We are excited to share a new partnership between the Vision Catalyst Fund (VCF) and Clinton Health Access Initiative (CHAI). We are joining forces to help the Government of Cambodia strengthen the provision of non-communicable disease (NCD) services. This includes taking a patient-centred approach to integrating eye care into routine diabetes and hypertension screening and treatment.
In Cambodia, NCDs, including diabetes and hypertension, are among the highest causes of disease and death. In fact, 23 percent of all premature deaths in Cambodia are attributable to NCDs. Prevalence rises considerably with age—from the latest STEPS household survey in Cambodia, among adults aged 45-54, the prevalence of raised blood pressure is 22 percent while of raised blood glucose is 15 percent. These populations often disproportionately suffer from eye health conditions, such as diabetic retinopathy or cataract. Despite this, most patients are diagnosed late, if at all, and even fewer are taking regular medications.
The Royal Government of Cambodia has made a significant commitment to dramatically increase access to NCD services through investments from the H-EQIP II (Health Equity and Quality Improvement Project II), which is a pooled donor and government funding mechanism. This presents an excellent opportunity to ensure that all Cambodians over the age of 40 are screened early for NCDs and can access lifesaving and life-improving health services, including those related to eye health.
The partnership opportunity
By Dr Andrew Cooper, Chief Executive of Vision Catalyst Fund
The Vision Catalyst Fund (VCF) strategy globally involves building new financial mechanisms to unlock new capital, as well as integrating eye health with other development interventions such as other public health disease programmes, education, and employment initiatives.
VCF is partnering with Novartis, an innovative investor in health systems strengthening. Novartis expressed interest in strengthening the health system so that the patients in need of NCD care could be identified and treated. At the same time, CHAI approached us with an opportunity to support the Ministry of Health of Cambodia to meet Cambodia’s ambitious commitment to scale up NCD services, with a focus on the whole patient’s needs and building government capacity for long-term change.
Like many, I feel ever more convinced by health programmes that adopt a patient-centred and integrated approach. Over the past thirty years, too often, health services in low- and middle-income countries have been delivered in isolation to others. It is a lot of effort for a patient — and especially the more vulnerable ones — to come all the way to a health centre or hospital, with the risk of being negative for that one condition. Instead, integrated programmes build an innovative patient pathway for which populations can be screened simultaneously for the most prevalent diseases in the patient’s age group or for which comorbidities are common (e.g. if a patient has diabetes, his eye health should be screened). However integrated programmes are complex to plan, implement and monitor at high levels of quality.
This is why this partnership with CHAI and the Ministry of Health of Cambodia is so meaningful. This programme will not only support the government’s efforts to alleviate the scourge of NCDs and eye health issues in Cambodia but also help improve the health system in the long run.
In addition, thanks to the OneSight EssilorLuxottica Foundation, the Vision Catalyst Fund has donated glasses and lenses to CHAI Cambodia to support eye health work for the most economically disadvantaged. This contribution will enable CHAI and the Cambodia National Eye Health Programme to serve the most vulnerable people and direct resources toward systems strengthening work. ATscale, a global partnership driving access to assistive technology around the world, has provided funding to kickstart the work.
A systems’ change approach
By Giselle Hadley, Deputy Country Director (Cambodia) at Clinton Health Access Initiative
At the core of CHAI’s values is a deep commitment to driving transformative change through a government-owned and sustainable approach. For this work, we are embedding staff into two parts of the central government of Cambodia: the Preventive Medicine Department, responsible for NCDs, and the National Programme for Eye Health. CHAI will work hand-in-hand with our government partners to help deliver permanent access to treatment for Cambodians living with diabetes, hypertension, and eye health issues, with a focus on those over 40 years old.
In addition, we are basing one staff member in the Kampot Provincial Health Department. In our experience, working at the national and provincial levels allows for rapid learning and adaptation. Our staff will support health facilities to quickly test new initiatives at the provincial level and share feedback with policy designers at the national level on what is working and what could be improved. The lessons learned from this province can thus eventually help the Ministry of Health develop new patient pathways and processes countrywide.
The Cambodia Ministry of Health is visionary in its ambition to integrate NCDs into its Universal Health Care journey. Decentralizing care for NCDs from approximately 15 per cent of health centres to almost 100 per cent in a few years will require a sustained joint effort and learning rapidly from early experiences. The embedded CHAI team will help build capacity for long-term change through training health facility staff and community volunteers, strengthening the availability of medication and supplies, introducing strong data systems to monitor progress, and building a body of evidence for integrating eye health services into NCDs.
Investing in Cambodia’s future
We are proud to be working together with the Cambodia Ministry of Health on this ambitious and impactful project. By leveraging our relative strengths as well as global and in-country networks, this partnership will catalyse a step-change in eye health and NCDs in Cambodia. Eventually, this model may also inform other countries wishing to take an integrated approach. By combining creativity, determination, and hard work, even the toughest challenges can be overcome.
Image on top: Rapid blood glucose screening in Takeo province. Photo courtesy of Clinton Health Access Initiative.