Cambodia: Resilience and Nutrition Security
Cambodia has made great improvements in decreasing child mortality and morbidity over the past decade. Most recent estimates of mortality rates of children aged under 5 showed 35 deaths per 1000 live births in 2014, down from 54 in 2010 and 83 in 2005. However, rates are still amongst the highest in the region and many more improvements need to be made.
The major causes of child mortality are neonatal, such as birth asphyxia (30%), followed by infections such as diarrhea and pneumonia. Malnutrition is a leading cause of disease burden in children under 5; approximately one third of child deaths are related to malnutrition.
In the South East Asia region, Cambodia has a maternal mortality rate second to only Laos. Maternal deaths account for 17% of overall mortality in Cambodian women aged 15-49 years. Thanks to the efforts of the Cambodian government and development organizations such as People in Need, in recent years Cambodia has managed to improve healthcare significantly, and the mortality of women giving birth has decreased by an average of 55% since 2005. In Takeo province, where PIN worked since 2008, maternal mortality has been reduced even further – by over 75%.
Despite this success, a Cambodian woman giving birth still undertakes a risk of not surviving the delivery that is thirty times higher than women in European countries. Four conditions are responsible for the majority of deaths: post-partum haemorrhage, pregnancy-induced hypertensive disorders (eclampsia and pre-eclampsia), obstructed labour and infections. Many of these conditions can be improved by proper antenatal care and skilled birth attendants.
PIN works in a number of integrated activities to improve maternal and child health across 4 provinces. We provide quality training sessions to improve the level of care provided by midwives and health centre staff, and we support and train health workers to conduct health promotion at a community level. These cover topics including newborn care, nutrition, and hygiene.
Finally, in 2013 PIN piloted an innovative programme using mobile phone technology in Kampong Chhnang Province. Mothers who subscribe to the programme receive regular voice messages with important information on how to take care of their newborn child and themselves.
Impact: We work in 4 provinces (Kampong Chhnang, Takeo, Koh Kong and Phnom Penh) across rural and urban populations in over 30 health centers and hospitals, with over 90 midwives and 50 health centre staff. Our ongoing projects will benefit over 45 thousand people.
Partners: Urban Poor Women Development (UPWD), Magna Children at risk, Wetlands Work!, Open Institute, 17 Triggers, Instedd
Donors: Czech Development Agency, Czech Embassy of Cambodia, USAID, Real Aid and Real Gift
Disaster Reduction and Early Warning (DREW)
Many households in rural areas of Cambodia still do not have access to adequate and improved sanitation, which can lead to health problems for children and vulnerable people through ingesting contaminated food and water. An estimated 34% of children under-5 years old are stunted. In 2015, an estimated 40% of people in Cambodia still practiced ‘open defecation’, which is primarily due to a lack of adequate sanitation facilities.
The project aims to promote the use of latrines and increase the number of ‘Open Defecation Free’ villages within the rural target area. The SanMark approach aims to facilitate and enable local markets of sanitation products through both creating demand to purchase latrines among households, while also teaching businesses how to construct latrines. Household demand is promoted through a health education approach in target villages.
PIN is focusing on increasing the sustainability of the market for sanitation products through capacity building of local sanitation businesses. PIN’s support for local business includes components such as entrepreneurial training, book keeping, and marketing in surrounding villages.
Disaster Resilience and Water Management
Healthy Family Community (mHealth)
Beginning in Kampong Chhnang Province in 2013, the Healthy Family Community project uses mobile phone technology to deliver health messages regarding maternal and child health. Mothers and pregnant women who have registered receive automatic prerecorded voice messages to their phone which are designed to improve health behaviours and increase health service demand. These messages provide information and advice on a range of topics, such as avoiding harmful traditional health practices, and improving nutrition of the mother and baby.
The first program implemented in Kampong Chhnang delivered messages for the first 28 days of the baby’s life. As a result of our mHealth programme in 2014,
- 64% fewer mothers used traditional remedies to treat their baby’s cord stump
- 48% fewer mothers consumed alcohol after birth
- Twice the number of mothers could recognise danger signs in their baby
- Admissions of children to health centres increased by more than 2.6 x
Due its popularity and success, a new expanded service will deliver messages for the first 1,000 days of life, spanning from pregnancy until a child’s 2nd birthday. This is known as the window of opportunity, whereby better nutrition can have a life-changing impact on a child's future and help break the cycle of poverty.
