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CAMBODIA FIELD EXPERIENCES By Dr. Hong Sun Huot Senior Minister, Minister of Health 12 th GAVI Board Meeting 9-10 Decem

CAMBODIA FIELD EXPERIENCES By Dr. Hong Sun Huot Senior Minister, Minister of Health 12 th GAVI Board Meeting 9-10 December 2003 Geneva, Switzerland. Country Profile. Total Population (2001) 13.1 millions Rural Population (1999) 80% People below poverty line (1999) 36%

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CAMBODIA FIELD EXPERIENCES By Dr. Hong Sun Huot Senior Minister, Minister of Health 12 th GAVI Board Meeting 9-10 Decem

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  1. CAMBODIA FIELD EXPERIENCES By Dr. Hong Sun Huot Senior Minister, Minister of Health 12th GAVI Board Meeting 9-10 December 2003 Geneva, Switzerland

  2. Country Profile • Total Population (2001) 13.1 millions • Rural Population (1999) 80% • People below poverty line (1999) 36% • GDP per capita (2002) US$360 • Percentage of women who are illiterate 32% • Total Fertility Rate (2000) 4.0 • Maternal Mortality Ratio (2000) 437/100,000LB • Infant Mortality Rate (2000) 95/1000 LB • Under-five Mortality rate (2000) 125/1000 LB • % Children under weight (2000) 45%

  3. GAVI Support to Cambodia 2001-2003 • Bundled Combined DPT-Hep.B for 1 OD (2001) • Bundled Combined DPT-Hep.B for 2 OD (2002) • Bundled Combined DPT-Hep.B for 19 OD (2003) or about 25% of the OD. • Injection Safety for all routine antigens (2002-2003) • Immunization Service Sub-account (2001-2003)

  4. Immunization Status DTP3: 1992-2002 • District report DPT3 ≥80% 10 / 73 (2002) • Overall expect slightly improvement of coverage in 2003

  5. Acceleration Routine Coverage (1) Different Strategies used: • Coverage Improvement Plan (CIP): 11 OD • Contract NIP/OD for Outreach: 16 OD • 1st quarter outreach support: all 75 OD • Multi-antigens supplementary immunization campaigns in selected remote areas; • Mapping the un-reached and abandoned villages; • IEC activities to create demand for immunization.

  6. Acceleration Routine Coverage (2) Improving Data Quality • Data Quality Audit (DQA) 2001: Verification Factor 87%; • Data Quality Audit (DQA) 2003: Verification Factor 98%; Post Activity Assessment (PAA): • Spot check to validate reported result of the related village used in “Contract” for allocation part of support for outreach. Improving Partners’ Coordination in Immunisation • Quarterly NIP/NGO meeting to coordinate support and to share experiences; • Quarterly ICSC meeting to discuss the progress and coordinate funding for immunization; • Bi-monthly NIP meeting with WHO, UNICEF, CVP/PATH for Technical Guidance.

  7. Introduction of new vaccine and Safe Injection • Expand Combined DPT-Hepatitis B vaccine to 25% of the ODs (19/75) in routine EPI (2003); • Pilot Hep.B birth dose in 49 Health Centers and 8 hospitals (2003); • Exclusive use of AD syringes for all antigens in routine EPI since end of 2002; • Progressively Implement new cold chain policy with one refrigerator per Health center and introduction of open vial policy.

  8. Disease Initiatives Reported Measles cases 1999-2003 Measles Control: • At lest 95% of children 9 months – 14 years old countrywide received supplementary dose of measles; • Over 90% reduction of reported measles cases comparing the period 1999 (13,827 cases) to 1,361 in 2002 and 379 cases in 2003 with more reliable surveillance system. Maternal Neonatal Tetanus Elimination (MNTE) • TT Supplementary for CBAW implemented in 25 identified high risk OD using surveillance data (2000-2003); • Est. 23 OD classified as low risk, 11 OD as high risk & 39 OD with unknown risk as of end 2003. Polio Free Status maintained since 2000 • With high quality AFP surveillance.

  9. FSP for immunization (1) • Signed Officially in Dakar, November 2002; • Government increases budget for vaccine procurement (US$450,000 for 2003-04) using Vaccine Independent Initiative (VII) with commitment for future; • Government & partners’ committed all required new cold chain equipment (2003-2005); • FSP annually updated to reflect the actual annual need; • Negotiations are taking place with the Department of Finance (MOH) to design strategies for securing outreach funding for rural health centers in 2005

  10. FSP for immunization (2)

  11. Challenges • Partners’ longer-term commitment for immunization; • Vaccines Security; • Salary for health staff, access to national budget; • Sufficient and on time Funding for Outreach; • Improve fixed site immunization along with the implementation of new cold chain policy; • High turn over of staff; • Low demand for immunization in some areas; • Human Resource Development; • Strengthened linkages of immunization services with maternal and child health programs and health sector reforms (decentralization)

  12. GAVI Board Attention • Request for full (100%) 5-Year support of Combined DPT-Hepatitis B vaccines to spread over 8 years to facilitate Phase-in of other donor support • Request GAVI to consider support for expansion of the Monovalent Hepatitis B Birth dose vaccine • Immunization Service Sub-Account: important for trialing new initiatives in Cambodia (micro-planning, contracting)

  13. SPECIAL THANKS TO: GAVI-VF UNICEF WHO CVP JICA AusAID Other DONORS

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