The village participatory assessment is conducted in 299 villages that situate in border communes along country borders and adjacent to economic corridors. The assessment result is summarized as below:

•  156 villages or 52% of assessed villages reports with equal or more than half of village residents have learnt in secondary school or higher level while 143 villages or 48% report that more than half of residents are low educated.
• 50% of border villages are in mountain areas, mostly in north eastern provinces, which are surrounded by newly forest degradation land, farms and plantation areas or mountains.
• Over 50% of villages are very remoted and hard to access especially during rainy season.
• People mobility rate reports high by around or over 20% of households in two provinces of Banteay Meanchey and Battambang while other eleven provinces report less than or around 10% of households.
• 17% of assessed villages are in dirty condition with rubbish, plastic bags, pots, water containers around the house compounds.
• 99% of villages reports that equal or more than 75% of households in each village drink safe water.
• 64% of assessed villages reports that equal or more than 75% of households in each village drink safe water.
• 26% of assessed villages reported that equal or more than 75% of households in each village have cleaned household compounds.
• 59% of assessed villages having equal or more than 75% of households using toilet.
• Common health problems are diarrhea and respiratory tract infection which is reported by most community members while dengue fever, worm, malaria and digestive tract problem stands behind. Malaria is reported to occur in all villages in north eastern provinces of Kratie, Stung Treng, Ratanakiri, Mondilkiri, Preah Vihear, and some villages in Battambang province. Download

4.According to ADB’s 2009 Safeguard Policy Statement (SPS), the Borrower requires to prepare an Indigenous Peoples Plan (IPP) to protect and ensure benefits for EMGs affected by the Project. According to the Indigenous Peoples Safeguards Sourcebook :

“The borrower/client is responsible for assessing projects and their environmental and social impacts, preparing safeguard plans, and engaging with affected communities through information disclosure, consultation, and informed participation following all policy principles and safeguard requirements.” According to the Sourcebook, “IP safeguards are triggered when a project affects either positively or negatively and either directly or indirectly the indigenous people (para 8).” Furthermore, “the project is expected to have only limited impact and is accordingly categorized as B (para 67).”

5.As per the ADB SPS, “if Indigenous Peoples are the sole or the overwhelming majority of direct project beneficiaries and when only positive impacts are identified, the
elements of an IPP could be included in the overall project design in lieu of preparing a separate IPP.” While the project is expected to have positive impacts on IPs, they are not the sole or overwhelming majority of direct project beneficiaries. Furthermore, given the scale and complexity of this regional project, the potential for not achieving certain intended positive impact on ethnic monitories justifies a category B and warrants preparation of this IPP to help achieve intended impact on IPs and other vulnerable EMGs. Download

1.               This indigenous peoples plan summarizes the Cambodia-specific analysis, strategy, and plan for addressing indigenous peoples concerns/issues for the GMS Health Security Project based on the Government’s and ADB’s policy on indigenous people as described in the ADB 2009 Safeguard Policy Statement (SPS). Indigenous Peoples (IPs) make up a small part of the population in Cambodia. They live in the poor north-eastern provinces, which is part of the project area. IPs elsewhere are mostly fully mainstreamed in Khmer society[1]. It is practical to focus on marginalized IPs that lack access to services, are being displaced, or lack citizen rights and empowerment. In the context of the Project, this IPP focuses on the first group, remote IPs, as well as internal and external migrants, some of whom are IPs. The challenges of control of infectious diseases of regional relevance in these two subgroups are quite different.

2.               The proposed GMS Health Security Project (the Project) aims to improve regional public health security by strengthening health security systems and CDC in border areas, in particular for migrants, youth, and ethnic minorities. Three outputs or outputs[2] are proposed: (i) improving regional cooperation and CDC in border areas, (ii) strengthening surveillance and response systems, and (iii) improving diagnostics and management of infectious diseases.

