New developments bring new challenges
Cambodia was among the seven countries in the Western Pacific Region that achieved measles elimination in 2015. The efforts took more than a decade of devoted action, while their impact went beyond health care into social and economic improvements of peoples’ lives. Yet, it was these same social and economic developments that brought also new challenges to the country, including reoccurring outbreaks of measles.
As the economy grows people tend to move more frequently within the country and internationally: working parents often leave children in the care of grandparents; garment factory and construction workers relocate to find employment; seasonal farmers migrate in line with seasons. Moreover, there are some groups of people who rarely have a permanent residence, such as those living in floating villages or homeless people in urban areas. This makes it difficult to provide adequate immunization services and has resulted in several outbreaks of measles since 2016, reaching a total of 684 laboratory confirmed cases in 2019. The emergence of COVID-19 pandemic amplified existing challenges, but also introduced new ones in dealing with communicable diseases.
Ministry of Health and WHO take action
To address the twofold challenges of measles and COVID-19, WHO engaged in numerous activities in line with national priorities and global developments.
First, to learn about reasons behind reoccurring outbreaks of measles, the Ministry of Health reviewed its National Immunization Programme (NIP). WHO contributed to various stages of this process. The review focused on international borders and urban areas, which have high levels of human migration and the highest number of reported measles cases. WHO experts joined teams in visiting districts and health centres in order to understand the situation. Moreover, WHO supported national health bodies in data management and analysis; resource mobilization for provision of services; and preparation of isolation wards/referral facility for patients. Upon completing the review, WHO was the major partner in implementing recommendations such as fixed-site, outreach, and high-risk community vaccination services as well as active case search, surveillance, and reporting.
Second, WHO assisted in developing strategic guidance on the continuation of immunization during the COVID-19 pandemic and a risk management plan covering potential developments. Finally, service delivery sites were equipped with supplies that protect health workers, enable safe waste disposal, and inform the public on COVID-19 preventive measures.
Achieving in the present and planning for the future
The review of the NIP produced more than 25 recommendations. In the medium term, they build a foundation for integrating the immunization programme into the 2021-2025 National Health Strategic Plan. In the short term, the review highlighted the importance of flexible immunization services – for example, immunization provision after parents come home from work or on weekends and holidays. Moreover, the role of village chiefs was emphasized in identifying new settlements; registering children for immunization; and sharing knowledge in communities. Finally, recommendations were made as to financial, organizational, and information management. As a result, Cambodia interrupted the large-scale transmission of measles and reduced the number of confirmed cases to 371 by October 2020. The reported cases of measles have fallen to the lowest levels in four years and the downward trend continues.
While the outbreak of measles has been suppressed, Cambodia has continued to report imported and sporadic clusters of COVID-19 cases. WHO support was pivotal in maintaining primary health care services, drafting guidelines for immunization during COVID-19, and providing protective equipment. In addition, WHO supported communication campaigns informing parents and caregivers that vaccination sites are open, and health workers were well informed on preventive measures. In this way potential fears were addressed and primary health care services maintained, while the number of confirmed COVID-19 cases was kept below 400 by December 2020.
The combined challenges of measles and COVID-19 outbreaks amplify the importance of cooperation and joint action. The Cambodian government and WHO will continue to move forward, contributing to the goals of the GPW 13 and aiming to achieve the SDGs by jointly addressing challenges and promoting health, rather than merely fighting disease.
Photo caption: A child receives vaccine at the health center.
Photo credit: WHO
