REPORT NO. 5 JUNE 2021 Results from the High-Frequency Phone Survey of Households Round 5 (1–21 March 2021)1 Authors: Wendy Karamba, Isabelle Salcher and Kimsun Tong INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic and its effects on households create an urgent need for timely data and evidence to help monitor and mitigate the social and economic impacts of the crisis on the Cambodian people, especially the poor and most vulnerable. To monitor the evolving socioeconomic impacts of the COVID-19 pandemic and inform policy responses and interventions, the World Bank designed and conducted a nationally representative High-Frequency Phone Survey (HFPS) of households in Cambodia. The survey covers important and relevant topics, including knowledge of COVID-19 and adoption of preventative behaviors, economic activity and income sources, access to basic goods and services, exposure to shocks and coping mechanisms, and access to social assistance. The survey will track the same households over 10 months, with selected respondents—typically the household head—completing interviews every 8 weeks. Monitoring the well-being of households over time will improve understanding of the effects of, and household responses to the COVID-19 pandemic in near-real time. This brief summarizes the findings of Round 5 (R5) of the HFPS. The information presented is based on a sample of 1,688 households, of which 379 were drawn from the nationally representative Living Standards Measurement Study Plus (LSMS+) survey and 1,309 from the list of beneficiaries of the conditional cash transfer program for pregnant women and children under 2 with an IDPoor equity card (IDPoor sample). IDPoor is Cambodia’s national poverty identification program and official targeting mechanism for programs that support the poor. Unless otherwise noted, the results presented are primarily drawn from the LSMS+ sample. To trace the evolution of key indicators, the results of Round 5 (R5) implemented in March 2021 are compared against results of Round 4 (R4) implemented in December 2020–January 2021, Round 3 (R3) implemented October–November 2020, Round 2 (R2) implemented August–September 2020, and Round 1 (R1) implemented May–June 2020. HIGHLIGHTS -- HFPS ROUND 5 Access to food staples remained robust as markets continued to function well. Almost all households seeking to buy medicines or access ❖ medical treatment were able to do so, even as demand for health services remained high. While many respondents were aware that the COVID-19 vaccine was available in Cambodia, few had received the vaccine at the time of the survey in March 2021. Cambodia had recently launched the COVID-19 vaccination program in February 2021. Most respondents had not received a COVID-19 vaccine because they were either not in the priority group for receiving the vaccination or did not know how to access the vaccine. ❖ Children’s engagement in learning activities increased as schools re-opened after a second nationwide closure and school term holiday. After declining to 57 percent in December 2020, the proportion of households with school-age children engaged in learning activities rose to 90 percent in March 2021, returning to the levels observed in October and before the pandemic. With the resumption of in-person instruction, learning returned to more face-to-face meetings with teachers and shifted away from remote alternatives. 1 Wendy Karamba and Kimsun Tong led the Cambodia High-Frequency Phone Survey (HFPS) team that comprised of Maheshwor Shrestha, Sokbunthoeun So, and Isabelle Salcher. Nuppun Research Consulting implemented the survey with technical and financial support from the World Bank. Additional contributions for the HFPS were received from the Public Financial Management and Service Delivery Trust Fund contributed by Australia and the European Union. The Food and Agriculture Organization (FAO) of the United Nations assisted with the analysis of the food insecurity based on the application of the Food Insecurity Experience Scale (FIES). The team benefitted from advice and comments from World Bank Group colleagues including Maheshwor Shrestha, Nareth Ly, Rinku Murgai, and Sokbunthoeun So. REPORT NO. 5 JUNE 2021 Employment has yet to return to pre-pandemic levels. With 69 percent of respondents working in March 2021, employment remained ❖ relatively unchanged compared to December 2020 but below its pre-pandemic level when 82 percent of respondents were working. Seasonality in farming is the primary reason respondents stopped working since the last round. The negative impacts of the COVID-19 pandemic on non-farm family businesses remain substantial with weak consumer demand driving ❖ the losses in business revenues. In March 2021, 1 in 2 households operating non-farm businesses still reported having