Recently we receive funding from UNICEF for expanding mHealth activities to Kratie province and have since begun training midwives on the First 1000 days, Healthy Family Community programme.
You can download more information here and here
Water, Sanitation and Hygiene (WASH)
Integral to its the community health promotion activities, PIN promotes healthy hygiene practices both within health centres and in the community. Together with social enterprise Wetlands Works!, PIN supported the pilot project of innovative flood proof latrines in a peri-urban community that is subject to annual flooding. In addition, PIN has partnered with Urban Poor Women Development (UPWD) to assess and improve the level of knowledge and awareness of hygiene practices within the impoverished communities of Phnom Penh. We have tailored lessons for community outreach based on our assessment of the knowledge, attitudes and practices of families within the community, in order to deliver the most relevant information to those who need it most.
PIN works to improve access and standards of health infrastructure in rural and disadvantaged communities. This has included construction and renovation of health centres, postnatal rooms and WASH. In the province of Koh Kong, we have constructed a health centre in a remote, hard-to-access area where people were forced to relocate from their homes and communities due to economic development. Previously, these communities had no choice but to travel long distances to access health care, and now approximately 1500 households will receive convenient healthcare as a result of this new centre.
Moreover we have a partnership with RWC (Rainwater Cambodia) in Koh Kong for implementing a subsidized water jars and latrines project. This has been supplemented by CLTS (Community Led Total Sanitation) activities promoting handwashing and safe water use.
Newborn care and nutrition
People in Need provides quality training to improve the level of care focused on midwives and the staff of health centres. Training specializes in various areas such as resuscitation of newborn babies and infection control. In addition, PIN trained and supported health centres in the promotion of health care at community level. It focuses on the problems associated with breastfeeding and complementary feeding, holds cooking classes and demonstrations by mothers teach how their families prepare simple and nutritious meals.
In 2016 specialised training has taken place for health centre staff across two operation districts in Kampong Chhnang. Following that training, Post-Partum Hemorrhage and Anti-Shock garments (NASG) were donated to the HCs.
Building Disaster Resilient Communities IV
Tepmachcha Scale Up
During this project, PIN’s Disaster Management and Innovations Teams were able to increase the coverage of the flood detection to 4 further provinces (from the original 2 in 2016) and therefore contributed to improving extreme weather resilience for more than 40,000+ people in the designated areas.
Changing water systems in Cambodia are expected to increase incidence and severity of flooding and drought, which impact public health among vulnerable populations such as children 0 to 5 years old, pregnant, and elderly persons. Flooding can cause the spread of pathogens and contamination to water sources, whereas drought can impact hygiene practices. Cambodia’s vulnerability to climate change is primarily a result of 80% of the country lying within the Mekong river basin, which experiences large fluctuations of water levels between wet and dry seasons. On top of this, Cambodia is currently ranked 165th in the world in terms of access to improved water, with disparities remaining based on rural and urban populations and between economic quintiles.
Overall, PIN found that promoting climate-related resilience in WASH systems should account for both flooding and drought, as villages that were surveyed were vulnerable to both types of hazards. Flooding and drought were also shown to significant impact livelihoods, primarily through reduced agricultural output (including causing livestock deaths). Inadequate water during drought for impacts hygiene practices, while flooding is stated to pollute water through lack of waste management systems. Both flooding and drought led to increased rates of open defecation, either resulting from flooding of latrines that dysfunctional during flooding, or through lack of water for cleaning/flushing latrines.
The report also aims to identify methods of practical improvements in resilience for community and household based WASH infrastructure.
Improvement of health care access in Takeo
In Takeo Province, People in Need has improved healthcare access and community infrastructure by building 3 health centres, and PIN also donated medical equipment for training HC staff in specialized eye care, diagnosis and treatment. Additionally, one primary school was refurbished in Takeo in (3rd quarter of) 2015, ensuring safe and suitable conditions for children to attend school.
Access to health care, safe water and sanitation for displaced communities in Koh Kong province
Improving the quality of mother and child health through sustainability of mHealth programming and content adaptation
As part of the project, we have been training clinicians in clinical skills or nutrition education in communities to prevent acute malnutrition of children. Thanks to the project, we have also expanded our innovative messaging system (mHealth), which provides services to families to improve neonatal health.