CAMBODIA FIELD EXPERIENCES
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CAMBODIA FIELD EXPERIENCES By Dr. Hong Sun Huot Senior Minister, Minister of Health 12 th GAVI Board Meeting 9-10 December 2003 Geneva, Switzerland. Country Profile. Total Population (2001) 13.1 millions Rural Population (1999) 80% People below poverty line (1999) 36%

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CAMBODIA FIELD EXPERIENCES

By Dr. Hong Sun Huot

Senior Minister, Minister of Health

12th GAVI Board Meeting

9-10 December 2003

Geneva, Switzerland


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Country Profile

  • Total Population (2001) 13.1 millions

  • Rural Population (1999) 80%

  • People below poverty line (1999) 36%

  • GDP per capita (2002) US$360

  • Percentage of women who are illiterate 32%

  • Total Fertility Rate (2000) 4.0

  • Maternal Mortality Ratio (2000) 437/100,000LB

  • Infant Mortality Rate (2000) 95/1000 LB

  • Under-five Mortality rate (2000) 125/1000 LB

  • % Children under weight (2000) 45%


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GAVI Support to Cambodia 2001-2003

  • Bundled Combined DPT-Hep.B for 1 OD (2001)

  • Bundled Combined DPT-Hep.B for 2 OD (2002)

  • Bundled Combined DPT-Hep.B for 19 OD (2003) or about 25% of the OD.

  • Injection Safety for all routine antigens (2002-2003)

  • Immunization Service Sub-account (2001-2003)


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Immunization Status

DTP3: 1992-2002

  • District report DPT3 ≥80% 10 / 73 (2002)

  • Overall expect slightly improvement of coverage in 2003


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Acceleration Routine Coverage (1)

Different Strategies used:

  • Coverage Improvement Plan (CIP): 11 OD

  • Contract NIP/OD for Outreach: 16 OD

  • 1st quarter outreach support: all 75 OD

  • Multi-antigens supplementary immunization campaigns in selected remote areas;

  • Mapping the un-reached and abandoned villages;

  • IEC activities to create demand for immunization.


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Acceleration Routine Coverage (2)

Improving Data Quality

  • Data Quality Audit (DQA) 2001: Verification Factor 87%;

  • Data Quality Audit (DQA) 2003: Verification Factor 98%;

    Post Activity Assessment (PAA):

  • Spot check to validate reported result of the related village used in “Contract” for allocation part of support for outreach.

    Improving Partners’ Coordination in Immunisation

  • Quarterly NIP/NGO meeting to coordinate support and to share experiences;

  • Quarterly ICSC meeting to discuss the progress and coordinate funding for immunization;

  • Bi-monthly NIP meeting with WHO, UNICEF, CVP/PATH for Technical Guidance.


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Introduction of new vaccine and Safe Injection

  • Expand Combined DPT-Hepatitis B vaccine to 25% of the ODs (19/75) in routine EPI (2003);

  • Pilot Hep.B birth dose in 49 Health Centers and 8 hospitals (2003);

  • Exclusive use of AD syringes for all antigens in routine EPI since end of 2002;

  • Progressively Implement new cold chain policy with one refrigerator per Health center and introduction of open vial policy.


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Disease Initiatives

Reported Measles

cases 1999-2003

Measles Control:

  • At lest 95% of children 9 months – 14 years old countrywide received supplementary dose of measles;

  • Over 90% reduction of reported measles cases comparing the period 1999 (13,827 cases) to 1,361 in 2002 and 379 cases in 2003 with more reliable surveillance system.

Maternal Neonatal Tetanus Elimination (MNTE)

  • TT Supplementary for CBAW implemented in 25 identified high risk OD using surveillance data (2000-2003);

  • Est. 23 OD classified as low risk, 11 OD as high risk & 39 OD with unknown risk as of end 2003.

    Polio Free Status maintained since 2000

  • With high quality AFP surveillance.


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FSP for immunization (1)

  • Signed Officially in Dakar, November 2002;

  • Government increases budget for vaccine procurement (US$450,000 for 2003-04) using Vaccine Independent Initiative (VII) with commitment for future;

  • Government & partners’ committed all required new cold chain equipment (2003-2005);

  • FSP annually updated to reflect the actual annual need;

  • Negotiations are taking place with the Department of Finance (MOH) to design strategies for securing outreach funding for rural health centers in 2005



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Challenges

  • Partners’ longer-term commitment for immunization;

  • Vaccines Security;

  • Salary for health staff, access to national budget;

  • Sufficient and on time Funding for Outreach;

  • Improve fixed site immunization along with the implementation of new cold chain policy;

  • High turn over of staff;

  • Low demand for immunization in some areas;

  • Human Resource Development;

  • Strengthened linkages of immunization services with maternal and child health programs and health sector reforms (decentralization)


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GAVI Board Attention

  • Request for full (100%) 5-Year support of Combined DPT-Hepatitis B vaccines to spread over 8 years to facilitate Phase-in of other donor support

  • Request GAVI to consider support for expansion of the Monovalent Hepatitis B Birth dose vaccine

  • Immunization Service Sub-Account: important for trialing new initiatives in Cambodia (micro-planning, contracting)


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SPECIAL THANKS TO:

GAVI-VF

UNICEF

WHO

CVP

JICA

AusAID

Other DONORS


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