she showed her ID Poor card at the registration desk, the hospital staff knew what to do. ‘The process was easy,’ said Yin La. ‘The staff informed me that I’m entitled to these payments and explained how to claim them.’ 

Yin La’s seamless experience is testament to one of Cambodia’s youngest institutions, the National Social Protection Council (NSPC), which was established in 2017 as an inter-ministerial coordination platform for social protection initiatives countrywide. Together with its operational arm, the NSPC General Secretariat, the NSPC built policy consensus for the cash transfer scheme across relevant ministries and facilitated its design and roll-out.

The establishment of the NSPC and General Secretariat is one of the early successes in the Cambodian government’s ambitious effort to introduce a comprehensive social protection system. Since 2016 the German government, with additional financing from the United States, has provided technical advice on the design and operationalisation of the NSPC and General Secretariat, thereby helping to lay the groundwork for an inclusive, efficient and financially sustainable social protection system in the country.

New institutional arrangements for a new era of social protection

The idea of cash transfers to benefit poor pregnant women and their babies is not a new one in Cambodia. For years development partners had been supporting pilot schemes in selected provinces, but the lessons from these experiences were never consolidated and there was no policy platform where representatives of the Cambodian government and development partners could review the various approaches, debate their benefits, and discuss whether and how to scale them up.

Sok Soan with her newborn

This was the case not only with cash transfers, but with other social protection schemes as well: allowances for persons with disabilities, food and nutrition programmes, benefits for orphans and vulnerable children, and scholarship programmes. ‘The sector was very fragmented,’ recalls Sambo Pheakdey, the Deputy Secretary General of the NSPC General Secretariat. ‘Everyone was doing their own thing and focused on their own agendas. There was nobody to look at the bigger picture.’ 

The situation began to change in 2017 with the adoption of the National Social Protection Policy Framework (NSPPF), which outlines the government’s commitment to provide social assistance to the country’s most vulnerable citizens and to gradually extend social security – including health insurance and pensions – to the entire population. The NSPPF’s vision is expansive, ranging from emergency relief, vocational training and school feeding schemes to workplace injury compensation, disability benefits and unemployment insurance. Against the backdrop of sustained economic growth, and in line with the government’s intention that Cambodia become a middle-income country by 2030, the goal of the policy framework is to harmonise and strengthen existing social protection programmes and to gradually expand coverage of the social safety net to all citizens. 

‘The NSPPF represents a long-term roadmap, and to implement it Cambodia needed new governance arrangements which would bring all the different social protection actors together under a single roof,’ explains Kelvin Hui, a technical advisor with the Social Health Protection Project, implemented by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) in Cambodia. ‘Social protection is cross-cutting, it’s not something that one ministry or agency can do alone.’ 

Designing a fit-for-purpose governance architecture

Families identified via ID Poor are entitled to free health services, as well as other benefits

In 2016 German development cooperation, with additional financing from the United States Agency for International Development (USAID), began working closely with the team of Cambodian policymakers at the MEF’s Department of Pensions and Insurance who were driving the reform process and who were tasked with conceptualising the new institutional arrangements. An international expert, recruited through the Center for International Migration and Development (CIM) and jointly funded by Germany’s Federal Ministry for Economic Cooperation and Development (BMZ) and USAID, joined the Department as a full-time employee in November 2016. In addition, advisors with the Social Health Protection Programme, who were already working with the team on social health insurance for poor Cambodians, began to advise on the development of the social protection system more broadly. 

From the start, it was clear that all the ministries and agencies already involved with social protection should be represented in the new governance arrangements. In addition, the new body needed to have enough political power to convene key actors and to make decisions about policy. It should also be able to channel external expertise – including from development partners and academia – so that deliberations about policy options could be made jointly and transparently.  

After months of negotiation about where the new institution should sit and what powers it should have, the design of the new governance architecture came into focus. At the apex would be a National Social Protection Council, chaired by the Minister of Economy and Finance (MEF), and composed of 17 Ministers and Secretaries of State from various government entities involved with social protection. The NSPC would set the policy direction and be supported by an Executive Committee, composed of lower-ranking representatives of the same institutions. The Executive Committee, in turn, would be advised by expert groups, a development partners consultative group, and a social partners forum comprised of civil society representatives.

The task of the General Secretariat, with its complement of 25 staff, would be to give life to the overall social protection framework at an operational level. In practical terms, this would mean guiding the design and roll-out of specific social protection schemes, and handling key strategic functions, such as monitoring and evaluation, information systems and communications. The Secretariat’s structure would mirror the main work streams, with two programme units dedicated to social insurance and social assistance, respectively, a legal department, and a general affairs department.

