This is the final part of our four-part series detailing the parliamentary delegation RESULTS led to Cambodia a few weeks ago. The delegation examined how, in light of its devastating history, Cambodia is improving basic education and how it is addressing key health issues like TB. In this post, Megan Wilson-Jones, Health Advocacy Officer at RESULTS, looks back at what Cambodia is doing to improve child health and reduce child mortality:
The majority of us are unaware of the vaccines we received as a child. In the UK and other parts of the Western world we often take these vaccines for granted – failing to reflect on the fact that they have saved our lives many times and will continue to do so over the course of our lives. In Cambodia, this is a luxury that not all children have been able to enjoy until recently.
Since the Khmer Rouge regime destroyed much of the health infrastructure and health workforce during its rule between 1975 and 1979, the Cambodian population suffered poor health outcomes and high child mortality. When Khmer Rouge leader, Pol Pot, was eventually defeated in 1979, there were only an estimated 50 doctors left in the country who hadn’t fled or been killed. Cambodia effectively had to rebuild its health system from scratch.
Many of the health problems facing Cambodia today are a direct result of the impact of the Khmer Rouge regime, and this is particularly true for the health of children and mothers. The survival of children is directly influenced by the availability of life-saving prevention and treatment interventions, delivered through a functioning health system. Making sure kids are immunised is one of the most cost-effective and powerful tools to reduce child deaths and prevent disease.
During the delegation, we spent a day with UNICEF who partner with the Cambodian Government and GAVI to vaccinate kids against top causes of child illness and death in developing countries – like pneumonia, diarrhoea, measles, rubella, diptheria, tetanus, whooping cough, hepatitis B and haemophilus. The UK  is a key donor to GAVI, which seeks to increase access to immunisation in over 70 of the world’s poorest countries and has been instrumental in the scale up of vaccines in Cambodia.
We visited a government hospital and a smaller health centre where we saw children being immunised against major childhood diseases with GAVI support. I was particularly struck by the understanding of mothers about the importance of these vaccines and their commitment to ensure their children are able to receive all available vaccines through continued return visits to the health facility.
Dramatically increasing the number of kids who are vaccinated has played a central role in reducing Cambodia’s child mortality rate from 116 to 40 deaths per 1,000 live births between 1990 and today. As such Cambodia is on track to achieve Millennium Development Goal 4 – to reduce their under-five mortality rate by two thirds between 1990 and 2015.
Despite this progress, child mortality in Cambodia is still high by regional standards. More work needs to be done to make sure every child receives life-saving vaccines, especially the poorest and hardest to reach, who continue to miss out. In addition, immunisation services need to be integrated with other child health interventions, such as safe water, improved sanitation and hygiene (WASH) practices, nutrition and treatments for common childhood diseases like pneumonia and diarrhoea.
We heard from the Minister of Health, Dr Mam Bunheng, and from RACHA (Reproductive and Child Health Alliance), a Cambodian-based NGO, about how Cambodia is finding innovative ways to more children with these interventions. Their approaches include the use of volunteer healthcare workers to identify sick children for referral to health centres and promotion of health.
We were able to visit an outreach initiative where we saw health workers deliver vaccines to the community and watched a community health volunteer explain to expectant and new mothers the benefits of breastfeeding and proper nutrition. This type of outreach was remarkable, considering these women don’t otherwise have access to health services. Like mothers in any country, these women were eager to learn about how to safeguard their children’s health and how to make sure their kids grow up to lead healthy lives.
Other strategies the Government and RACHA are carrying out include training local shopkeepers to identify and diagnose diarrhoea, and supply simple treatments such as oral rehydration solution (ORS) and zinc. Mobile kitchens are also visiting communities to educate people about how to cook nutritious foods, which has been particularly successful in improving child nutrition – the underlying cause of 45% of all child deaths. It is as a result of these innovative strategies by the Government in partnership with others that improvements in the health of children have been so significant.
Looking ahead, as Cambodia’s economy continues to grow, it is on track to become a middle-income country in the next few years. This will have important implications on its eligibility for donor funding, including support through organisations such as the GAVI Alliance. The global health community needs to consider how funding decisions are made and the implications for countries such as Cambodia, which have shown such dramatic progress and need to continue to be supported during this transition phase.
