On June 14th, 2012 H.E. Prof Eng Huot launched (download here) the Social Health Protection Association (SHPA). The association has registered itself as an NGO at the Ministry of Interior. The NGO’s Mission is to support and promote the quality, sustainability and coverage of Health Insurance and other social health protection schemes in Cambodia.
It is being funded by the Cambodian-German Social Health Protection Program, implemented through GIZ and financed by the German Federal Government (BMZ). It is gradually becoming recognized that peer educator networks also contribute to social health protection by facilitating access to chronic care and helping to reduce out-of-pocket health expenditure. It is relevant, because surveys indicate that NCD is a main cause of catastrophic health expenditure.
During a workshop on 18-12-2012 download here, the SPHA members reviewed the informal sector and the challenge of creating effective and efficient coverage with social health protection mechanisms. With the Peer Educators becoming part of Cambodia's National Strategy to Prevent NCD, MoPoTsyo may have ideas to contribute because the current health system was only designed to meet acute health needs, with NCD care at specialised clinics, whereas the majority of the health needs require that chronic care is delivered close to the patient's home, promoting self-management in primary care settings. The 2 systems must be well connected to create the coverage that is needed. We will have to cross the river by feeling the stones....!
GIZ (formerly GTZ, the German Technical Cooperation) has decided to provide funding to MoPoTsyo to support Peer Educator Networks in the provinces Kampong Thom and Kampong Speu. Thanks to this funding we can make a start in 2 new OD’s, namely Stoong and Kampong Speu OD.
Thanks to the first grant from GIZ we can implement some reorganizations and improvements to help us prepare for the expansions and our new role as a capacity building NGO, helping OD's to implement a national strategy to prevent NCD. These adaptations include a new accounting system and some restructuring.
New national strategy
The Ministry of Health’ Preventive Medicine Department has begun to prepare a plan to multiply the Peer Educator Networks in Cambodia, starting 2013. MoPoTsyo will help Operational District authorities to create, maintain and supervise Peer Educator Networks. The Ministry of Health is now developing a Terms of Reference for MoPoTsyo. In the meantime, during July, August and September 2012, Cambodia has been preparing a new Strategy for Prevention of Noncommunicable Diseases (NCD) for 2013-2020. Technical support has been provided by WHO, Dr Belinda Loring in collaboration with national WHO staff Dr Kim Sam Ath. MoPoTsyo staff participated in a series of consultative meetings on the strategy that was put together with inputs from the development partners, including MEDICAM’s NCD Task Force members. The new strategy includes also a call for a roll out of Peer Educator Networks for Diabetes and High Blood Pressure. Now we wait for the official approval of the new strategy.
Pharmacy automation system
Upon request of the Ministry of Health, MoPoTsyo has begun to set up automated dispensing for its Revolving Drug Fund in the public service. Members who present their patient book with the bar code can buy their medicine. MoPoTsyo equips the Hospital or Health Center pharmacy with a computer and reader of the bar code (see picture).
Through VPN the system synchronizes with the central database where “adherence to prescribed medication” is monitored besides prescription behavior but also stock - and supply data to ensure uninterrupted supply. The next step will be to link the dispensing database with the patient database. The plan is to make the data accessible for OD health authorities, so they can begin to analyze what is going on with regards to their own patients per Health Center coverage area in their own OD.
Lab Results and CKD
Our laboratory now produces the results of the last 3 profiles in a row, so the treating physician can see them in the one glance. Besides, it is also interesting for the patient to see the trends in their own lab results example of new lab result. We would like to investigate if and how this information helps patients. We know already that patients who use the lab have better adherence but we do not know in which direction the causality works: in other words we don’t know if the lab results motivate patients or if more adherent patients are more interested in the lab results. We also know that poor patients are less inclined to spend money on the lab services because they have other priorities. We also know that one in three patients with diabetes has elevated creatinin which should be early diagnosed to get the optimal treatment to delay the onset of Chronic Kidney Disease. A third of diabetes patients may be progressing towards CKD. With reliable lab results on proteinuria, creatinin and an eGFR we can provide diagnostic support to the reduction of the negative impact of CKD on the population in the future: a little bit of money now to avoid dialysis in a few years.
MoPoTsyo board convened on Saturday October 20th. The board approved the financial annual report 2011 download here, after the Audit 2011 had been completed, as well as the Narrative annual report 2011. Download here. The board members extended the period of delegation to the current CEO with 12 months from 31 December 2013 until the 31 December 2014. One new board member was admitted, Dr Khiv Sokha of MoH. Dr Khim Sam Ath of WHO was granted observer status and will participate on board meetings from now onwards. This brings our board meetings to 8 members and 1 non-voting observer. The Board has also decided to organize elections for the Presidency of the Board.
The Provincial Health Department of Kampong Speu invited the Ministry of Health and MoPoTsyo to join in World Diabetes Day in the provincial capital on November 10, a Saturday. As it is the custom, the day began with a 2.5 km walk with slogans and key messages on large banners. It was a spectacular event, broadcasted on the 3 main national TV channels. The peer educators had prepared comedy inspired by their work experiences as peer educators in real life situations. There was live music. The lunch consisted of very healthy, yet delicious, low glycemic Khmer food. More than 100 peer educators and a 1000 diabetes patients joined in this event.
Diabetic Retinopathy Screening:
Children Surgical Centre and MoPoTsyo have begun to organize Diabetic Retinopathy screening among the urban poor. A total of 397 diabetes patients were screened. The results are 88 cases in urban area (22%) with diabetic retinopathy. The Peer Educators reinforce the follow-up system.
Yes, They Can,
A peer reviewed publication about the first rural Peer Educator Network was published as Chapter 8, Title 8. Yes, they can. Peer Educators for Diabetes in Cambodia, Maurits van Pelt, Henry Lucas, Chean Men, Ou Vun, MoPoTsyo, and Wim Van Damme" in a book at Routledge http://www.routledge.com/books/details/9781849714174/
Transforming Health Markets in Asia and Africa: Improving quality and access for the poor – Edited by Gerald Bloom, Barun Kanjilal, Henry Lucas, David Peters.
New research plans:
The American NGO PATH and MoPoTsyo prepared 2 abstracts about their upcoming collaborative research initiatives:
1) with regards to the key success factors of the Peer educator networks
2) with regards to screening techniques for diabetes Download here.
Health Systems Research Symposium (Beijing) :
MoPoTsyo was present with an abstract and a poster at the 2nd Global Symposium on Health Systems Research (HSR) download here. held in Beijing (P.R. China) from 31st October to 3rd November 2012.
Mobile Phone SMS Study
MoPoTsyo has finished the baseline data collection as part of the 3-country study (Philippines, DR Congo and Cambodia) on Mobile Phone Diabetes Self Management Support. We have distributed mobile phones to 484 Diabetes patients (our members) in 9 different locations (2 areas in Phnom Penh, 6 in Takeo and 1 in Kampong Speu province). Half of these 484 DM patients are receiving daily SMS messages from us to help them adhere to better lifestyle and treatment, during a period of 26 months, the other half do not receive SMS messages from us. We will regularly measure if we find significant differences in health outcomes. Baseline data entry was completed in December 2012.
This research is coordinated with technical support from Antwerp Tropical Institute and funded with a BRIDGES award, an International Diabetes Federation project supported by an educational grant from Lilly Diabetes (see http://www.idf.org/bridges/supported-projects/long-term/LT10-341 )