Mission

Through direct technical collaboration with the Royal Government of Cambodia (RGC) and health partners, strengthen institutional capacity and sustainable systems for preventing, detecting, and responding to public health needs.

Vision

All people in Cambodia, regardless of geographic location or socioeconomic status, live healthier, safer, and longer lives.

Principles

• Innovative: Foster a culture of on-the-ground innovation in delivery models for public health programs and encourage early adoption of the latest World Health Organization (WHO) guidance
• Inclusive: Address the needs of marginalized and vulnerable populations, with a particular focus on maternal and child health
• Passionate: Work as a team with urgency and purpose to execute the USCDC Cambodia Mission and achieve the Vision
• Proactive: Continuously monitor opportunities to be seized and risks to be addressed rather than waiting for events to occur
• Locally, regionally and globally engaged: Develop and maintain relationships with and leverage support from local, regional, and global partners to strengthen public health systems in Cambodia
• Science, research, evidence, and data based: Encourage rigorous and ethical research and collection and use of data and evidence to drive public health policy and programmes and achieve maximum impact while ensuring most efficient use of resources
• Strategically responsive: Address and respond to priorities of the Ministry of Health, particularly through alignment with the National Health Sector Strategic Plan 2016-2020
• Field focused: Provide on-the-ground technical support for programme implementation at facility/site level

Goals

• Accelerate reduction in the burden of communicable and non-communicable diseases
• Enhance health security and health system resilience
• Increase effectiveness and efficiency of public health systems
• Strengthen capacity of the public health workforce

CDC Key Officers

• Country Director: Robert Newman
• Deputy Director for Management and Operation: Meg LaFontaine
• Deputy Director for Programs: Vanthy Ly

Office Location

• Primary location: National Institute of Public Health, #80, 289 Samdach Penn Nouth St. (289), Phnom Penh, Cambodia
• Secondary location: U.S. Embassy, #1, St. 96, Sangkat Wat Phnom, Khan Daun Penh, Phnom Penh, Cambodia
• Field office location: Provincial Health Department, Prek Mohaleap, Svay Por, Battambang, Cambodia

CDC Cambodia-Funded Partners

• Royal Government of Cambodia’s Ministry of Health (MoH)
• National HIV/AIDS, Dermatology and STD (NCHADS)
• National Institute of Public Health (NIPH)
• National Center for Tuberculosis and Leprosy Control (CENAT)

CDC Cambodia Programs

• Division of Global HIV and TB (DGHT)
• Influenza Program
• Applied Epidemiology Training Program (AET) Program
• Cambodia Applied Veterinary Epidemiology Training (CAVET) Programs

Division of Global HIV and TB

DGHT Cambodia office works with USAID and other partners to implement the President’s Emergency Plan for AIDS Relief (PEPFAR). Launched in 2002, and co-located at the Royal Government of Cambodia’s Ministry of Health (MOH), CDC’s office consists of 16 technical staff (10 local employee staff; 6 US direct hires) assisted by a dedicated team of support staff. CDC Cambodia also draws on subject matter experts from its regional office in Thailand and its headquarters in Atlanta. The total FY 16 budget is approximately 6.2 million.

In addition to providing support at the national level, DGHT Cambodia also provides the Ministry of Health with direct support. Over the last 15 years, CDC Cambodia has proven a key partner on Cambodia’s path towards virtual elimination of HIV. DGHT Cambodia collaborates with the Royal Government of Cambodia, international agencies, and other PEPFAR partners to support:

Translating the Latest Policy into Programs

In 2016, Cambodia adopted the WHO¬ recommended Test-and-Treat policy, achieving a majormmilestone in the efforts aimed at mitigating HIV infection-related mortality and morbidity, by starting all people living with HIV/AIDS (PLHIV) on treatment immediately after testing positive, regardless of their immunological or clinical conditions at enrollment. This means better health outcomes for patients, and is a significant step towards achieving virtual HIV elimination efforts in Cambodia. We know from past studies that patients are more likely to be retained in the HIV care cascade if they start treatment immediately. CDC has supported MOH to update the treatment guidelines, necessary to implement this new strategy.

Another priority of Cambodia’s MOH is to scale up viral load (VL) testing country-wide. Previously, Cambodia only had one machine able to test viral loads of HIV patients, which limited Cambodia’s testing capability to about 20,000 tests per year. At the end of 2016, the National HIV/AIDS and Dermatology and STD (NCHADS) was able to acquire a second machine, and CDC has been providing technical expertise to NCHADS to expand the reach of viral load testing. The combined results from this expansion have been impressive. As of December 2016, Cambodia has documented viral load suppression on 81% of PLHIV and more than doubled the amount of tests conducted, with over 48, 000 tests taking place in 2016.

