Capacity Building at a Systems Level PATH: Preventing Diarrheal Deaths in Cambodia Sarah Wright, RN, MPH Candidate in Community Health Sciences School of Public Health, University of Illinois at Chicago Background Elements of Success Discussion For children under the age of five, diarrhea is the second leading cause of death worldwide at 16% and a major contributor to hospital admissions at 40%. Only about 39% of children in developing countries receive the recommended treatment for diarrhea, which includes low-osmolarity oral rehydration salts (ORS) and zinc tablets. In Cambodia, that surmounts to about 2,300 child deaths caused by diarrhea per year. Most of these deaths are due to poor hygiene and sanitation, lack of clean drinking water, and malnutrition. In rural Cambodia, about 80% of the population is lacking access to clean water. Program for Appropriate Technology in Health (PATH) is a nonprofit taking steps in Kampong Thom, Kampong Speu, and Kandal provinces to address this dire public health issue. Overview: PATH was successful in properly implementing its project in order to create change. Of the VHVs, 60% stated they saw a decline in diarrhea cases being sent to local health centers; meaning children were being treated properly at home. In addition, the percent of mothers that stated they would provide ORS and zinc tablets to their children with diarrhea increased from 58% to 95%. Limitations: PATH’s program evaluation mainly included qualitative survey responses. However, even further evidence should be included in PATH’s evaluations and reports, in which tracking of diarrhea cases and deaths within each province should be the standard. Future Direction: PATH was expanding its project model to other provinces in Cambodia and to other countries, such as Laos and Myanmar. The VHVs’ education sessions were called Mother Classes, which automatically excluded men. PATH could educate fathers and male family members in the future to even further ensure sustainability. Resource Utilization PATH appropriately utilized several types of resources, including materials, people and networks, available health care services, and finances. PATH was able to use a local manufacturer to make ceramic water pots and then systematically distribute those pots equally among the community. PATH increased accessibility to preventative medications through improved distribution methods. Through proper networking, PATH had influence within the health system and enhanced quality access to diarrheal treatments. Local Partnership PATH was able to successfully create local partners with VHVs, district and local health care establishments and providers, and officials within the Cambodian Ministry of Health’s National Acute Respiratory Infection and Diarrheal Disease Control Program. PATH had clear set goals and actions that encouraged teamwork and relationship building. Positive outcomes, such as increased education and use of ORS and zinc tablets, were seen due to equal efforts made among all partners. Capacity Building at a Systems Level Through awareness and fortifying competencies, PATH was able to build capacities at a systems level. Nationally, MOH and PATH executed a new policy and collaborated with the district health care system and the local health system to follow those new guidelines. Connecting the private sector with public health efforts provided a long-term prevention strategy. Through a multi-organizational partnership, the systems that were in place to advocate, respond, and prevent diarrheal disease were strengthened. Policy Impact National Policy on the Control of Acute Respiratory Infection and Diarrheal Disease Among Children Under Five. PATH worked with the MOH in order to create this updated policy to help maintain investment on a national level and encourage best practices on a local level. Through policy established authority and expertise guidance, MOH and PATH were then able to orient and mandate evidence-based interventions with health district chiefs and health center staff. Interventions Policy Change: PATH worked together with the Cambodian Ministry of Health (MOH), and in 2011, a new policy was produced. Guidelines within the policy included having health providers abide by the WHO regulations for diarrhea care, increasing access to ORS and zinc tablets, and promoting community education about home care treatment methods. Education and Access: Education was provided to health workers and Village Health Volunteers (VHVs). VHVs included information about diarrheal disease within the community’s monthly Mother Classes. Access to the rotavirus vaccine, ORS, and zinc tablets increased through larger supplies at health centers and local distribution by VHVs. Safer Water: Working with VisionFund and Hydrologic Social Enterprise, ceramic water pots were made and distributed to families. Each family was able to pay the $20 fee over a span of multiple months. After the intervention, the percentage of households with ceramic water pots increased from 7% to 21%. In addition, 80% of those households stated they were still using the pots one year later. Conclusion Modifying health perceptions and behaviors can be challenging, but through advantageous partnerships and evidence-based interventions, PATH was successful in properly implementing its project in order to create change. Sources Baum, N. (2010). Resource allocation in public health practice. Health Services Organization and Policy: The University of Michigan. 1-8. Johansson, E. W., & Wardlaw, T. (2009). Diarrhoea: Why children are still dying and what can be done. UNICEF/WHO. Ministry of Health (2011). National policy on control of acute respiratory infection and diarrheal disease among children under the age of five. Kingdom of Cambodia. Ministry of Health: National Maternal and Child Health Center. PATH. (2006). PATH’s safe water project in vietnam and cambodia: Partnerships for commercialization of household water treatment and storage products. Seattle, WA. PATH. (2012). Combining forces in cambodia to overcome child diarrhea and pneumonia. Seattle, WA. PATH. (2012). PATH’s integrated approach to reducing diarrheal disease in cambodia: Combining prevention and treatment. Seattle, WA Rosensweig, F., & Schalk-Zaitsev, S. (2012). Lessons learned in organizational capacity building for health systems strengthening. Health Systems 20/20 Project, Abt Associates Inc. Bethesda, MD. Zahner, S. J. (2005). Local public health system partnerships. Public Health Reports. Madison, WI. 120. 76-83. Zeigler, D. W., & Babor, T. F. (2011). Challenges and opportunities implementing the WHO global strategy on alcohol. Policy Studies Organization.