3.               The project covers a total of 13 provinces in Cambodia about 7.6 million people live in targeted project areas, of whom just under half are IPs. The targeted provinces in Cambodia are Banteay Meanchey, Battambang, Kampot, Kandal, Kratie, Mondulkiri, Preah Vihear, Prey Veng, Ratanakiri, Stung Treng, Svay Rieng, Pailin, Tbong Khmum. The indigenous peoples found in Ratanakiri, Mondulkiri, Stung Treng, and Kratie represent about 66%, 71%, 7%, and 8%, respectively, of the total populations in these provinces. The most populous Indigenous groups are the Phong located in Mondulkiri, Stung Treng, and Ratanakri, the Tampuon located in Rattanakiri and Mondulkiri, the Kuy located in Preah Viher, and Stung Treng and the Jarai located in Rattanakiri[3]. The five provinces in the north-east: Preah Vihear, Stung Treng, Rattanakiri, Mondulkiri, and Kratie, all have poverty rates over 30%.

Increased movements of people through travel and trade, social and environmental changes linked to urbanization
compounded with a rapid adaptation of microorganisms call for an effective global surveillance and response system as a communicable disease in one country today is the concern of all because Communicable Diseases recognize no borders in this new era whereby physical national borders become bridges to facilitate trade and travel. Epidemics of emerging
infectious diseases as exemplified by Severe Acute Respiratory Syndromes (SARS), Avian Influenza A/H5N1, Pandemic Influenza A/H1N1 have potential negative impact not only on human health but also on other socio-economic aspect.
In the 1969 version of the IHR, the three diseases that are required to be reported by States Parties to the World Health Organization, namely chorea, plague and yellow fever are no longer valid. The world requires an updated global system that can rapidly identify and contain public health emergencies and reduce panic and the disruption of trade, travel and society. The IHR 2005 requires World Health Organization (WHO) Member States to assess, develop, strengthen and maintain their country's capacity at a level to meet the minimum core capacity requirements for disease surveillance and response. The specific disease list is now replaced by a broader term of “Public Health Emergency of International Concern” (PHEIC).
Communicable Disease Surveillance and Response assists countries with building an integrated alert and response system for epidemics and other public health emergencies based on strong national public health systems and capacity and an effective international system for coordinated response.
In Cambodia, the Communicable Diseases Control (CDC)  Department was officially established as a result of the MoH reshuffle in 1997.   Its main function is to effectively prevent and control epidemic prone diseases through early detection and coordinated response system. In late 2003, a risk assessment and disease prioritization exercise was conducted. The list of four diseases in the weekly zero-reporting system was expanded to create a list of 12 diseases/syndromes. The reporting structures from the community to the national level were maintained in order to ensure that all diseases reporting are complete, accurate and timely. Download

In Cambodia, malaria transmission is endemic in 21 out of 25 city and provinces excluding Phnom Penh, Kandal, Prey Veng and Svay Rieng. It occurs primarily in the hot and rainy season between July and November. It is estimated that 58% of the population, or approximately 8.6 million people, live in malaria at-risk areas1. Malaria risk is highest in forest or forest fringe areas in the north eastern part of the country.
In 2016, Cambodia has classified malaria endemic areas into two groups of operational district (OD), burden reduction and elimination according to malaria elimination action framework (MEAF) 2016-2020. Elimination targeted ODs are those in which malaria annual parasite index is lower than 1/1000 population while burden reduction targeted ODs, API is equal or over 1/1000 population. Download

(Special Operations)

(Greater Mekong Subregion Health Security Project)

(Cambodia Component)

between

KINGDOM OF CAMBODIA

and

ASIAN DEVELOPMENT BANK

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Project Number: 48118-002

October 2016

Proposed Loans and Grant

Kingdom of Cambodia, Lao People’s Democratic Republic, Republic of the Union of Myanmar, and Socialist Republic of Viet Nam

Greater Mekong Subregion Health Security Project

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