As the world continues to grapple with the COVID-19 pandemic, the most important message remains relevant: preparation is key. For more than a decade, the Royal Government of Cambodia, particularly the Ministry of Health (MOH), the World Health Organization (WHO) and partners have been working to strengthen the health security system in the context of the overall health system. As we learn more every day about COVID-19 and how to tackle the virus, the country continues to improve its preparations.
“As long as the virus is circulating anywhere—in any village, province or country—everyone is at risk,” said Dr Li Ailan, WHO Representative to Cambodia. “Preparation always pays off. If we strengthen the health system, it will benefit us now and into the future.”
Collective action is crucial
In Cambodia and around the world, COVID-19 preparedness requires all of society to work together to isolate, test and care for people with COVID-19, as well as trace and quarantine their contacts. Information sharing and coordination between provinces, national authorities and international bodies is crucial. Local preparedness for the COVID-19 response has been a priority for the Cambodian MOH and WHO.
As part of these efforts, Dr Li participated in the joint MOH-WHO missions led by H.E. Dr Or Vandine, Secretary of State for the MOH, to advise provinces on COVID-19 preparedness and ensuring the continuity of essential health services.
Dr Li Ailan and Her Excellency Dr Or Vandine speak with health workers at the Cambodia-Japan Friendship Referral Hospital in Banteay Meanchey.
© WHO/Chor Sokunthea
“I have been honoured to join the missions to 12 provinces to date” said Dr Li. “In each province, governments and health authorities have made significant strides in preparing for community transmission. I was especially pleased to see the strong efforts that have been made to reach out to migrant workers, indigenous people and other vulnerable groups.”
MOH and WHO officials visited health care facilities, including provincial hospitals and operational health districts, as well as border crossings, quarantine centres and villages. They met with provincial governors, provincial COVID-19 committees, public health directors, commune leaders and health-care workers, from hospital staff to village malaria workers.
Health-care workers spoke about what a difference preparation made.
“At first, we felt nervous because the disease is deadly and contagious,” said Sok Vandy, Chief, Ampil Health Centre in Kampong Cham. “After we were trained, we felt more confident.”
Like many health workers, Sok Vandy, Chief of the Ampil Health Center in Kampong Cham, feels more confident now compared to the beginning of the COVID-19 pandemic.
© WHO/Allison Smith
Throughout Cambodia, health authorities, with the support from WHO, have focussed on a number of common priority areas, including multisource surveillance; early COVID-19 detection and contact tracing; health care preparedness; risk communication and community engagement; and intersectoral coordination and partnership at local and national levels.
Local solutions to local challenges
Each province has faced its own set of challenges. In March and April, more than 100,000 Cambodian workers crossed from Thailand into Cambodia, particularly Banteay Meanchey, Battambang and Siem Reap. With this influx of people, provincial authorities rapidly expanded quarantine management and testing services.
Across the country, WHO helped to train almost 3,000 members of the Rapid Response Teams (RRTs), who are public health staff, on the COVID-19 case definition, surveillance mechanisms, and contact tracing and management. In Kratie, similar to other provinces, the provincial health department quickly trained strong RRTs, improving the province’s surveillance and contact tracing capacity.
In Mondulkiri and Ratanakiri, local health authorities made special efforts to reach indigenous groups and hard-to-reach populations. Messages about how to prevent COVID-19 were broadcast in indigenous languages on social media, in radio broadcasts and even in loud speakers directly in the communities.
Provincial governments in Prey Veng and Svay Rieng developed relationships with health authorities in Viet Nam, coordinating and sharing information for a stronger response on both sides of the border. In case of a large outbreak, a district hospital in Svay Rieng is ready to be repurposed as a COVID-19 treatment centre.
In preparation for Pchum Ben, a major religious holiday in Cambodia, religious leaders and monks at pagodas in Kampong Cham, Stung Treng and Tbong Khmum were engaged to gather feedback on ways to keep worshippers safe, and to ensure they understood how their promotion of preventive health measures can protect their communities.
From left to right: H.E. Dr Or Vandine, H.E. Un Chanda, Governor of Kampong Cham, and Dr Li with the joint MOH-WHO delegation to Kampong Cham.
© WHO/Khy Lim
“Even though there is no community transmission right now, we had cases in this province before,” said Sem Chon, an advisor to a pagoda in Kampong Cham, “and so we are alert.”
In Kampong Chhnang, strong links between health centres and district hospitals meant people were efficiently screened at local health centres and referred to a district hospital if they had symptoms of COVID-19. Numerous individuals were screened, tested and reported in this way.
“Leaders in each province have innovatively applied COVID-19 prevention measures to their local context,” said Dr Li. “It is encouraging to see how they have risen to this challenge—while also continuing to deliver safe and essential health services like vaccination, pre-natal screening, and the detection, prevention and management of many other diseases.”
Despite the successes described above, several challenges to full preparedness still remain. Further efforts need to be made to improve public compliance with public health advice, build human resource capacity and ensure special protection of vulnerable groups.
We can all play a part
As provincial health departments and operational districts take a greater role in offering health services to Cambodians, multisectoral coordination and partnership at national and sub-national levels become even more important. Yet COVID-19 does not only demand a whole-of-government approach—it also demands a whole-of-society approach, where the public takes responsibility to prevent transmission.
Dr Li urged the public to remain vigilant and to comply with public health measures implemented by local authorities.
“Be a good citizen and protect yourself, your family and your community from COVID-19 by practicing hand hygiene and physical distancing. Avoid the three Cs: crowds; close-contact settings; and confined spaces. Healthy choices and protective behaviours can save lives and stop transmission.”