In addition, in 2015 and 2016, CDC supported the Cambodian Ministry of Health’s National Center for HIV, Dermatology and STIs (NCHADS) to implement a pilot of external quality assurance (EQA) for point of care rapid HIV diagnostic testing in four provinces at a total of 28 health centers and community based-sites. Nationwide expansion of the program by NCHADS is key for reaching the goal of 90% of all people living with HIV in Cambodia knowing their HIV status. Since 2014, CDC has also partnered with NCHADS to implement an intensive Continuous Quality Improvement (CQI) in four provinces, a program designed to improve patient care, which involves quarterly meetings of relevant staff at the national, provincial, operating district and site-levels for an interactive data review focused on improving quality of care. This program directly contributes to the goal of 90% of patients on ARV achieving viral suppression through a focus on patient retention.

Enhancing Strategic Information and Surveillance Systems

A core strength of CDC is its ability to develop, strengthen and evaluate surveillance and strategic information systems. These data systems provide an evidence base for decision-making as well as for targeting and implementing programs with maximum impact.

Tracking Patients through the Cascade

Reaching Cambodia’s ambitious long ter m goal of an AI DS-free generation will require moving from a system where data are collected in an aggregate manner to one in which individua l patients are tracked through the HIV cascade from diagnosis, to treatment , to documented treatment success – whic h is measured as suppression of HIV viral load. CDC is collaborating closely with the National HIV program as it implements this new approach, known in Cambodia as Integrated Active Case Management (IACM). Accomplishing this will require the development and deployment of information systems that allow tracking of individual patients using unique identification numbers, as well as staff trained to use the data to optimize the quality of care for each patient.

Implementing Tuberculosis Infection Control

Although the Cambodia MoH has made significant achievements, Cambodia remains one of the 22 high TB burdened countries. Tuberculosis poses high risks, especially to those with compromised immune system like those living with HIV/AIDS. In collaboration with other partners, CDC provides technical and financial support to CENAT to implement TB infection control activities. At the national level, CDC supports development of a guideline/standard operating procedure, and implementation mechanism. At the provincial level, CDC helps train service providers and funds procurements of personal protective equipment and educational materials like posters. Started in late 2014, CDC has supported more 17 health facilities with TB infection control implementation.

Strengthening Laboratory Quality Management Systems (Cambodia – LQMS)

A strong laboratory system is the foundation of a public health system. In collaboration with the MoH and other partners, CDC is working to develop a consolidated Cambodia-LQMS by combining the best practices derived from two existing models, and adapting the information to the Cambodian context. The country-owned program will take labs two years to complete. During this time they will participate in workshops that cover all the main components of a laboratory quality management system, and receive continual support from experienced mentors. At the end of the process, labs will conduct a final audit to see how far they progressed. The first phase of implementation will focus on 23 laboratories, with further scale-up planned. In addition, CDC is supporting two national reference laboratories, the NIPH and NCHADS Laboratories to achieve an ISO 15189 accreditation.

Building Partnership for Blood Safety

Strong partnerships are the foundation for public health impact and therefore core to CDC’s mission. CDC aims to foster mutually respectful collaborations, with all partners including USG organizations, to maximize investments for public health impact. One example of a current successful partnership is the interagency effort to assist the MoH’s National Blood Tra nsfusion Center (NBTC) to establis h a safe and adequate blood supply.

As a PEPFAR implementing agency along with USAID, CDC has partnered with the Australian Red Cross Blood Service since 2010 to help NBTC safely plan, collect, and deliver safe blood to where it is most needed to save lives. The Department of Defense Pacific Command has constructed 3 new blood centers in Cambodia, and construction of two more will begin in late 2017. The Global Fund has pledged to equip the new facilities. With the well-coordinated support of the USG and multilateral partners, NBTC is moving towards meeting Cambodia’s needs for a safe and adequate blood supply, and international accreditation.

Partnerships to Explore a Platform to to address Non-Communicable Diseases (NCDs)

The double burden of communicable and NCDs in low and middle income countries is well recognized and widely acknowledged as an important issue facing the health and well-being of citizens, and Cambodia is one of those countr ies. There has been substantial attention to communicable diseases, suc h as HIV, Malaria and Tuberculosis, but less resources have been invested to address NCDs, such as heart disease, stroke, diabetes and cancer. Currently, Cambodia does not have a platform on whic h to serve chronic NCO patients, and policy makers have little data to change this or attract more funding for this topic. In response, CDC is partnering with Duke-National University of Singapore to identify specific opportunities for strengthening healthcare services to manage chronic diseases in Cambodia, and explore mechanisms for linking service delivery platforms with others such as HIV and TB.

