Quarterly Review 3 – 2021

A trimester horribilis: A series of bad things happened during this year’s 3rd quarter :  A lethal traffic accident claimed the life of one of ours peer educators working in Kong Pisey. She was on her motorbike returning home on National Road 3. She had been helping with the medical consultations at the Referral Hospital. Late afternoon, she was hit from behind by a car driven by a drunk guy. She lost her life at 71 years of age having worked 6 years for MoPoTsyo. In addition COVID19 exacted its toll:  we deplore two deaths from COVID19 of ODPM’s (Managers of our peer educator network): in the 2 Operational Districts Chiphou and in Angkor Chey the peer educators lost their manager. Unvaccinated – despite having been offered the opportunity – both succumbed in the last week of July. Then the Delta virus COVID19 impacted our office staff: first one staff member became positive. Immediately, our laboratory technicians tested everyone but at that moment everyone else was still negative. Then some became positive in following days: 3 days later another one but working in the same room: likely a contamination that had already happened before the 1st case was detected by us through the Rapid Tests that we use for those with symptoms. Anyway, from the 1st case detection onward, we had suspended employee presence at the affected office building for the required 3-week period, while testing employees regularly. An unrelated 3rd infection in another building then also emerged. This case had also already infected a co-worker in the same room before our lab technicians could detect it through Rapid Test. We applied the disinfection with spraying on all buildings. All positive cases were notified to authorities as required by regulations. At the time notification was still a condition for having the permission to do the Rapid Tests. After this, we decided to buy air-filters capable of filtering out virus. They will be installed after Pchum Ben Festival (early October) which has been adapted this year to minimize chances for transmission. In Angkor Chey Hospital the Vice Director and also the RDF pharmacist went in isolation. But September saw resumption of our laboratory activities in Chiphou Operational District (OD) and medical consultations in some of the OD’s including Angkor Chey RH where it had been suspended because of COVID outbreaks. In several places such as Angkor Chey OD we have been switching services back and forth between the Referral Hospital and the Health Center. There this meant that service provision inside the OD could continue even it was suspended in one facility temporarily because of COVID. At end of Q3 the medical consultations remain suspended in 4 out of 21 Operational Districts where we normally organize sessions but then those patients can travel to services in other OD’s. This is problematic for patients and leads to high cost for the patients because Cambodia has no public transport.

Peer Educator vaccination: At end of Q3 out of 194 active peer educators all are vaccinated except 9 PE’s.  179 (=92%) out of 194 have 2 vaccinations. There are 9 who even have the 3rd shot and 7 have the J&J vaccine. In Cambodia people older than 60 got Astra Zeneca, while younger get Sinovac and Sinopharm. Cambodia’s COVID19 vaccination coverage is among the highest in the world.

Expansion: The public health services are very busy with vaccination activities for COVID19. This delayed our expansion plans but still on 30 July we went to Kampong Tralach (Kampong Chhnang province) for a meeting with OD Director, Referral Hospital Director plus key staff to discuss about setting up the services and to see the actual RH lay-out. Next step was the “exposure visit” for the RH Hospital staff to see and talk with colleagues who already implement our model. It took place in September: Kampong Tralach Hospital staff including OD Director came to visit the China-Cambodia Friendship hospital (This is the Sen Sok OD Referral Hospital in Phnom Penh) to see our model in action. Next month will be “refresher training of the Doctors” which cannot take place at Center of Hope because of COVID19. The online option was not feasible. We may replace it with on-site-trainings by a consultant trainer.

MoPoTsyo’s Revolving Drug Fund:

Registration of RDF medicines: In Cambodia, only MoPoTsyo can import the low-cost generic NCD medicines from the world market thanks to special permissions each time from MoH. Over the past years we bought well over a 100 million tablets from The Netherlands where at least 2 renowned large suppliers specialize in this activity for United Nations programs, Governments and Non-Government actors in developing countries. The good news is that our main supplier – IMRES – has agreed to register officially the medicines it distributes. The relevance for improving access to lower cost medicines for Cambodian patients with diabetes and hypertension nationwide) was discussed with Cambodian NCD Alliance. MoPoTsyo submitted an official request for Fast Track process registration of the generic IMRES medicines mentioning support from a number of stakeholders: the General Secretariat of the National Council for Social Protection, the Cambodian NCD Alliance, Preventive Medicine Dpt of MoH. Adding further weight, also the World Diabetes Foundation’s project Mid Term Evaluation came out via WHO with a recommendation to address the lack of availability of low-cost generic medicines in primary care. Now it seems World Bank has come on board as well. WB represents Cambodia’s main development partners for the financing of the prestigious multi-phase H-EQIP program, a multi-year multi-million USD funded program (a mix of loans and grants). Developing Partner designs for new effective NCD projects need a sustainable solution for low cost medicines for chronic patient daily medication in primary care.

Losartan Potassium recall: Because of impurities in “Sartans” (Angiotensin Receptor Blockers) our supplier made us recall affected Losartan Potassium. This is a worldwide recall. Similar thing happened two years ago but then our Losartan batches were not affected. We recalled more than 330,000 tablets and replaced them with the tablets from unaffected batches that we had in stock fortunately. The official destruction of Losartan and expired drugs happened on 23/9 at the Phnom Penh Medical Waste site.

Imports: IMRES sent off its seafreight container from Rotterdam a few days later than planned so the medicines arrived also a week later, at the same time as COVID19 emerged among our staff. Fortunately, we managed to keep our Stocks operational, so medicines could enter and exit our stocks. We ordered 150,000 Blood Glucose strips and lancets in China for airfreight in November.

Wearables: MoH and NIPH held a Zoom meeting to discuss new technology and IT in general and the opportunities to use “wearables” like armbands that measure blood pressure etc. NIPH had interviewed MoPoTsyo patients about their experience. This was all positive. Also their Willingness to Pay was recorded and that seems realistic for the future.

World Diabetes Foundation Midterm Review (WDF) was completed: the draft MTR-report written by the evaluator of the partnership project in Kampot and Battambang was discussed in a partner meeting. The report has relevant recommendations: the creation of an API to be able to link existing databases to the new PMD database, improving availability of low cost generic medicines in primary care. It also recommended options for the role of the peer educator provoking a discussion which model is best. MTR showed that MoPoTsyo’s model produces the best health outcomes when compared to others.

National Institute for Public Health (NIPH) has launched a survey in several provinces about the cost of the routine medicines to find out how much people have to pay. So we have supplied data directly to NIPH for RH’s Angkor Chey and Kirivong.

I.T.-Technical: The upgrade of our database is ready. We can begin to monitor the introduction of Gliclazide in selected facilities.

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