Non-infectious diseases that low-income countries should notice

Non-communicable diseases (NCDs) are not caused by infectious pathogens. NCDs refer to chronic diseases such as diabetes and high blood pressure which last for a long time and progress slowly. Such diseases are particularly dangerous for low-income countries with their mortality staggering at 24.3%.

- Article: Newsroom / Photography: KOFIH
Strengthening Non-communicable Diseases (NCDs) Management in Northwest Provinces

KOFIH has implemented various projects for prevention and management of NCDs, mainly in Battambang, Pursat and Pailin Provinces, northwestern part of Cambodia. Cambodia needs to be cautious since 25.9% of its population are aged 40 or older, an age group closely related to NCDs. However, only 8% of healthcare facilities can manage them within the project areas. First, KOFIH focused on cervical cancer, a typical NCD for women. Cervical cancer can be managed by vaccinating human papillomavirus (HPV), a major cause of the cancer.

However, it is not easy to distribute vaccines in low-income countries, such as Cambodia, due to cost. For that reason, KOFIH shifted its focus to cancer screening so that cervical cancer could be detected and treated at an early stage, while meeting Cambodia's national policy. To this end, training for health center employees was conducted to strengthen their screening capacity, and education was provided so that Village Health Support Group (VHSG) could share accurate health knowledge to residents and recommend them to get medical check-ups.

Through such activities, KOFIH plans to improve the awareness on cervical cancer in Cambodia, reduce its incidence rate and lay the foundation for reinforcing the capacity of healthcare workforce. Projects are also actively underway to reinforce management of chronic diseases such as diabetes and high blood pressure.

Above all, considerable time and workforce were invested in establishing a system that can effectively manage local patients with chronic diseases. KOFIH is endeavoring to accomplish three major systemic changes. First of all, it aims to supplement the drug purchase system. As local health facilities in Cambodia have difficulties in managing chronic diseases due to insufficient drug distribution from the central government, KOFIH intends to introduce a method of purchasing and distributing drugs at bulk at lower than market prices through province-specific funds.

This will enable patients to be prescribed to stable and reliable drugs without need to spend time and money for transportation to visit provincial hospitals. Data management for chronic diseases is also an important issue. Thus far, the system for aggregating and managing relevant data has been insufficient in Cambodia as it has put less emphasis on chronic diseases at the national level.

Considering this, KOFIH is carrying out a project to install computers, train workforce and conduct supervisory activities in Cambodia to operate a chronic disease data management network at all healthcare facilities within the project site. It is designed to be used for policy development and direction setting for Cambodia’s national project on chronic diseases management.

From the first half of next year, data on chronic diseases is expected to be stably managed. Finally, KOFIH clarified which organization takes the role of managing chronic diseases. Up until now, it was difficult for the system of the provincial health department to function properly as the Ministry of Health was in direct charge of managing the diseases. So, KOFIH established a system in which the provincial health department can independently manage chronic diseases based on consultation with the central Health Ministry.

Interviewee: Country Representative Kim Sang-kyun of KOFIH Cambodia Office
Why should KOFIH support chronic disease projects in partner countries including Cambodia?

KOFIH has been working to strengthen the health system by implementing the maternal and child health projects in Cambodia for the past 10 years. Building on such outcomes, we need to pay more attention to chronic diseases.

In local emergency rooms of Cambodia, the largest number of patients are the ones with stroke. Many of them collapsed without even knowing that they have high blood pressure or diabetes. Health centers and hospitals are also in shortage of workforce to treat patients with diabetes or high blood pressure, so most patients do not receive proper healthcare services.

As you mentioned, KOFIH has been promoting the maternal and child health project in Cambodia for the past 10 years. Please tell us what difficulties you have while promoting the chronic disease project.

As for the maternal and child health project, there was a national program that Cambodia had already established, but it was not the case for chronic disease-related projects. So we had to start from the top in all aspects. Since necessary healthcare workforce, such as nurses and midwives, should be able to acquire basic knowledge on chronic diseases and to provide proper care, KOFIH should strive to enhance their capacity. Plus, there are some issues to be tackled such as establishing a system that can manage chronic disease data and the shortage of medicines supplied by the government.

What are your vision or outlook for chronic disease management in 2025 and afterward when KOFHI’s chronic disease project comes to an end?

Currently, patients with diabetes or high blood pressure have to visit and pay for private medical clinics or tertiary hospitals. Low income people have difficulties in receiving even basic medical check-ups or treatments. Hence, if we develop efficient chronic disease management system models in the three project target regions under the project, the Cambodian government will be able to effectively utilize the model when it sets the direction for the chronic disease management in the future.
Capacity Building Project on Screening of Cervical Cancer and Human Papillomavirus(HPV)

KOFIH implements the Capacity Building Project on Screening of Cervical Cancer and Human Papillomavirus(HPV) in the Republic of Uzbekistan. In the country, the number of women aged 15 or older stands at 11.2 million, an age group with a risk of developing cervical cancer. Also, in Uzbekistan, cervical cancer is so serious that 1,795 women lose their lives from cervical cancer each year. Against the background, KOFIH has conducted a capacity building project on HPV screening in Tashkent, Samarkand and Andijan since 2020.

KOFIH plans to conduct HPV screening tests on 50,000 Uzbek women within its project sites by 2023. Starting with HPV screening on 546 women living in Tashkent last April, a total of 22,211 women were screened by July this year. KOFIH opened the cervical cancer screening center in Andijan in this February and in Samarkand this July. In addition, KOFIH plans to make efforts to reduce the incidence rate of cervical cancer in Uzbekistan and raise awareness on HPV screening through the efforts such as provision of research equipment, invitational training program for capacity building for local experts, and campaigns for cervical cancer and HPV prevention.