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MEDiCAM with support from the Global Fund for Health System Strengthening and in collaboration with the Department of Planning and Health Information, Ministry of Health, organized a Community based NGO planning forum for all MEDiCAM’s members and the planning teams from the Provincial Health Departments of Kampong Thom, Kampong Cham, Prey Veng and Svay Rieng. This is a summary report of the forum that was held on August 27-29, 2007 at Phnom Pros Hotel, Kampong Cham.

There were in total 46 participants who attended the forum and they were from CNGOs, INGOs, DPHI, DIC, Global Fund, and PHDs (see the appendix for the list of participants). Four key facilitators from DPHI were invited to present about the 6 steps in AOP and they are the key people to answer straightly to the questions from participants. Two guest speakers were invited to be the moderators and respond to the relevant questions that were raised by participants.

2- To discuss the current challenges, issues, difficulties, and seek practical solutions for this integration of the AOP.

The event was opened by H.E. Dr. MAM Bun Heng, secretary of state, MOH. In his opening speech, he mentioned that NGOs and the government should cooperate and join their discussions on the AOP for the effectiveness of the health sector’s work. With this regard he highlighted some achievements made by the MOH, health partners and NGOs such as the decrease of the HIV prevalence among women age 15-49 years old that stay at home, and reduction of child mortality rate to achieve the millennium development goal, the reduction of TB, malaria, dengue and MOH plan. He stated that the immunization coverage and the universal use of breast feeding have increased. He added that NGOs and MoH/PHD should strengthen more of their effort to reduce the rate of HIV infection, TB, and dengue to the lowest rate possible. At the end of his speech, he thanked all stakeholders for their efforts in contributing to this success. He strongly encouraged all development partners (NGOs) and PHD to discuss the integration of NGO’s plans into the AOP (Annual Operational Plan).

Dr. Lun Chan Reaksmey, Deputy Director of Kampong Cham PHD, started his speech by welcoming all the participants attending the forum. He also mentioned about the importance of the AOP and the three year rolling plan of the government and some achievements that have been made by the PHD in 2007. The relevant activities toward these achievements are focusing on HIV/AIDS, dengue, immunization, and disaster relief and support etc.

Dr. Sin Somuny, MEDICAM Executive Director, said that the integration of plans into the AOP is the core obligation of the development partners and NGOs because it

improves the transparency, improves the cost efficiency, and achieves the common goals which have been set and approved by the PHD and the partners.

This integration of plans responds to the global trend that the development partners and the community donors want to see the effective use of their funding support and it’s based on the five following key principles in the declaration in Paris of the development partners:

2. Alignment: All donors’ funding must support the government plan (AOP, HSP, NSDP)

3. Harmonization: All the development partners must approve on principle of the funding support

5. Mutual accountability: Have the mutual accountability between the development partners and the country that provides funds

Lastly, he expected that all participants would actively participate in the discussion on the AOP during the three days of this forum and they all would receive the actual knowledge and understanding about AOP. It follows that at the end of the forum we will have the practical solutions which will contribute to a better implementation of AOP in future.

The objectives and the program of the forum were drafted with consultation from key stakeholders such as the representative of Health Planning and Information Department, MOH.

Dr. Khem Thann, PNCB Coordinator, presented the objectives of the forum, agenda and summarized the process of the forum (See Appendix for the agenda and objectives).

Dr. Ngin Seila Phiang, Planning Officer from DPHI/MoH gave the overview of the Annual Operational Plan (Step1 to step 6 of planning cycle)-See Appendix for the detailed slides. The PHD representative from each province presented about the difficulty, challenges, and recommendation toward the integration of AOP with all partners (all of these presentations have been included in the appendix). The issues of integration from MoH’s perspective and why integration is very important for MOH were presented by Dr. Lo Veasnakiry, Director of Department of Planning and Health Information, and many questions were asked (see Appendix for the presentation).

Dr. Khem Thann, PNCB Coordinator, summarized the issues that had been raised at the annual sharing event on Day 1 and 2. All the issues had been discussed in plenary discussion which was moderated by Dr. Sin Somuny, Executive Director of MEDiCAM.

The participants discussed how to integrate NGOs plans in to an AOP. Objectives of the discussion were (1) to make NGOs aware of the planning process and the timeframe of AOP. (2) to discuss the current challenges, issues, difficulties, and seek practical solutions for this integration of the AOP.

During the first two days of the presentation, participants have asked many questions. Some questions were responded to immediately by the facilitators from DPHI and some complicated questions were left behind for Dr. Lo Veasna Kiry and Dr. Sin Somuny to answer on the third day. Those related questions and some responses were recorded by Dr. Khem Thann, PNCB Coordinator, and are reported below:

Questions

Answers

1. How can we set up the budget plan so that it can respond or achieve the target set up? (eg: increase the delivery cases at HC from 20%-45% of the expected pregnant women) (slide 24, 3. Target)

1. Will be presented in the next step of the presentation.

2. Why do we need to separate between the objective and the target as the target is already included in the objective? (slide 24, 3. Target)

2. Because the target set is based on the resource budget and the timeframe. It’s combined already but no objective. It just covers the target and predictions.

