Annual Report 2012 can be downloaded here. Thanks to our improved database, the analysis of adherence that had been done for the first time in the 2011 annual report was improved and done again per district in 2012. Also, this annual report contains for the first time an analysis of the unit costs of the Peer Educator Networks. Until now in the annual repots only the expenditures had been provided.
Second drawing competition was held in Takeo province:
In 2013 almost 40,000 children in Takeo have been given the opportunity to compete by making a drawing on prevention themes: 1. healthy food, 2. no smoking, 3. physical activity. There were all in all 90 winning drawings, providing a rich display of artistic expression.
The 2nd prize awarding ceremony was held on June 30, 2013 in Prey Kabas OD. Many of our peer educators are school teachers. The second drawing competition was for the school children in 56 schools (400 classes). We add this to the figures of the first drawing competition held in last December-January in Ang Roka OD (also Takeo).
This activity was one of a project, funded in part by our second grant from the World Diabetes Foundation, based on Kopenhagen.
Starting April 2013, the Ministry of Health is taking official responsibility for the Peer Educator Networks in 5 OD’s in Takeo province, with MoPoTsyo preparing to move the care for about half of MoPoTsyo’s members into the public health system in these 5 OD’s and assist the MoH in setting up Peer Educator Networks in 3 other provinces.
Under the HSP2 project, the Ministry of Health is to begin manage and finance the Peer Educator Network activities in those 5 OD’s. In 2013, MoH was supposed to contract MoPoTsyo to assist the MoHand the OD's with their new responsibility, but that has not happened yet. The administrative process is taking a long time. In 2013, the Peer Educator Networks have been made financially sustainable as far as that was still necessary. The patients were already paying most of the cost of their care. With small adaptations we were able to avoid that the administrative delay jeopardizes the continuation of the “continuum-of-care” now that there is no longer an external donor for Takeo such as WDF.
However for poor chronic patients the situation is not as good as it can be: in order to provide efficient social health protection for poor chronic patients with high prescription costs, the Health Equity Fund standard benefit package for chronic patients has to insert a new item: payment for prescribed routine medication, a minor but important adaptation of the official benefit package. Special Delivery Grants financed by funds that are pooled by the Ministry of Health’ main development partners can then fund this activity. By making the adaptation, social health protection can be extended to help chronic patients efficiently with a system that is just as sustainable as Health Equity Funds themselves. The computerized patient management database makes it possible to manage and contain the cost.
For the remaining half of the networks, that is in non-SOA areas, MoPoTsyo will also build the capacity of the OD’s to supervise the Peer Educator Networks but the administration and financing of the peer educator network activities will continue to be done by MoPoTsyo using direct donor support. The involvement of the OD Directors in the management and financial administration of the networks there is continuing. OD Directors routinely sign off on the activity reports of the peer educators and their cost declarations.
GIZ has extended financial support for MoPoTsyo until June 2014 in non-SOA operational districts in Kampong Thom, Kampong Speu and Kampot province, but GIZ support for the 2 OD’s in Kampong Speu province ends in 2013: After 3 years of AusAID and 1 year of GIZ financial support the mature network in Kong Pisey OD is financially sustainable. However for Kampong Speu OD, a private donor from Australia was found to help complete the work which had only just been started. In 2013, the first peer educators were trained and they have only just begun their screening activities, so it is much too early to abandon them. Like in Kampong Thom province, there is very strong commitment of the province and operational district authorities to support the peer educator networks. The Revolving Drug Fund pharmacy outlets are being expanded into the public services of Kampong Speu as well. Funded by GIZ and invited by Kampot province and Angkor Chey OD, our peer educators have selected the first group of 6 candidate diabetes patients to become peer educator in Angkor Chey OD in Kampot. These six will begin their 6 week training at the start of 2014. The normal time needed to set up a new peer educator network in an OD is 2 to 3 years. Funding is assured until June 2014, so additional funding must be found in time to avoid the same situation as in Kampong Speu OD.
With Louvain Coopération au Développement, the Belgian NGO that is connected with the Université Catholique de Louvain (UCL), we have just completed a project to set up a peer educator network in Baray Santuk OD in Kampong Thom Province at the end of 2013. We are preparing a new project with the same partner NGO for 2014 – 2016.
