Cambodia: Resilience and Nutrition Security

The action is focused on the impacts of COVID-19 on the Tonle Sap region and includes districts with the highest number of returned migrants. Returned migrants are specifically targeted by the action for inclusion in training and business development opportunities, either to start their own small business or for employment with service providers to existing small and medium agro-

enterprises. The action utilises a market-systems approach to boost the production of high-value products and add value in the horticulture and poultry value chains. Linkages are strengthened with buyers, who are technical partners, in order to increase sales and thereby income for small and medium enterprises. PIN is working with various beneficiaries such as agricultural cooperatives (AC), producer group (PG), framer trainers, local vet shops, chick producer, demonstration farms, slaughterhouses, veterinary companies, and social enterprises. The project aims to contribute to inclusive economic recovery in the Tonle Sap region by improving food security, income, and employment opportunities for fishing and farming communities and returnee migrants, by leveraging existing relationships with the private sector and local civil society partners to further strengthen value chains by linking producers, processors, and buyers of the products. The project ensures that smallholder farmers and fishers have increased food production and consumption in the horticulture and livestock value chains through their use of effective agricultural practices, products, and services. Returning migrants and laid-off workers in COVID-19 affected sectors have improved access to market relevant skills, affordable finance, and social protection.

Every year, millions of Cambodians are affected by natural disasters. In 2013, for example, more than 1.8 million people were affected by heavy rain and flash floods across 20 provinces, causing more than $350 million in damage. Unfortunately, extreme-weather events are occurring with more frequency and intensity due to climate change. Thanks to funding from the Swiss Agency for Development and Cooperation (SDC), PIN, in collaboration with ActionAid Cambodia, is helping at-risk populations in Cambodia avoid floods and droughts with early warning information and dissemination systems. PIN’s activities with the DRAW Project have a focus on the Early Warning System 1294 (EWS1294), which was launched in 2013 and is now scaling up. EWS1294 alerts people in high-risk areas before disaster strikes. Today, EWS1294 has more than 80,000 users, covering some 200,000 individuals in 11 provinces.

PIN has received the SanMark grant of the Cambodia Rural Sanitation and Hygiene Improvement Program led by Plan International through the Global Sanitation Fund. PIN has received this funding through having experience in both WASH behavioral change and promoting sustainable markets for socially beneficial products in rural Cambodia.

Many households in rural areas of Cambodia still do not have access to adequate and improved sanitation, which can lead to health problems for children and vulnerable people through ingesting contaminated food and water. An estimated 34% of children under-5 years old are stunted. In 2015, an estimated 40% of people in Cambodia still practiced ‘open defecation’, which is primarily due to a lack of adequate sanitation facilities.

The project aims to promote the use of latrines and increase the number of ‘Open Defecation Free’ villages within the rural target area. The SanMark approach aims to facilitate and enable local markets of sanitation products through both creating demand to purchase latrines among households, while also teaching businesses how to construct latrines. Household demand is promoted through a health education approach in target villages.

PIN is focusing on increasing the sustainability of the market for sanitation products through capacity building of local sanitation businesses. PIN’s support for local business includes components such as entrepreneurial training, book keeping, and marketing in surrounding villages.

Every year, thousands of Cambodians are affected by natural disasters. In 2013, more than 1.8 million people were affected by heavy rain and flash floods across 20 provinces causing more than US$350 million damage. Between 2015 and 2018, more floods occurred during the rainy season, and droughts during the dry season, causing major damages to several households’ livelihoods. These type of events are unfortunately likely to occur again in the future, and possibly with more intensity due to the changing climate. Thanks to funds from SDC, PIN in collaboration with Action Aid Cambodia are improving the access for at-risk populations in Cambodia to floods and drought early warning information and dissemination systems. PIN’s activities with the DRAW Project have a focus on the Early Warning System 1294 (EWS1294), which was launched in 2013 and is now scaling up. In the specific, people in risk prone areas who have registered to the EWS1294 can receive warnings that are timely and potentially lifesaving. Today EWS1294 has over 80,000 users, thus covering over 200,000 individuals in 11 provinces of Cambodia.

