From health practice to “Health Policy”: For the first time ever, the Ministry of Health included the continuation and expansion of Peer Educator Networks into its Annual Operational Plan for 2013. This decision is conform Cambodia’s draft National Strategy for Prevention of NCD. An important next step is a competitive bidding process for NGO’s such as MoPoTsyo.
There is a need for technical assistance to help the MoH implement its AOP to set up new Peer Educator Networks in 3 OD’s (pink color) that have Special Operating Agency status, Peareang, Sotnikom and Preah Vihear and to integrate existing Peer Educator Networks in 5 OD's in Takeo province within the public system.
With GIZ support, MoPoTsyo is setting up Peer Educator Networks in Kampong Thom and Kampong Speu, in Operational Districts which are not SOA's but in the regular administrative system. At the end of March, the first peer educator for Stoong OD (Kampong Thom) passed her exam. She returned to Stoong OD, health center area Chomnar Kroam with the peer educator kit to begin screening for early diagnosis and in organising care in her area. She was the only one of her group of 5 to pass the exam until now. Later in 2013, we will begin to set up the peer educator network in Chhouk OD in Kampot province, which also receives development support from GIZ. Since the end of 2012, we are involving more the Operational District director in supervising the Peer Educator Networks activities, the reporting and the rewarding of the peer educators. We try to promote some collaboration between the health centers, the peer educators and the village high blood pressure groups as part of the public health care system.
At the end of February 2013, the Board of SHPA, the Social Health Protection Association, has decided to accept MoPoTsyo as one of its members. MoPoTsyo needs to link the work of the peer educators with the existing mechanisms for social health protection, such as Health Equity Funds and Health Insurance operators.
A Drawing competition was organized in Ang Roka OD in Takeo province. We had never done this before. Just short of 20,000 school children in Takeo province’s Ang Roka OD had been given the materials plus opportunity to join in a drawing competition on chronic NCD prevention themes, such as "no smoking", "healthy nutrition" and "physical activity". School Teachers selected first the 5 best from the pupils in their own class, and among those (>2,000 drawing) the 45 best have been selected by MoPoTsyo staff. The winners were awarded with prizes during a ceremony held on Sunday 20 January 2013 at one of the high schools.
It was great appreciated and attended by the Vice District Governor and Director of the Education Bureau and the Operational district Director and 2000 school kids. Before mid-2013, we will organize a second drawing competition in another district of the same province, Prey Kabas OD, in May of this year following a similar process. These drawing competitions are the final activities financed under a grant from the World Diabetes Foundation 09-463,a project that was essentially a continuation and replication of what been started under an earlier grant WDF07-229 to set up the first peer educator network in Cambodia. With their adoption as part of national strategy these networks are likely to become a sustainable tool in the fight against chronic NCD in Cambodia in the coming decade. We have to congratulate WDF's Board for their historic and visionary decisions.
Out of Office: On 8 February 2013, upon request of the Provincial Health Department in Takeo MoPoTsyo has moved out of its one room office out inside the PHD. We had preferred to maintain office inside the PHD as part of our close collaboration on the prevention of NCD, a shared objective. The PHD is carrying out repairs and urgently needs the space for other purpose.
Tuberculosis & Diabetes: Screening for Diabetes among Tuberculosis patients and for Tuberculosis among Diabetes Patients. The international TB epidemiologist Dr Wendy Cronin came to Cambodia to give some guidance on how the elderly people can best be reached, because the elder TB patients (>55)years are the ones who are most often missed. Her visit coincided with the first time that the main Cambodian stakeholders gathered to talk about Tuberculosis and Diabetes and compare data. From one rigorous study conducted by URC it appears that both diabetes (5% among TB patients) and pre diabetes (22%) are highly prevalent.
MoPoTsyo’s own data of a very small sample suggest much higher prevalence (31% diabetes & 20% pre-diabetes) but there may be bias in our own data as the people who collect them are actively trying to detect DM cases, so URC's figures are probably better. Whatever.... what is already clear is that hyperglycemia prevalence is high among TB cases and that it represents a large “unmet health need”, although some of this hyperglycemia may have been caused by the anti TB drug Rifampicin.
New movie:We produced a 19 minute movie about the lives of 2 patients in Kong Pisey OD in Kampong Speu, where AusAID had funded the set up of a peer educator network. The project was completed at the end of 2012. The movie title is "Diabetes in the paddy fields" watch here.
WHO ALLIANCE : The inception meeting was held on 22-03-2012 for a new prospective observational study, financed by the WHO’s Alliance for Health Policy and Health Systems Research , called “Access to Medicine for Chronic NCD in Rural Cambodia: synergizing the District Health System, Risk Protection Schemes and Socio-cultural factors”. The study may shed further light on the impact of peer educator networks on the lives of patients with chronic disease. It will compare a district without a peer educator network, one with a new peer educator network and one with a mature peer educator network, interviewing 5000 individuals in each district. The study will be conducted by C & J, a Cambodian company.
POWER: The German government's technical development cooperation agency, GIZ, generously donated a generator which can ensure power supply to keep our revolving drug fund stock below 25 degrees Celsius (that is 77 Fahrenheit) despite the Cambodian heat which is cooking everyone these days.
The Endocrinologist-Anthropologist Dr Sudah Yehuda who knows our program well and writes about it on his blog, joined the early morning peer educator group in Anlong Kangan, a resettlement area on the outskirts of Phnom Penh. This peer group dates from 2005, so it now almost 8 years old.
Thanks Dr Yehuda's positive publications a small group of interested visitors from Indonesia came in February 2013 to study our intervention to see if and how it can best be adapted to the situation in Bogor (Java, near Djakarta). It will be exiting to see a replication in some form of peer educator networks in another context in South East Asia.
A new research:
On 8 February 2013 PATH (Seattle, Washington USA) and MoPoTsyo signed a contract to conduct a research that compares the different screening tools and methods for diabetes. The research will be done in another resettlement area in one of the outskirts of Phnom Penh. After approval from the National Ethics Committee for Health Research this research will begin hopefully in May 2013. It compares results from Fasting Blood Glucose, Oral Glucose Tolerance Test, Glycated Hemoglobin A1c, urine glucose strips and other data from about 1400 adults