According to a health provider (#26), Lack of water is often the main issue for remote villages inthe dry season; they are forced to use whatever water isavailable in ponds, sharing with animals, the water is dirty and the source of diseases.. Poverty is still a problem; there remain households thatgo without basic needs such as food and water. It has long been acknowledged that factors influencing individual and population health are many (Marmot and Wilkinson 2000), aside from biomedical and behavioural conditions of individuals (Davey Smith and Ebrahim 2001). Improving access to hospital care for the poor: comparative analysis of four health equity funds in Cambodia. Smoking is so prevalent in villages, regardless of places - inside or outside homes, according to a community volunteer (#36), 30years of age from O Tanov village inPrey Chhor district. Jarl J, Cantor-Graae E, Chak T, Sunbaunat K, Larsson CA. The authors gratefully acknowledge the contributions of faculties and staff members of UHS and McGill University in the coordination and administration of funding. The liberalization of themarket economy and private sector growth contributed to consistent double-digit economic growth overseveral years in the 2000s and 2010s; andthe country hasrecently been upgraded toa lower-middle-income country (World Bank 2019). A total of 31 primary health careproviders of the planned 32 participated in the self-administered surveyand face-to-face in-depth interview. A framework for educating health professionals to address the social determinants of health. [14] Plasmodium falciparum resistance to artemisinin drugs was first confirmed in western Cambodia; treatment failures to artemisinin-based combination therapy (ACT) have been reported from multiple sites on the Thailand-Cambodia border.
Despite the fact that population health is so intertwined with socio-economic, political and cultural conditions, studies on SDH in low- and middle-income countries have been limited and often neglected. [citation needed] However, such governmental infrastructure is not available in rural provinces: NGOs take bigger roles in the rural healthcare setting in Cambodia. 2008). Another worrying trend is thatof young peoplesmoking (i.e., those in their late teen years), according to a village woman volunteer. PMC legacy view Thanks to the MOH, public health administration governance has been centralized and organized so that decisions and actions are facilitated to act quickly and critically in response to public health problems. government site. Ir P, Horemans D, Souk N, Van Damme W. Using targeted vouchers and health equity funds to improve access to skilled birth attendants for poor women: a case study in three rural health districts in Cambodia. One healthprovider (#15), 25years of age said, Ive never been trained in this but if the client looks distraught, Id ask her why out of curiosity., Referral guidelines exist for different health issues, but even for thesesituations, adherence to the guidelines was limited. [8] Mortality data suggests emerging burdens specifically from injuries (traffic accidents), high blood pressure, heart disease, and liver cancer. Referral of tuberculosis symptomatic clients from private pharmacies to public sector clinics for diagnosis and treatment in Cambodia. Gender-biased social norms have a role in facilitating gender-based violence (GBV) and prejudice which have become a public health issue in many countries and are associated with adverse maternal and child health outcomes (Krantz 2002; Hill et al. Solutions to these problems require sustained and coordinated actions of multiple actors and institutions and involvement of differentlevels of authorities, i.e., from commune authorities to district and provincial, then to a central body, such as a national council or ministry. Careers. None of the officials declined the request for an interview. Anne Andermann contributed to the study design and manuscript writing. Training frontline primary health careproviders and providing them with adequate information about referral and available social servicesand local resources in the community are among the prerequisites in this endeavour and add tostrengthening human resources for health. Lack of income and unemployment are prevalent among rural households, and constitute the main source of poverty. Participants of the study were frontline providers of health and social care and were purposively selected: 32 primary healthcare providers from 16 health facilities, three provincial and district health officials, two commune council members and two village women volunteers in the two health districts. [1] One such example is the Cambodian Health Equity Fund, largely financed by the country itself, created in 2000 to increase access to free health care to around 3 million poor people. Subnational mechanisms such as the Implementation of Social Accountability Framework and Commune Investment Plan have been leveraged to ensure adequate multisectoral coordination in addressing community social problems, most notably in education, health and social welfare sectors (NCDD 2015). sharing sensitive information, make sure youre on a federal Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The under 5 mortality rate, per 1,000 births is 90 and the neonatal mortality as a percentage of under 5's mortality is 34. Ministry of Health (MOH): Ministry of Health in Cambodia has been taking the leading role in improving the health of the people in Cambodia since the 1990s when help from foreign NGOs and external government aids were welcomed in Cambodia after the establishment of relative political stability. All ofthese are reflected in shared commonalities documented in an increasing number ofpolicy documents of different countries, most often high-income countries, outlining their approaches to SDH. Community workers, volunteers and local authorities are also among the first contact people in the community and can serve to facilitate access to and referral for services, and including them as important stakeholders in SDH intervention is necessary (Le et al. Strengthening district health service management and delivery through internal contracting: lessons from pilot projects in Cambodia. Bell, K., Corbacho, B., Ronaldson, S., Richardson, G., Torgerson, D., Robling, M., & Building Blocks trial group.
