Restore funding for outreach to support community health

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A child with dengue fever is placed on a drip at the National Paediatric Hospital in Phnom Penh. Hong Menea

Here is a seemingly simple question: what is the world’s deadliest animal? Common answers are snakes, lions, crocodiles and hippos.

However, the correct answer is the mosquito.

Mosquitoes kill as many as 830,000 people a year, with two types carrying and transmitting dengue fever and malaria from one person to another, according to The Deadliest Animal in the World study by the Bill Gates Foundation in 2014.

There has been an outbreak of dengue fever in Southeast Asia in the first six months of this year.

There have been more than 6,000 cases in Singapore (including four deaths), compared to 3,000 in each

of the past two years, according to Singapore’s National Environment Agency.

Cambodia has suffered from an outbreak of dengue fever across urban and rural areas and in both the young and old.

According to the Ministry of Health, there were 13,843 cases, including 24 deaths, in the first six months of 2019. This is a fivefold increase from last year, with 2,530 cases, seven resulting in death.

The cause of the outbreak is due to the negligence of people in the early rainy season allowing stagnant water to collect, leading to the breeding of the Aedes aegypti mosquito larvae.

In particular, there is little awareness of dengue and a lack of community participation in taking preventative measures.

People are also ignorant of the importance of maintaining clean surroundings or of taking sick children to a health centre or hospital, instead of a private clinic, where the majority of owners are public health servants themselves.

But people in some areas complain that their health centre is not always open even if it should offer 24-hour access by regulation.

This is why people tend to go to private clinics first.

But should a patient become very sick, they then need to be rushed to the hospital, by which time it may be too late.

With regards to outreach activities conducted by health workers, they comply with Ministry of Health guidelines for local service delivery if donor grants are available, such as for vaccinations for children and mothers in rural and urban areas.

Outreach guidelines include the promotion of hygienic environments, clean water, care-seeking behaviour and the prevention of infectious and non-communicable diseases.

However, very few provinces have explicit budgeting for outreach activities at the community level.

If the health centre does not have the funding, officials will simply not provide such services.

Expand healthcare budget

The national budget law of 2019 already approved by the National Assembly for the Ministry of Health does not mention any specific spending for outreach activities.

The problem is that when outreach activities are not budgeted for, the risk of dengue outbreaks will only continue to persist, since they are the few programmes to educate people on preventive measures.

Health officials have always pointed to rapid economic growth as a major contributor to vector-borne diseases, when it is instead overcrowding and climate that provide the conditions for mosquitoes to breed and transmit disease.

For example, Europe’s cooler climate cannot support mosquito breeding.

Previously, local healthcare activities, including outreach, were funded mostly by development partners.

So when partner organisations pull funding, there is none from the government to continue them.

Therefore, the government should expand the primary healthcare budget to include community health activities so that health centre staff can be incentivised to conduct health education activities at the community level to contribute to reducing the risk of dengue outbreaks.

Like recently, the government has set up a subsidies programme to support pregnant women from eligible poor families from pregnancy to two years after birth, where each woman can receive up to 760,000 riel (around $200) per child.

This policy has been welcomed by Unicef, which is considering contributing to the programme.

Health centres that do not provide a 24-hour service should be fined.

Furthermore, as per decentralisation reforms, the commune chief, as head of the health centre management committee, should strengthen the services provided by such health centres.

Tong Soprach is a social-affairs columnist for The Post’s Khmer edition. Comments: [email protected].