STEADY PROGRESS IN CAMBODIA Report of a Parliamentary Delegation to Cambodia February 2014 Contents 4 EXECUTIVE SUMMARY THE DELEGATION 6 BACKGROUND TO THE ISSUES In February 2014, four parliamentarians from the UK visited health and education programmes in Cambodia, accompanied by staff and board members from RESULTS UK. The aim of the delegation was to assess how Cambodia is addressing major development challenges relating to these issues. The members of the delegation were: TUBERCULOSIS Baroness Alison Suttie (Liberal Democrat) Michael Connarty – MP for Linlithgow and East Falkirk (Labour) CHILD HEALTH Nic Dakin – MP for Scunthorpe (Labour) Mark Pawsey – MP for Rugby (Conservative) EDUCATION Reg Davis – Member of the Board of RESULTS UK, former Head Teacher KEY FINDINGS AND Steve Lewis –Global Health Advocacy Manager, RESULTS UK 8 Jessica Kuehne – Health Advocacy Officer (Tuberculosis), RESULTS UK RECOMMENDATIONS Megan Wilson-Jones – Health Advocacy Officer (Child Health and Vaccines), RESULTS UK TUBERCULOSIS ACKNOWLEDGEMENTS The Global Fund to fight AIDS, TB and Malaria We are grateful to the Cambodian Government, especially the Ministry of Health, His Excellency Mam Bun Heng, and the Ministry of Education, Youth and Sport, for welcoming the delegation to the country and ensuring the delegates were able to speak with officials CHILD HEALTH and visit government hospitals, health centres and schools. We are also grateful to UNICEF for leading the health site visits. Our special thanks go to Mr Chan Sophea, Lynn Dudley and their team at the Ministry of Education, Youth and Sport; Denise Shepard-Johnson, Immunisation and Gavi, the Vaccine Alliance Rowena Campbell, Dr Pharin Khiev, Aun Chum and their team at UNICEF; Dr Mao Tan Eang and his team at CENAT; Dr Thai Sopheak and her team at the Sihanouk Hospital Center of HOPE; Dr Chris Vickery, an advisor to Australian Aid (and formally to UK Aid); Chea Pneumonia, Diarrhoea and Undernutrition Vantha, Richard Winterton and their team at VSO; Bill Longhurst and Bryony Mathews from the British Embassy in Phnom Penh, and Theary Chan & her team at RACHA, an important Cambodian local NGO. EDUCATION ACRONYMS The Global Partnership for Education CENAT - The National Centre for Tuberculosis and Leprosy Control DFID – UK Department for International Development GFATM– The Global Fund to Fight AIDS, TB and Malaria 14 ITINERARY GPE – Global Partnership for Education HIV/AIDS – Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome MDG – Millennium Development Goals NGO – Non-Governmental Organisation 16 ABOUT RESULTS ORS – Oral Rehydration Salts RACHA – Reproductive and Child Health Alliance TB – Tuberculosis UNESCO - United Nations Educational, Scientific and Cultural Organisation ABOUT ACTION GLOBAL UNICEF – United Nations Children’s Fund 16 VSO – Voluntary Services Overseas ADVOCACY PARTNERSHIP WHO – World Health Organisation EXECUTIVE SUMMARY In February 2014, a delegation of four British parliamentar- TB programmes, focussed on scaling up TB treatment. Education Cross-cutting ians visited Cambodia to explore some of the key health Since receiving this support in 2003, more than 40,000 issues facing the country, including its prominent burden of people with TB in Cambodia have been diagnosed and Cambodia has succeeded in considerably reducing its Over the course of the delegation, through our site tuberculosis (TB) and high rate of under-five child mortality. treated, including patients requiring second-line treatment out-of-school population, from 91,000 children of primary visits and meetings with government officials, health These challenges are not unique to Cambodia and face for drug-resistant TB. school age in 2006 down to 31,000 in 2011. However, poor workers, patients, families and teachers, we learnt that many developing countries as they strive to improve the quality of education is a major challenge, caused in part many of the issues facing the health and education health of their populations and develop their economies. In addition, TB REACH, an initiative developed by the Stop by a lack of trained teachers. The Global Partnership for status of Cambodians are cross-cutting. Sustainable Health was the primary focus of the trip, but as health TB Partnership, provides funding to develop innovative Education (GPE) is a partnership of governments, civil development relies on a number of interlinking factors, and education are closely connected the trip also approaches to find and treat those individuals who are society, teachers, foundations and the private sector who including: the environment in which people live; access to included an education site visit to understand why so many currently being missed and who would otherwise not help developing countries access