According to the local authorities and healthproviders, maltreatment of children wasalso rare; this was referred toas verbal, sexual or physical abuse of children. However, it is often unknown whether or not a referral client has received a service. National Academies of Sciences, E., and Medicine . Cost of illness studies on reproductive, maternal, newborn, and child health: A systematic literature review. [4] Cambodia falls into the "very bad" category when evaluating the right to reproductive health because the nation is fulfilling only 57.1% of what the nation is expected to achieve based on the resources (income) it has available.[4]. This is a Cambodian case study to illustrate the important roles of frontline service providers in addressing SDH and to provide an understanding about the current practices by the frontline primary health careproviders in this field. 2014). While access to health services wasconsideredadequate, households and communities had several major risk exposures. Bell CA, Ilomaki J, Pichenda K, Duncan GJ, Saini B. Both districts were ahead of the countryin terms of literacy, with almost all population aged 1845 being literate, higher than the country average (82%).
The midwives were invited to their respective health district office, informed about the study on newborn care and the qualitativein-depth interviewsrelated to social and community issues. The Journal of Nervous and Mental Disease. Training primaryhealth careproviders about available socialsupport services and how to refer people in need was cited as part of the essential package of an intervention addressing SDH. [15] Since the beginning of passive surveillance in 1980, the case fatality rate has decreased from 15% to 0.3% from 1980 to 2010 [16]. So seeing a patient lacking even these basic commodities, as a health provider I can only give suggestions where to seek assistance,says ahealth provider (#10) in Cheung Prey district. At the community level, referrals for social services lack formal establishment and occur on an ad hoc basis; verbal referral is the norm, with lots of uncertainty in getting the services or help. Officials from different sectors, for example, in thecase of the GBV working group,included representatives from justice, policeforce,and health and social affairs, whoparticipate in these bodies. According to the Ottawa Charter for Health Promotion, peace, shelter, education, food, income, a stable ecosystem, sustainable justice and equity were counted as prerequisites for health (World Health Organization 1986). Progress in socio-economic and health sectors, 19902014, Cambodia, CDHS data (except whenotherwise indicated); n/a, data not available;GDP(USD), gross domestic product (US dollars); * Maternal mortality, 19902015, Cambodia: https://www.who.int/gho/maternal_health/countries/khm.pdf; ** MOH Achievement report 2017; ^World Bank data (WB 2019). The data were supplemented by secondary data on different aspects of the districts and Cambodia. This study aims to illuminate social determinants of health and to identify challenges and opportunities in addressing social determinants of child health (SDCH) in rural Cambodia. La pauvret, le manque de produits de base et les conditions sociales dfavorables restent des problmes pour la sant de la population. Addressing SDCH requires broad and coordinated efforts of stakeholders from multiple sectors. It recurred only occasionally, often among families of heavy drinkers. 2016). Significantly, a low prevalence rate in the general population masks far higher prevalence rates in certain sub-populations, such as injecting drug users, people in prostitution, men who have sex with men, karaoke hostesses and beer girls, and mobile and migrant populations. At the time of study, Keovathanak Khim was a Postdoctoral Fellow in the Department of Family Medicine at McGill University, Montreal, Canada. [21] Prematurity, pneumonia, birth asphyxia, diarrhea, and injuries remain the top 5 killers of children under 5 years of age in Cambodia. For example, we need irrigation, good water connection, people with ajob, child care centres, but we cant get all these at once,says a commune council member (#35). In relation to tobacco useand exposure to second-hand smoke, most of the healthproviders said children continue to be exposed to tobacco use and second-handsmoke in many households. Children in the highest economic quintile have lower mortality rate than those in the lowest quintile (16 versus 62 per 1000 live births); children born to a mother with no education have higher mortality rate than those born to a mother with secondary education or higher (63 versus 26 per 1000 livebirths) (NIS. According to the CDHS data in 2010, the rate of children under 5 with moderate to severe malnutrition or with acute respiratory infection was more than twice as high in children living in rural areas compared to those living in urban areas, as well as children in lowest quintile household compared to those in highest quantile household. 