Quarterly Review 1 – 2021

Impact of COVID19:  A) On vaccination: A steady stream of vaccines has begun to arrive, but English variant of the virus also came. The people are afraid, wear masks but prevention is not perfect. It is not clear if the virus can be kept under control.  People with diabetes and hypertension are more vulnerable to COVID19 due to their chronic illness. This extra vulnerability gives them higher priority for vaccination. During the past months, most diabetics here were counseled in a way that made them hesitate and decide not to take the vaccine. As long as the epidemic is not raging out-of-control in Cambodia we may not see the consequences but if it does, then many families and patients may regret their decision not to have been vaccinated. During 2021-Q1, so far 6 of our urban peer educators have had the Astra Zeneca vaccine, the ones > 60 years old. Others, including employees are on one or more lists. In the provinces also some peer educators got it already. B) The authorities in OD Svay Chrum Svay Rieng and OD Svay Teap told our networks they need entire Referral hospitals Svay Chrum and Samaki Romduol for COVID19, so we stopped medical consultation and RDF there by shifting the patients to Svay Teap Referral Hospital where we continue. C)  On March 3rd, we stopped blood/urine collection at our office and moved this to Health Centers. No more patients come to our office for giving a blood- urine sample for a lab profile. D) In Phnom Penh, we reduced number of patients coming for medical consultation at Samaki HC to 10 people per session. E) The authorities in OD Sen Sok, Chinese Friendship Hospital, informed us that because of COVID19 we must move the medical consultation and RDF temporarily back to the Health Center Anlong Kangan, where it had been located for many years until 31-12-2020, less than 2 months ago. F) We put extra wall fans to regulate in- and outflow of the air through our office buildings.

Expansions: Despite some delays and concerns of COVID19 spreading, we made good progress: On March 3, 2021 we went to Operational District (OD) Kampong Tralach in Kampong Chhnang province in order to explain the program to OD Director and to get his permission to identify candidate peer educators. The training of the first group of 6 candidates started on 17 March. They stay together until the exam on April 9th. That group of 6 will have to remain 14 days in quarantine upon returning to their province.

Investments: The new HbA1c machine has arrived. It is a Response 920, with enough capacity to handle the increasing laboratory activity. It is automated.

Database upgrade including the new lab profile report with the Complete Blood Count and the new patient dossier, that we can print out for our counterparts, are in principle ready to be used in 2021-Q2.

External environment in which we operate:  The Ministry of Economy and Finance (MoEF) issued new rules per 2020-12-31 for businesses and for “Not-for-profits”. After checking with our Auditor about it, he confirmed we are already compliant with it. On 2021-01-06, the Director General Department for Taxation decided in response to our formal application during 2020-Q4 to exempt MoPoTsyo as non-profit NGO from income tax.  We pay other taxes such as VAT, Salary taxes and Withholding Taxes.

Social Protection in Cambodia: A delegation from the General Secretariat of the National Council for Social Protection (GS-NCSP) visited Referral Hospitals Angkor Chey, Kong Pisey, Baray Santuk and also Sen Sok Chinese Friendship Hospital to see how the peer educator networks function. The GS-NCSP is in charge of coordinating for policy making on social protection mechanisms in Cambodia, of which there exist already a few important ones such as Health Equity Fund, National Social Security Fund, Cash Transfers. We had a discussions with them. Patients who are member of MoPoTsyo are taking on average 4 to 5 drugs per day. During 2020 alone, those patients got >27 million tablets from MoPoTsyo provided from the Revolving Drug Fund (RDF). As MoPoTsyo helps more and more patients getting and keeping access to affordable good quality daily medicines, an important question arose: “Who will supply the government hospitals enough medicines and insulin and syringes for those patients if MoPoTsyo would be no longer doing that?”  In areas where there is no RDF those medicines are often not available: not in the public service in rural hospitals and neither in rural private pharmacies. The free market very often fails to provide the items which would be the best for patients, because it supplies what is best for the pharmacist or the Doctor.

Our MoU with MoH 2018-2020 had expired end of last year, which left us hanging without legal framework for our activities. On 2021-01-29, Director of Ministry of Health Preventive Medicine Department signed the Department’s official support in a letter.  After clarifying misunderstandings and last minute changes a new MoU 2021-2023 was finally signed off on Thursday afternoon 25-02-2021.  

Medicines and Imports: After receiving the signature on the new MoU 2021-2023 we contacted our suppliers overseas for urgent delivery by air. The 1st airfreight under the new MoU with Enalapril and Metformin arrived in March at Phnom Penh Airport.

Cooperation with others: MoH-PMD, WB and others including consultants and MoPoTsyo met by Zoom to discuss ideas for the new HEQIP phase. In another zoom meeting organized by WHO, MoPoTsyo presented its achievements in Kampot province, Angkor Chey OD, during 2020 regarding the WDF partnership project. The value of MoPoTsyo’s regular expenses in that area amounted to more than USD 40,000 over 2020, which WHO sees as a contribution of MoPoTsyo as partner to the project. That is fine.

Internal Organization

Accounting Reform: Our hired Management Accounting consultant set up the new Quickbooks system in Riels. We used the start of 2021 as the moment to change several things: 1) Accounting in Riels 2) The revenue is booked in the system by the Departments themselves 3) We can follow the orders and stock movements, outstanding amounts and invoice payments in the QB system. 4) Introduction of systematic scanning of support documents. 5) Replacing advances to staff with more direct payments (water- and electricity and NSSF) through internet banking.  On March 1 2021, the financial audit of 2020 started as foreseen and field work was completed.

e-Learning planning: After several meetings with a software company Codingate, we chose among the various platforms the so-called Moodle (Open Source) platform as the basis for our E-learning platform. It would enable our peer educators (PE) and also patients will be able to learn, even using their mobile phones, about diabetes and hypertension self-management. Our aim is to make a large part of the peer educator training module available for learning to patients who want to become PE. This helps the scale-up in the future and the challenge of PE replacements over time. We have not started the training yet.

Staff Retreat: On 8 and 9 February 2021 we had staff retreat at S Mango Resort in Ksach Kandal. Our President Mr Men Cheanrithy was present. Through group discussions and plenary discussions, we were able to find solutions to a number of organizational bottlenecks. It was a productive meeting but shorter than the retreats in earlier years. We plan another retreat later.

Yearly donations: After signing the MoU our friends in Australia and Switzerland (resp PFE-DAK and FSM) sent their donations to help us pay for some of the huge medicine bills and transportation bills.

Board member changes: Founding member Dr Kho Vuthi resigned from our Board because of old age, and he is being replaced by 2 new Board members, with a lot of experience in the health sector, Dr Oum Virak and Dr Kov Buntor. Board member/founder Dr Ky Kanary, our former Head of Finance, but nowadays employed elsewhere and no longer employed by MoPoTsyo, proposed a change of her position in the Board. This was accepted and therefore board member Dr Chroeung Sokhan took her position as Treasurer while she remains on the board as ordinary member. All these changes were accepted by our own Board but are not valid until formally recognized by the Ministry of interior. So this remains to be confirmed during Q2.  

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