Community health services in rural areas of Cambodia

Main activities

To improve patient care in health care structures

Renovation of buildings:

• Connection to main water supply and construction of a latrine unit within the main hospital grounds.
• Refurbish one health care center
• Keep health care facilities running (through repairs and regular maintenance) with funds generated through cost recovery.

 

Equipment and medical supplies:

Throughout the course of the project, E&D has regularly provided and replaced the medical supplies of the health centers (stethoscopes, blood pressure cuffs, dental care equipment) and provided equipment and materials to offer improved working conditions for the staff (radio systems, solar energy, incinerators, wells, latrines, motorcycles for the mobile services, information signs.).

Training of staff:
Training the health care workers, a pillar of the project in a country where human resources have been damaged by thirty years of internal conflicts, has focused on the care of patients, the most common illnesses, clinical examinations, management of the health centers and adapting the services to the needs of the users. The objectives were to improve the quality of services so as to reinforce the credibility of the public structures and increase their use, and to reduce the levels of maternal and child mortality rates. In turn this should reduce the level of poverty of the population through a rational use of near-by services, accessible even to the most poor thanks to an exemption system (approximately 30% of consultations are free).

Reorganization of work within the health care structures:
The most notable changes are namely due to:

• The job descriptions defined for each health care worker and the district professional teams
• Supplementary salaries based on performance and professional attitudes
• Training
• Establishment of performance indicators in each health center

Cost recovery:

E&D has established a system of cost recovery in the 8 health centers at its own charge, which is supported by an elected Management Committee of the health center. This procedure allows for a transparent and participatory management of the center. The committees are involved in all decisions regarding the running of the center, the dissemination of important information to the surrounding community, and concerned with the maintenance of a professional attitude among the teams.

This approach allows a reduction in the level of poverty of the users, by stimulating the use of public services less expensive than private ones and free for the poorest, the rate of which are validated by the committees before being applied.

Training the professional teams of the district:

• Training in management systems: financial, medical and human resources.
• Financial and logistical support permitting the teams to regularly supervise the services provided and educate in community health care.

Improve maternal and children health care outside the health care structures

Set up of mobile maternal-child health care (MCH) and vaccination services in the villages of the area covered by the health centers:

The provision of services is based on:

• Bringing technical standards up to level
• Continuous training
• Financial and logistical support
• Supplementary salaries linked to pre-defined indicators
• Information and education campaigns
• Regular census of newborns by the village chiefs assisted by Volunteers
• Participation of Village Volunteers who inform and bring together mothers and children during team visits.

 

Training of midwives:

Traditional birth attendants, most often illiterate and elderly, assist with 80% of births in Cambodia . The difficulty in training these birth attendants is due to their low level of education. Training must therefore emphasize the practical and visual. E&D also supplies delivery kits and per-diem which allows the birth attendants to participate in monthly meetings with the health center midwives where they can discuss practical cases, find support and review their roles and responsibilities.

 

Improve the sanitary infrastructure

Construction of wells and latrines:

Access to drinking water is extremely low in rural Cambodia where 30% of rural homes (versus 12% of urban families) use lake or river water for their personal consumption. At the same time, only 1% of rural houses in Cambodia have running water (33% in urban areas). Other sources of drinking water vary: open public wells (22%), boreholes (21%).

Sanitary installations remain rare; 79% of the population doesn't have access to latrines (80% in rural areas). Only 6% of the population possesses flush-toilets connected to a sewer or a septic tank.

One of the primary causes of infant mortality is diarrhea transmitted by contaminated water and lack of personal hygiene.

In order to reduce the prevalence of pathologies linked to poor sanitary conditions, E&D has put in place an approach to distribute latrines and wells or boreholes among the community. It is based on an individual or collective contract with the receivers, who establish a defined period for the construction of latrines or wells with the provided materials, and request a financial contribution from the beneficiaries.

Raising awareness of good hygiene:

The low level of general education among the population slows the integration of new knowledge and sometimes also clashes with traditional beliefs held by elders.

Improve the knowledge of health issues among the population

Set up a network of health care workers:

This network came into effect at the start of the project, consisting of 333 village volunteers, the 59 members of the Management Committees of the health centers, 127 midwives and 54 health center employees.

The content of the training is based not only on the most common health problems occurring among the target communities (dengue fever, diarrhea, respiratory infections, fever, tuberculosis, AIDS .) but also on behaviors such as nutrition, vaccinations, breastfeeding, and family planning.

Two people per health center were instructed in the educational methodology and in turn trained the members of the health network.

E&D has also produced an educational kit, containing posters, summaries of lessons, and important messages on each subject that were given to each volunteer to assist them in their educational actions within their villages.

Introduction of health education at school:

This component started in four primary schools in Bati District and spread to two other schools in Kong Pisey District in 2002. The approach is based on the Child-to-Child method. Children of primary grades 4 and 5 are trained to become health educators and then train their peers during class sessions once a week. They are supervised by teachers, themselves volunteers trained in this method and from now on able to teach this approach and ensure the continuity of activities.

The main subjects covered include: malaria, dengue fever, body and dental hygiene, fever, iodine deficiency, intestinal parasites, clean water, nutrition, vaccinations, the dangers of smoking and children's rights.