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Cambodia: Changing Behaviour Crucial to Child Survival

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24-Aug-2005
Last Edited

June 25, 2004-  - How rampant are incidences of child morbidity and mortality in Cambodia?

Cambodia has the highest incidence of child mortality in the WHO Western Pacific Region and that rate is higher than any in the South-East Asia region. Almost half (45.6%) of the nation's children are malnourished. Again this is among the worst in the region. Read more...

Is this situation attributable to failure in health policies-- and by consequence a failure in the healthcare system-- or is it caused by cultural/traditional practices?

The leading causes of childhood illness worldwide are diarrhea, acute respiratory infections, malaria, malnutrition, and measles. These are also the leading causes in Cambodia. Dangerous traditional practices, poor health education, and lack of access to quality health care all contribute, as of course does poverty. Child malnutrition in Cambodia, for example, comes first from poor material health - Vitamin A and iron deficiency, then poor breastfeeding practice - throwing away colstrum and non-exclusive breastfeeding, from weak immunization coverage in rural areas, from poor transition to complementary foods - avoidance of green leafy vegetables (even where available), and poor management of diarrhea.

Many mothers do not bring their children to the rural health care system in Cambodia, and have never done so. The project will focus on changing behavior practices. Part of our success will rely on improving use of the health care system, which in turn will depend on the efforts of health system strengthening projects.

How does the status of women (level of education, social mobility, access to latest information on child survival strategies, drugs and gadgets) affect child survival?

The status of rural Cambodians, both male and female affects child survival. Change in behavior needs involvement of the family decision makers, not only just mothers. Cambodia is a rural country. Access to quality education and external information is extremely limited in the village. Many do not travel even to the provincial capital - the closest "urban center." Knowledge in rural Cambodia is passed on in the village. Drugs are often purchased from local markets or untrained sellers. Adult literacy of women is less than that of men, although primary school attendance is about equal. Men do hold more decision making power. However, the dreadful rates of child mortality and morbidity in Cambodia are not primarily due to the status of women in comparison with men, but with the status of all Cambodians in factors mentioned above compared with those of their neighbors. Community education will be conducted by female village health support group members because they can convince the decision makers to change their behavior.

What part will the Cambodian health authorities play in this project?

Child Survival is a priority for the Royal Government of Cambodia. Cambodian health officials know what needs to be done. This project will not set up a parallel system to that of the Ministry of Health. We will work closely with other child survival partners. Efforts are underway to strengthen all levels of the health system down to the health center.

What is needed is action at the community level. Intervention at that level is beyond the current reach of the Ministry of Health. This project will assist them to extend interventions to some of the most remote and least healthy areas of Cambodia. Hopefully the Red Cross can continue to serve as an auxiliary to the Ministry of Health in other areas after this project ends.
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How will you ensure sustainability the structures that will be imparted in this project's lifetime?

We do not expect the Royal Government of Cambodia to internally generate the level of financial resources this project brings to the community after the project period ends. We will use existing human resources in the project area to the degree possible. In order for the already trained village health support group members to remain active in their villages once project inputs discontinue, they will need to receive some monetary incentive. We believe their marketing of health products, initially at subsidized prices, will provide that incentive. The community based surveillance system will be installed by health officials, and can be maintained by them after the project is completed. So at the village level in our project area, there will be a structure that remains in place to support the health system at the community level.

Ministry of Health staff, who are the key trainers of village health support groups (VHSG), will retain their knowledge and be able to impart it to VHSGs elsewhere. However, replication of the project will require additional financial inputs. The Cambodian Red Cross as the project implementer will retain the ability to mobilize trainers and VHSGs throughout Cambodia if resources continue to be unavailable to the Ministry of Health.

Are you working with local women's groups to realize the objectives of this project?

The project will be implemented through female village health support group members based in each village. Efforts of other partners, including local NGOs, will be coordinated through provincial health coordination meetings.