PATH helps the Cambodian government increase access to immunization

Vaccines can prevent many life-threatening diseases, but getting them to infants and children in Cambodia can be challenging. Most women give birth at home, away from hospital or clinic staff who could vaccinate their newborns. Their families may be too focused on survival to make immunization a priority and bring their children to the clinic, especially if it is not close by.

In a health system still recovering from decades of war and civil strife, Cambodia’s health professionals, equipment, facilities, and financial resources are all in scarce supply. It’s no wonder that many children miss their best chance at a healthy start in life.

Over the last several years, PATH and the Cambodian government have made strides in breaking down barriers to immunization. Improvements at all levels of the health system, together with the introduction of a hepatitis B vaccine, are increasing the number of children receiving vaccines. In 2003, just 12 months after the government and PATH teamed up to increase immunization, nearly 25,000 more children were receiving vaccines per year. And by October 2006, 67 percent of all children in Cambodia were fully vaccinated—up from 39 percent just five years earlier.

What’s the plan?

We helped 12 health districts develop specific plans for increasing the number of children vaccinated. The plans help district health workers identify areas or populations missed by immunization services—and then spur them to find ways to fill those gaps. One district dispersed small vaccination teams to reach the farthest corners. The teams overcame transportation barriers by riding railcars, then taking motorcycles the rest of the way. By increasing coverage district by district, these plans also enable managers at the province and national levels to accurately project costs and allocate resources.

At the national level, we helped Cambodia become one of the first countries to complete a long-term plan for making immunization financially sustainable. The plan is a roadmap for Cambodia to achieve its immunization goals, and it is required by the GAVI Alliance, which provides funding to Cambodia’s immunization efforts.

Baby steps to birth dosing

People who are first infected with hepatitis B as infants are much more likely to become chronic carriers of the infection, which can cause liver cancer later in life. In Cambodia, many mothers pass hepatitis B to their newborns during delivery. Fortunately, it is possible to prevent mother-to-child transmission of the disease—with a “birth dose” of vaccine given within three days of delivery. The tricky part is reaching infants within three days of birth, because 90 percent of infants are born at home.

Starting in just one province, Kampong Chhnang, PATH and government health workers enlisted communities’ help in setting up systems for passing the word about new births. Now when health workers find out about a birth, they can make a home visit and deliver the vital vaccine.

By the end of 2003—only nine months after initiating the new systems—coverage rates in the province reached 40 percent, with more than 1,100 newborns vaccinated. The efforts also expanded to four additional provinces, accounting for about 30 percent of all newborns. In 2004 more provinces were added, increasing coverage to 72 percent. The government expected to reach all eligible children by the end of 2005.

Vaccination on demand

Most immunization strategies depend on the demand for immunization—parents’ eagerness to have their children vaccinated. We helped the national immunization program communicate the benefit of vaccination to families through radio and TV spots, printed materials designed for local audiences, engagement of local political leaders, volunteer networks that spread the word in their villages, and outreach through workplaces. In one district, these activities helped double immunization coverage in just a year’s time, bringing the rate up to 84 percent.

Sustainable change, amplified impact

The partnership between PATH and Cambodia has established sustainable plans and system improvements at the national level and tested new strategies for increasing immunization coverage. By partnering with the government and providing technical guidance, we helped forge successful strategies that are now being expanded into new areas. Soon, all children in Cambodia will have access to the best protection that modern science offers.

Photo: Philippe Blanc.