made “less” or “no revenues” relative to the previous month. Although there was a significant reduction in the share of non-farm business households reporting having made “less” or “no revenues” since May (81 percent), there was no further reduction since October (54 percent). While fewer households reported declines in household income, 45 percent still reported that household income had declined relative to ❖ the last survey. A higher share of households reported an income reduction relative to January 2020 than relative to June 2020. Since the launch of the nationwide COVID-19 relief transfer program in June 2020, there has been a marked increase in the share of IDPoor ❖ households receiving social assistance from the government, mostly in the form of cash transfers. By March 2021, 95 percent of eligible IDPoor households had received relief cash transfers and most of them had received multiple payments. Nearly half of households perceive that their current well-being and economic status is lower compared to the previous year. Beneficiary ❖ households of the relief cash transfers perceive the program to have positively contributed to their economic well-being. Moderate-or-severe food insecurity increased between December 2020 and March 2021. Among IDPoor households, the prevalence of ❖ moderate-or-severe food insecurity rose from 34 percent in December to 55 percent in March. Among the LSMS+ sample, the prevalence of moderate-or-severe food insecurity was 32 percent in March 2021 and 17 percent in December 2020. Among both IDPoor and LSMS+ households, the prevalence of servere food insecurity has remained at around 1 percent since December 2020. ACCESS Despite the COVID-19 pandemic, markets remain functional and able to supply basic necessities. Since May 2020 TO BASIC (Round 1), almost all households regardless of poverty status and area of residence were able to buy rice, fish/meat, NECESSITIES and vegetables/fruits when needed in the 7 days preceding the survey. Access to medicine and health services has also remained nearly universal throughout the COVID-19 pandemic. Nearly all households that tried to purchase FOOD STAPLES medicine in the 7 days preceding the survey were able to do so, even as the share of households demanding medicines rose and remained high. Access to medical treatment remained high, even after the largest COVID-19 outbreak in Phnom Penh in February 2021 commonly referred to as the “February 20 incident”. Nearly all households that needed medical treatment since the previous survey round (or pre-COVID-19 for Round 1) were MEDICINE able to access medical services (Figure 1). IDPoor households were more likely to consult a public healthcare provider whereas LSMS+ households were more likely to visit a private medical provider (Figure 2). Nearly all of the households that first consulted a public health care provider received medicines for treatment. Only 3 percent of IDPoor and 13 percent of LSMS+ households had to purchase some or all medicines themselves (Figure 3). Among households that accessed medical services, over two-thirds reported that the health staff adopted behaviors to curb the spread of COVID-19, such as wearing a mask, social distancing, and handwashing. Figure 1: Households needing and able to access medical treatment since the last round 1 1 2 45 39 37 40 44 34 35 38 61 74 99 100 100 99 100 100 98 100 100 100 % 55 61 63 60 56 66 65 62 39 26 R1 R2 R3 R4 R5 R1 R2 R3 R4 R5 R1 R2 R3 R4 R5 R1 R2 R3 R4 R5 LSMS+ IDPoor LSMS+ IDPoor Needed medical treatment Accessed medical treatment (for those who needed treatment) Yes No Page 2 REPORT NO. 5 JUNE 2021 Figure 2: Type of healthcare provider first consulted Figure 3: Households provided with medicine by public since last interview health facilities 5 1 2 1 2 1 13 3 33 34 39 41 58 65 62 64 97 % % 87 66 64 61 58 41 34 37 31 R2 R3 R4 R5 R2 R3 R4 R5 LSMS+ IDPoor No, patient needed to buy some/all medicines LSMS+ IDPoor for treatment Yes, health facility provided medicines for Public Private Not medical sector treatment COVID-19 Cambodia began its vaccination program on February 10, 2021 after having received its first batch of COVID-19 VACCINATION vaccines on February 7, 2021. China donated one million doses of the Sinopharm COVID-19 vaccine. Cambodia also purchased the Sinovac COVID-19 vaccine and gained access to the AstraZeneca vaccine via the UN-backed COVAX program.2 As of March 21, 2021—when Round 5 of the HFPS data collection concluded— 1.9 percent of the population in Cambodia had received at least one dose of the COVID-19 vaccine and 0.8 percent were considered fully vaccinated against COVID-19.3 Government officials, armed forces, health workers, educators, and journalists were among the priority groups to receive the vaccine first.4 While most respondents