1. Social Protection Expenditure and Performance Review (SPER) Jean-Claude Hennicot Consulting Actuary Findings CAMBODIA

2. Social Protection Expenditure and Performance Review (SPER) Background and objectives:  SP Diagnostic Tool developed by ILO  Comprehensive overview and assessment of a country’s Social Protection system  Helps to identify coverage gaps and to highlight critical policy issues  Improve knowledge base for policy making

3. SPER Comprises the following parts:  Review of country setting Demography, economy, and labour market Social indicators (e.g., poverty, fertility)  Overview of SP system: schemes, benefits, benefit levels, and governance  Assessment of SP Financing: Expenditure and funding source (  Social Budget)  Assessment of Coverage and gaps  ‘Performance’ of system

4. Challenges in Cambodia  Availability of data  Many different actors  No centralized database  No standardized financial reporting  Limited data for off-budget programmes (mainly ODA and NGO-funded schemes)  New Schemes / Provisions  Policy formulation still ongoing (NSSF, NSSFC, NFV, NSPS, est.)  Timeframes for Implementation?

5. Demography Source: NIS, Population Census 2008

6. Labour Market

7. Employment

9. Population and employment

10. Social Protection Coverage Map

11. Current State of Social Protection Public sector workers: Mostly covered by NSSFC and NFV Private employees: Labour law provisions and NSSF (work injury) Own-account workers (informal economy): Only CBHI so far but low coverage The poor and vulnerable: Mainly health care (HEFs) and child benefits

12. The National Social Security Fund for Civil Servants (NSSFC)  Established 2009  Autonomous scheme (MoSVY supervision)  Administration of social security benefits for civil servants and their family dependents  To become social insurance fund  Annual expenditure: ~ 23 million US$ (2009)  Beneficiaries: 67,500 pensioners and 4,500 cash benefits (2009)

13. The National Fund for Veterans (NFV)  Established 2010  To become autonomous (MoSVY supervision)  Administration of social security benefits for war veterans, armed forces and the police  Plan to introduce contributions  Expenditure: ~ 19 million US$ (2010)  Beneficiaries: 199,000 pensioners (2010)

14. The National Social Security Fund for private sector workers (NSSF)  Established 2008 by Royal Decree (  Social Security Law, 2002)  Autonomous body under MoLVT supervision (Tripartite board of directors)  Work Injury branch implemented in 2008 (Expenditure ~ 0.6 million US$ in 2010)  Social Health Insurance planned for 2012  Pension branch planned for 2015

15. Labour Law provisions for private sector workers  Paid sick leave (  company regulations)  Paid maternity leave  90 days at 50% of salary  Severance Pay (‘dismissal allowance’)  Minimum wage (Garment sector only so far)  Employment Injury  employer liability

16. Social Assistance and Safety Nets Main programmes:  MoSVY social welfare services (for Orphans, Disabled, Elderly, Poor, Disaster victims)  Emergency Relief Aid (NCDM coordination)  MoEYS social welfare programmes - Scholarship programme for poor students - School Feeding programme (WFP)  MOH fee waiver provisions for the poor  Health Equity Funds  Public Works Programmes  Vocational Training (TVET)

17. Health Care Main Observations: -High maternal and child mortality  economic cost substantial -High level of OOP expenditure -Limited quality of care at public health facilities -Private providers largely unregulated -Total Health Expenditure: 860 million US$ (~ 7% of GDP or about 62$/capita/year)

18. Health Financing in Cambodia Health Expenditure by source:

19. Social Health Protection Main objectives:  Ensure access to care for the poor  Protect non-poor against catastrophic health expenditures  Risk pooling (health insurance)  Improve quality of care  Incentivize service delivery

20. Policy Development Framework Outlined in several strategic policy documents: Rectangular Strategy, phase II National Strategic Development Plan, update 2009 – 2013 Strategic Framework for Health Financing (2008 – 2015) Financial Sector Development Plan (2011) National Social Protection Strategy for the Poor and Vulnerable (2011)

21. Policy Directions in Social Protection  Extension of SP for the poor and vulnerable  National Social Protection Strategy (2011) - Extension of HEFs and CBDHI - Cash transfers (Children, Elderly, Disabled) - Public Works Programmes - Vocational Training  Extension of Social Security for formal sector workers - Social Health Insurance (NSSF, NSSFC) - Pensions (NSSF)

22. Critical Issues  Financing for Social Protection  ODA funding & national budget  Fiscal Space  Policy formulation  choice and design of programmes  Institutional framework  Implementation arrangements  optimize benefit delivery

23. Recommendations Continue efforts to implement SP strategies:  National Health Financing Strategy, 2008 - 2015  National Social Protection Strategy (NSPS) Continue development of institutionalized arrangements and programmes  Shift from ODA-funded projects to national systems  Allocate funding through national budget Consider universal cash transfer schemes Strengthening of SP institutions (  develop human and institutional capacity) Ensure policy coordination and coherence

24. Thank you Questions & comments are welcome