3. When will they evaluate the planning manual? Which kinds of format should be followed or used, as there are different formats which have been introduced? To learn the theory is easy but it was difficult to implement.

3. Do not know about the planning manual evaluation. But what PHD should do is to follow the format of program base budget. DPHI/MoH understands that it was not easy to implement. But the change of the format is adapted to the donors’ requirement.

4. Different per diem policy between the government and NGOs so that is why the participants only show their interest and make their involvement to those who provide more Per diem. How to mediate this issue so that NGOs and government has only one standard of per diem policy?

5. NGOs and government should meet to discuss about the concerned issue and find the common solution toward the improvement of per diem policy

5. One NGO has already developed and agreed its own plan for cost sharing with PHD but were then asked for extra budget to support PHD side of the costs later on. So what should the NGO do and how is it reported in AOP?

6. There is separate line between government and NGOs budget. The budget in AOP is just the projection budget and the expenditures can be updated. To join the plan it does not mean that NGOs must always have the money to support PHD. What the government wants is the TA support.

6. Step 1, slide 10 how to monitor the result of each year compared to the previous year.

-How do we set up the target of each year? Do you set up the target separately between each year or do we make a cumulative target from one year to the next?

6. We should set up the target separately from one year to the next and we cannot make a cumulative target

7. How to join the planning if there is a different fiscal year between NGOs and Government?

7. Will not include in the joint planning if there is difference of fiscal year. The AOP fiscal year starts from January to December of each year. So NGOs can put their plan into AOP if their work plan falls on between that period only. We do not require NGOs to follow all 6 steps. NGOs can choose to joint some steps among the 6. Integration of a plan does not mean that NGO has to put all of their plans into AOP and follow the format of government.

8. Step 1, slide 10 how to monitor the result of each year.

-Could we add one more column into the format of how to monitor the result in order to add the justification or explain about the deviation of the result compare to the plan indicator?

8. What has been presented is following the MoH format. It has a means of verification column.

9. Joint planning process is not working well because there were not many NGOs who participated and those who joined with the planning were not so active.

9. One NGO felt that the involved NGOs are active. Dr. Or Vandine added that joint planning does not mean that NGOs must always have the budget to support PHD and it means NGOs can be involved in the planning too, although they do not have budget to support PHD. We support the work of NGOs who have been working in remote areas as some of those working in government can not even do so. In some cases NGOs should follow the MoH strategy. MoH has developed a Pro-TWGH so that NGOs and government can support each other and can report about their achievements, their difficulties and try their best to fill the gap in order to reach the common goal.

10. Is there any mechanism to analyze the cost effectiveness?

10. It’s too early to conceptualize the approach.

11. Step 2, Slide 13 how to define the objective and its format.

-This format does not describe the specific activities and the target area. So how do we know that there is no overlapping of activities and area of work?

11. There are other forms that have specific activities and target areas.

12. The grass roots level, do not understand well how to develop indicators. So what can they do so that the grass roots level understands better how to develop the indicators?

12. They have a clear formula on how to develop the indicator. There has been training on how to develop indicators in the past.

13. People understand or try to interpret differently, the terminologies that have been used in the planning process. How can we ensure that NGOs and government have the same understanding of the terminology.

13. Although people have different understanding, if you are clear on what we have trained today, that is fine. The ideas or concepts are not much different. You will notice that people have used the word goal, objective, immediate objective in the planning process.

Day II

1. What is the difference between the project circle of project implementation and 6 steps of AOP

1. Government develops annual plan and

three year rolling plan.

-Plan in 2006 will be implemented in

2007

-Maybe the government plan is bigger

than NGOs plan

-NGos can put their existing plan into the

AOP.

-The partner should participate in AOP

2. The objective is not described in the format of activities plan. So how are the activities linked to the objective and which object does it link to?

2. It’s combined already but no objective. It just covers the target and predictions.

3. Amount of budget in the original plan exceeds the amount approved. So what can we do? Should it be deleted or reduced?

3. Yes, it is based on the availability of government. In some cases, NGOs can provide support to fill this gap, but it should not overlap other activities.

4. Preparing budget plan in 2007 for implementing in 2008. So what can we do if there is no support from donors at all?

4. This is the budget projection and we are not 100 percent sure if we will receive it.

5. What does the multi and bilateral refer to? If you do not specify clearly about the name of the donor the amount of budget will be overlapping.

Suggestion: Should specify clearly about the name of donors supported for avoiding of overlapping the budget (Eg: HSSP/WB, HSSP/DFID…..)

5. The multilateral are Khana, or WHO and bilateral are NCHAD etc. However the sources of donors should be clearly identified.

6. Do NGOs need to attend the monthly and quarterly meeting to discuss the monitoring plan or not and how often? Is it separate meeting from Prococom or Pro-TWGH?

