Quarterly Review 2 – 2020

(April, May and June 2020)

Corona Virus and MoPoTsyo: During the 2nd quarter of 2020, the services have continued. People with diabetes and hypertension are extra vulnerable to COVID19.  We try to help them keep good control of blood sugar and blood pressure but also prevent transmission of COVID19. We introduced better hygiene at our office and. We continue to supply PE with DIY (Do it yourself) alcohol-based handrub 60 – 80%, following WHO recommendations and 3 layer cotton masks for our employees and PE’s to be produced for distribution. So far, Cambodia reports no deaths due to that virus but more than 130 confirmed cases

Corona Virus and the medicine supply chain: Corona created uncertainty for the supply system with huge international disruptions in the supply line which began in 2020-Q1 and continue to be a very big concern as long as COVID19 spreads. It did not hit MoPoTsyo because we had never introduced a so-called “Just-In-Time management system” in our supply line. By adding airfreights and short cut in the import procedure, we were able to continue supplying our contracted pharmacies throughout 1st semester 2020.

Hep C screening had been interrupted on 27 March 2020 when MSF France suspended Hep C treatment to focus all of its activities on COVID19.  But already less than 2 months later, on 20th of May, we resumed the screening for Hep C among our Diabetic members. MSF France will stop the Hep C program at the end of 2020. Since we started in mid-2018, we have screened 5,675 patients, of whom 266 (4.7%) were positive HCV (rapid test). Their blood was tested with PCR tested to measure virus load which found 144 patients (2.5%) needed treatment to cure Hep C. Since the start 26 patients did not show up. This treatment is free for the patients, but it is prices around USD100,000 in USA or Europe despite production cost of just a few hundred dollars. It is tough for governments to nudge pharmaceutical companies into decent corporate behavior.

7 Candidate Peer Educators, whose training had begun during Q1 passed their exam at the start of Q2 just before the brief Cambodian lockdown in mid April 2020.

Set – up new service location: We switched from a private pharmacy in Tram Khnar in Kampong Speu along Road 4 to contracting a public Health Center at only 5 km from away from the former location. The Director of Popel HC visited Rompea Meanchey HC where we have already both consultations and RDF. As a result we signed a contract and will open the RDF there. Later when that HC will have a Doctor we may start medical consultations there as well.

On 26th of June the program team set up a new Medical Consultation service and Revolving Drug Fund at Health Center Kantoak in Posenchey OD. The automation system will be set up in early July and first medical consultation will happen in 3rd week of July.

Takeo: We discussed re-engagement in Takeo, visiting all other OD’s one by one and having several meetings and facilitating exposure visits for them to study the care model which has evolved considerably since 2007 when we first began to operate in Takeo province. After meeting PHD in Takeo to discuss the standardization of our intervention model in the OD’s and to get permission for OD staff to visit as example Pochentong RH on June 12th , all OD’s including Vice-PHD came to visit: Pochentong RH Dr gave a presentation on cooperation with MoPoTsyo, followed by open discussion. It was clear they were interested to re-engage with us. On 19th I gave a presentation at the ProTWG in Takeo.

Re-training of Medical Consultation doctors: We renewed the contract with Center of Hope for 2-week training in theory and on-the-job. We pay USd 600 for 1 doctor. During Q2-2020 2 Doctors (Samaki Romduol Referral hospital in Svay Teap OD + Rompea Meanchey HC in Kong Pisey OD) will be trained.

A new MoA for 2021-2024: We wrote a draft for a Memorandum of Agreement between MoPoTsyo and MoH to follow up on the one that expires at the end of this year, so for a new 4 year period from 2021-2024. It has been submitted to MoH-Preventive Medicine Department to ask for its support. Together with PMD we carried out monitoring visits to Phnom Penh, Kampong Speu and Svay Rieng: MoH-PMD Vice Director plus Vice Chief of the NCD Bureau went on monitoring visit to Anlong Kangan HC, to Oudong RH, Oudong OD, and to Romeas Hek RH and OD. The process of collecting support letters from our provincial counterparts began and we receive them one by one.

Scientific publications update: On April 24th, “JMIR mHealth and uHealth” published Lesley Steinman’s article about MoPoTsyo called ”Facilitators and Barriers to Chronic Disease Self-Management and Mobile Health Interventions for People Living With Diabetes and Hypertension in Cambodia: Qualitative Study”, see https://mhealth.jmir.org/2020/4/e13536/ for the link to the article. Also, “Can mHealth and eHealth improve management of diabetes and hypertension in a hard-to-reach population? Lessons learned from a process evaluation of digital health to support a peer educator model in Cambodia using the RE-AIM framework was accepted for publication in a special issue of JMIR later this year. PLOS accepted Dr Mayuree Rao’s article “Utilization of diabetes management health care services and its association with glycemic control among patients participating in a peer educator-based program in Cambodia” (PONE-D-20-00770R2) which will be published soon in PLOS.

Partnerships and working with others:

KHANA telephone survey: KHANA proposed to cooperate on a study of impact of COVID19 on NCD patients. It is 2-country qualitative and quantitative study together with Andra Pradesh in India. Having contributed to the protocol, we also officially supported KHANA’s application at NECHR to get Ethical Clearance for a telephone survey among our members on impact of COVID19 on access to care.

HSD TB & DM  : Through Zoom meeting with HSD Dr Som Hun we agreed  that our peer educators (PE) get training for half a day to understand more about Tuberculosis symptoms and the national CENAT program, to prepare for CATA (sub-recipient from KHANA) doing screening for TB in diabetic people. The training of the first 13 peer educators took place on 22 June. The objective is to let PE counsel and refer suspected cases to CATA via HSD. We will monitor how it goes and integrate key messages about TB into the standard training of the PE.

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