A lack of donor funding means that a project providing 24,000 of the city's poorest

residents with vital health care and childbirth services could be shut down by the

end of April.

In the interim it has been forced to borrow from a fund established to pay for emergency

treatments for the poor. The money in the fund comes from consultation fees of a

few hundred riel charged to those urban poor able to pay.

David Wilkinson, technical advisor to the Health Services for the Urban Poor project

(HSUP), said the situation was desperate.

"At the moment the project is surviving, just, on small amounts from UN Habitat,

donations from Servants for the Urban Poor, and money borrowed from the urban poor

themselves," Wilkinson said of the joint donor-municipality initiative. "I

return to my plea to donors not to let the poor of Phnom Penh fall through the safety

net."

He said that no firm pledges of funding had been received, despite an "extremely

strong response" from the municipality that the project should not only continue,

but expand.

The HSUP, which is regarded by many health sector professionals as a highly successful

pilot project, operates health rooms at two squatter relocation sites and in the

Boeung Kak slum. It started in 1999 and runs on an annual budget of just $120,000.

Wilkinson's plea came after a workshop on March 5 which discussed the future of the

HSUP project, as well as moves to integrate the provision of basic services for the

urban poor.

Donors and other bodies such as the World Health Organization were unanimous in stressing

that a new approach linking aspects such as health care and water supply was vital.

Peter Swan, advisor at UN Habitat, said there had so far been limited collaboration

between different departments on delivering services to the urban poor.

"Health is a life-and-death matter, and all these sectors - sanitation, water

supply and garbage collection - impact directly on people's health and well-being,"

Swan said. "The need to better coordinate the different providers of services

... for the urban poor is extremely compelling, primarily because there is such a

small amount of money actually targeting them."

Wilkinson said the HSUP project, which is currently teetering on the verge of bankruptcy,

could provide that first step towards integration.

"Because health is so important, especially in Cambodia, it was felt that health

could be a useful entry point into the development of integrated services,"

he said. "The long-term strategy is to fold HSUP into an integrated approach

to basic services."

Many health sector professionals said that despite the government's rhetoric, its

current approach was 'sectoral based', with little collaboration between departments.

Donors and lenders such as the Asian Development Bank (ADB) said the lack of coordination

in meeting basic needs hurt the poor.

"Although the government has put considerable efforts into developing sanitation,

water supply and public works, the services have not yet been integrated, and gaps

in service provision are particularly felt by the poor," said Januar Hakim,

the ADB's Manila-based urban development specialist.

Hakim said that integrating services for the poor was important because it acknowledged

that "poverty is multi-dimensional and cannot be solved using a narrow, sectoral

approach".

Dr Aye Aye Thwin, sectorwide management advisor at the World Health Organisation

(WHO), also stressed the need for collaboration both within government, and between

it and donors.

"The most important thing is to capture opportunities and give health messages

at the same time, and you are missing that opportunity if you don't integrate,"

Dr Thwin said. "It calls for the municipality and the Ministry of Health to

form a partnership and have a joint strategy on addressing the needs of the urban

poor and then bringing them in line with other partners."

The government and many donors focus on rural areas as having worse health indicators

than urban locations, yet Dr Thwin said there was "a very distinct difference

between non-poor and poor in urban areas in terms of health indicators".

The Phnom Penh Intra-urban Health Survey 2001 shows that young, poor teenage women

living in urban slum areas are more than twice as likely to become pregnant as non-poor

urban residents.

A quarter of women in these areas do not have any access to antenatal care, and many

cannot afford vaccination for their children. Just 57 percent of children in slum

areas have been vaccinated, compared with 95 percent of non-poor urban residents.

Wilkinson warned that the growing number of poor people coming to the city each year

would mean that projects such as HSUP would become even more important.

"It is an extremely short-sighted approach to ignore the urban poor because

they are such a rapidly growing population," Wilkinson said. "There are

around 35,000 new people coming from rural areas into Phnom Penh every year."