The Health Sector Annual Operational Plan 2012 of the Ministry of Health was finalized 08-12-2011 in a workshop on joint annual appraisal held at MoH presided over by H.E. Dr Mam Bunheng the Minister of Health. The document is the result of an extensive consultative process that also involves development partners, donors, MEDICAM etc.
This year it contains for the first time specific provisions (numbers 51 to 55 and also 65) on risk factor control for NCD. Reading shows that they fit well with the activities routinely deployed by the Peer Educator Networks. Also budget has been allocated by the Ministry of Health to implement these priorities in 2012. All this suggests a firm resolve by the Ministry of Health to support Operational Districts and provinces in the expansion of their Peer Educator Networks and integrate the latter into its primary care system. Undoubtedly these allocations will improve coverage further and help more Cambodians live healthier lives and delay onset of complications as a result of diabetes mellitus, hypertension and dyslipidemia’s. The ball is back in MoPoTsyo’s camp to finish its “social business plan” in the required format. We are working on it zealously.
The Belgian NGO Louvain Coopération au Développement (LD)
and the Cambodian NGO MoPoTsyo signed a contract to collaborate in Baray Santuk OD in Kompong Thom province to set up a Peer Educator Network there. LD specializes in mental health. MoPoTsyo wants to forge functional links between Peer Educators and other aspects of the primary health care system there.
World Diabetes Day: On Sunday November 27th, 2011 we celebrated World Diabetes Day. The event was organised by the Provincial Health Department of Banteay Meanchey Dr Keo Sopheaktra with our support. The Secretary of State of Health, H.E. Ung Pirun represented the Ministry of Health. The provincial government was represented by Vice Governor H.E. Chhum Vannarith, the former Provincial Health Director. Prof. Lim Keuky, the President of the Cambodian Diabetes Association was also spoke in presence of many officials including Dr Thach Varoeun of the Preventive Medicine Department of MoH. Peer Educators from 4 provinces joined as well as members from Thmar Pouk OD in Banteay Meanchey. Professional comedians (Mr Neay Swet) who happen to be diabetic provided entertainment but also lay-comedian Peer Educators from Takeo and from Kompong Speu having produced original diabetic performances for this unique event. The taboo of self-injecting that some diabetics still encounter in society remains a great source of inspiration for comedy. The day started with a Diabetes Walk in which all participating dignitaries and patients who were able to walk joined. The march led through downtown Sisophon including around the busy Sunday morning market. It was a well organized demonstration of everyone’s commitment to regular physical activity. National TV stations had recorded the event and it was broadcasted on the major TV channels in the following days (click here to see the video). It was also covered in the country’s major Khmer language newspapers. The speeches from our Cambodian counterparts were full of praise and encouragements for the work of the Peer Educators and for MoPoTsyo.
ICIUM: MoPoTsyo was present with abstracts / posters 363 and 371 during the 3rd ICIUM conference organized by WHO and Harvard ( http://www.inrud.org/ICIUM/Scient
ific-Program.cfm) in Antalya Turkey from 14 to 21 November 2011. The Medical Anthropologist Chean Men presented his research abstract 300 “I wish I had AIDS”. The appeals from people with Diabetes were heard loud and clear at this influential conference and even made it into the conference’s summary. Our messages were not just that continued neglect of Diabetes patients in low income countries is inequitable but also that accepting the situation is no longer unnecessary because cost effective strategies exist to help prevent secondary complications related to diabetes and high blood pressure. The fact that for the first time a special UN Summit was held on the topic of NCD (September 2011 http://www.ncdalliance.org/ ) is also a sign that politicians in the 21st Century will have to give more attention to the topic of NCD in developing countries. On the other hand there is no common and clear vision among the stakeholders on the details of how this must be done. The chronic NCD remain a hot and also much feared policy topic. Since the UN Summit it is more difficult for politicians to disagree with allocating more resources to the needs from NCD. However, with the ongoing financial crisis the prospects for increasing aid flows to developing countries are dim. There is a growing threat that donors will shift resources from communicable programs to noncommunicable programs instead of adding them to the existing envelopes. The scarcity of resources makes it even more relevant to demonstrate that costs of care can be significantly brought down to levels that can be made sustainable for low income countries themselves. How people with disease themselves take a very active role in the delivery of their primary health care for themselves and for others is demonstrated every day by the Peer Educator Networks in Cambodia.
Board Meeting: MoPoTsyo’s board meeting was held August 2011 with all board members present. We welcomed a new board member: Mr Chroeung Sokhan Pharmacist and President of the Cambodian Association of Pharmacists. He brings a great experience and skill to the board at a time when we are expanding our Revolving Drug Fund. His arrival brings the total number of board members to 7.