were aware that the COVID-19 vaccine had become available in Cambodia, few had received the vaccination in March. Only 5 percent of respondents that were aware of the availability of the COVID- 19 vaccine (91 percent) had received the vaccine (Figure 4 and Figure 5). Not being part of the priority group eligible for the COVID-19 vaccination and not knowing how to access the vaccine were the primary reasons respondents had not been vaccinated (Figure 6). Few respondents who had not been vaccinated had concerns about the safety of the vaccine. Awareness and vaccination rates are lower among respondents from IDPoor households. Only 84 percent of IDPoor respondents knew that the COVID-19 vaccine had become available in Cambodia and of those, only 1 percent had been vaccinated against COVID-19. IDPoor households primarily cited not knowing how to access to the vaccine as a reason for not having been vaccinated. 2 https://www.aljazeera.com/news/2021/4/15/uk-covid-variant-pushes-cambodia-to-brink-of-national-tragedy (last accessed April 29, 2021). 3 https://ourworldindata.org/coronavirus/country/cambodia (last accessed May 11, 2021). 4 As of 24 May, nearly 23 percent or 2,280,875 of the targeted 10 million population have been vaccinated – of which 1,646,994 have already received their second doses. See https://www.khmertimeskh.com/50862220/cambodias-vaccination-coverage-reach-an-amazing-23-percent/ (last accessed June 2, 2021). Page 3 REPORT NO. 5 JUNE 2021 Figure 4: Respondents Figure 5: Respondents who Figure 6: Reasons for not having received aware of availability of had received the COVID-19 COVID-19 vaccine COVID-19 vaccine in vaccine (among those aware Cambodia of vaccine availability) 9 16 10 2 34 40 95 99 % 91 % % 84 60 35 5 1 12 4 LSMS+ IDPoor LSMS+ IDPoor LSMS+ IDPoor Other Yes No Yes No Not eligible (too old) Not the priority group to get the vaccine Don’t know how to access the vaccine SCHOOLING In March 2021, children’s engagement in learning activities returned to the level reached in October 2020. In March 2021, the proportion of LSMS+ households with school-age children (ages 6–17) engaged in learning activities was 90 percent (Figure 7). This matched the level of engagement observed before the onset of the pandemic and in October 2020, when 92 percent of LSMS+ households with school-age children engaged in learning. In contrast to LSMS+ households, engagement in learning for IDPoor households was slightly lower in March 2021 than in October 2020. Only 79 percent of IDPoor households with school-age children reported that their children engaged in learning activities in the 7 days preceding the survey in March 2021, compared to 86 percent in October 2020 ( Figure 7). Participation in learning was low in December 2020 (57 percent) because most schools, particularly public schools, had concluded the academic year at the time of the survey. Engagement in learning activities for children in IDPoor households was relatively lower likely due to a greater reliance on public schooling which concluded earlier than private schools. The day that Round 5 of the HFPS data collection concluded, a third nationwide school closure was imposed on March 21, 2021 in response to another large COVID-19 transmission. The third nationwide school closure likely brings new disruptions to children’s learning not captured in Round 5. Figure 7: Children engaged in education or learning activities in last 7 days Page 4 REPORT NO. 5 JUNE 2021 With the reopening of schools in January following the second school closure and the school-term break, most children had resumed in-person instruction in March 2021. In March 2021, 68 percent of households with school- age children met with teachers compared with 86 percent in October, and 66 percent in August (Figure 8). Yet, fewer households met with teachers than in October (Round 3) when all schools nationwide had resumed in- person instruction following the first school closures. The proportion of households with school-age children using mobile learning applications was 19 percent in March 2021, which was above the October level of 10 percent. In March, IDPoor households with school-age children were more likely to have met with teachers and less likely to have used mobile learning applications than LSMS+ households but were equally likely to have completed assignments and watched educational television programs (Figure 8). Figure 8: Children engaged in education or learning activities in last 7 days 86 8278 84 66 68 66 58 47 4544 36 32 35 31 2832 3130 28 29 25 29 24 20 19 14 15 14 13 10 10 3 7 7 2 6 3 8 5 % Met with Completed Mobile apps Watched TV Met with Completed Mobile apps Watched TV teacher assignment learning teacher assignment learning LSMS+ IDPoor Round 1 Round 2 Round 3 Round 4 Round 5 Schools resumed