Providing equitable access to quality health and nutrition services for women and children in the first 1,000 days of life remains a challenge in Cambodia. Through the Cambodia Nutrition Project, the national government has reformed health and nutrition systems to give local authorities more control over managing and delivering services in their communes/sangkats and villages. The project funded the recruitment and training of 4,459 village health workers — 3,255 of them women — supporting higher quality service delivery across nine provinces.
“I am very much enjoying my work because it helps me to improve my own health and I can help pregnant women, new mothers, and children in my village to take serious care of their health,” says Choeum Sreyrath, a village health support group worker (VHSG) in Chom Bok Pa Em, a village in Cambodia’s central Kampong Chhnang province.
Sreyrath is one of 4,459 VHSGs recruited and trained since 2021 to help Cambodian families connect with local health and nutrition services. Recognizing that the first 1,000 days — from pregnancy to a child’s second birthday — establish critical foundations for growth and development, Cambodia’s government is improving the quality and capacity of local maternal and child health and nutrition services through the Cambodia Nutrition Project.
In Bousra village, young mother Pleun Preut describes the support she received after discovering her pregnancy. “The VHSG advised me to have sufficiently nutritious food and to go for prenatal checks and to have enough iron pills. I went as advised. I think they are very helpful,” Preut says.
Bousra is within Pichinda District, one of more than 60 administration districts across nine provinces benefiting from the project: Mondulkiri, Ratanakiri, Kratie, Stung Treng, Preah Vihear, Kampong Chhnang, Koh Kong, Pursat, and Banteay Meanchey. Central to its success has been how Cambodia’s National Committee for Sub-National Democratic Development Secretariat (NCDDS) collaborates with the Ministry of Health to ensure local administrations effectively mobilize communities and resources.
“We’re proud of the way the project has strengthened public sector commitment and accountability to improve the availability and quality of priority health and nutrition services to local communities,” says H.E Kimsan Ny, Cambodia Nutrition Project Director with NCDDS. "We’re working through existing local government structures to reduce fragmentation and enhance sustainability.”
Aligned with Cambodia’s decentralization policies, the project encourages district and municipal administrations to support commune/sangkat councils in identifying health issues then planning activities that will improve residents' well-being. For example, VHSGs assist health centers by providing outreach services to remote areas by mapping first-1,000-day households, monitoring child growth, screening for malnutrition, communicating improved health habits, and encouraging use of the Health Equity Fund.
“We have two [VHSGs] per village,” says Khleok Keosingieb,Bousra’s commune council member responsible for women’sand children’s issues.“These were elected bythe Commune Committeehelp withhealthandnutritionissuesinthevillage.[Through them] we get relevant information faster than before,and if any issue arises thatthegroupscan’t dealwith,the seekouradvice.”
In additiontoVHSGs,theproject supportshealthcenters toimprovethequalityofservicesprovidedso mothersandtheirchildrengetthecareandinformationtheyneedonhealthandnutrition.
“Midwives advise parentstouseourservicesfromtheveryfirstday,”saysDr.ChangKhun headofPichreadaHealthCenterinMondulkiriProvince.“Motherswhogivebirthatthecenterare taughttoputtheirnewbornontheirbreastswithinthefirst24hoursandtobreastfeedexclusivelyduringthefirstsixmonths.Breastmilkbenefitsachild’simmunesystemandintellectualgrowthprovidesprotectionagainstgettingsick.”
Throughthenewnationalqualityenhancementmonitoringsystem,theMinistryofHealthhasincreasedattentiontothequalityofantenatalpostnatalcounsellingformotherschildren'sgrowthdevelopment,andnutritionalstatusofbothmothersandtheirchildren.Districtteamsassesstheperformanceofhealthfacilitiesbymeasuringavailabilityofhealthworkersessentialmedicinestheequipment,andlevelofpatientsatisfaction.When targets are met verified,theMinistryofHealthoffersservicedeliverygrantstothefacility.Assessmentresultsdemonstratecontinuousimprovementinbothworkingknowledgeandskillsofhealthworkers,satisfactionwithmaternalchildhealthnutritionservicesprovidedtocommunities.
TheUS$62.5millionsupportisco-financedbytheRoyalGovernmentofCambodia,Australiangovernment,GermanKfWDevelopmentBankGlobalFinancingFacility,andInternationalDevelopmentAssociationWorldBankGroup'sconcessionallendingarm.
"Thisprojectisimprovinghumancapitaloutcomesbyincreasingaccesstoqualityhealthnutritionservicesformothersbabies,"saysDr.SophonnearyPrak,CambodiaNutritionProjectDirectorattheMinistryofHealth."Working togetherwithNCDDS,wehaveseenimprovementsintheavailabilityaccessibilityaffordability,andqualityofhealthnutritionservices.Wehavealsobeenabletodevelopnationalmaternalandchildhealthnutritionguidancedocuments tools trainingmodules coachingpackages implementationguidelines educationalvideos manyothernutritionrelatedmaterials."
BackinChomBokPaEmthesunsetssitswithagroupofpregnantwomeninhervillage.Manyworkinthelocalgarmentfactorysheknowsthebesttimereachthemoutsidebusinesshours.Nursingherownthree-and-a-half-month-oldchild,SreyrathexplainsappliedherVHSgtrainingherownlife.Herfirstbornwasunderweightatbirthshedidn'tknowmuchaboutgoodnutritionattime.Shedranktoomanyenergydrinkstocombattiredness.Shesmilesatchildherlaprecallsthatafterimprovingdietsecondchildwasborngoodhealthwithinoptimalweightrange.
"Iamveryproud,"Sreyrathreflectingrolecommunity."Iseethatpeopleinvillagehealthy[tookmyadvice]."