The end of 2019 offers a chance to reflect on a decade of progress in paediatric healthcare in Cambodia – and define AHC’s impact in the decade going forward.
In doing so, we’ve undertaken the exercise of articulating the intention and outcomes of our core activities, the long-term, sustained change they deliver, and implementing enhanced processes for measurement. Beyond definition, we aim to demonstrate this impact and the change we’re affecting aligned to our strategic goals.
From each child who walks through our gates and each student in our classrooms, to the studies published internationally and national policies and guidelines we inform, we hope to capture our impact from the individual, professional, community and societal level. In this bi-annual Impact Report, we introduce you to our impact model.
AHC's Impact Model
AHC tracks key output metrics to demonstrate impact across activities.
POLICY, GUIDELINES, AND TOOLS DRIVING CHANGE NATIONALLY
As a respected actor in healthcare nationally, AHC’s practices, methods, and interventions inform and contribute to policy and guidelines in Cambodia, accelerating the adoption of healthcare best practices to systemically improve patient outcomes.
Introducing Cambodia’s First Screening Tool for Developmental Milestones, cDMAT
In low-income countries like Cambodia, western tools and performance reference charts can be inappropriate and invalid when identifying and characterising functional limitations across social, language, cognitive, and physical skillsets in children.
Identifying a need for a culturally-adapted assessment tool, AHC hospital director Dr Pheaktra and board member Lina Saem Stoey co-developed the Cambodian Developmental Milestone Assessment Tool (cDMAT). The assessment tool facilitates early identification of delays and disability in Cambodian children using the the Denver Development Screening Tool (DDST II) milestones, modified for the Cambodian setting.
AHC is aiming for formal adoption and integration of the tool into protocol by the Ministry of Health. Already, international institutions like USAID, Humanity & Inclusion (formally Handicap International), Save The Children and United Nations Research Institute for Social Development (UNRISD) have endorsed the dissemination of cDMAT to other institutions in Cambodia. The tool has received support from the National Paediatric Hospital in Phnom Penh, and is listed in the World Bank database.
THE WIDEST REACH OF KNOWLEDGE DISSEMINATION
AHC’s commitment to evidence-based knowledge and data-based analysis results in robust research that solves national and international challenges in paediatric healthcare. Our research, regularly published in international, peer-reviewed journals, informs the hospital’s provision of care, contributes to the national dialogue on pressing healthcare issues, and influences child health on a global scale.
Study Reports Positive Impact of Pneumococcal Conjugate Vaccine in Cambodian Children
In January 2015, the Cambodian Ministry of Health introduced a pneumococcal conjugate vaccine (PCV13) to the national immunisation schedule, designed to prevent some cases of pneumonia, meningitis, and sepsis. AHC-COMRU investigated the effects of the vaccine’s introduction on pneumococcal colonisation, invasive disease and antimicrobial resistance in patients under five in AHC’s outpatient department.
The study indicated that three years after its introduction, the vaccine was having a positive effect: declines were found in both vaccine-type and multi-drug resistant pneumococcal colonisation, as well as in invasive disease.
"Impact of 13-Valent Pneumococcal Conjugate Vaccine on Colonisation and Invasive Disease in Cambodian Children" Clinical Infectious Diseases
"A Treatment-Decision Score for HIV-Infected Children With Suspected Tuberculosis" Pediatrics
"Towards understanding global patterns of antimicrobial use and resistance in neonatal sepsis: insights from the NeoAMR network" Archives of Disease in Childhood
"The cost-effectiveness of the use of selective media for the diagnosis of melioidosis in different settings" PLoS Neglected Tropical Diseases
BUILDING ORGANISATIONAL CAPACITY
AHC provides tailored training, technical support and ongoing mentorship to healthcare workers along the continuum of care to increase access and improve quality within the healthcare system. We ensure the support provided in referral hospitals, health centres, health posts, and villages equips and empowers healthworkers with the skillsets needed to carry out training within themselves, ultimately, ensuring sustainability.
Khna Po is a rural health centre in Sotnikum Operational District, approximately 40km from AHC. For more than two years, AHC's Health System Strengthening (HSS) team has been providing training and support to health centre staff.
Tep Ratanak, a registered nurse, is Khna Po's Health Centre Chief. We asked Ratanak how the ongoing support from AHC has affected knowledge, capacity and care at his health centre in this Q&A.
Q: How has the Health System Strengthening training impacted your work?
A: The training was really important for us as it gave us the knowledge we needed to provide neonatal resuscitation and other skills. This was especially important for our midwife as it gave her the skills that she needs to support mothers and children when delivering babies. In the past, the government has also provided courses about neonatal resuscitation, but through AHC’s Satellite Clinic we received the most up to date knowledge and techniques that have allowed us to provide more appropriate care.
