Cambodia

The Promoting Healthy Behaviors (PHB) project supports the Royal Government of Cambodia to improve health behaviors among Cambodians across six health areas: tuberculosis; sexual and reproductive health; maternal and child health; water, sanitation and hygiene (WASH); malaria; and nutrition. PHB has two objectives: to strengthen public sector systems for oversight and coordination of social and behavior change at the national and provincial levels, and to improve the ability of Cambodians to adopt 12 key behaviors from the health areas above. To achieve both objectives, PHB takes a collaborative approach to design, implement and monitor effective social and behavior change interventions, using best practices and sharing and learning from the results. PHB works both at the national level and implements social and behavior change interventions in six provinces: Kampong Chhnang, Battambang, Pailin, Kampong Cham, Tbong Khmum and Phnom Penh.

PSI Cambodia is implementing USAID’s Enhancing Quality of Healthcare Activity project, led by FHI360, which is designed to provide technical assistance to public and private healthcare practitioners to improve quality of care based on evidence in the areas of tuberculosis, HIV/AIDS, maternal and child health and malaria, as well as sexual and reproductive health in six provinces. With technical guidance from FHI360, PSI Cambodia is adapting and implementing a quality improvement collaborative approach to build the capacity of provincial health departments, operational districts, health centers, referral hospitals and private health facilities to address gaps in quality of care by focusing on the client, involving teams of health workers to test changes for care improvement, using data to measure the effect of these changes, facilitating cross learning and yielding improvement through change processes and healthcare delivery systems. In close collaboration with FHI360, PSI Cambodia will also support the optimization of the existing licensing and re-licensing standards and processes for private health facilities at the national and sub-national level through the Department of Health Services, Ministry of Health and sub-national government entities.

Since 1997, PSI Cambodia has worked to improve the reproductive health of poor and vulnerable women with a focus on reducing unintended pregnancy and maternal mortality. Since launching the OK oral contraceptive in 1997, PSI Cambodia has introduced a comprehensive mix of contraceptive products, including both short- and long-term methods, providing women with a wide range of options to meet their reproductive health needs.

PSI Cambodia also uses behavior change communications materials and mass media in addition to an extensive network of community mobilizers and interpersonal communication workers to inform women of their contraceptive options and refer them to appropriate healthcare facilities. To ensure that clients receive high-quality health services, PSI Cambodia provides training and support to improve the capacity of providers and pharmacists.

In addition to its work with local partners, PSI Cambodia also started its own social franchise of private sector providers, the Sun Quality Health Network, in 2002. Creating the franchise further harnessed private sector potential and increased access to high-quality health services, especially reproductive healthcare. Sun Quality Health Network providers receive training on contraceptive counseling and service provision, supportive supervision and quality assurance visits and support in managing adverse events and complications. In addition, PSI Cambodia creates demand for these high-quality providers through its outreach programs. In return, providers agree to adhere to certain quality and reporting standards. At the end of 2019, there were over 200 Sun Quality Health Network providers.

In response to previously high unsafe abortion rates and related maternal mortality in Cambodia, PSI Cambodia began distributing a quality-assured and safe medical abortion product in 2010. Today, PSI Cambodia offers two legally registered and safe medical abortion products through its distribution channels of licensed pharmacies and clinics. PSI Cambodia supports providers at clinics and pharmacies through behavior change communications sessions in person and by phone to ensure that they offer women correct and complete counseling for using medical abortions. PSI Cambodia also offers a hotline that women can call if they have any questions on safe abortion or sexual and reproductive health in order to ensure that they have received safe treatment and post-abortion care as needed. The hotline also provides information on post-abortion sexual and reproductive health and referrals for contraception as needed.

PSI Cambodia began its work fighting HIV in 1993 when it partnered with the Royal Government of Cambodia to implement the 100% Condom Use program. In 1994, PSI Cambodia successfully launched a social marketing campaign for Number One Condoms with the goal of reducing the spread of HIV and other sexually transmitted infections and improving access to contraception in Cambodia. In 2005, PSI Cambodia introduced a second condom brand, OK condoms, as a part of its OK-branded reproductive health products and services which are targeted at sexually active men with the lowest socio-economic status. That same year, PSI Cambodia also launched co-packaged condoms and lubricant sachets, now branded as OK Plus, to offer a product specifically designed for men who have sex with men and transgenders who engage in commercial sex. For the past 20 years, PSI Cambodia has been a very active condom distributor in the country and currently it holds a strong market position with over 70% share of condom market in terms of volume.

Beyond the marketing of condoms, PSI Cambodia has also expanded its portfolio of products to include OK oral contraceptive pills (1997); OK injection, a 3 milliliter injectable contraceptive (2002); Medabon brand medical abortion pills, IUDs and implants (2010); Eva Marvelon oral contraceptive pills (2012); and Next72 emergency contraceptive pills (2013).

In 2015, the Cambodian Ministry of Health announced that they would like to increase the percentage of women using a modern method of contraception even further, from 39% to 51.5% by 2020. This means that Cambodian women need access to a range of reproductive health products at reasonable prices from a source that is trusted and sustainable. PSI Cambodia aims to provide such products and improve the health of low-income and vulnerable Cambodians through sustainable market-based solutions in collaboration with the Royal Government of Cambodia. As donors move away from subsidizing health commodities, it is critically important to have stable, established, sustainable markets in place for these essential products. By prioritizing the achievement of cost recovery for all short-term methods of contraception, PSI Cambodia has moved away from subsidized prices and is working with the Cambodian Ministry of Health and other key stakeholders to increase access to quality health products in a sustainable way for Cambodians.

PSI Cambodia launched its malaria program in 2003 with the introduction of malaria test kits, branded as Malacheck, and anti-malarial drugs, branded Malarine. In 2006, insecticide-treated nets, or Malanets, were added to complete the portfolio of products made available through private-sector outlets across the country. As the malaria epidemic in Cambodia has changed, so has PSI Cambodia’s response and role. Though no longer operating through the private sector or selling malaria-related products, today PSI Cambodia works across 17 malaria endemic provinces in Cambodia and continues to work in close partnership with the National Center for Parasitology, Entomology and Malaria Control (CNM).

Cambodia’s focus is now on malaria elimination, with forest goers and other mobile migrant workers the highest priority for both CNM and the international health community, in order to eliminate anti-malarial medication resistant malaria in Cambodia. To support elimination efforts, PSI Cambodia delivers malaria programs on remote worksites through mobile malaria workers who test and treat suspected malaria patients. PSI Cambodia staff provide monthly technical and material support to mobile malaria workers in exchange for data they have collected on the malaria caseload at their worksites which is reported directly to local health authorities and CNM. In addition, PSI Cambodia is moving its activities closer to the forest where the remaining malaria cases are found, using community engagement and as a technique to empower communities to support the malaria elimination efforts, and to continue to find, test and treat the hardest to reach cases.

In addition, under the Global Fund Regional Artemisinin Initiative 2 Elimination project, PSI Cambodia and three international consortium partners provider technical assistance to the government to implement a core packages of malaria elimination services in eight provinces.