To further contributing to building the resilience of urban and rural communities in Cambodia, PIN took over the lead of the consortium of the ECHO funded project to build disaster resilient communities, working alongside ActionAid Cambodia and Dan Church Aid. PIN is currently engaging in activities with both institutions involved in Disaster Management and Disaster Risk Reduction, and communities affected by frequent disasters. At the institutional level, the Project Team is ensuring that national-level stakeholders increase their leadership and coordination, while authorities at the subnational level in urban and peri-urban areas increase their capacity in community based disaster risk reduction. At the community level, PIN is conducting promotional activities on DRR and the EWS1294, and continues the system’s scale-up process. Lastly, PIN and the Consortium are also working on the development of a cash transfer app, to ensure that disaster affected population has quicker access to emergency cash assistance.

In order for EWS1294 to actively function, with funds from USAID, PIN successfully installed six new prototype versions of the Tepmachcha devices in targeted flood prone areas of Cambodia. The Tepmachcha flood detection device is a solar powered, cellular data connected, sonar stream gauge, designed to record water levels in rivers and streams in Cambodia and send nearly instant early warning messages via mobile phone to people in affected areas. The devices are connected directly to PIN’s EWS1294 Early Warning mobile phone alert system and are providing near real time water level data in six different provinces across the country.
During this project, PIN’s Disaster Management and Innovations Teams were able to increase the coverage of the flood detection to 4 further provinces (from the original 2 in 2016) and therefore contributed to improving extreme weather resilience for more than 40,000+ people in the designated areas.

PIN conducted a research report for UNICEF to understand the situation of climate resilience of water, sanitation and hygiene (WASH) systems in drought and/or flood prone areas of Cambodia.

Changes to water systems in Cambodia are expected to increase the rate and severity of flooding and drought, which will significantly impact public health, especially in vulnerable populations. Flooding can cause the spread of pathogens and contamination to water sources, whereas drought can impact hygiene practices. Cambodia’s vulnerability to climate change is due to the fact that 80% of the country is within the Mekong River Basin, which experiences large fluctuations of water levels between the wet and dry seasons. Additionally, Cambodia is ranked 165^th in the world for access to improved water, with huge economic and geographic disparities.

PIN’s report determined that flooding and drought cause significant impacts to livelihoods, primarily through reduced agricultural output (including causing livestock deaths). Droughts also affect hygiene practices, while flooding pollutes potable water supplies by overwhelming waste management systems. Both flooding and drought led to increased rates of open defecation, either from the flooding of latrines or a lack of water for flushing.

Nonetheless, PIN determined that implementing WASH systems could inoculate people from the risks caused by flooding and drought. The report also identified methods of practical improvements in resilience for community- and household-based WASH infrastructure.

 

In Takeo Province, People in Need has improved healthcare access and community infrastructure by building 3 health centres, and PIN also donated medical equipment for training HC staff in specialized eye care, diagnosis and treatment. Additionally, one primary school was refurbished in Takeo in (3rd quarter of) 2015, ensuring safe and suitable conditions for children to attend school.

The projects were implemented with the aim of contributing to positive behavioral change in relation to prenatal and postnatal care, nutrition and hygiene. We have also concentrated on training volunteers in the field of mobile health (mHealth) and key hygiene topics.

Koh Kong is a remote province located near the Thai border between the Cardamom Mountains and the Sea of Thailand.  Climate change impacts, especially irregular rainfall patterns, increased rainfall intensity, and dry-season drought, are having negative impacts on the sustainability of livelihoods in the coastal communities’. This, combined with the effects of destructive livelihood practices including over-fishing, and significant mangrove and rainforest deforestation, the level of vulnerability to the effects of natural hazard for the people living in Koh Kong is one of the highest in Cambodia.