in-person instruction in January 2021 following a second nationwide closure in November 2020 in response to a local COVID-19 outbreak. The second nationwide school closure came shortly after all schools had reopened for in-person instruction on November 2, 2020. Soon after, on November 30, 2020, all schools across the country were shuttered according to a new directive of the Ministry of Education, Youth and Sport (MoEYS) issued on November 29, 2020. Public schools concluded the 2019 –2020 academic year early while private schools suspended in-person instruction for 2 weeks while applying e-learning during this period. Grade 12 classes—that were preparing students to sit for the national high-school examination in December—could continue depending on the level of risk for COVID-19 transmission the high school faced. Following a school term break in December/January, public schools commenced the 2020–2021 academic year on January 11, 2021 and private schools started reopening on January 4, 2021. Before the second nationwide closure, Cambodia had followed a three-phase approach to school reopening. On March 16, 2020, MoEYS directed the closure of all schools nationwide in response to the COVID-19 pandemic and students were required to continue their studies remotely with the aid of technology. After a five-month period of school closures, Phase 1 of school reopening commenced in August 2020. During Phase 1 of school resumption, a handful of international private schools located in the cities of Phnom Penh, Battambang, and Siem Reap were permitted to reopen provided they followed the highest safety standards set out by the Ministry of Health to prevent the spread of COVID-19. Phase 2 of school resumption was applied on September 7, 2020, allowing some public and private schools—kindergartens, primary and secondary schools—to resume operation. Schools from grades 9 to 12 could reopen across the country, while schools of all grade levels could only reopen in low-risk provinces. Schools throughout Cambodia reopened on November 2, 2020 for the first time since March when the first nationwide school closure was instituted. All public and private schools across the country, ranging from preschools to high schools, were allowed to resume in-person instruction as part of Phase 3. Page 5 REPORT NO. 5 JUNE 2021 EMPLOYMENT Employment has yet to return to pre-pandemic levels. Prior to the COVID-19 outbreak, 82 percent of respondents PATTERNS AND were working. Following the onset of the pandemic, 71 percent of respondents were working in May and this HOUSEHOLD remained relatively unchanged until October when there was a further decline in employment to 65 percent (Figure INCOME 9). Employment increased back to 72 percent in December 2020 and remained relatively unchanged at 69 percent in March 2021. The share of respondents who stopped working since the last round and the share of respondents EMPLOYMENT STATUS who had been out of work since the last interview also remained unchanged between December 2020 and March 2021 (Figure 9), suggesting that employment outcomes have not worsened further. Seasonality in farming (54 percent) and seasonality in employment (11 percent) were the primary reasons earners had stopped working. However, some respondents also stopped working because they needed to care for an ill relative (11 percent) or due to COVID-19 related business closures (9 percent). After continuously increasing between May and December 2020, employment for the main earners in IDPoor households remained relatively unchanged in March 2021. COVID-19 related business and office closures were the primary reason the main earner in IDPoor households had stopped working since the last round. Figure 9: Respondents (LSMS+) or household’s main Figure 10: Changes in sales revenues in non-farm earner (IDPoor) working in last 7 days household businesses relative to last month 18 20 21 19 20 16 10 7 10 4 4 5 5 5 5 4 8 5 10 7 12 15 11 10 13 9 12 11 5 4 3 31 40 37 46 42 44 46 29 6 5 4 2 8 1 % % 78 82 81 73 65 65 64 68 67 65 61 62 52 58 46 48 48 40 8 3 3 4 2 4 5 3 R1 R2 R3 R4 R5 R2 R3 R4 R5 R1 R2 R3 R4 R5 R2 R3 R4 R5 LSMS+ IDPoor LSMS+ IDPoor Out of work since last round Stopped working since last round Currently working (changed job since last round) Currently working (same job since last round) No revenue Less The same Higher The negative impacts of the COVID-19 pandemic on non-farm family businesses remain substantial. Half of non- farm household businesses continued reporting earning “less” or “no revenues” relative to the month prior in March 2021 (Figure 10). This is compared to 81 percent in May, 64 percent in August, 54 percent in October, and 58 percent in December 2020. Meanwhile, the share of households reporting their business revenues “stayed the same” tripled