In Cambodia, a push to bring healthcare to remote areas

http://www.youtube.com/watch?v=jlBYFnCafCk

By Denise Shepherd-Johnson
UNICEF

PHNOM PENH, Cambodia, 4 October 2012 - Baby Moeun has just come into the world. Though he doesn’t know it, he has a difficult journey ahead of him.

Moeun was born at home, in the remote province of Ratanakiri. His mother, Reur, is an ethnic Kreung woman who doesn’t speak the national Khmer language and earns a basic subsistence income as a rice farmer.

In this hard-to-reach province, one child in every 30 dies in the first month of life. One in 12 does not make it through her or his first year. One in 10 children dies before reaching her or his fifth birthday – mainly of preventable and easily treatable diseases.

Overall, a steep decline in under-5 mortality

In the past 10 years, Cambodia has made impressive gains on key health indicators for children. According to the 2010 Cambodia Demographic and Health Survey, between 2005 and 2010, the infant mortality rate was halved. The percentage of children of age 12–23 months who had been fully vaccinated by 12 months of age increased from 60 percent in 2005 to 74 percent in 2010. The number of women giving birth in a health facility went from one in five, in 2005, to one in two, in 2010.

According to the 2012 Progress Report on Committing to Child Survival: A Promise Renewed, the under-5 mortality rate declined by 64 per cent between 1990 and 2011.

Him Timpor is a community health volunteer in Kampong Thom province, Cambodia. “Since I started doing advocacy work in the village," she says, "people have gained knowledge and understanding about health issues.”

Progress slower among marginalized populations

Infant mortality among the poorest 20 per cent of Cambodians is 71 per cent higher than the national average. Infants born in rural areas are three times more likely to die during their first year of life than infants born in urban communities.

Remote and diverse ethnic populations are sometimes reluctant to seek healthcare because of traditional beliefs, language differences and social stigma. The distance to reach the health centre can also be a barrier.

Reur says, “Everybody here in this village is willing to go to the health centre, but sometimes when they needed to go, they didn’t have gasoline. Also, sometimes if the labour pains start at night they don’t have time and give birth at home.”

Outreach provided by community health volunteers

Across the country, health volunteers are increasing Cambodia’s outreach to remote communities. They help pregnant women to identify danger signs, and new mothers to be aware of the symptoms of such childhood illnesses as pneumonia and diarrhoea. They refer women to health centres and hospitals.

Across the country, health volunteers help pregnant women and new mothers identify warning signs and refer the women to health centres and hospitals.

Community health volunteer in Kampong Thom province Him Timpor discusses the progress she has seen: “Since I started doing advocacy work in the village, people have gained knowledge and understanding about health issues. For instance, most women go to the health centre now rather than delivering at home with a traditional midwife.”

Health institutions supported

Cambodia is also improving the quality of services provided at health facilities to encourage diverse populations, including marginalized ones, to access healthcare. Nou Vichetra is a midwife in a health centre in Kampong Thom. “The most important advice I can give is for health staff to be courteous,” she says. "They should not stigmatize people based on class. It’s also important to be at the station in 24 hours.”

With UNICEF support, Cambodia’s Ministry of Health and partners continue to work to reduce preventable child deaths further – especially for remote and marginalized populations. By improving health service planning, training more community volunteers and making emergency transportation available for timely and appropriate healthcare, Cambodia is taking steps to ensure that baby Moeun and children like him can look forward to a healthy childhood.