2018). The psychosocial comparison approach explains the sentiment and perception of ones social standing and the social experiences which could be linked to mental and psychological conditions, such as isolation, maltreatment and discrimination. [19], Since 1996, reported incidences of death due to injury have increased drastically in corollary to increasing number of vehicles. . These data are suggestive of high presence of SDCH in the districts, with high poverty rates, high number of orphaned children and of people with disability and of migrant populations. Learn more The Fund, which pays for traveling expense and even daily allowance for anyone accompanying a patient, has resulted in increasing health care seeking among Cambodians who otherwise could not afford any kind of medical care. All the interviews were conducted face to face. Khim, K., Ir, P., & Annear, P. (2017). No software was used to assist the analysis. . Recently amid the COVID-19 worries caused by thepandemic, the resultant economic downturn and job losses, the social protection scheme funded by theCambodian government had implemented cash transfer for over two million poor and vulnerable populations (NSPC 2020). 2000), and the effect of the differences in these translated into hierarchies andhow social distances define ones social standing and perceptions of communal structures (Kawachi and Kennedy 2002). Krieger NA.
Hill A, Pallitto C, McCleary-Sills J, Garcia-Moreno C. A systematic review and meta-analysis of intimate partner violence during pregnancy and selected birth outcomes. International Journal for Equity in Health. I dont know why [older women or those not good-looking] cant find a job in the factory; but those who are good-looking are always easy to get a job, says a woman village volunteer (#36). Opportunities were present, including social services being existent albeit poor functioning, the traditional practice of social inquiry, existing frontline providers being open to furtherinformation and training, existing subnational coordination bodies at district and provincial levels, and use of evidence in planning and resource allocation. (2019). A small number of healthproviders met or knew mothers of young childrenwhose family had a problem with drug use. 2017); these are lacking and had seen limited applications inlow- and middle-income countries (Bennett et al. The new PMC design is here! The health-care system is still ill-prepared to deal with mental-health problems. [25] Ratanakiri also has the country's highest rates of severe malnutrition. [24], Ratanakiri residents' poor health can be attributed to a variety of factors, including poverty, physical remoteness, language and cultural barriers that prevent Khmer Loeu from obtaining medical care, poor infrastructure and access to water, lack of accountability in the medical community, and exacerbating environmental factors such as natural resource degradation, decreasing food production, and internal migration. Poverty, lack of basic commodities and adverse social conditions remained problems for population health. This is due to the bad experienceof not receiving a service when needed, or people being dissatisfied with the level and quality of public services. [14], Dengue fever is especially prevalent among children in between 4 and 6 years old, living in urban Cambodia. Les dfis lis la lutte contre la SDCH taient la prvalence leve de conditions sociales et domestiques dfavorables, ainsi quele manque de formation des prestataires, dinformations sur les services sociaux, de coordination efficace et de confiance dans les services publics. In: Wilson J, editor. However, according to village volunteers, discrimination in recruitment for employment does occur. Social conditions and living environments in the districts are already indicative of the needforgreater social care and local supportservices. Policy approaches to address the social and environmental determinants of health inequity in Asia-Pacific. 