The Secretariat starts to takes shape

The NSPC met for the first time in March 2018 and it took most of that year to get the Secretariat up and running. Office space had to be secured, staff needed to be hired and basic work processes and regulations had to be put in place. At the same time, work on existing social health insurance and pension schemes couldn’t be halted: the core team members from the MEF continued doing their previous work at the same time they were building the new institution.  

Staff of the NSPC General Secretariat

Sambo Pheakdey, who was part of the original MEF team and is now Deputy Secretary of the General Secretariat, recalls this initial period as both exciting and daunting: ‘There was so much to do be done at the start, it was difficult to set priorities.’ He acknowledges the important contributions which development partners made to building the capacity of the emerging Secretariat during this early period. GIZ, for example, facilitated training opportunities, brought in short-term consultants to advise on specific technical questions, and arranged an exposure visit to Indonesia which allowed the Secretariat’s core team to learn about the set-up of that country’s social protection system. 

By early 2019 the Secretary-General, Dr Chan Narith, had assumed his position and another round of hiring ensued. Rather than having individual ministries second employees, the decision was taken to recruit completely new personnel who would be employed by the same organisation and focused solely on its mandate. For the new hires, most of whom came from the private sector, the learning curve has been steep: ‘Social protection is very complicated: pensions are one thing, health insurance is another, and social assistance schemes something else entirely,’ says Pheakdey. ‘None of us had experience in this area before.’

As the staff of the Secretariat have grown into their new roles, the integrated experts – who currently include a CIM expert and a USAID-funded advisor with Palladium – have been a great asset: ‘It’s been really good to have them sitting with us every day, discussing both the technical and administrative issues,’ says Pheakdey. In addition to regular project-based teamwork, the CIM expert, for example, facilitates a weekly lunchtime meeting where an aspect of social protection is explored in detail, or where staff members returning from conferences or meetings present what was discussed and how it is relevant for the work of the Secretariat. These sessions not only deepen technical understanding, but also help to build the presentation and communication skills which Secretariat staff need to effectively present the work of the NSPC to external parties.

A central player in the social protection arena

Two years ago, the NSPC General Secretariat was little more than an organogram on paper, but today, it has begun to play its envisioned role as a clearing house for social protection initiatives countrywide.

Just as it has taken time for the Secretariat staff to grow into their jobs, it has also taken time for other actors in the social protection arena to accept the role of this new entity. ‘This coordination function is totally new, and you could see the resistance at first. People felt like they were losing power,’ says Pheakdey.  ‘But we’ve tried to show that we’re not interfering, we’re just trying to improve things. As we’ve begun talking and working together, the cooperation has started to happen.’

Not only is intra-governmental cooperation improving, but interactions with development partners are also becoming more streamlined. The development partners’ social protection coordination platform is now affiliated to the General Secretariat. Rather than taking up proposals individually with specific ministries, development partners now bring ideas to the Secretariat. Those which are in line with policy priorities can be referred to the Council or the Executive Committee for consideration. While it’s still early days, this consolidation of activity around the NSPC and General Secretariat should, over time, help to reduce fragmentation, minimise duplication, and expand the coverage of social protection programmes to citizens who require them.

‘A lot of positive impact on people’

The evolution of the cash transfer scheme for poor pregnant women and young children illustrates the value that the NSPC and General Secretariat is already adding to the social protection landscape:  in less than a year, the cash transfer scheme went from a pilot project led and funded by UNICEF to a national scheme paid for by the Cambodian government. The NSPC approved the idea and the General Secretariat helped to facilitate an implementation agreement between the Ministry of Health and Ministry of Social Affairs, Veterans and Youth Rehabilitation. Prior to the establishment of the NSPC there was no vehicle for scaling up such schemes, or for working out operational details such as the size of the benefit and the conditions which would be attached.

The new programme exemplifies the advantages of an integrated approach to social protection. The cash payments, although modest, are meaningful for the poor women who receive them, and because they are tied to specific services, they encourage the use of public health facilities. 

Sothea Nguon is a senior midwife at Kampot Referral Hospital and was on duty when Yin La delivered her daughter. She’s been working in the health system for 27 years and sees a lot of positives in this new initiative: ‘Many patients at our hospital are poor, so any additional money at all makes it easier for them,’ she explains. ‘It also encourages them to go for antenatal care and to bring their children in for immunisations.’ 

Yin La didn’t realise that her ID Poor card entitled her to any additional benefits related to giving birth, but Cambodia’s nascent social protection system did. Now Yin La knows better. And she has every intention of bringing her daughter for her scheduled check-ups.

Karen Birdsall,
November 2019

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