Global Health Security

Ten years ago, the international community joined together to create a new, comprehensive framework to prevent the spread of infectious diseases and other health threats. These are known as the International Health Regulations (2005) (IHR). The IHR are used by countries to prevent and control public health threats while avoiding unnecessary interference with international travel and trade. The regulations require that all countries have the ability to detect, assess, report and respond to public health events.

As part of their commitment to the IHR, participating countries agreed to comply with these rules by 2012. However by 2014, only about 1/3 of participating countries (64 countries) reported fully achieving the core capacities. Cambodia has not yet achieved the IHR core capacities. One way in which CDC is helping countries reach the goals of the IHR is through our work in global health security. CDC is currently working with its partners to actualize the IHR through the Global Health Security Agenda. The GHS Agenda is “an effort by nations, international organizations, and civil society to accelerate progress towards a world safe and secure from infectious disease threats; to promote global health security as an international priority; and to spur progress toward full implementation of the IHR.”

Cambodia signed on as a Phase II GHSA country in 2015 and the Government of Korea has committed financial resources to assist Cambodia to fulfill this commitment to reach IHR standards. In February 2017, CDC Cambodia secured $1.35 million from the Korean International Cooperation Agency (KOICA) for an initial 2-year (2017-2019) project to support the MOH’s GHSA/IHR goals within the following action packages: laboratory systems strengthening, surveillance, and health workforce development and combatting anti-microbial resistance.

Influenza Program

Initiated in 2006, an influenza program, comprising three staff members: an American director and two locally hired Cambodian nationals – a laboratorian and a budget analyst, focuses on surveillance of influenza-like illness and severe acute respiratory illness. This is in collaboration with the Ministry of Health’s Department of Communicable Disease (CCDC). CDC contributes to WHO’s Global Influenza Network; addresses the U. S. government strategy for preparedness, communication, surveillance, and response; and helps to build Cambodian capacity to respond to seasonal and pandemic influenza. In addition, CDC works with the Cambodian government and partners to identify and characterize circulating influenza viruses and to support early identification of novel influenza viruses such as avian influenza. Through CDC’s technical and financial support to the National Institute of Public Health Laboratory (NIPHL), the laboratory is on the verge of achieving National Influenza Center (NIC) certification by WHO.

Other Surveillance Systems in Cambodia

Infectious disease surveillance systems in Cambodia include the following: syndromic Cambodian Early Warning Surveillance System (CamEWARN), event-based, and influenza sentinel surveillance systems.

The Influenza Sentinel Surveillance System, as shown in the map, captures both outpatient respiratory illnesses (Influenza-Like lllnesses or ILI) and inpatient or hospitalized respiratory illnesses (Severe Acute Respiratory Illnesses or SARI) from various sites throughout Cambodia. This system is implemented with other respiratory-foc used surveilla nce systems and partners with CDC’s support.

Applied Epidemiology Training (AET) Program

Since 2011, CDC has supported the Applied Epidemiology Training Program (AET), a six-month Field Epidemiology Training Program (FETP)-like training program launched with support from WHO. AET aims to increase surveillance and response capacity within the Ministry of Health.

Cambodia Applied Veterinary Epidemiology Training (CAVET) Programs

CDC placed a resident advisor in Cambodia in 2014 to support AET (and eventually the Cambodia Applied Veterinary Epidemiology Training (CAVET), launched in 2012). The AET and CAVET programs are implemented with funding from the Defense Threat Reduction Agency (DTRA).

From 2010 to 2015, CDC collaborated with the National Immunization Program to establish population-based meningoencephalitis surveillance in two provinces and conduct a mass vaccination campaign for Japanese Encephalitis. In addition, in late 2016, CDC Cambodia collaborated with the CDC Atlanta Rabies branch and WHO to initiate a pilot project on integrated bite case management (IBCM) in a target province.

Laboratory Strengthening in Biosafety/Biosecurity

Through support from Department of Defense’s Defense Threat Reduction Agency (DTRA), CDC Thailand and USG DOD/Naval Medical Research Unit 2 (NAMRU-2), CDC facilitates annual certifications of biosafety cabinets at public health laboratories in Cambodia. All 40+ biosafety cabinets at public health laboratories in Cambodia are now certified annually.