technical and financial clean water, sanitation and hygiene; nutrition; agriculture; children worldwide do not have access to good quality basic receive quality TB care. The delegation were able to resources and expertise to achieve their national educa- job opportunities and worker’s rights, among others. Very education. visit sites supported by both GFATM and TB REACH, tion goals. rarely do these factors operate in isolation, and therefore where they saw healthcare workers actively seeking improving the health and education of citizens relies on Following Khmer Rouge rule in the 1970s and decades of patients with TB and ensuring they received appropriate Cambodia joined the GPE in 2006 and received a US the ability to understand these links and on ensuring that civil war, the health system of Cambodia was effectively treatment. $57 million grant for the period of 2008-2012, and in a comprehensive approach is in place to improve the eco- destroyed, with fewer than 50 doctors remaining from a 2013 received a second grant of US $38 million. The nomic and social development of countries. previous workforce of approximately 600. Cambodia was Child Health delegation visited the Ang Suong Primary School in Bati the poorest country in Asia, with severe famine affecting District, Takeo Province, one school that benefited from this the population. The Cambodian Government has since Progress on immunising all children with routine vac- funding. During the visit, the delegates were happy to learn made dramatic strides in rebuilding its health system and cines has been impressive in Cambodia, with coverage that thanks to GPE funding, the school has made some improving health outcomes (including in controlling HIV/ rates reaching 95% in 2012, up from just 60% 10 years tremendous progress, now having three preschool classes AIDS and polio eradication), but many related indicators earlier. This is in part due to the work of Gavi, the Vaccine and achieving a 94% enrolment rate for Grade 1. remain some of the worst in the region. Alliance (previously the Global Alliance for Vaccines and Immunisation), a worldwide public-private partnership, that works to increase access to immunisation in the world’s poorest countries. In Cambodia, Gavi has provided more than US $43 million since 2001 to support the rollout of a number of routine childhood vaccines, helping to expand national coverage to current levels. During our visit, the delegation saw children and families benefiting from life-saving vaccines supported by Gavi in part- nership with the government and the United Nations Children’s Fund (UNICEF) at hospitals, health centres and in the community. Whilst immunisation rates are increasing, other challenges remain. Around 14,000 Cambodian children under the age of five continue to die every year from mostly pre- Tuberculosis ventable and treatable conditions, such as pneumonia and diarrhoea. Child survival in Cambodia is made more difficult due to existing high rates of undernutrition. It is TB is a particular problem in Cambodia. It is one of 22 estimated that 40% of the child population are stunt- high TB burden countries, which together make up 80% ed, or chronically malnourished. On the delegation we of TB cases globally. Despite a struggling health system, learned about the important work the government and Cambodia has made impressive strides in combatting its NGOs such as Reproductive and Child Health Alliance TB epidemic. Integral to Cambodia’s success in the TB (RACHA) are doing around expanding access to simple epidemic are two international funding mechanisms: the technologies to improve child survival. These include Oral Global Fund to Fight AIDS, TB and Malaria (GFATM) and Rehydration Salts (ORS) solutions and zinc supplementa- TB REACH. tion to treat diarrhoea; Amoxicillin, a powerful antibiotic used to treat pneumonia; and multiple micronutrient-rich We met with the Minister of Health, His Excellency Mam ‘Sprinkles’ which are given to mothers to mix into their Bun Heng, who explained to us that the Cambodian Minis- children’s diets, thereby improving their intake of essential try of Health and the National Centre for Tuberculosis and micronutrients. Leprosy Control (CENAT) are recipients of GFATM support and, to date, have received US $35 million to implement 4 5 BACKGROUND TO THE ISSUES TUBERCULOSIS The purpose of the delegation was to learn more about key TB continues to unnecessarily cause death or disability global health issues and their impact on development. The Cam- for millions of people globally each year. The World Health bodian health system collapsed during the genocidal Khmer Organisation (WHO) estimates that 1.3 million people died from Rouge regime in the 1970s, leaving the country with some