Prakas implementation and other private sector policies related to HIV/AIDS

All Cambodian citizens, under the Cambodian Constitution, are equally entitled to health, and as defined by the Law on the Prevention and Control of HIV/AIDS passed by the National Assembly in 2002, all PLHIV are entitled to free primary health care. The HIV/AIDS Law also provides confidentiality protections for PLHIV, with penalties for non- compliance. In 2003, following up the HIV/AIDS Law (above), ILO signed an agreement with the MoLVT to implement the new law, which was followed by pilot projects over the next three years. As a result, MoLVT adopted guidelines on managing HIV and AIDS in the workplace and Trade Unions adopted a related policy in 2006. As below, I have compiled a synopsis of various policies, strategies and commitments related to the private sector, development and HIV/AIDS in Cambodia:

Table 3. Existing policies, strategies and guidelines related to the Private Sector and HIV response

Policy/Strategy/Commitment Expected goals related to private sector development & response to HIV

The Government’s Rectangular Strategy Private sector growth and employment development are key goals.

The National Strategic Development Plan 2006 – 2010

+ Private sector further developed, with specific attention to SMEs.

+Enhanced overall economic development spurred, in part, by the private sector.

+ Enhanced private sector participation in domestic and international trade.

National Poverty Reduction Strategy +The promotion of broad-based sustainable and equitable economic growth, with the private sector playing the lead role.

+ Diversification of the private sector.

National Strategic Plan for a Comprehensive and Multisectoral Response to HIV /AIDS 2006 - 2010

• issued in November 2005

+ Increased accessibility and availability of condoms in the public and private sectors.

+ Increased capacity for effective leadership in HIV/AIDS response across all sectors of society (government, private sector & civil society).

+ Increased involvement of the private sector in the national HIV/AIDS response.

Law on the Prevention and Control of HIV/AIDS

* Issued in 2002

+ rights of employees to HIV prevention, care and support in non-discriminatory workplaces.

- Has not been accompanied by the identification of measures to ensure the enforcement of law, such as the provision of penalties for HIV/AIDS discrimination in employment.

PRAKAS on the Creation of the HIV/AIDS Committee in Enterprises and Establishments and Managing HIV/AIDS in the Workplace

+ Introduces guidelines for how to address HIV and AIDS in the workplace, including that of setting up workplace committees and ensuring

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• issued in May 2006 the rights of employees to HIV prevention, care and support.

Operational Plan 2008-2010 of Ministry of Public Works and Transport and Ministerial AIDS Committee (MPWT/MAC) & policies on HIV/AIDS and Prevention in Response to Activities of Public Work and Transport Sectors in the Kingdom of Cambodia

• issued in August 2006

+ Operational Plan provides guiding principles for involving the private sector in HIV/AIDS programmes targeting mobile populations (such as long distance drivers and public transport passengers); ministerial civil servants; and affected communities.

Universal Access (UA)targets by UN

+ The UA target increasing the number - 60 - of large workplaces that have workplace policies and interventions to 60 by 2010.

ILO: International Labour Standards + HIV/AIDS related Labour Standards, such as Occupational Safety and Health, Equality of opportunity and treatment in workplaces.

Prakas (086) is a practical guideline directing companies and workplaces on the creation of the HIV/AIDS committee in enterprises and establishments and the prevention of HIV/AIDS in the workplace. It is identified as aiming to stimulate discussion, raise awareness and prevent the spread of HIV infection in the workplace. Prakas is based on the recognition of HIV/AIDS as a workplace issue that should be addressed and treated like any other serious illness/condition in the workplace.

It is also based on principles of non-discrimination, solidarity and respect for human rights as well as gender equality, and the role of healthy work environments for the prevention of HIV. Prakas states the demand to ensure confidentially of employees’ HIV status, as well as the right to employment of HIV positive employees. (ILO 2001; 2002; 2005; MoLVT 2006.) All employees, Prakas states, are entitled to affordable health services and to non-discriminatory workplace environments which care for the physical and mental well-being of employees:

A healthy work environment facilitates optimal physical and mental health in relation to work and adaptation of work to the capabilities of workers in light of their state of physical and mental health (MoLVT 2006, 10).

The Cambodian officially licenced business sector has been noted as facing, in general,

“bureaucratic hurdles that result in long delays and high levels of uncertainty.” Licenced companies face, on average, 16 inspections per year. (SME Secretariat 2006, 6.) This milieu of close regulation is also reflected in the language of Prakas 086, which focuses on duties and responsibilities and on the organizational procedures for setting up Workplace Committees. Prakas 086 places, generally speaking, high demands on workplaces: all companies with 8 or more workers are obligated to set

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up an HIV/AIDS working group or a committee. Instructions as to how this is to take place are detailed, and their tone is punitive rather than encouraging:

Fifteen days after the date that the HIV/AIDS Working Group or HIV/AIDS Committee is officially set up - - the Chair of the Working Group or the Chair of the Committee shall notify the Ministry of Labour and Vocational Training in writing.

This notification shall have attached a list of the members of the working group or committee .. (MoLVT 2006, 4.)

Whilst the legislation and guidelines related to HIV in the workplace set clear standards for how to address HIV in the workplace, their implementation and enforcement - due to inadequate resources and mechanisms to monitor their implementation - is weak (Economics Today, July 2008, 14;

Watchir & Ward 2003). Whilst the Royal Government of Cambodia (RGC) has committed to apply the current HIV/AIDS Law and has ratified various international standards, such as ILO’s International Labour Standards, the enforcement of these laws and policies, likewise, is weak.