between May 2020 and March 2021. Note, between 24–32 percent of LSMS+ households and 12–13 percent of IDPoor households operate a non-farm family business. The share of households operating a non-farm family business has remained relatively unchanged among LSMS+ and IDPoor households. However, there have been shifts in sector. After dropping to its May level of 67 percent in December, the share of businesses in retail trade rose back to its August and October levels of around 80 percent in March 2021. In turn, fewer businesses were in manufacturing and personal services. Household businesses in urban areas were more likely to report less or no revenues than household businesses operating in rural areas. Weak consumer demand continues to drive revenue losses for non-farm family businesses. Having fewer or no customers, as reported by 78 percent of households operating a non-farm business, is the primary reason for not generating revenue or generating lower revenue. Lower demand is disproportionately affecting household businesses in urban areas. INCOME While widespread reductions in household income continue, there are signs of slowdown with fewer households experiencing declines. In Round 5, 45 percent of households experienced declines in income between December 2020 and March 2021 (Figure 11). This compares to 48 percent in Round 4 that experienced declines between October and December, 51 percent in Round 3 that experienced declines between August and October, 63 percent in Round 2 that experienced declines between May and August, and 83 percent in Round 1 that experienced declines between the COVID-19 outbreak and May. Reductions in household income between December and March were more commonly reported in urban areas, but irrespective of poverty status. In Round 5, households Page 6 REPORT NO. 5 JUNE 2021 reported that their total household income decreased by 15 percent since the last interview, which compares to a reported reduction of 17 percent in Round 4, of 18 percent in Round 3, and of 23 percent in Round 2. With households reporting an average reduction in total household income of 37 percent in Round 5, 40 percent in Round 4, 39 percent in Round 3, and 41 percent in Round 2, the amount of income loss is assumed to be considerable. Figure 11: Changes in total household income since the last round 1 8 7 9 8 1 12 9 9 5 16 11 29 32 43 42 43 47 46 45 % 83 88 63 57 51 48 45 44 46 52 R1 R2 R3 R4 R5 R1 R2 R3 R4 R5 LSMS+ IDPoor Reduced Stayed the same Increased Relative to January 2020, for many households total income fell largely due to shocks to farm and non-farm labor income. Since January 2020, income from family farming activities declined for 40 percent of households and income from non-farm family businesses and wage employment decreased for 57 percent and 30 percent of households, respectively (Figure 12). Households reporting a reduction in these income sources experienced average declines of 45 percent relative to January 2020. Remittances and family or non-family assistance were also negatively impacted, but the share of households drawing these sources of livelihoods is relatively small (7 percent and 3 percent, respectively). Most households derive their livelihoods from wage employment (69 percent), family farming (52 percent) and non-farm family businesses (32 percent). Among households deriving income from social assistance, there has been a striking increase in assistance received from the government or NGOs relative to January—likely following the launch of the COVID-19 relief transfer program and increased support from NGOs during the pandemic. Relative to June 2020, labor income has stabilized, while assistance from the government or NGOs has not increased further (Figure 13). Page 7 REPORT NO. 5 JUNE 2021 Figure 12: Changes in income by source since January Figure 13: Changes in income by source since June 2020 2020 IDPoor 6 family Family IDPoor 58 36 family Family 41 53 6 farm farm LSMS+ 40 49 11 LSMS+ 7 62 31 IDPoor 59 31 10 IDPoor 10 35 55 Non- farm Non- farm biz biz LSMS+ 57 40 3 LSMS+ 6 44 50 IDPoor 5 53 42 non- Remitt- Wage IDPoor NGO Pension property family ances empl. 47 49 4 non- Remitt- Wage NGO Pension property family ances empl. LSMS+ 30 59 11 LSMS+ 8 67 25 IDPoor 67 33 IDPoor 3 20 77 LSMS+ 49 34 17 LSMS+ 24 27 49 Income family / IDPoor Assist- Income family / IDPoor 36 35 29 Assist- 10 35 55 ance ance LSMS+ 42 58 LSMS+ 88 12 IDPoor IDPoor 100 from 100 from LSMS+ 100 LSMS+ 100 IDPoor 83 17 IDPoor 17 83 LSMS+ 85 13 LSMS+ 9 92 IDPoor 29 64 7 Assist- Govt/ IDPoor 33 ance 95 Assist- Govt/ ance LSMS+ 4 11 85 LSMS+ 32 65 3 Reduced Stayed the same Increased Reduced Stayed the same Increased Perceived household well-being and economic status have deteriorated in recent months as well as relative to the previous