Recommendations

The 2006 World Bank report on managing risk and vulnerability in Cambodia has attempted to identify the main risks threatening each age-group, current interventions and areas that need improvement and support (Table 1). Pertinently the areas that need further support give us an idea of areas where the most improvement is needed and / or informs us of areas that may have been relatively neglected during past interventions. It is thus strongly recommended that policy makers formulate intervention activities keeping in mind the areas that have been identified as needing further support. Thus, for example, while there are current intervention programs that aim at improving maternal and child health of infants; there is an urgent need to initiate programs that target infant nutrition.

Table 10.1: Social Protection Coverage across Stages of the Lifecycle

Source: The World Bank, Managing Risks & Vulnerability, 2006

Built upon the situation analysis, interventions are recommended as follows:

Availability

Reducing the cost of production

Modern agricultural inputs such as fertilizers (organic and inorganic) and improved seed varieties are expensive in Cambodia. The price of fertilizers and fuel has risen continuously at unprecedented rates in recent years, but the price of farm produce has not kept pace. This has resulted in farmers being unable to afford agro-chemicals and improved seeds and hence being unable to maximize productivity. Most countries in the world, developing and developed, provide some support to their agriculture - some provide outright subsidies, others input price support, and yet others modern technical services. It will be useful to explore what combinations of support instruments will work best in the Cambodian context.

Possibilities for addressing this problem of high input costs include:
a. Bulk purchase of fertilizers from sources that offer lowest landed prices - Either local government institutions present in a village or local cooperatives can undertake to buy fertilizers in bulk (thus obtaining the same at a lower price) and sell it at a no profit no loss basis to farmers.
b. Select substitution of fertilizers by farmyard manure - This would require extensive and superior agricultural extension to enable farmers to optimize input application (UNDP, 2007).

Crop diversification

More than 90 percent of farm land is allocated to rice, this despite the country having the environment to produce a number of crops like maize, soybean, cassava and some pulses, in addition to a range of horticultural and tree crops. Extensive monocropping over a long period of time depletes the soil of certain essential nutrients. Furthermore, a dependence on one crop can be catastrophic to farmers in the event of rice crop failure or a bad season. Among problems faced by individual farmers in growing other crops is that at most locations, the marketable supply is not large enough to attract other buyers for anything other than rice. Lack of a critical minimum supply volume of alternative crops also inhibits the agro-industry from establishing value chains of Cambodian food products (UNDP, 2007). Agricultural extension and the advocating of a farming systems approach could help in promoting crop diversification.

Note: Integrated 'farming systems' approach - This is an approach wherein a combination of different perennial (including tree) and seasonal crops, along with livestock and even fisheries in farm ponds or flooded agricultural lands, are jointly planned at the farm/household level. This approach seems appealing in Cambodian conditions, even for small farmers; it yields more income, protects the ecology and shields farmers against natural disasters or price fluctuations.

Increasing Crop Productivity

Some of the other options by which crop productivity can be increased include:

The propagation of newer innovations like System of Rice Intensification (SRI). SRI is a relatively simple and inexpensive method of rice planting that provides higher yields. Such an approach would be ideal for poor food-insecure farmers who can now try and increase yield without needing to invest large sums of money (SFFSN, 2008).
Scaling up the national Integrated Pest Management programme (IPM) (SFFSN, 2008).
Encourage the widespread adoption of aquaculture among small hold farmers.
Training extension workers to work with small farmers on increasing rice productivity, crop diversification, productivity of non-rice crops, upland agriculture systems and livestock (SFFSN, 2008).

Access

Alternate options to present pricing system

Paddy farmers will benefit enormously from a more remunerative rice farm gate price. The following options to the present pricing system has been researched and reported in the UNDP Human Development Report for 2007.

Alternative 1: Individual farmers have no control over prices, but act collectively to obtain better prices for themselves. Organizations of farmers, which might help in augmenting their bargaining power, are largely nonexistent in Cambodia. Such an organization could provide for the establishment of collective grain storage facilities so that farmers borrow against their grain rather than sell it in distress, and the grain is sold only when the prices are at their most remunerative. Such a proposal has been piloted in Prey Veng and Kampot and the possibilities of scaling up should be considered.

Alternative 2: Farmers can make collective agreements with millers for a 'negotiated price,' at which the farmers would be obliged to sell to the millers at harvest. Contracts with millers rather than a miller, renewed each season, can be most beneficial to farmers. The major difference between this and Alternative 1 is that farmers will not have to provide rice storage. Success will depend upon how fast a domestic rice milling industry modernizes and grows.

Alternative 3: A more rigorous form of Alternative 2 is a formal contract arrangement between farmers and food processing companies. In Cambodia this has been very limited, but at least two successes have been recorded in the cases of fragrant rice and tobacco.

The need to bridge the Urban-Rural gap

Cambodia’s average annual population growth rate for the period 1990 – 2005 is one of the highest in the world at 5.6%; the comparable figure for East Asia was just 3.6%. Furthermore, in the same period Cambodia’s urban population increased by 54% (WB, 2007). Thus not only has Cambodia’s population increased but this increase in population is concentrated in urban areas (due in part to rural to urban drift).