2018). The commune council members agreed that incomes fromsuch labour jobs were too small to sustain the livelihood of these families. All participants of the study gave consent before joining the interviews. [11], Tuberculosis incidence and prevalence declined significantly, and within just 20 years from 1990 to 2010, the incidence rate declined by 25%, and the prevalence rate declined by 48%. ICF International 2015). Nevertheless, improving social care services and infrastructures requires strong coordination, planning and adequate resource allocation. The conflicts could be related to quarrels or disputes from the past. Restoring public trust is difficult and needs time and proofof effectiveness. Other assistance mostly in charity forms and on an ad hoc basis comes from private donations and high-ranking government officials. They said houses and living facilities were not built with child protection in mind; for example, ponds and stairs were not barricaded to prevent small childrenfrom falling in or down; wateris stored in deep jars and could be a drowningsafety issue for small children; bushes surrounding the house are sources of mosquitos and other bitinginsects. When we know a case of domestic violence, we report to the commune office, the perpetrator is apprehended and educated and asked to sign a pledge. (2016). Noirhomme M, Meessen B, Griffiths F, Ir P, Jacobs B, Thor R, et al. For example, district and provincial authorities, in coordination with the Ministry of Labour or the Ministry of Social Affairs, have to negotiate with a garment factory to change policy in the recruitment of women of a certain age group or people with disabilities. Second, the purposive sampling of providers and the small sample of districts included in the study mean that the results of the study are limited to the study districts. The quality of health in Cambodia is rising along with its growing economy. [14] The following surveillance activities were intensified in the 18 districts: following up on cases, investigating focal areas, and conducting response interventions. Due to a woman lacking education, they lack the knowledge that services to benefit their health are even available to them, creating this health care inequality. Malnutrition remains to be a major risk factor for children's health. The authors declare that they have no conflict of interest. For health services, we seemed to be doing well, and people seek our services, but for other social issues, it rests with local authorities. HIV became an increasing problem in 1998, but the epidemic has since been almost curbed. And we sometimes hear back from commune or other providers if help is provided.. In Cambodia the number of midwives per 1,000 live births is 6 and the lifetime risk of death for pregnant women 1 in 110. [4] When looking at the right to health with respect to children, Cambodia achieves 96.8% of what is expected based on its current income. We have many poor households in the community and they need everything, even food and water. At the community level, all village volunteers received some form of training in social and health topics, and their role is predominantly for referral and facilitation of community activities, e.g., child vaccination, blood testing, and mobilizing and facilitating hand-outs of social assistance, for instance, from the Red Cross. Cambodia was able to reduce the prevalence of HIV transmission among the general population aged 1549 from a peak of 2.8% in 1998 to 0.6% in 2006 (Charles 2006). It is primarily the result of disparity in socio-economic conditions, political decisions and/or cultural factors (Friel et al. (2018). Accessibility Problems of social and health inequity are also prevalent in urban areas. Examples of social infrastructures include public water distribution networks, public health services, safety and security, and exposures to household and communal adverse conditions, such as second-hand tobaccosmoke, druguse, and violence. This lesson of multisectoral response has been replicated in addressing other problems, such as violence against women, and social and disability inclusion. Des opportunits taient prsentes, y compris des services sociaux existants bienque fonctionnant mal, la pratique traditionnelle de lenqute sociale, les prestataires de premire ligne existants tantdisposs encoredinformations et de formation, les organes de coordination sous-nationaux existants au niveau des districts et des provinces, et lutilisation des preuves dans la planification et lallocation des ressources. We know what we need and what to do, but without adequate resources, like budget and manpower, there is so much we can do, and this applies to all services and sectors. Zimmer Z. In 1967, the Cambodian Civil War broke out and the following decade turned out disastrous for the country and the Cambodian people. Both districts are located along the National Road 6, Northeast of the