year. Compared to the previous year in January 2020, 49 percent of households perceive their well- PERCEIVED being and socioeconomic status to have fallen, while 42 percent perceive it to have stayed the same (Figure 14). WELL-BEING This indicates that the COVID-19 pandemic hit households hard and that disruptions to employment and livelihoods led to a perceived deterioration in well-being. Compared to June 2020, 45 percent of households reported a perceived reduction in well-being and socioeconomic status (Figure 14). A similar share of households reported a perceived reduction in well-being compared to June 2020 in Round 4 and Round 3. Households cited the most recent month, February 2021, as the toughest month in terms of well-being since January 2020 (Figure 15). Some households also cited March and April 2020, when the pandemic began, as the worst month, while others mentioned August, September, and October 2020. This suggests that the COVID-19 pandemic not only led to initial shocks, but also had cumulative impacts on household well-being and that households do not perceive a strong recovery yet. In fact, while 44 percent of households expect no further changes in household well-being over the next few months, almost as many (40 percent) expect further deteriorations (Figure 16). Expected changes in household well-being are similar for IDPoor households. Page 8 REPORT NO. 5 JUNE 2021 Figure 14: Changes in perceived household well-being and economic status Compared to January 2020 Compared to June 2020 9 6 3 9 5 8 13 5 42 42 48 45 50 45 53 49 % % 40 37 40 33 36 36 30 23 9 16 9 13 9 9 15 15 LSMS+ IDPoor R3 R4 R5 R3 R4 R5 LSMS+ IDPoor Increased by a lot Increased by a little bit Increased by a lot Increased by a little bit Stayed about the same Reduced by a little bit Stayed about the same Reduced by a little bit Reduced by a lot Reduced by a lot Figure 15: Worst month in terms of household well-being Figure 16: Expected change in household well- since January 2020 being over next few months 14 11 30 44 48 19 % 12 1212 10 % 9 7 8 6 6 87 8 6 7 31 31 4 55 3 4 44 11 11 2 9 10 Jan Aug Feb Jan Mar Apr May Sep Feb Nov Jul Oct Jun Dec LSMS+ IDPoor 2020 2021 Much worse Slightly worse The same Slightly better LSMS+ IDPoor Much better On June 24, 2020 Cambodia launched a nationwide cash relief program to support poor and vulnerable SOCIAL households during the COVID-19 pandemic. The program provides cash transfers to households identified by the ASSISTANCE government as part of the Identification of Poor Households Program, known as “IDPoor.” The program is a temporary measure intended to alleviate the economic hardships that the poor and vulnerable face because of COVID-19. The government initially intended to provide cash payments to households covered under the IDPoor program for 7 months (June–December 2020). As the pandemic continued, the Prime Minister announced that the relief program would be extended until March 2021. In June 2020, Prime Minister Hun Sen had announced that the program would spend US$25 million a month to support IDPoor households and would benefit around 560,000 families.5 In March 2021, the government had spent US$30.7 million per month to support more than 690,000 households (2.7 million people).6 Since June 2020, there has been a marked increase in the share of eligible IDPoor households receiving social assistance from the government.7 The share of eligible IDPoor households that received any type of social support increased considerably from 50 percent to 91 percent between June and August 2020, then remained high at 92 percent in October before reaching 95 percent in December 2020 and 96 percent in March 2021 (Figure 17). Of the eligible IDPoor households receiving social assistance, nearly all received social assistance provided by the government and nearly all assistance in the form of direct cash transfers (Figure 18 and Figure 19). 5 Associated Press. June 24, 2020. “Cambodia to provide cash to poor hit by COVID-19 outbreak.” 6 The Ministry of Social Affairs, Veterans and Youth Rehabilitation. 7 Eligible IDPoor refers to an IDPoor household with a valid equity card. Page 9 REPORT NO. 5 JUNE 2021 Figure 17: Percentage of Figure 18: Percentage of Figure 19: Percentage of beneficiaries social assistance beneficiaries beneficiaries reporting … as main reporting receiving types of SA since last interview source of SA 95 96 96 91 92 96 % eligible IDPoor households % households % households 50 1 0 0 2 0 R1 R2 R3 R4 R5 Government NGO Food Religious body Other Direct cash transfers Other in-kind transfers (excl. food) Most IDPoor households had received 9 installments of the COVID-19 relief cash transfers by March 2021, averaging a total of US$366. Those who verified the validity of their equity card with the local authorities