The Disaster Resilience through Improved Education and Livelihoods (DRIEL) project works directly with communities in Koh Kong to improve their understanding of and resilience to environmental hazards and disasters and a changing climate. Starting in 2014 and going through 2018 the DRIEL project aims to impact nearly 40,000 people living in 46 coastal villages of Koh Kong province. Our approach is two pronged; our partner Save the Children works directly through the education system, building on the demonstrated capacity of school children to be potent agents of change in family and communities regarding livelihoods, environment, DRR planning, and other life-skill dimensions, while People in Need works directly with community members and local authorities simultaneously, to give them the basic tools and techniques they need to build concepts of resilience into their community structures and livelihoods.

Despite the progress in recent years, the province of Kampong Chhnang continues to have above-average newborn deaths (27 per 1,000 births) compared to other areas of Cambodia. The consequences of malnutrition are serious.
As part of the project, we have been training clinicians in clinical skills or nutrition education in communities to prevent acute malnutrition of children. Thanks to the project, we have also expanded our innovative messaging system (mHealth), which provides services to families to improve neonatal health.

Beginning in Kampong Chhnang Province in 2013, the Healthy Family Community project uses mobile phone technology to deliver health messages regarding maternal and child health. Mothers and pregnant women who have registered receive automatic prerecorded voice messages to their phone which are designed to improve health behaviours and increase health service demand. These messages provide information and advice on a range of topics, such as avoiding harmful traditional health practices, and improving nutrition of the mother and baby.

The first program implemented in Kampong Chhnang delivered messages for the first 28 days of the baby’s life. As a result of our mHealth programme in 2014: 64% fewer mothers used traditional remedies to treat their baby’s cord stump; 48% fewer mothers consumed alcohol after birth; Twice the number of mothers could recognise danger signs in their baby; Admissions of children to health centres increased by more than 2.6 times.

Due its popularity and success, a new expanded service will deliver messages for the first 1,000 days of life, spanning from pregnancy until a child’s 2nd birthday. This is known as the window of opportunity, whereby better nutrition can have a life-changing impact on a child's future and help break the cycle of poverty.

Recently we receive funding from UNICEF for expanding mHealth activities to Kratie province and have since begun training midwives on the First 1000 days, Healthy Family Community programme.

You can download more information here and here

Integral to its the community health promotion activities, PIN promotes healthy hygiene practices both within health centres and in the community. Together with social enterprise Wetlands Works!, PIN supported the pilot project of innovative flood proof latrines in a peri-urban community that is subject to annual flooding. In addition, PIN has partnered with Urban Poor Women Development (UPWD) to assess and improve the level of knowledge and awareness of hygiene practices within the impoverished communities of Phnom Penh. We have tailored lessons for community outreach based on our assessment of the knowledge, attitudes and practices of families within the community, in order to deliver the most relevant information to those who need it most.

PIN works to improve access and standards of health infrastructure in rural and disadvantaged communities. This has included construction and renovation of health centres, postnatal rooms and WASH. In the province of Koh Kong, we have constructed a health centre in a remote, hard-to-access area where people were forced to relocate from their homes and communities due to economic development. Previously, these communities had no choice but to travel long distances to access health care, and now approximately 1500 households will receive convenient healthcare as a result of this new centre.

Moreover we have a partnership with RWC (Rainwater Cambodia) in Koh Kong for implementing a subsidized water jars and latrines project. This has been supplemented by CLTS (Community Led Total Sanitation) activities promoting handwashing and safe water use.

People in Need provides quality training to improve the level of care focused on midwives and the staff of health centres. Training specializes in various areas such as resuscitation of newborn babies and infection control. In addition, PIN trained and supported health centres in the promotion of health care at community level. It focuses on the problems associated with breastfeeding and complementary feeding, holds cooking classes and demonstrations by mothers teach how their families prepare simple and nutritious meals.

In 2016 specialised training has taken place for health centre staff across two operation districts in Kampong Chhnang. Following that training, Post-Partum Hemorrhage and Anti-Shock garments (NASG) were donated to the HCs.