Eliminating measles and strengthening health services in Cambodia

April 2013

Cambodia has found a way to immunize more children against measles and improve access to other health services.

Immunizing the last 20%

Cambodia almost doubled the number of children being immunized against measles in the ten years after 2000. But by 2011, 20% of the country’s children were still not getting even the first of the two vaccinations they need to protect them from measles.

An immunization outreach event in rural Cambodia, targeting populations often missed by health-centre-focused campaigns.
WHO/R. Duncan

In 2011, the WHO helped Cambodia’s National Immunization Programme use two nationwide measles immunization campaigns to check the vaccination status of women and children and to map out which communities were at highest risk of missing out on immunization. Most proved to be poor, and many were from ethnic minorities and internal migrant populations – groups who often found it hard to access regular health services.

If children were unable to come into health centres to be vaccinated, it became clear that the Programme would have to work harder to take vaccinations to the children.

It identified 1600 communities where children were not getting vaccinations, and set up a system linking health centres with local health volunteers.

“Many communities that previously had no health outreach visits [are] now receiving regular services.”

Dr Chham Samnang, WHO

“Reaching Every Community” outreach

Health centre staff communicate with local health volunteers by mobile phone. The volunteers, in turn, alert the community to upcoming measles immunization sessions. These sessions often take place in mobile immunization sites in market places or village leaders’ homes. Volunteers help health centre staff bring mothers and children to the session.

An invitation slip to an immunization outreach session in rural Cambodia.
WHO/R. Duncan

When children come in for their measles vaccination, health officials check whether they have been vaccinated against other diseases. They can then ensure that those children catch up on missing immunizations.

From routine immunization to other health services

This new “Reaching Every Community” strategy both helps increase vaccination coverage, and address challenges of improving overall health service delivery. New guidelines from Cambodia’s Ministry of Health propose integrating other health services into immunization outreach.

“The new focus by the National Immunization Programme in targeting immunization services to communities most at risk is having a real impact,” says Dr Chham Samnang, WHO’s National Technical Officer, High Risk Communities and Measles Elimination. “Outreach health services to these communities are improving. Health centre staff are now better skilled to identify, provide services to and monitor immunization levels in these communities, and the linkages with village health volunteers are having benefits for community health beyond immunization.”

Immunization programmes give health workers the chance to reach people with other important services such as antenatal care and post-natal visits for mothers, which can include advice about contraception. They also provide a way to educate families about childhood respiratory infections, and to distribute vitamin A, oral rehydration salts and zinc to treat diarrhoea.

A rural Cambodian child is vaccinated during an immunization outreach campaign focused on finding “missed” children.
WHO/R. Duncan

Professor Sann Chan Soeung, Advisor to the Ministry of Health, recognises the challenges in integrating other health services into routine immunization, but notes: “What we’re doing now is the interim step to getting to universal health coverage.”

Cambodia’s National Immunization Programme reported no measles cases for a full 12 months up to December 2012 – down from 700 reported cases in 2011. And the wider health benefits continue: “Many communities that previously had no health outreach visits [are] now receiving regular services,” says Dr Chham Samnang, WHO’s National Technical Officer, High Risk Communities and Measles Elimination.