2024-Q1 Quarterly Review

A temporary suspension: 31 December 2023 was the deadline for renewal of the 3-year cooperation agreement that we have since 2005 with the Ministry of Health. But it expired and our imports of containers with medicines for the revolving drug fund got stuck. These medicines had been ordered at the start of 2023. Some shipments had already arrived at the port, while some were about to arrive. So, when our stocks ran out without the refill that had been planned for November/December 2023, we had to suspend our supply to our counterpart-public hospitals and health centers on February 1st, 2024. The port’s electricity kept the reefer containers with medicines cooled during the months they spent in the port. This costs a lot of money which comes on top of hefty demurrage and storage fees. Most important was, however, that these medicines were needed by 25,000 diabetes patients in 40 public health facilities in 12 provinces. MoPoTsyo is only one headache NGO among more important issues the new leadership at Ministry of Health has to deal with. It was through a polite alarm-letter that we managed to draw attention to this public health issue. Fortunately for the patients the letter worked: At the start of March the needed permissions were issued by Ministry of Health. And with those we could submit further applications at CDC, then at Customs, to get the medicine shipments out of the port and into our stocks one by one, but after paying the understandably high port fees. At the end of March enough shipments were cleared to resume the activities, ending the suspension. With everything returning to normal and covered by the new 3-year agreement, we sent out the standard agreements with the Health District Authorities (OD’s) as well as contracts for peer educators were sent out for their signature.

Expansion: With the new MoH agreement signed, we went to revisit Boribo district to resume our talks about collaboration that we have been holding since several years. They already visited another OD to see how the peer educator network facilitates the care. During the meeting it was decided that all the parties agree to set up the program at referral hospital Boribo in Kampong Chhnang province and that we are ready to sign the agreements. It will be set up as soon as possible this year.

Program News:  At Chamkarleu OD we discussed with health authorities if and how to continue to serve the patients in Bos Khnor commune. It was a productive exchange on how we should change the care model that we have been piloting there. Later this year, we will apply a more standardised solution in the same commune. Program staff had joined Provincial Technical Working Group at Kratie province, doing a presentation about collaboration between peer educator network and Chhlong Operational District in 2023. It is very successful, appreciated by local stakeholders, notably patients and doctors.

Ministry of Health CMS medicine supply: We expect (hope) that a supply boost of Central Medical Store Non Communicable Diseases medicines planned for April 2024 will improve the situation for Health Equity Fund patients and for National Social Security Fund patients who want to use their entitlements to social health protection without having to show up every week at the health facility for one week of routine medication for a chronic condition. Others can continue to contribute financially for the Revolving Drug Fund medicines that they get inside the public service facilities but still must pay the 10% Value Added Tax. Even though we did not get the Tax exemption from Tax department in the past, MoPoTsyo is preparing a new request for 10% VAT exemption for the Revolving Drug Fund medicines, this time directly to the Ministry of Economy and Finance, but only if we get support for that from the Ministry of Health itself. During this year we have to work on that. That will mean a fundamental harmonization of these systems that have evolved side by side for two decades through various institutions In addition, we are revising downward the prices of the Revolving Drug Fund medicines because their cost prices has come down for the new shipments that are entering our stocks this quarter.

Monitoring:  Data for the Annual Report 2023 have been collected and are being entered for producing the annual report. The financial audit 2023 started and the first draft report was issued. Our team has prepared the questionnaires for survey in 8 OD’s on the reasons for patients loss. The sampling has been done. The interviews will be done in Quarter 2. An IT consultancy was done in February to assess capacity of our IT staff and recommend on data security. We have begun to implement its recommendations. We hired a Management Information System Adviser for database upgrade, data and reporting. We will adapt our program to the changing needs in primary care to fit with the government program.

Health Promotion: On 15 January ,the TTK TVK broadcasted TV FORUM about Diabetes with participation of 10 Peer Educators from MoPoTsyo who spoke about how they can live with diabetes in a successful way. It was funded by WHO.

During the TB-DM meeting of 23 February 2024, national anti TB institution CENAT updated our technical working group members on the results of screening for Tuberculosis among Diabetes patients, most of them referred by the peer educators. This shows how relevant the peer educators can be for reaching public health objectives such as detection of TB in special groups.

Laos showed interest to learn about different models for NCD care and primary care. MoPoTsyo was given the great honor to present the peer educator network experience during a symposium held in the Laos capital city Vientiane chaired by H.E. the Minister of Health for a national audience of government officials, WHO, experts and a possible donor. The future will tell if certain elements of the patient-centred low-cost approach to construct bridges between patient-communities and public facilities make it into Laos design of its primary care system. Also Laos will sooner or later have to provide an effective answer to the needs of increasing numbers of people with diabetes and hypertension.

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