Slightly smaller than the U.S. state of Oklahoma and poised to become a lower middle-income country, the Southeast Asian nation of Cambodia is home to nearly 16 million people. About one-third of Cambodia’s population is under the age of 15 years, but declining fertility rates and increasing life expectancy mean the population structure is slowly aging.
According to WHO, health status has substantially improved since 1993 with a substantial drop in mortality rates coupled with a rise in life expectancy at birth to 62.5 years in 2010 — a 1.6-fold increase from 1980. Although the Government has made significant gains toward rebuilding the health system since the 1990s, including significantly increasing funding for healthcare, the actual amount allocated remains at only 1.4% of GDP.
While Cambodia’s adult HIV prevalence rate is just 0.64 percent, risk of other infectious diseases such as bacterial diarrhea, hepatitis A, and typhoid fever — along with vector-borne diseases like dengue fever, Japanese encephalitis, and malaria — is extremely high. Non-communicable diseases (NCDs) are also on the rise and are now estimated to account for an equal number of deaths as infectious diseases.
WHO reports that inequities in health outcomes — particularly differences in urban vs. rural healthcare and those based on socioeconomic status — remain an obstacle to achieving health outcomes that are on par with other countries of the region.
With support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, AIHA launched a blood safety project in Cambodia in December 2012. In late 2015, we launched an injection safety project through our HIV/AIDS Twinning Center Program, which is supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), and funded by CDC/Cambodia.
Cambodia Injection Safety Initiative
(2015 – 2019)
This initiative supported the Cambodian Ministry of Health’s efforts to prevent parenteral transmission of HIV, particularly through unsafe and unnecessary injection practices. In addition to the Ministry of Health, AIHA also worked with two local NGOs — 17 Triggers and Ponleur Kumar — to implement this PEPFAR-supported project under our HIV/AIDS Twinning Center Program.
The 2014 HIV outbreak in Cambodia’s Battambang’s Roka commune resulted in more than 240 people contracting HIV and highlighted the fact that unsafe injections have the potential to greatly contribute to HIV incidence in the country. Due to this outbreak, the Ministry of Health has since prioritized risk reduction strategies to mitigate this mode of HIV transmission.
In response, AIHA launched a new HIV/AIDS Twinning Center partnership in 2015 to support the Cambodian Ministry of Health’s efforts to reduce the demand for unnecessary injections and increase the demand for non-injectable alternatives among the general public.
With funding from PEPFAR, HRSA, and CDC/Cambodia, this project worked to raise public awareness about unsafe injection practices through targeted behavior change communication and outreach interventions.
AIHA engaged two local implementing partners to implement the project — 17 Triggers and Ponleur Kumar — and developed a research protocol, translated it into Khmer, which was submitted to the Ministry of Health for approval in January 2017. Following approval, AIHA and our partners conducted an assessment to determine which messages and interventions are the most viable to achieve the project’s objectives.
17 Triggers conducted various trainings and workshops to involve all stakeholders in decision making at various stages throughout the project.
In October 2017, 17 Triggers completed a mixed-methods study that provided insights into Cambodian patients’ and health service providers’ behaviors around using injections and IVs for treating ailments, addressing the first two goals of the project. Based on insights from the field, 17 Triggers developed a behavior change strategy that proposed a two-pronged approach of (1) a TV spot, complemented by (2), a community intervention using a game to educate people about good and bad health seeking behaviors around injection use.
Despite close coordination with National Centre for Health Promotion, the project team was unable to procure Ministry approval to develop and broadcast a TV spot. The project team therefore decided to focus on developing the community intervention as it allowed multiple messages to be conveyed to the community, all in line with Ministry of Health guidelines. After a third and final round of testing with front line staff, the community intervention tool kit was finalized and submitted to AIHA along with the storyboard and script of the TV spot.
Project to Strengthen Blood Services in Central Asia, Ukraine, and Cambodia
(2012 – 2018)
AIHA supported the implementation of the Cambodian National Strategic Plan for Blood Transfusion Services 2013-2017 across four strategic areas: national policy and legislation; hospital and patient blood management; community and donor motivation; and nationally coordinated blood services. Additionally, this project supported three cross-cutting areas — health system integration, training and education, and monitoring and evaluation.
Building on an assessment of the blood services in Cambodia performed in 2011-2012 by the Australian Red Cross International Humanitarian Blood Program, AIHA is supporting ongoing technical assistance for the implementation of the country’s National Strategic Plan for Blood Transfusion Services 2013-2017 (NSP).
Over the years, this project has come to represent a collaborative model for successful implementation of health systems strengthening efforts. Click here to learn more.
Key accomplishments of this project are included in the full closeout report, which can be read here.