Phnom Penh, Cambodia, 12 October 2006 - A new health survey from Cambodia reveals a dramatic increase in the number of children fully vaccinated each year. Today, 67% of all children are fully immunised, up from 39% just five years ago. Reforms in the national immunisation program and the broader health sector enabled Cambodia to cut its infant mortality rate by nearly half.
The Government of Cambodia mobilized a global health coalition to reach more children through routine immunisation. PATH, the University of Melbourne, UNICEF, the GAVI Alliance, and the World Health Organization (WHO) worked under the government's leadership toward a unified strategy that capitalized on the skills and experience of each organization. With technical assistance from partners, Cambodia's Ministry of Health identified weaknesses within its immunisation program and applied proactive management strategies to fill the gaps and bring lifesaving vaccines to more infants.
"The collective experience of our partners, combined with our commitment to the health of Cambodia's children, were central to achieving the improvements we see today," said Dr. Sann Chan Seoung, director of the national immunisation program. "Better management at all levels has not only enabled us to reach more children with vaccines in the short term, but it has helped us create sustainable solutions that will continue to impact the health of our communities."
Management reforms included integrating immunisation planning within the country's broader health strategy, along with microplanning at the district level to more efficiently allocate resources from funders like the GAVI Alliance. In 2001, Cambodia became Southeast Asia's first recipient of GAVI's Immunisation System Support, or ISS, funding. ISS funding is unique in that it is driven at the country level, allowing grantees to invest resources where they are most needed. Subsequent ISS funding, in the form of performance rewards, is contingent on country grantees demonstrating annual increases in coverage rates.
Immunisation is essential to reduce global childhood mortality, a priority emphasized by the United Nation's Millennium Development Goals. A recent Lancet article documented that GAVI ISS funding catalyzes increased immunisation coverage in poor countries and noted the pivotal role of public-private partnerships in global health. Such collaboration between governments, donors, and nongovernmental organizations was central to success in Cambodia. The government's leadership of its partners, along with its proactive management reforms, is a model that can be replicated in other poor countries and has the potential to impact other health interventions and areas of development. Higher rates of immunisation also benefit the broader health system through improvements in the logistics of health care delivery, such as transportation and infrastructure. Healthier communities also spur a country's social and economic growth.
"There is very strong evidence that immunisation is one of the best health buys," said Julian Lob-Levyt, executive secretary of the GAVI Alliance. "Cambodia is a great example of what can happen when health and immunisation partners align resources with the right strategies and political will to combat disease. This process creates a virtuous circle enabling countries to lift out of poverty and reach the health-related Millennium Development Goals."
Dr. Jean-Marie Okwo-Bele, director of the WHO Department of Immunisation, Vaccines and Biologicals, added, "The tremendous positive results achieved by Cambodia confirm that immunisation is highly cost-effective and is spearheading the development of public health worldwide. Immunisation is the cornerstone of interventions for reaching the Millennium Development Goal of child mortality reduction."
Health care delivery is particularly challenging in Cambodia, where only 16% of the population lives in urban centers. A 2004 analysis by PATH noted that 80% of childhood vaccinations are conducted in villages through health outreach programs. Since many standard vaccinations require more than one dose, follow-up by caregivers in these settings is especially difficult. In 2000, more than half of Cambodian infants receiving the first dose of DTP-3 (for diptheria, tetanus, and pertussis) did not make it back to the clinic for subsequent shots. Thanks to the reforms described above, 78% received the complete DTP-3 series in 2005. Likewise, full immunisation coverage in rural areas now matches that of the urban sector, where health services can be easier to access.
Rather than rest on the success of their efforts over the last five years, Cambodian health officials are looking ahead to ensure that even more infants are immunised and improvements in the system are applied across interventions to impact basic care. Infant mortality dropped by 40% in the last five years, but current rates estimate that one in 15 Cambodian infants does not survive his or her first year. Social mobilization and immunisation advocacy are top priorities in the government's campaign to sustain and build upon program improvements.
"With the growing availability of new and underused vaccines, as well as future advances in logistics and delivery, immunisation programs in developing countries will continue to be challenged," said John Grundy, project manager for PATH's immunisation activities in Cambodia. "But as we've seen through its accomplishments in recent years, the national program here has built a strong foundation for implementing reforms and proactive strategies to meet and overcome those challenges."
Details on immunisation coverage improvements, as well as other health sector statistics, can be reviewed in the 2005 Demographic and Health Survey. This document is a publication of the worldwide MEASURE DHS Project ( www.measuredhs.com), funded by the US Agency for International Development.
PATH is an international, nonprofit organization that creates sustainable, culturally relevant solutions, enabling communities worldwide to break longstanding cycles of poor health. By collaborating with diverse public- and private-sector partners, PATH helps provide appropriate health technologies and vital strategies that change the way people think and act. PATH's work improves global health and well-being. For more information, please visit www.path.org.
About the GAVI Alliance
An alliance of all the major stakeholders in immunisation, the GAVI Alliance includes among its partners developing country and donor governments, WHO, UNICEF, the World Bank, the vaccine industry in both industrialised and developing countries, research and technical agencies, nongovernmental organizations, and the Bill & Melinda Gates Foundation. It is estimated that more than 1.7 million early deaths will have been prevented as a result of support by GAVI up to the end of 2005.
GAVI's efforts are critical to achieving the Millennium Development Goal on child health, which calls for reducing childhood mortality by two-thirds by 2015. Of the more than 10 million children who die before reaching their fifth birthday every year, 2.5 million die from diseases that could be prevented with currently available or new vaccines.