World Bank analysis suggests that Cambodia’s development process has concentrated largely on improving facilities and infrastructure in urban areas, leading to a marked difference in standards of living between rural and urban areas. Growth has been generally unbalanced, centered in urban areas, and also narrowly based, largely driven by activities such as garment manufacturing, construction and tourism. In contrast, growth of rural activities based primarily on agriculture, shows considerable variability and significantly lags behind the rest of the economy. If growth continues to remain urban-focused, poverty reduction gains will be much less and rural poverty will remain high, especially since the depth of poverty is greater in rural areas

Furthermore, if agriculture and rural development continues to grow slowly and development continues to be primarily focused in urban centers; then migration to urban areas will continue to increase.

The adverse effect of this (hypothetically) could be:

High population growth rate + Increasing rural-urban migration = High Labor Force Growth rate = High urban unemployment / under-employment.

Thus it is crucial the Urban-Rural development gap be addressed and to ensure that development and progress is uniform. The following areas, with respect to rural agricultural productivity and economy, can be considered high priority areas

(a) Irrigation facilities and access to water

(b) Access to agro-chemicals & agricultural extension

(d) Farmer’s access to credit and low interest loans

(e) Ensure education & health facilities in rural areas are on par with urban zones

(f) Development & encouragement of grass-root cooperatives

(g) Allocation of de-mined land to the rural poor and food-insecure.

3. Market systems in Cambodia, including markets for food, require further development of infrastructure, services and capital to provide an improved access to foods at the local level (SFFSN, 2008).

4. The development and expansion of transport facilities in particular has great significance for agriculture. Currently farmers lose a share of profit margin due to high costs of transportation. Similarly the consumer pays a higher price due to added transportation costs. A cheaper and more effective transportation system will not only make agriculture more productive for the farmer but also help bring down (and stabilize) prices.

5. Food-for-work and food-for-training activities to improve rural incomes, agricultural practices, reduce post-harvest losses, expand rural transportation infrastructure and augment irrigation facilities in order to enhance resilience to, and mitigate the adverse impact of, drought, floods and other natural disasters.

6.    Encouragement of the non-food sector
Some non-food rural industries and services have succeeded in the market despite being located away from centers of commercial activity. Typical ones include:
(a)    Silk weaving and cotton weaving
(b)    Brick making
(c)    Wood processing and furniture making
(d)    Weaving mats from rattan and other natural fibers
(e)    Stone quarrying
(f)    Handicrafts and pottery
(g)    Rural water and road transport (operation and repair)
(h)    Hides and leather
(i)    Rural electrification - power from diesel engines for local distribution, charging batteries, etc.
(j)    Retail trade and transport

Most of these activities are currently characterized by outdated technologies, relatively high unit costs and low productivity - and hence are threatened by imports. Yet these activities provide critical services in rural areas and create much needed jobs. They also hold an important key to reducing excessive dependence on agriculture and fishing. Hence it is recommended that this sector be studied more closely and efforts must be taken to increase the efficiency, effectiveness and productivity of the non-food rural sector.

Education interventions:

1. Expand safety net activities, i.e., food for education, to provinces classified as high chronically food insecure and to those with the poorest education indicators.

2. Continue monitoring and reporting primary school attendance and advocate an expansion of WFP project monitoring systems to the national level.

3. Promote efforts to encourage early entry and reduce dropout rates in schools through initiatives such as pre-school education.

4. The expectation of schooling opportunities beyond primary education in the form of Lower Secondary School availability increases early access to school and reduces primary school dropout.

5. Women's education & child malnutrition: Mother's education impacts children's nutritional status positively, with 3% of children of highly educated mothers stunted, compared with 51% of those whose mothers had no education (UNDP, 2004). As with other health indicators, child malnutrition sharply declines with increases in the level of the mother's education. As in other countries, it appears that educating women is a critical factor in reducing malnutrition over time. Thus the education of women is not only a goal in itself but has the added advantage of reducing child malnutrition.

6. Promote the availability of health-related facilities (i.e., drinking water, latrines) and learning facilities (i.e., libraries) to promote educational retention and learning outcomes.

7. Teachers' educational backgrounds and pre-service training are diverse and unevenly distributed across Cambodia. Improving the quality of teachers is a key factor in improving education, increasing enrollment and lowering drop-out rates.

Utilization

Health & Nutrition interventions:

1. Expand safety net activities, i.e., Maternal & Child Health (MCH) and supplementary feeding, in priority provinces with the poorest nutrition, health and utilization indicators

2. In addition to the current WFP MCH provinces it is recommended that further nutrition assessments and monitoring be conducted in Kandal, Otdar Mean Chey, Pousat and Prey Veaeng provinces where wasting rates are high, as recommended in the IPC

3. Vaccination Programs: The 2005 CDHS collected information on vaccination coverage for all living children born in the five years preceding the survey. The percentage of children fully vaccinated is lowest in the provinces of Mondol Kiri / Rattanak Kiri (35 percent), Kampot/Krong Kep (41 percent), and Siem Reap (43 percent). Thus it is recommended that future vaccination programs take particular care to ensure greater coverage in these provinces.

