Quarterly Review 3 – 2020

(July, August and September)

Setting – up new service locations: The program team has set up a new Medical Consultation service and Revolving Drug Fund at Health Center Rompea Meanchey (Kampong Speu province, Kong Pisey Operational District (OD) and at the Referral Hospital Samaki Romduol (Svay Teap OD in Svay Rieng province). The Revolving Drug Fund was set up at Health Center Popel (Kong Pisey OD, Kampong Speu province) and at Kantok HC in Posenchey OD in Phnom Penh municipality. We are discussing about one more HC in that OD.

Preparations for launching and relaunching OD’s: On  11th, Prek Phnov OD, RH Prek Phnov, Ksach Kandal OD, RH Ksach Kandal plus Kandal Provincial Health Department’s Vice Director came to visit Pochentong Hospital to get to know our activities and talk directly with our counterparts. New Peer Educators: On 3rd and 4th nine PE from Svay Rieng passed exam. We visited Takeo OD’s Koh Andaet, Bati and Ang Roka to discuss with OD Directors on terms of re-engagement. On the 12th of August we went to visit to Kratie to present our program at PHD during the Prov-Technical Working Group where other NGO’s participate. In order to expose the future counterparts from Chhlong and PHD to seeing how the peer educator networks function in practice, we invited Chhlong OD to come to visit Romeas Hek OD, where our program has been in place for 5 years. This visit took place on 13th and 14th of August: We were in Svay Rieng province to welcome visitors from Tboung Khmum province (PHD Director) and OD staff and Hospital staff from Krouch Chhmar, as well as representative of Kratie PHD, OD Chhlong, and both hospitals there, for their official visit facilitated by Provincial Health Department Svay Rieng and OD Romeas Hek. It was a great success and very encouraging to see cooperation between OD and RH in Romeas Hek as well as their achievements so a great role model for the new OD’s to get inspiration from.

Trying to link: Angkor Chey OD is where the Ministry of Health with partners (including MoPoTsyo) is implementing the World Diabetes Foundation project (Kampot + Battambang), and where the peer educator network is active since 2014. It is also where MoH PMD aims to set up “an NCD clinic” but it reports too little activity. We had meetings with partners on 15th and 17th in Phnom Penh, and with OD and PHD Kampot on 24th in Angkor Chey RH to discuss how to meet the requirements of MoH PMD in order to link and integrate. Information Technology has been an important obstacle. One objective is to include medical consultations facilitated by peer educator network activities as part of the NCD clinic activities. PMD asked us to draft an agreement between MoPoTsyo and PMD.

Application Programming Interface (API): A team of IT specialists, hired by NGO Louvain to create MoH Preventive Medicine patient database, discussed with our IT about technicalities of linking. It seems possible provided we start to use PMRS ID as patient identifier, same as MoH-PMD will be doing. We are preparing the ToR for an important upgrade of our database and training of our IT staff by the software developer so we will have more skill in house. The same challenge of how to link the database is faced by larger hospitals in Cambodia who already have their own management databases. We are not alone… IT has an important role to play in smooth linking of the peer educator networks, medical services and activities with the new MoH database that is now in its final stages of programming.

TB & DM Dissemination Workshops: During workshop in Siem Reap on July 10th MoPoTsyo reported on early feedback received from peer educators who had been trained by HSD (CATA-CENAT) on referral of suspect TB cases among DM patients.  On 25th of September similar reporting of encouraging feedback from urban Peer Educators 3 months after that training.  The urban peer educators refer suspected cases to HSD. So far HSD finds 4.2% Tuberculosis among screened diabetics. WIth that rate we would have 700 tuberculosis patients prevalent hidden among our registered DM patients.  HSD will continue to train PE.

Medicine Supply: Airfreight: On 24th July an expensive airfreight with Metformin arrived at Pochentong (as we were about to run out) to enable us to cover the remaining period until late arrival of sea container in September. Ministry of Health approved the short-cut import process allowing fast release from customs so it arrived at our stocks on time to ensure no shortage of Metformin in supply to the contracted pharmacies. The delayed sea-freight then arrived in September 2020.

Internal Moves: Our 3rd Building C, situated behind the Program Building A is ready: Internet installed, 1st container with Metformin arrived at Building C stock. The Program Department will move into Building C’s 1st floor on October 2nd, while the laboratory will move into the more spacious office of the program department in Building A. In order to reduce underutilization of laboratory services we have been sending personal letters to patients who did not use the laboratory service for >2 years. These letters create higher demand for tests so we recruit 1.5 lab technician more. Despite heavy rains no more flooding of our office, thanks to the new sewage system and drainage.

Sharing of our Educational Materials: 1) National University Singapore (NUS) is helping MoH to create a good model for chronic care. It has asked access to all our training materials. So we did share it on condition that that they will acknowledge use. 2) On 3rd of August the NGO Heart to Heart (see http://heart-heart.org/en/ ) (Korean Christian) came to visit us to ask for replication of our model to Thmar Koul OD in Battambang. After discussing with PHD Battambang we agreed to let them copy. This is the 2nd Korean NGO, but the 1st postponed because of COVID19. We shared our training documents with them so they can train candidate diabetes patients to become peer educator using our materials. They may be financed by KOFIH in the future if they win bidding.

The Cambodian Noncommunicable Diseases Alliance invited our Chairman H.E. Mr MEN Cheanrithy to conduct Focus Group Discussions with diabetes patients (and film) in Anlong Kangan project area and elsewhere, to create advocacy material.

Refresher Training of Doctors at Center of Hope: During Q3 in 3 Doctors got this 2-week training.

Provincial support letters:  We are still collecting the letters to support our new MoU 2021-2024.

Update on research & Scientific Publications:

Main author Dr Mayuree Rao. On July 9th, 2020 PLOS published “Utilization of diabetes management health care services and its association with glycemic control among patients participating in a peer educator-based program in Cambodia”, see https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235037

Main author Dr Nazaneen Nikpour (UK) submitted her article “An innovative model for management of Cardiovascular Disease Risk factors in the low resource setting of Cambodia” to “Health Policy and Planning”. Fingers crossed.

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