6. Yes NGOs should attend every quarter. It is different meeting from Prococom or Pro-TWGH

7. Suggestion from NGO to PHD: PHD should invite the focus person who has experience with planning to this quarterly meeting. Based on the experience they invited the wrong people who do not know how to do the plan because the person in charge at the provincial level is administrator and not the planner.

7. Usually PHD invites the person in charge of the office or the director or deputy director if they know one. In this regards, the NGOs should assign the right people to attend as sometime the PHD does not know for sure about the right people. It requires good collaboration between PHD and NGO partners. On the other hand the PHD should specify clearly about specific objective and agenda so that NGOs can assign the right people in accordance with the topics in agenda.

8. The quarterly meeting on monitoring plan is held on the first week of the beginning of each quarter (Guideline of AOP).

8. Recommendation: Should be held on the first week of second quarter so that we can report about the progress report.

9. Can NGOs have different program and sub-program from government or not? -Should NGO include their admin and salary cost into the AOP or not?

9. The government does not require NGOs to put their admin and salary into AOP yet at this time. What government really insists is the TA support.

In the third day of the forum, Dr. Sin Somuny, Executive Director of MEDICAM, summarized the questions and issues that have been raised by participants on the first two days. They then handed over these related issues for plenary discussion in order to get the common practical solution, recommendation, and approval from participants. The final issues and practical solution or recommendations are reported as following:

Issue

Recommendations

1. Participation Annual Review Quarterly Review AOP development Pro-TWGH Updated or revised AOP after approved budget Monitoring and Evaluation

PHD

Health Partners

• Good leadership

• Good facilitation

• Clear invitation with agenda and include other partners agenda if requested

• PHD should invite all partners to attend regardless of small or big (Prey Veng PHD invited all to attend Pro-TWGH but not all of them attended and their

• Co-facilitation with partners

• Should participate in the Annual Review, setting activities, quarterly review

• Should ensure their presence at the meeting

• Should ensure seniority of NGO representative at the

representatives were not able to make decisions or provide inputs)

• PHD should not blame or request for something that is not relevant to their program

• Fix date of the Pro-TWGH meeting one month

• PHDs should organize revised AOP after approved budget with full participation of stakeholders

meetings

2. What to integrate and how 4 programs 18 sub programs Budget

• NGOs are not required to align with all the steps of AOP process

• Transparent planning: duplications and budget (in response to e.g. raised by an NGO participant regarding pushing out of NGOs from the area, not time for removing NGOs yet, MDGs can not be achieved without participation of NGOs/Health Partners)

• Include their activities in relation to 4 program areas of AOP

• Integrate the amount of budget that NGO supports the activities (not NGO staff or its administration)

• Activities integrated will be implemented by NGOs themselves or in partnership with PHDs but financial management and project management lie with NGOs/Health Partners

• Invite specific NGOs that implement specific activities at different specific time to avoid wasting time.

3. Different Fiscal Year

This is not a problem because planning this year will be implemented next year

4. Uncertainty and central decision

• Should be able to put and finalize at the step of updated AOP after budget approval

• Provincial focal points should communicate with central NGO leaders in advance of AOP development

5. Limited Capacity

• Participate in NGO/CBO planning forum

A quick evaluation form was distributed to participants, of which 33 participants returned the evaluation form. There were 7 questions asked to get their opinions and suggestions for this forum and for the improvement of the future forum (the full results from the evaluation are included in the appendix). All 33 participants responded that the forum was useful for them and they really would appreciate having it again next year.

Asked what were the most interesting topics, the respondents included o the six steps of the planning circle and its format,

Asked what topics they would like to suggest for next year, 25 respondents mentioned that the monitoring on what have been approved and recommended, the progress of AOP and constraint, goal of MoH in 2015, how to make Pro-TWGH more effective, details on how to develop indicators, and leadership and management of program activities.

Asked what should be improved for the next meeting, respondents mentioned that MEDICAM should organize this forum in each province to increase participation of NGOs, the guest speakers should attend full time during three days to respond to the questions. The participants also felt that the period of discussion should be longer and we should make more time for making conclusions on the last day,. Also MEDiCAM should ensure the hand outs distributed and presentation slides are the same.

Dr. Sin Somuny, Executive Director of MEDICAM made a conclusion by reviewing the issues and recommendations that have been made so far and asked for approval from participants. Then Dr. Lo Veasna Kiry closed the forum by giving his remarks on the key issues, the collaboration between NGOs and government. He said that the government cannot work alone without NGO involvement. The work of NGOs is very important as they can fill the gap that government cannot cover.

In conclusion, the CBO/NGO planning forum was able to resolve a number of issues with NGO involvement in the AOP. NGOs now have a greater understanding of the process and their involvement with it. Concerns from NGOs on time frames, what needs to be included, alignment of fiscal year and ownership of activities have been addressed. The importance of the involvement of the appropriate NGO staff has been emphasized by the PHDs and they have agreed to sent out clear agendas to help the NGOs send the correct person. The AOP integrated planning activity helps to prevent overlap of activities within a province and the PHDs are able to mobilize resources from one area to support another activity if required.

Participants found the forum very useful and encouraged MEDiCAM to hold a similar event next year.