The lack of capacity of the public sector is, in part, reflective of a lack of national budget to follow up legislation, policies and strategies – particularly in rural areas where the majority of the population resides. The public health care system is a case-in-point. As demonstrated by the Administrative Health Facility mapping conducted in 2004 (NIS 2004a), there are more than 900 health centres and referral hospitals in Cambodia, and their location largely corresponds with the population density. However, as noted by the CHDR 2007, two main challenges exist: health services are located in proximity with roads and thus do not reflect the spread of the population into more remote areas, and health services are, with few exception, not available free of charge (UNDP

& MoP 2007). In addition, health centers in rural areas are more likely to be understaffed and underequipped, and the public health sector in general suffers from limited trust – and limited use, as most Cambodians prefer to use the services of private rather than public health care service providers (MOH 2006; NIS 2004c).

From the private Sector point of view, Cambodian HIV/AIDS prevalence does not present en eminent threat to the economy, nor to the productivity and profit of companies. Compared to many countries in Africa, it is hard “to sell” HIV/AIDS interventions to private sector companies. The perceived lack of need to address HIV/AIDS, particularly given Cambodia’s relative success to date in curbing the epidemic, has effected the slow roll out of the HIV/AIDS law, and policy

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implementation has been slow and there has been a lack of law enforcement mechanism. I have synthesized key ‘milestones’ in the private sector response to HIV/AIDS in Cambodia below:

Table 4: Key milestones in the Private Sector Response to HIV in Cambodia z 1999 CARE starts to survey the sexual health and behavior of garment sector workers.

z 2001 CARE launches a 2-year HIV & AIDS program in partnership with PATH, Britain’s Health unlimited and three Cambodian groups > 35 000 workers in 15 companies.

z 2002 Law on the prevention and Control of HIV/AIDS.

z 2003 ILO signs an agreement with the Government to implement the new Law.

z 2004 ILO/USDOL launch a 3-year project targeting 11 enterprises in the garment, z hotel and construction industries.

z 2005 UNICEF launches 5-year project with garment manufacturers (H&M), z implemented by the Women’s Development Association.

z 2006 MoLVT adopt the Guideline (Prakas) on managing HIV and AIDS in the z workplace, and the trade unions adopt a related policy.

z 2006 Beer Selling Industry Cambodia (BSIC) is formed.

z 2007 ILO/USDOL extends it project by 6 months targeting 7 more companies in the z garment, hotel, construction and petroleum industries.

z 2007 Cambodian Business Coalition on AIDS is formed.

z 2007 Lok Chumteav Bun Rany Hun Sen undertakes various activities in her capacity as Cambodia’s National Champion for the APLF. Private Sector Champions are awarded for the first time during the World AIDS Day.

z 2007 National Private Sector & HIV Working Group is officially launched with 17 members from the Private Sector, Government, Civil Society, NGO’s and Donors to coordinate and ensure the effectiveness of the business response to HIV/AIDS.

z 2008 A new Tripartite Coordination Committee terms is launched in October, and a terms of reference is developed.

Only a relatively small number of companies in Cambodia actually have HIV/AIDS related programmes or activities, and the implementation of Prakas is lower still, with only 15 companies implementing Prakas²⁷. Whilst Prakas 086 has been revised and adapted for the Cambodian context, at present there are no simple practical guidelines as to how to implement Prakas. Whilst it is somewhat self-evident that the commitment of business executives and leaders is important, one challenge many companies face with Prakas implementation is an immediate one: with employees already often overworked and with busy business schedules, who should be responsible for

27 According to Business and AIDS in Cambodia 2008-2009 guide

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effective, sustainable responses to HIV/AIDS in businesses? At the moment, as defined by the Cambodian Prakas, Workplace Committees in enterprises and establishments that employ from 8 to 50 workers “should comprise at least one representative of the employer and at least one representative of the local unions”, and in enterprises and establishments that employ over 51 workers, these will be comprised of “at least two representatives of the employer, two local union representatives, and one person who is in charge of the enterprise’s infirmary” (MoLVT 2006, 2 – 3). Meetings, it is suggested, should be held one a month or on quarterly basis, and key tasks include those of disseminating information on HIV/AIDS, developing HIV preventive education programs, training managerial staff on HIV/AIDS, assisting HIV infected workers to access care and treatment, and developing proposals for workplace programs (ibid., 5 – 7). Clearly, by all indication if implemented following the Prakas 086 guidelines, this is a time-consuming and potentially complicated task. An related unaddressed issue related to Prakas 086 is that of deciding whether or not employers or employees should be compensated for setting up an HIV/AIDS workplace committee.

In October 2008, a new tripartite coordination committee (TCC) was officially launched in late to coordinate Prakas implementation between Labour Unions, Employers and Government. TCC’s key mandate is to focus on Prakas implementation and to support law enforcement. According to its (draft) terms of reference, the TCC’s mandate is to provide strategic and policy guidance on the workplace response to HIV/AIDS in the world of work in Cambodia, with a specific mandate to promote the implementation of Prakas (086). In addition to its advisory function, it is to play a role in the monitoring and evaluation of workplace HIV/AIDS activities. The TCC, as articulated by its terms of reference, is to be chaired and convoked by a senior government official designated by the Minister of Labour and Vocational Training. The TCC have also two Co-Vice Chairs, representing both employers’ and workers’ organisations. (NAA 2008.) By emphasizing both tripartite coordination and Prakas (086) implementation, the TCC clearly represents ILO’s approach to private sector response, and is a first serious attempt for implementation and law enforcement of ILO’s Code of Code of Practise on HIV/AIDS and the World of Work policy/guideline.

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5.5. Conclusions to Cambodian private sector response: Private Sector and