In Banteay Meanchey’s Thmar Pouk OD there were major developments in 2013. The well-known and popular Community Based Health Insurance scheme of CAAFW was discontinued because of lack of funding. Also changes were made in key personnel in the public health services. Our Peer Educators continue their activities. The database shows that most members continue to use the continuum of care organized by the peer educator network including the revolving drug fund and the medical consultation service at the hospital and laboratory services, all put into place through the ICCO-KIA partnership project. In the first half of January 2014, MoPoTsyo as chair of the Thmar Pouk Partnership Secretariat organizes a workshop at BMC to link Peer Educator Network with the HEF operated by PFD and review the progress so far. The workshop is also an opportunity to discuss the involvement of the public services in the peer educator network activities as part of the new national strategy.
Phnom Penh Poor Areas: The geographic boundaries of the OD’s in Phnom Penh are about to be redrawn. A decision is expected in early 2014.
In 2013, MoPoTsyo Patient Information Centre became member of the Social Health Protection Association (SHPA). We were admitted because the Peer Educator Networks in their current form provide effective social health protection for MoPoTsyo’s s members, patients with chronic disease, a type of protection that is not provided by the existing social health protection schemes, such as HEF or CBHI or formal sector. The exact links between the Peer Educator Networks, functioning under OD responsibility, and the HEF and CBHI remain to be worked out.
With peer educator networks in the new National Strategy for Prevention of NCD (2013-2020) under the Operational District Office, the issue of how best to help those chronic patients who are too poor to be able to afford to pay for their routine medication can be studied once the first HEF-Operator is going to be allowed to pay for the medicines as part of the standard benefit package. With a database that registers patients, prescriptions, dispensing and payments for medication at pharmacy outlets in public sector, computer technology has opened the way to organize this its cost can be effectively planned and contained so Cambodia does not end up in the same situation as in the countries where Cambodia’s health policy experts all come from.
On 23 November 2013 World Diabetes Day was organized by the Provincial Health Department of Kampong Thom, with national level representatives of Ministry of Health and more than 800 diabetes patients, members of MoPoTsyo and all 129 the peer educators. The event was funded this year by Louvain Coopération au Développement. As usual the event started with a Diabetes Walk through the provincial capital to draw attention to diabetes and raise awareness about the ways to prevent chronic NCD.
PATH USA, our partner in research. Both Ethical Committees, the one in Cambodia, and PATH IRB in the USA have cleared the research that we are planning to carry out: a study to compare different diabetes screening methods. The study has taken a year to prepare. We have had visitors from PATH USA: Dr Tina Neogi came during May 2013 to conduct training of our research team. At the end of May, PATH’s new Director for Noncommunicable Diseases, Helen MacGuire, previously at the International Diabetes Federation, visited our program. She visited one of the urban peer groups and went to Kong Pisey OD to see a rural Peer Educator Network in action. The study has formally started on November 19th with small groups of adults living in a sub urban area of Phnom Penh volunteering to take part in the study. The screening is coupled with the usual MoPoTsyo peer educator services and continuum-of-care for those who are found to have chronic disease like diabetes, hypertension and dyslipidemia.
BRIDGES Translational Research: A delegation from the International Diabetes Federation traveled to Cambodia to evaluate the Mobile Phone SMS research that we are conducting here among 500 randomly selected diabetes patients. Last year 2012 September these 500 patients had been randomly selected among the patients who have been more than 6 months in follow-up by the 9 busiest peer educators in Phnom Penh, Takeo and Kampong Speu province. It was a good moment to compare the results of the 3 baseline studies that were done before starting the SMS messages to the 250 patients in the “intervention group”. During the 26 months period of the study, there are 250 diabetes patients who will get 6 messages per week and 250 patients who will not get those SMS messages that are meant to help them adhere to treatment and behave more healthily. With at the baseline an average HbA1c of 7.1 and blood pressure in two thirds of our diabetes patients already under control it will be difficult to make much positive impact but we will do our best. This research is funded through a grant from Lily Education and you can read more about it at http://www.idf.org/bridges/supported-projects/long-term/LT10-341. We plan to expand the scope of messaging to voice mail when we have analysed the 2nd assessment, which has just been completed.
Conferences: From 12 to 15 November, GIZ held its regional conference in Hanoi. MoPoTsyo’s peer educator networks were present through a poster. From 13 to 16 December the Health Systems in Asia conference was organized at Singapore’s Lee Kuan Yew School, NUS, Singapore with MoPoTsyo’s Peer Educator Networks presented in the Subplenary Session on Empowerment, health literacy and ICT’s organized by Gerald Bloom of IDS, see ppt.