Quarterly Review 2 – 2023

Expansion and implementation during 2nd quarter of 2023: During April the freshly graduated first group of peer educators for Krouch Chhmar OD in Tboung Khmum province began to do Primary Prevention activities involving awareness raising and urine glucose strip distribution in 31 villages in 5 communes. This activity in particular helps to get them introduced with the local authorities and the population in the OD. During these first weeks they accumulated more than a 100 new patients registered in order for the first medical consultation session to be organized. That took place in early June and it used the lab profiles resulting from the first blood- and urine collections organized at the hospital. During that same preparation period, however, the first two doctors from the Referral Hospital Krouch Chhmar came to Center of Hope in Phnom Penh, one by one, to receive a 2-week refresher course in treatment of Diabetes and Hypertension. This refresher helps them technically when the medical consultations start. Noteworthy, is also that in Krouch Chhmar RH also the patient pays the medicines physically at the central cash of the hospital, instead of at the pharmacy where the pharmacist now only has to dispense and not touch the money. This requires daily reconciliation between the pharmacist and cashier and the computer system at the pharmacy indicates whether the patient has paid at the cashier or not yet. This system is copied from Ang Roka OD, where it was tried out for the first time. Also, we visited Cheung Prey OD (Kampong Cham province) to finalise and sign the agreements for starting cooperation. So far, 6 candidates were trained as peer educator in the first health center coverage areas, together with 2 more candidates from other OD’s (Chhlong and Chamkarleu). Also, we signed the agreements with Mekong OD in Phnom Penh. In Chhlong OD, there are now so many patients that it is too much for 2 sessions per month, so we are thinking to split into 4 sessions, but we must consider that some patients from neighboring Krouch Chhmar got registered in Chhlong and will in the future prefer to get service close to home in Krouch Chhmar, which is a reason not to split into 4 sessions but keep only 2 per month. The Mekong OD (Phnom Penh) has signed the MoU with MoPoTsyo. Regarding the inclusion of Krakor OD (Pursat province) we have to discuss again with PHD and with KOFIH to agree more specifically on how we can ensure complementarity of the support. Both in Kang Meas and in Ksach Kandal the program has been active for more than 1 year so we shared the RDF income for the first time in those OD’s and had good feedback from our counterparts. The performance of Kang Meas was double that of Ksach Kandal. That may be related to the fact that Ksach Kandal has only 1/3 of its Health Centers with a peer educator, while in Kang Meas OD 2x the numbers of new PE are active. We will try again to find candidates in Ksach Kandal. It did not work out previous time we tried it.

Quality Improvement: We hired professional coach to re-assess and improve the Laboratory using the standard checklists of Ministry of Health that are based on WHO tools. For the Medicines (Revolving Drug Fund), we reorganized the RDF department in such a way that one of our pharmacists working there is the person in charge of Quality Assurance, Control and for Regulatory Affairs. Also, a new stock manager was recruited.

Logistics: We suffered a delivery delay due to a different port of discharge on original the Bill of Lading than the actual port of discharge where our medicines arrived by container. This led to a delay in clearing of the medicines for import and their arrival in our stocks. We are finalizing the order for the last delivery of 2023. Our copy machines broke down (again). One was replaced because cumulative costs of repair started to become too expensive.

Our website: We paid for increased speed of our MoPoTsyo website. It was too slow for users. Clean Air: So far, we built 10 Corsi Rosenthal filters, effective in reducing particles sized <2.5μmeter to safe levels inside our offices.

Financial Audit 2022: We have signed off on the final financial audit report on the year 2022 and submitted to the authorities at ACAR.

Donor: A new agreement with Ministry of Health: Our current 3-year agreement ends on 31-12-2023. To prepare for a new 3-year agreement, we have sent out all 14 requests to the 14 Provincial Health Departments to ask for their official letter of support for a new 3-year Memorandum of Agreement 2024 – 2026 between Ministry of Health and MoPoTsyo. Since decentralization law, these support letters are also agreed by the provincial governors. So far, we received 8 with the rest still in process. ECAM LaSalle-school of Engineering in Lyon (France) and MoPoTsyo signed an agreement: From 12 June until early September, a French intern helps us develop further our Standard Operating Procedures for the RDF to comply with GSP and GDP regulations. She is specialized in supply management.

Meetings with partners and others: MoH: Meeting Technical Working Group on MoH Clinical Guidelines Diabetes: I joined the workshop to review the new guidelines that must be ready on for the HEQIP II project. They will be used for training PHD and then cascade training down to Health Center level. WB & WHO expert meeting: In most countries the fight against NCD to reach the 2030 targets is not on track at all. In WHO and WB there is rising concern about this but those who benefit from the epidemic continue to thrive, such as the sugar industry and pharma etc. MoPoTsyo’s model got attention from experts at a meeting to brainstorm about what can be done. In summary, WB and WHO want to get better data and boost what has been agreed and to make things work better using AI. There are business opportunities of course but also Peer Education is now part of the tools, and so is IT, and innovative provider payment mechanisms. Data confidentiality and use is a big concern.

PSI and MoH: PSI received funding from USAID to prepare tools (video etc.) to support and promote population (healthy) to go for screening at Health Center once a year. There is concern that this will just boost the private sector. Promotional videos are needed for the MoH PMD program, we help to make HEQIP II work by facilitating for PSI to find suitable healthy people residing in Phnom Penh peri urban areas who want to be interviewed and filmed. Also, we joined in a PSI MoH workshop to share our tools and experiences.

NIPH workshop: The EU funded SCUBY research project led by ITM Antwerp ended with a large meeting to share scientific results. Important stakeholders joined and MoPoTsyo was also invited to participate because several studies included patients from relevant areas. Two cascade studies were published with results of 2 analyses of >5,000 people surveyed in 5 OD’s. 2 of the OD’s had a peer educator network intervention (Daunkeo in Takeo and Kong Pisey in Kampong Speu) but actually very few patients had ended up in the sampling frame of the survey, which says more about MoPoTsyo’s low coverage of patients compared with the prevalence in those OD’s than about program effectiveness. The researchers and implementers had useful technical discussions about bottlenecks and solutions.

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