AN official from the National Aids Authority (NAA) offered public criticism on Monday of the government’s decision to modify compensation schemes for civil servants, saying there is a “real risk” to public health in the Kingdom if reforms set to be implemented later this year go forward.

Tia Phalla, vice chairman of the government-run NAA, told a gathering in Phnom Penh organised by the Cambodia Development Resource Institute that the cessation of salary supplements for civil servants, announced in December, may lead to a critical shortage of services for the Kingdom’s most underserved residents.

“There is a real risk that the huge gains made in Cambodia over the last 15 years might be reversed if staff remuneration is inadequate,” Tia Phalla said in a presentation to the gathering, warning of a possible “second wave” of HIV/AIDS in the absence of health professionals to administer antiretroviral treatments to poor Cambodians.

“It is critical to the further success of prevention, care and treatment efforts that an early and satisfactory solution to the problem of salary supplementation is found,” he said.

Under several kinds of salary supplement programmes, donors had been assisting the government in bolstering the often-paltry salaries of civil servants across a variety of sectors. Two such supplement programmes – Priority Mission Groups (PMGs) and Merit-Based Performance Incentives (MBPIs) – were implemented in recent years to allow donors to target specific projects and promote a culture of meritocracy among government workers.

In December, Minister of Economy and Finance Keat Chhon said that effective on January 1, the government was cancelling all such programmes as part of a broader administrative reform effort. This provoked an outcry from NGOs and development partners who said they had no time to prepare for the reforms, and in January, Keat Chhon announced a six-month transition period in which straightforward salary supplements, though not PMGs or MBPIs, would be allowed to continue.

In a meeting with development partners held earlier this month, government officials outlined plans for a new remuneration scheme based on a principle termed “Priority Operating Cost” (POC), according to Sin Somuny, director of the local health group Medicam.

In his presentation, Tia Phalla described POC as an “interim scheme” in which funding is allocated for pre-determined expenses in advance of a project. POC payments, he said, “are not compensation or salary supplements”, noting that POC payments cease with the end of the specific project for which they have been earmarked.

Health workers who have not been receiving incentive payments during the transition period have shown an increased likelihood of absenteeism, loss of motivation and decreased working hours, Tia Phalla said. As the incomes of skilled health professionals decline, he added, such workers may head to the private sector, leaving poor Cambodians who depend on public health services without proper treatment.

In a letter to colleagues in Cambodia that was excerpted in Tia Phalla’s presentation, William Patton, country programme director for the Global Fund to Fight AIDS, Tuberculosis and Malaria, said representatives of his organisation had observed a number of ways in which the incentives termination had adversely impacted the health sector.

“Technical partners are observing loss of staff to the private sector,” Patton wrote. “Proliferation of dual practice by public-sector health providers may already be placing an increased burden on the poor and most vulnerable.”

Council of Ministers spokesman Phay Siphan said reform of civil servant remuneration was necessary to standardise compensation methods and ensure that government employees who work on donor-supported projects do not gain unfair benefits over their colleagues.

“Some people work the same, but they get more money from the other sources, so the others, they feel unhappy,” Phay Siphan said. He dismissed concerns that the POC scheme was not an adequate replacement for incentive payments, saying that employee compensation will be accounted for in project expenses.

Sin Somuny said that at the meeting earlier this month, the government agreed to work with development partners both to implement the POC scheme and to formulate plans for compensation reform that fit into the government’s broader public administration reform effort.

The Global Fund may decline to wait for the outcome of this reform effort, however. At a meeting of the Global Fund’s country coordinating committee scheduled for Friday, Tia Phalla said, committee members will consider whether to reinstate incentive payments despite the government’s order to terminate them – a plan he said he supported.

“We need to come back to the incentives and provide [them] back to the healthcare workers so they can gain and continue to work,” he said.