4. Specific support to other vulnerable populations (such as TB patients, people living with HIV/AIDS, and orphans and other vulnerable children) to complement the safety nets activities.

5. Advocacy for increased wells and water filtering facilities to provide clean drinking water.

6. Food-for-training programmes for nutrition, health and hygiene education.

7. Anemia amongst rural women: With 47 percent of women having anemia, it is a critical public health problem in Cambodia with 35 percent mildly anemic, 10 percent moderately anemic and just 1 percent severely anemic. Anemia is also higher among rural than urban women (CDHS, 2005). Weaning infants, adolescent girls and women of reproductive age are at particular risk of iron-deficiency anemia (IDA). Since the risk of irreversible cognitive and growth impairment increases with iron deficiency, iron supplementation is needed in appropriate doses during critical stages of development. There is an urgent need to develop and implement public health interventions to reduce anemia. Such interventions would include the distribution of iron-based supplements (FeSO4 drops/capsules) and the advocating of food-based strategies (diet diversification, fortified foods etc.).

8. Promote usage of Vitamin A supplementation for children 6-59 months and for post partum women within six weeks of delivery (SFFSN, 2008).

9. Promote universal household use of iodized salt (SFFSN, 2008). .

10. Conduct extension activities to educate women of all ages, and pregnant and post partum women in particular, on nutritionally adequate diets.

11. There is a need to increase awareness of good sanitation practices and increase investments in hygienic toilets in rural communities (SFFSN, 2008).

12. Increasing Access to Health Care: Health care in Cambodia is relatively expensive. Because the public health service is under-funded, obtaining service requires high fees at the point of service. The cost barrier to access to health services is one of the main factors resulting in low access to health care for the poor. It is clear that protecting the population from high health care-related out-of-pocket costs should be one of the priorities for health system development. This would not necessarily mean abolishing user fees but rather institutionalizing ways of protecting the poor and seriously ill from the full impact of user fees. Exempting women-headed households from health-care fees or providing subsidized health care to the poorest are two examples by which access to public health service can be increased.

13. Train existing paramedics who staff rural health centers to practice preventive medicine (e.g., ensure children receive a full course of immunizations, provide information about and simple precautions against infectious diseases, promote personal hygiene and sanitation education, promote the use of insecticide-treated mosquito nets, etc..) and simple diagnosis. They also can dispense/inject medicines for malaria, stomach infections or dehydration (i.e., oral rehydration salts) and conduct outreach in villages (UNDP, 2007).

14. Source medicines from countries that bulk-produce generic drugs to reduce costs and increase availability. A complementary solution to this problem is to provide a stimulus to the nascent local drug industry and set standards for quality (UNDP, 2007).

Vulnerability

Improved Disaster Management

Cambodia faces disaster hazards that can threaten human lives and the food security of the population. The most likely hazards in Cambodia are flood and drought disasters, which directly affect agriculture and result in food shortages. Some of the interventions that would assist in improving disaster management include:

Increased training/extension/inputs to vulnerable communities on better flood, drought, pest and disease-resistant crops.
Promote diversification of households’ livelihoods to include non-agricultural activities such as business and wage labor sources of income.
Maintain or improve the productivity and level of access of rural communities to Common Property Resources, which are often very important to the poor for coping with shocks, stresses or disasters.
Support the implementation of the priorities of National Adaptation Programme of Action to Climate Change (NAPA) (SFFSN, 2008).

Priority Intervention Provinces

In order to prioritize and eventually maximize cost effectiveness, an integrated intervention approach is proposed by province, combining MCH/MCN, FFW and FFE, wherever possible. A combination of key reference indicators and/or indirect evidence indicators is used, following the IPC classification. In addition to the underweight and stunting indicators, the under-five anaemia and infant mortality rates are used to prioritize MCH/MCN activities. Poverty rate and the average percentage of rice areas destroyed by drought over the last three years (2004-2006) were selected to prioritize FFW interventions. Finally, primary school enrolment, school attendance and completion rates were used to prioritize FFE activities. In addition, nutrition assessments are recommended to support the operations, given weak reliability of data in some provinces.

Following the integrated approach, the summary table below indicates that most of the high chronically food insecure provinces would become first priority provinces for interventions. Notwithstanding operational constraints, the integrated interventions could be extended to second priority provinces. The generally food secure provinces of Phnom Penh and Bat Dambang are not considered as priority intervention areas, unless further fine tuning of the selection criteria, specific indicators and arguments can be established.

Table 10.2: Recommended Priority Intervention Provinces

Due to resource constraints, high unit costs associated with transporting food to a small number of beneficiaries scattered over a widespread territory and limited availability of suitable partners, WFP's Protracted Relief and Recovery Operation will only be able to target 960,000 beneficiaries per year through the education, disaster risk reduction and health and nutrition sectors.

In 2008, WFP's highest concentration areas will be in 12 provinces, including Pursat and Banteay Mean Chey. The table below highlights WFP's indicative food allocation estimates.

Table 10.3: Indicative food allocation estimates by targeted province