When the three-day child survival conference opens this morning in Phnom Penh, Cambodia will have a very simple message to communicate to international organizations and donors.
Despite progress made in some areas—such as a sharp decline in measles cases and the elimination of polio—Cambodia still has one of the highest mortality rates in the region for children younger than 5-years-old, and this is unacceptable, Health Minister Hong Sun Huot said last week.
Cambodia knows what to do to change this but cannot make it happen without support. “I will appeal to them to work directly with us to save our children,” Hong Sun Huot said.
A benchmark report prepared by the ministry in cooperation with the World Heath Organization, the UN Children’s Fund and other organizations will show delegates that, during the last decade, the mortality rate of children younger than five has been rising.
Titled “Analysis of Slow Progress in Child Mortality Reduction,” the document estimates that 95 out of 1,000 Cambodian babies die during their first year of life; and for every 1,000 children who survive, nearly a third do not live beyond their fifth birthday. Malnutrition plays a role in more than half of those deaths, it said.
The benchmark report mentions that barely one woman out of three gets a skilled birth attendant to deliver her baby. As a result, about 30 percent of child deaths take place right after birth because of birth asphyxia, infections, tetanus or premature birth. Priority should be given to post-natal conditions where progress could be made quickly, the report said.
Slowing the child’s death rate will mean an array of measures—from vitamin A distribution and deworming campaigns, to improving hygiene and providing safe drinking water and sufficient food—in addition to offering basic health services to the whole population, which still is not the case nationally, the report said.
“It’s a collective failure in spite of all efforts,” said Maurice Hours, health project officer for Unicef in Cambodia since 1993.
In 1998, the government adopted a strategy called Integrated Management of Childhood, said Hong Rathmony, vice-director of the Communicable Disease Control Department, though the program’s reach is still limited.
Launching the program has taken a long time because of the lack of funds and human resources, said Severin von Xylander, medical officer for the WHO in Cambodia.
“The health sector is largely funded by international donors, who have not really supported this program,” he said.
During the last decade, children’s health issues worldwide lost their appeal for country aid organizations, said Jim Tulloch, the WHO country representative in Cambodia.
“Donor agencies are looking for quick results because they want to be able to tell their constituencies that their money is producing an effect,” Tulloch said.
In the 1990s, single-disease programs such as HIV/AIDS, polio and malaria became popular among donors, Tulloch said.
In marketing terms, single-disease programs are simpler to promote, he said. The tuberculosis campaign was very successful; its slogan “Stop TB” was straightforward, Tulloch said.
But Integrated Management of Childhood, whose concept is to treat a child as a whole and not just for a specific disease, is much harder to explain, he said. It involves a series of steps health workers must follow when they see children—including checking whether they suffer from malnutrition, have been vaccinated and, if need be, taking appropriate measures besides treating illness.
“It doesn’t make sense to [treat children] disease by disease; for clinical reasons and also for pragmatic reasons, it’s more efficient to do them all together,” Tulloch said. “So this makes it obviously more complicated because you need the healthcare system functioning to some sort of level.”
Delegates from international organizations—including the World Bank; the Asian Development Bank; the Bill and Melinda Gates Foundation; and Britain, Japan and US aid agencies—will join government officials at the conference to examine the state of children’s health in the country.