immediately following the launch of the program would have received about 9 installments around the time Round 5 of the HFPS was implemented.8 Among the IDPoor cash transfer beneficiary households, 68 percent had received 9 transfers, 7 percent 8 transfers, 7 percent 7 transfers, and 10 percent had received 6 transfers since the launch of the program in June 2020 (Figure 20). Only 9 percent report having received five or fewer transfers, likely due to later registration. The number of received installments can also vary as households enter or exit the IDPoor program over time. Since the launch of the COVID-19 relief cash transfer program, IDPoor households have received an average of US$366 (Figure 21). As expected, the average total cash transfer per household increases with the reported frequency of receipt. Figure 20: Number of times cash transfers were Figure 21: How much cash was received in total, by number received of times cash transfers were received 405 68 374 366 319 279 240 USD 220 % 155 87 10 7 47 4 7 1 1 2 2 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 Total The relief cash transfer program has reached many IDPoor households and only few eligible IDPoor households remain uncovered. Only 5 percent of households with an equity card had yet to receive the cash transfers in March (Figure 22). After having stagnated in December 2020, registration among those that have not yet received transfers decreased in March 2021 (Figure 23). Not having an IDPoor card was the primary reason for not having registered at the commune council (40 percent), with a further 18 percent of unregistered households reporting that their IDPoor card had expired. In comparison, only one-quarter of unregistered households (25 percent) cited unawareness of the program and only 8 percent mentioned that they did not know the transfers were for them. 8 Registration or validation of the equity card with the commune council is a prerequisite for receiving the relief cash transfers. Page 10 REPORT NO. 5 JUNE 2021 Thus, ensuring eligible households have a valid IDPoor card could help further expand the reach of the program, possibly more so than raising awareness of the program. Figure 22: Share of eligible IDPoor households that Figure 23: Registration among eligible IDPoor have received the government relief cash transfers households that have yet to receive relief cash transfers 10 8 7 5 60 59 74 78 % % 90 92 93 95 40 41 26 22 R2 R3 R4 R5 R2 R3 R4 R5 Yes No Yes No The relief transfer program is perceived to have contributed to the economic well-being of beneficiary households. Around 38 percent of IDPoor households receiving the relief cash transfers report that the program has been “extremely important” for their household's economic well-being, while another 40 percent report that it has been “very important” (Figure 24). As a result, the relief program is perceived to have had an impact on the economic well-being of beneficiary households and made “a complete difference” for 42 percent of these households (Figure 25). Figure 24: How important was the relief transfer Figure 25: How much of a difference did the relief for household economic well-being? transfer make to household economic well-being? 2% 22% 19% 38% 42% 40% 37% Extremely important Very important No difference Slight difference Moderately important Not so important Moderate difference Strong difference Not important at all Complete difference FOOD Moderate-or-severe food insecurity rose between December 2020 and March 2021, while severe food insecurity INSECURITY remained unchanged. Among IDPoor households in Round 5, the prevalence of moderate-or-severe food insecurity during the 30 days preceding the survey was 55 percent, including 1.1 percent who were severely food insecure (Figure 26).9 Following a decline from 67 percent in August (Round 2) to 39 percent in October (Round 3), the share of households affected by moderate-to-severe food insecurity was 34 percent in December (Round 4), statistically indistinguishable from Round 3. Moderate-or-severe food insecurity also increased among the surveyed LSMS+ households, but the prevalence of food insecurity is still higher among IDPoor households. Among 9 Food insecurity prevalence rates are based on the application of the Food Insecurity Experience Scale (FIES), an experience-based metric of food insecurity severity that relies on people’s direct responses to eight questions about their access to food. People experienci ng moderate food insecurity will typically eat low-quality diets and might have been forced to also reduce the quantity of food they would normally eat at times, while those experiencing severe levels would have gone for entire days without eating, due to lack of money or other resources to obtain food. See (http://www.fao.org/in-action/voices-of-the-hungry/sdgs/en/). Page 11 REPORT NO. 5 JUNE 2021 the LSMS+ sample, 32 percent of the population had experienced moderate-or-severe food insecurity in the past 30 days in March (Round 5), of which 1 percent were affected by severe food insecurity. In October (Round 3) and December (R4), 17 percent experienced moderate-or-severe food insecurity. Among both IDPoor and LSMS+ households, the prevalence of severe food insecurity has remained at around 1 percent between December 2020 and March 2021. Figure 26: Percentage of population experiencing food insecurity 67 55 48 39 % 32 34 17 17 5 1 1 1 4 3 1 1 R2 R3 R4 R5 R2 R3 R4 R5 LSMS+ IDPoor Total population Moderate-or-severe food insecurity Severe food insecurity Page 12 REPORT NO. 5 JUNE 2021 BOX: SURVEY METHODOLOGY The Cambodia COVID-19 HFPS consists of two separate samples: (a) Living Standards Measurement Study Plus (LSMS+) and (b) IDPoor households. LSMS+ is a nationally representative household survey implemented October–December 2019 by the National Institute of Statistics (NIS) with technical and financial support from the World Bank. LSMS+ consists of 1,512 households, of which 1,364 have a phone number. The phone survey successfully reached and completed interviews for 700 of 1,364 households in May 2020, generating a response rate of 51 percent. In August 2020, 612 households were successfully re-interviewed. In October 2020, 469 households were successfully re-contacted from August, while 437 households were interviewed in all three rounds. In December 2020, 410 households were successfully interviewed, of which 368 households were re-interviewed from October and 342 households were interviewed in all four rounds. In March 2021, 378 households were re-interviewed, of which 290 households were interviewed in all five rounds. No replacement households have been included. Sampling weights were adjusted according to the steps outlined in Himelein (2014) to obtain unbiased nationally representative estimates from the sample.10 LSMS+ sample weights were computed to ensure representativeness at the national and urban/rural level. To monitor and evaluate the Cash Transfer Program for Poor and Vulnerable Households during COVID-19, which was launched in June 2020, an additional 1,000 IDPoor households were sampled. Before selection, the beneficiary list of the conditional cash transfer for pregnant women and women with children under the age of 2 was assigned into five strata: (i) Phnom Penh and other urban areas, (ii) Plain, (iii) Tonle Sap, (iv) Coastal, and (v) Plateau and Mountain. The sample was randomly selected proportional to the number of IDPoor households in each stratum. The phone survey successfully interviewed 984 households in June 2020. In August, 784 households have been re-interviewed and 271 replacement households were added. Of these, 841 were successfully reached again in October, with 527 interviewed in all three rounds. In Round 3, 558 replacement households were also included. In December, 1,277 households were successfully interviewed, of which 945 households were re-contacted and 332 households were added as replacement households. A total of 675 households were interviewed in all four rounds. In March 2021, 1,309 households were interviewed, of which 991 households were re-interviewed and 318 households were replacement households. A total of 397 households were successfully interviewed in all five rounds. Sampling weights for the IDPoor sample were computed to ensure the representativeness of IDPoor households at the national and regional level. The HFPS was implemented using Computer Assisted Telephone Interview (CATI) techniques and the questionnaire was programmed using the Survey Solutions CAPI software package. Enumerators used mobile phone devices. Enumerators were given data bundles, allowing for internet connectivity and for daily data transfer and synchronization with the server. Field supervisors reviewed the survey responses with enumerators via one-on-one calls daily and addressed concerns that arose immediately following enumerators interview. At the same time, a research analyst was in charge of checking the uploaded data daily to identify errors so as to inform the field supervisors and enumerators. Data collection parameters, LSMS+ Round 5 ❖ Data collection period: 1–21 March 2021 ❖ Completed interviews: 378 households (110 urban; 268 rural) ❖ Average duration of interview: 23 minutes Data collection parameters, IDPoor Round 5 ❖ Data collection period: 1–21 March 2021 ❖ Completed interviews: 1,309 households (56 urban; 1,253 rural) ❖ Average duration of interview: 22 minutes 10 Himelein, Kristen (2014), Weight Calculations for Panel Surveys with Subsampling and Split-off Tracking, Statistics and Public Policy, 1:1, 40-45. Page 13