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Poverty is a root cause of a majority of the most commonly seen illnesses at Angkor Hospital for Children: lack of clean drinking water, malnutrition and low prevalence of good sanitation and hygiene practices all contribute to preventable child illness and death. 1 out of every 29 children born in Cambodia will die before his or her fifth birthday–one of the highest child mortality rates in the region. During the Khmer Rouge regime from 1974 to 1979, an estimated 1.5 million Cambodians were killed, and the educated classes were target. As a result, there were only 50 medical doctors in Cambodia in 1979, most of whom fled as soon as possible. The healthcare system collapsed; healthcare facilities were decimated and self-sufficiency (including healthcare) became a way of life. Angkor Hospital for Children is playing a part in the system’s recovery by providing healthcare education to students, graduates, medical staff (AHC and government employees) and conducting outreach programs in schools and orphanages. AHC is also working with communities so community stakeholders and families have a better understanding of basic healthcare.
The overarching theme of the health programme that cuts across all interventions is community engagement and empowerment. AHC community teams will work with community members to help them determine, prioritise and solve neonatal and child health problems within their own communities, leading to empowerment and sustainability of the programme. Comprehensive quantitative and qualitative data will be collected throughout the programme to determine the effectiveness of the implementation strategy. This data will be used to identify the key steps and methods in establishing a community program for the reduction of neonatal mortality and childhood morbidity, in order that the process is transferable to different geographical locations. At the health centre level, simple, low-cost, and proven interventions will be rolled out including an evidence based neonatal programme and establishment of Baby Stablisation Areas (BSAs) in each of the district’s 25 health centres, building the capacity of government health centre nurses through nursing process training, and implementation of an infection prevention and control programme. Screening, identification and referral procedures will also be improved for common childhood problems including for example malnutrition, common eye diseases, and child abuse. The focal point of school level health interventions is a mobile school health clinic which will travel to each of the 65 public primary schools in the district. The mobile health clinic team will comprise of a nurse, dental technician, and school health educator. School level interventions will focus on the prevention of common causes of childhood morbidity through improvements in school health and hygiene curricula, training teachers, and peer to peer education. The project will directly benefit 24,960 neonates, 61,800 primary school aged children, and 150 nurses. Indirectly, all children within the district will benefit from improved knowledge, behaviour and capacity of parents, teachers, and health care workers to address children’s health needs as well as improved health services in schools and health centres. It is expected that at the end of the project there will be a significant decrease in the neonatal mortality rate in the target communities. Results of the programme will be published in peer review journals and shared with the Ministry of Health in order to facilitate the implementation and rolling out of the program in other areas in partnership with the government of Cambodia.