Meeting to Collect Voices of Citizens on Emerging Priorities for Women’s, Children’s and Adolescents’ Health in Cambodia
Held at Bakan and Sampov Meas Operational Districts
Pursat Province, Cambodia
29th - 30th April 2015

The following recommendations and outcomes are taken from the Citizen’s Hearings held in Cambodia and organised by the Reproductive and Child Health Alliance Cambodia (RACHA) as part of the consultation on the new Global Strategy for Women’s, Children’s, and Adolescent's Health. On March 20, 2015, RACHA also conducted a consultation involving 33 representatives from 28 local and international health NGOs in Phnom Penn, the capital of Cambodia. 

The meetings were carried out in two sites of Pursat Province; one in Bath Kandal Village, Boeung Bath Kandol Health Center in Bakan Operational Districts (ODs); and one in Sampov Meas OD of Pursat Province. RACHA aimed to involve many people from different walks of life to ensure that it gathered a representative sample of perspectives.  

Amongst those present during the meetings were Members of the National Parliament Assembly for Pursat Province, Ministry of Health- Provincial Health Department Director, Bakan District Governor, Deputy Director of Provincial Education, Youth and Sports Department, Representatives from various Provincial Government Departments, Bakan Operational District (OD) Chief, Sampov Meas OD Chief, community and town leaders and village chiefs, Members of Commune Council for Women and Children (CCWC), Achars (clergy/Buddhist Pagoda Manager), Village Health Support Groups (VHSGs), Teachers, citizens, students and youth groups, and representatives from lesbian, gay, bisexual, and transgender (LGBT) groups 
 


RESPONSES FROM THE PARTICIPANTS AND CITIZEN RECOMMENDATIONS

Topic 1: Emerging priorities for women’s, children’s and adolescent’s health in Cambodia

  • The commune council has to develop the annual Commune Investment Plan (CIP)  in consultation with the community. So far, our priority activities focus on infrastructure (like building roads), but now with the commune budget being provided by the national level, it’s time for us to allocate funds  for maternal newborn, child, and adolescent health.  We encourage the community to help  implement  all the priority plan of activities, and as members of the community we have the right to involve and to monitor the CIP implementation. 
  • We are encouraged by traditional birth attendants, village health support groups, commune council members, and health care providers to deliver at health centers (HCs) but  some HCs  do not have waiting room, and room for post-delivery patients. Therefore, we need adequate health facilities to encourage women to come to the health facility. It would be good if HCs can also provide food for family members who take care of their patient.
  • Transport vehicles are very important for timely transportation of pregnant women and other emergency cases from the village to the health center or referral hospital. 
  • Health facilities must have an adequate number of trained staff. Modern equipment and materials are needed to diagnose and check for non-communicable diseases like cancer so that patients will no longer be required to go to other places for a check-up.

We need more information about the following:

  • Women’s and adolescents’ health and other health information, especially about physical changes among girls going through puberty.
  • Where to access information and assistance when confronted with reproductive health problems.
  • We expect health centers to provide the following:
  • Counseling from skilled, welcoming, and friendly health staff that young boys and girls can trust with confidential information.
  • A separate room for counseling adolescents to ensure privacy.
  • Services for girls who have suffered from rape or sexual violence, such as therapy, confidential counseling, and advice on use of emergency contraceptive and accessing legal assistance.  

We expect support from other government ministries and organizations:

  • To enable poor patients to access health services without discrimination, especially among those living in remote areas.
  • To promote education and strengthen the implementation of traffic laws and drug-related laws. 
  • To strengthen the implementation of laws related to sexual abuse and ensure that offenders will not get away with the crime by using their influence and money.  

Government Leaders - responses:

Her Excellency Em Pona, member of the National Parliament Assembly, said during the opening session that “the coordination and communication between local authority, the Provincial Health Department, the Provincial Youth and Sports Department, and other departments is still limited. As such, there is a need to have regular meetings to share, plan, and undertake collective implementation of priority activities for women, children and adolescents.” 

She also added that “in Cambodia, high child malnutrition rates are caused by poor water and sanitation. Studies have shown that many of the 162 million children under the age of 5 in the world who are malnourished are suffering less for lack of food than poor sanitation. This is a health issue that needs to be addressed in a collective way.” 

The District Governor of Bakan District said that “the services available for adolescent at health centers are limited. Even the term “adolescent” was not included in the existing community network.”  To increase community awareness, I would like to recommend that the Commune Council for Women and Children (CCWC) must include “Adolescent” and change it to Commune Council for Women, Children, and Adolescent  (CCWCA).  An appropriate package of activities should be defined and integrated into this component.” 