ADVANCING CAMBODIAN INTELLECTUAL SUSTAINABILITY
As one of the few paediatric teaching hospitals in Cambodia, AHC partners with government-run facilities, medical and nursing schools and private clinics to train students and healthcare staff in the highest standards of paediatric care. Since our founding, we've provided a comprehensive range of paediatric education programmes across disciplines and grades that allow healthcare professionals to go on to practice and teach in each of Cambodia’s 25 provinces.
Educating Cambodia’s First Paediatric Surgeons
The majority of children in Cambodia still cannot access safe and affordable surgical and anaesthesia care when they need it, leading to preventable deaths or chronic disabilities. Beyond treatment, opportunities in medical education for healthcare professionals in paediatric surgery are limited, and often of varying standards. AHC is one of a limited number of institutions which offer both major and minor surgical treatments and specialised, hands-on education in paediatric surgery.
Seeing a need for surgical specialists in Cambodia, Prak Farrilend decided to become a paediatric surgeon. He's currently training at AHC in the specialty, and hopes to make a life of continuous learning to advance expertise in the country.
PREVENTATIVE EDUCATION FOR COMMUNITIES AND CAREGIVERS
AHC’s community-based, holistic healthcare initiatives deliver health education, increase access to care, address rural health inequalities, and ultimately, improve health outcomes. We partner with key actors and stakeholders within communities to provide health awareness events, first aid trainings, health screenings and other interventions that educate and empower children, villagers, and community health workers to decrease preventable illness.
In the hospital, AHC provides health education to caregivers of admitted patients to help them understand and address the underlying causes of childhood illnesses, as well as develop healthy habits and behaviors, through one-on-one and group sessions.
Photo Essay: Dental Education with the TEP Truck
AHC’s TEP Truck is a mobile dental clinic which travels to schools and villages in rural Cambodia to provide free dental treatment to children as part of AHC’s dental outreach programme. In the second half of 2019, AHC visited 28 schools, treating 172 children, and educating over 1,116 children in dental hygiene.
Simple interventions like providing toothbrushes and teaching children how to brush can make a significant impact on overall health. AHC’s dental outreach programme educated children on proper daily dental practices while distributing over 10,000 toothbrushes and 300,000 fluoride washes in 2019. AHC also educates teachers about dental hygiene, empowering them with the tools and training to regularly monitor the health of their student’s teeth.
This boy sits in the dental chair for the first time in his life. He is 10 years old and, like so many children in Cambodia, has poor dental health; he has rotting teeth that need to be pulled out. Serious treatments like this are common for a Cambodian child's first visit to the dentist.
Here, four young boys between the age of six and 12 have just received dental treatment from AHC’s TEP Truck. It was their first-ever visit to a dentist; all four required extractions of rotten and infected teeth.
PREVENTATIVE EDUCATION ATTENDANCES THIS SEMESTER
PROVIDING SECONDARY AND TERTIARY SERVICES AVAILABLE NOWHERE ELSE
AHC prioritises treatment of paediatric sub-specialities, a strategic response to the needs presented amongst patients and gaps within the country’s healthcare system. This specialty care includes treatments in tertiary facilities, like neonatal and intensive care, as well as outpatient-based specialty services, like oncology, cardiology and neurology. As one of the only healthcare organisations providing this service, we’re establishing its importance to drive progress in specialty and routine service provision.
Meet Our Specialist Volunteer, Dr Aymeric Lim
Aymeric Lim is a professor and orthopaedic surgeon at Singapore’s National University Health System. Professor Lim’s specialty is hand surgery, with a sub-specialisation in peripheral nerve surgery.
After first visiting AHC in June 2017 with his family, he began volunteering with AHC’s Surgical and Physiotherapy Units. He noticed there were many cases of palsy – specifically, Erb’s Palsy (obstetric brachial plexus palsy). Without a resident in-house sub-specialist to perform the corrective surgery needed for Erb’s Palsy, AHC was not able to operate on the condition. But because of Prof Lim’s volunteer efforts and the established skill of AHC surgeons and physiotherapists, there was potential to offer the treatment.
Today, AHC surgical and physiotherapy teams are able to recognise cases with the condition, schedule the corrective surgery for Prof Lim’s return trips, and continue to follow-up with patients through recovery and rehabilitation.
HOLISTIC, COMPASSIONATE CARE FOR ALL
Since AHC’s founding, the organisation’s vision has remained: that all Cambodian children have access to quality, compassionate medical care, wherever they live and whatever their ability to pay. Between our 19 interconnected departments, we provide over 135,000 quality treatments annually to patients from each of Cambodia’s 25 provinces – delivered by staff who treat each patient as their own.