Translational Research: On 16-12-2011, the Cambodian Ethical Committee for Health Research gave its approvalto the collaborative research that we are planning to carry out in 2012 together with partners in Philippines and the Democratic Republic of Congo, with technical support from Antwerp Tropical Institute in Belgium. Our research partnership was one of the winners in Round 3 of the BRIDGES Funding for translational research (http://www.idf.org/bridges) . BRIDGES stands for Bringing Research in Diabetes to Global Environments and Systems. It is an International Diabetes Federation (IDF) program supported by an educational grant from Lilly Diabetes that funds translational research projects in primary and secondary prevention of diabetes to provide the opportunity to ‘translate’ lessons learned from clinical research to those who can benefit most: people affected by diabetes. The aim of our research is to measure the additional effects of SMS messages on people with Diabetes who are enrolled in the standardized continuum of care, learning how to self-manage from the Peer Educators. The SMS messages do not substitute for standard care but are an extra tool to reach people more effectively. The software developed to send the SMS is based on Frontline SMS an open source software(http://www.frontlinesms.com).
The research will last for 3 years. It is important to undertake this kind of research as mobile phone technology and infrastructure in Cambodia develops at high speed. We need these technological developments to turn them into the optimal advantage of our members with chronic disease.
WDC 2011 Dubai: During the World Diabetes Congress in Dubai 2011 and by entertaining 14,000 participants the conference organizers demonstrated again their impressive skills in how to run this type of mass event over several days for a wide variety of stakeholders. It is of course impossible to be present at the same time in 4 halls and 10 rooms to watch & listen, read posters, abstracts, meet old friends and make new ones, but there was overwhelming opportunity for all of this. Cambodia had several types of contributions, including a poster discussion on the first STEP survey that had been carried out in 2010 to study the prevalence of risk factors for NCD in Cambodia (D0666) by Dr Prak Piseth Raingsey Director of the MoH’s Preventive Medicine Department. MoPoTsyo’s Director Maurits van Pelt was given the opportunity to present on Action Research on Peer Educator Networks in Cambodia: Opportunities and Challenges. Number 140 in the Symposium on Science of Peer Education during a special symposium on this topic, the presentation can be downloaded here. It was part of the stream “education and integrated care”. Peer Educator examples from different contexts show how the role of peer educators can be adapted to fit with the existing health system. In the discussions that followed as a key message emerges time and again that Peer Education is necessary “for everybody” for maintaining health as it is grounded in a human craving for social interaction, a special feature that is not for sale as a commodity nor over the counter nor from a trained professional health service provider. If chronic patients do not get enough of this “special feature”, they will continue to feel deeply miserable although they get all the top notch medical treatment plans in the world. For that simple reason this feature must be built into the health delivery system in all contexts. To what extent it responds to do different needs, is entirely context dependent. As long as there is no better alternative mechanism, delivering a more cost-effective and affordable continuum of care, the Peer Educators must take a somewhat larger role but not made to occupy the entire vacuum either! Their integration into the public system as part of primary care is what is next on Cambodia’s agenda and other countries had better watch how this goes as we are crossing the river by feeling the stones. There will generate valuable lessons for many of our neighbors because this is area of health policy development is mostly terra incognita.
Our own efficiency: We moved to a more suitable office building located to the East of National Hospital Kossamak. It is situated in the same Phnom Penh street with Number 138 (House number 262) but this part of the street is located in Sangkat Tik Laak 2. The square meter price of our new office space is USD 1.50 per square meter, which is less the USD 1.80 we were paying per m2 since mid 2008. The move to a larger space had become necessary because of growth and in particular in view of the planned expansion of the Peer Educator Networks. This was the second time in 7 years that we moved our premises: the first time from Boeung Keng Kang 1 to Tik Thlae and now from Tik Thlae to Tik Laak.
The move took place before the Revolving Drug Fund stock is replenished with the annual order. So the shipment will arrive at the new stock. Also under “efficiency” we report that we have switched to an “M-system of reimbursements for peer educators” using financial transfers by mobile phone. Lastly, we are about to test the newly developed software that will allow us to start to dispense the Revolving Drug Fund medicines through the Government Health Centers to our members. This will make a start in the first trimester of 2012.
New Blog post Peers For Progress (PFP) added a blog to its already very interesting website on Peer Support initiatives in the world. We had been invited to contribute with our ideas on scale up. Please take a look at the webpage:
Jackie Green is a Canadian biochemist who obtained her Master in Anthropology at the University of Brunel in London (UK) in September 2011. In order to gather the material for her Master thesis she stayed with us for a couple of months at her own cost meeting with the peer educators and patients in slum areas and in rural areas in order to study Management of Diabetes in the Cambodian context. She also investigated how people use the urine strips. Her thesis called “I Do Diet”: The Construction of a Cambodian ‘Diabetic Patient’ and the Management of Diabetes in Cambodia” can be downloaded here. She was credited with an A with Distinction and we all agree that it should be nothing less than this.
Natalie Eggermont is a Belgian student of Medicine who recently obtained her Master in Medicine at the University of Ghent. In 2010, she came to Cambodia to gather material for her Master thesis as part of an independent evaluation. She was coached by Antwerp Tropical Institute in Belgium. The evaluation report can be downloaded here. It is relevant independent documentation and evidence combining both quantitative and qualitative data. The findings confirm largely what our internal monitoring and evaluation activities have been finding but the interviews provide much more depth and understanding of the situation which helps to explain the findings. A great job! Her poster was accepted for the Geneva Health Forum April 2012 (see http://www.ghf12.org/) and scroll down the web page until you find the introduction to her poster.