capital city of Phnom Penh and primarily treated as semi-rural districts, with large concentrations of population in the district towns. He was formerly Head of Public Health Unit at University of Health Sciences, Cambodia and is currently Monitoring, Evaluation and Learning Manager of the ACCESS Program in Cambodia. Cambodian children in rural areas are three times more likely to die than those in urban areas (under 5 mortality: rural area 52 versus urban area 18 per 1000 live births); this could be explained in partby economic status and mothers education,as well as access to health services. Content analysis was conducted by thematic area identified in advance of the fieldwork and corresponding to the research questions. Social determinants of health: Canadian perspectives. The situation of the districts may have changed a great deal, in terms of employment and improved livelihood given the increase in garment factories. Over half of health providers said women or caretakers had inadequate knowledge about child care. For other social matters, I simply refer to commune or district office as there is no information where to refer to, says a health provider (#16). This is further corroborated by the local authority, who says thatsmoking is still common in the community, though the prevalence decreased compared with 5years ago. [14] Since 2009, malaria incidence, cases, and deaths have all decreased. Phalla, T., Leng, H. B., Mills, S., Bennett, A., Wienrawee, P., Gorbach, P., & Chin, J. (2016).
Mothers are the major sources of care of young children, and their knowledge and practices in caring for young children are essential for good care. Only one provider said she met with pregnantwomen or mothers of young childrenwho reported the feeling of insecurity. FOIA So the problem of water shortage even for drinking among remote communities still exists,according to a Commune council member (#35). The impact of pre and perinatal lifestyle factors on child long term health and social outcomes: a systematic review. Health equity fund schemes to assist the poor and vulnerable, usually rural populations, to have free access topublicly funded health services were piloted in the late 1990s, scaled up in the 2000s and 2010s, and currently integrated into the health system (Annear et al. Poverty and user fees for public health care in low-income countries: lessons from Uganda and Cambodia. Addressing SDCH requires broad and coordinated efforts of stakeholders from multiple sectors. Alcohol use, drug use, feeling of insecurity, isolation and discrimination were still issues among a small number of households in the districts although they were not prominent and often unspoken because of their stigmatizing nature. This seems to reduce frequency and incidence of violence,explains a district health official (#32) in Prey Chhor. In this context, along with the training, a simple clinical supporttool such as that developed by theCLEAR Collaboration (https://www.mcgill.ca/clear/download#Kmer) could be modified and simplified to be culturally appropriate for Cambodian primaryhealth careprovidersto begin to ask about and address the SDCH (Naz et al. HHS Vulnerability Disclosure, Help Compiling and disseminating information about available social services in the districts are logical interventions to address the need. Some of the interventions implemented include awareness of safer sex and condom use campaign, universal access to HIV testing, and prophylaxis to HIV positive mothers to reduce mother-to-child transmission of the virus. Along with these challenges, opportunities for addressing these were also identified. 2012). The study was approved by Cambodias National Ethics Committee for Health Research and theMcGill Institutional Review Board. Similarly, in the disability area, cross-sectoral collaborations on interventions in public domains improve policy, coordination and access to rehabilitation services and improve the social and economic conditions of people with disabilities, what is generally called disability inclusion (Unicef, UNDP, & WHO 2018). Specifically, the MOH follows the current Health Strategic Plan 2008-2015 to better the health of the nation. The questions in the survey andinterview guide were developed, adapting fromthe CLEAR Toolkit of McGill University (Andermann 2016; https://www.mcgill.ca/clear/download#Kmer) and contained items reflecting the theoretical approaches described earlier related to material wealth, social infrastructures, and psychosocial aspects which are relevant to the issues of mental and psychological health and well-being, whichinfluence early childhood development.