The Provincial Health Department Director of Pursat Province said that “the involvement of men in mother’s, children, and adolescent‘s health is very important". He added that the Baby Friendly Community Initiative and Baby Friendly Hospital Initiative must be strengthened and must work in unison in promoting exclusive breastfeeding and in enforcing the Sub-Decree.

Topic 2: Health influencing sectors

Government Ministries - Responses

The representative from the Ministry of Social Affairs, Labor, Vocational Training and Youth Rehabilitation said that there are many factories in Cambodia, and occupational health for workers especially for women and adolescents has been neglected by the owners while the government’s monitoring systems of private sector require development: 

“There is a need for multi-sectorial collaboration among  public, private and civil society to work together to  support health of women and adolescents by improving working conditions, regulations, and compliance to national and international standards in export garment factories and in other workplaces.  Access to health information and services among the workers must be looked into and child labor must not be allowed.”

Representative of Provincial Agriculture, Forestry and Fisheries Department:

"Training farmers to plant vegetables, fish raising, poultry raising to support and improve nutrition status of women and children is very important. We need to promote organic farming and control the use of chemical fertilizer and insecticide which harm people’s health"

From the representative of Provincial Education, Youth and Sports Department:

"There are many health messages included in the college training curriculum but we do not have enough time to review those messages;  and adolescents’ health has not been well addressed. With Provincial Health Department and other relevant departments, we will sit together to review and decide the important topics for both female and male adolescents. To move faster, we encourage CSO who implement their project at all level to help to disseminate the adolescents’ health messages wherever possible.” 

Public Health Facilities - Citizen Recommendations

  • Health care in Cambodia does not yet meet the needs of all people, in both urban and rural areas.. To alleviate this situation,  Health Care should be: available, acceptable, and affordable to the majority of people, and the available of health care should be of Good Quality.
  • Quality healthcare should include:  positive interpersonal aspects such as attitude of care providers toward the patients, comfortable, clean, and private amenities, appropriate technical aspects of care including effective counseling and a sufficient number of health staff, and adequate supply of clean water. The social aspect includes health information to communities and involvement by the communities. The health care providers in the private sector need to be regulated by the government to reduce medical malpractice that causes more harm to the patients.
  • User fee rates at public health facilities must be posted and visible to the clients, their families and the community to avoid staff overcharging patients.
  • Public health facilities must be managed like private ones; with shorter waiting times, welcoming and cheerful staff, and providing quality health services.
  • To improve the services of public health facilities, the government must increase the salaries of the health staff to motivate them to work efficiently and stop them from engaging in private practice during working hours.

Education and communication - Citizen Recommendations

  • Information about maternal, child, and adolescent health must be integrated into school activities to improve students’ awareness and understanding of general health and health issues. 
  • People need more information and communication about health to improve their health-seeking behavior.  People still wait until their illness becomes severe before seeking health intervention.
  • The Health Center staff must provide health information related to adolescents/youth. They must have good interpersonal skills, be client friendly, and make the service available and accessible 24 hours.
  • The Health Equity Fund is needed for the poor and equally important is making poor people aware on how to access the financial support.  
  • People must be educated on environmental cleanliness and the importance of keeping their environment clean. Food vendors and other private business must observe good-hygiene practices and sell only safe foods.
  • Promote organic farming and inform people about the harmful effects of using insecticides on consumers’ health. 

Topic 3:  Health, Gender and Human Rights

Citizen Recommendations

  • Health education for both women and men is needed. Men should be involved
  • Awareness of provider’s and client’s rights is still limited. There is a need to disseminate information on client’s rights and provider’s right to all people in Cambodia - Health providers must respect client’s rights and people must respect provider’s rights as well.
The services available for adolescent at health centers are limited. Even the term “adolescent” is not included in the existing community network
— Governor of Bakan District
Coordination & communication between local authority, the Provincial Health Department, the Provincial Youth and Sports Department, and other departments is still limited. As such, there is a need to have regular meetings to share, plan, and undertake collective implementation of priority activities for women, children and adolescents
— H.E. Em Ponna, Member of National Parliament Assembly
Men should accompany their wives and children to receive health services. But normally most of men refused to join the health education sessions
— Dr. Khoy Dy, Pursat Provincial Health Department Director
People’s awareness on the importance of sanitation is still a main concern in Cambodia. Providing education on garbage and waste management to all people including children in school is crucial
— Representative of Provincial Environment and Tourism Department
To improve global climate we must eliminate factory chemical wastes that may harm people’s health
— Provincial Industry and Handicraft Department representative
There is a need for hygienic latrines for all households especially among poor families and in schools. Access to clean drinking water is very important to reduce diarrhea especially among children
— Provincial Rural Development Department representative