Transcript Dia 1

The Context and Background
for Programming in Resource
Constrained Settings
CMBH83
CMB – H83 Project OUTPUTS
Output 1

Hold inception meeting of stakeholders, to
Output 4
 Establish models of coordinated, communitybased best practice approaches and techniques
discuss development of Drug Abuse treatment
and rehabilitation services
Output 2

Establish Drug Abuse Prevention Interventions
Output 3

Output 5
 Increase the reach of information and services
to those vulnerable
Improve capacity of service providers
Output 6
 Select the best practices of service and training
protocols developed by the project for adoption
in Cambodia
Direct benefits
To Problem Drug Users: (strengthening the Continuum of Care)
• Assessment of mental and physical condition
• Peer based and other appropriate Counselling
• Community based Detoxification services, home-based care and
formation of support groups
• Assessment of treatment needs of and making appropriate referrals
To Affected Family Members:
• Understanding drug use, its consequences and their role as
care providers
• Formation of self-help groups/emotional support groups,
after care
To those at-risk of Drug Use:
• Prevention initiatives
• Peer Networks advocating healthy life practices
Project Office Cambodia
Project CMB-H83
Capacity
Building
for
Gathering
Evidence
Gathering
Evidence
Implementing
Integrated
Interventions
Based
On
Evidence
A
B
C
Memoranda of Understanding with NACD and MoH
Time-line: Phase A
January – August: Coordination Mechanisms National
and Provincial (PDCC)
January 2007
Q2
Clarity
• One national technical
working group
• Technical sub-working
groups on:
Community based
survey & data
management
• Technical sub-working
group on: Counseling,
Treatment and
Reinegration.
• 15 Master trainers
August – December: Capacity Building –
National , Provincial and Grassroots
Q3
Confidence
• Memoranda of
Understanding with
NACD and MoH.
• Training by
International Expert
and National Master
Trainers to provincial
ToTs and grassroot
workers.
Q4
December 20
Competency
• 3 National workshops,
6 bi-provincial
trainings
• 300 persons trained
for evidence
gathering.
• Epi Data Software
developed
• 12 Data Entry
Operators trained
Human Resources- by number
240
250
200
150
100
50
4
15
24
12
0
International Master
Experts
Trainers
Provincial Provincial Data Entry
TOTs
Trainees Operators
Human Resources- by gender
195
200
159
180
160
140
120
100
Males
96
81
Females
80
60
40
20
11 4
14 10
MTs
TOTs
11 1
0
PTs
DEOs
Total
Human Resources- by sector
300
250
200
150
100
50
ea
l th
H
A
N
So
c
Ed ial
La
uc
w
at
En
io
fo
n
rc
em
O
th en t
er
G
ov
t.
N
G
G
O
ra
ss
ro
ot
s
To
ta
l
Sa
m
pl
e
CD
0
H um a n R e s o urc e s by s e c t o r
Time-line: Phase B
Survey
January 2008
Q2
Clarity
•3255 persons reached
•Qualitative and
quantitative data analysis
Dissemination
Q3
Q4
Confidence
•Two national
dissemination workshops
by NACD and MoH held in
May and June.
•Survey result
incorporated in three
country documents;
AUSAID HAARP report;
UNIFEM/UNDP Gender
Score Card and UNESCONACD Cambodia Drug
Treatment assessment
Integrated work plan
Q1
December 2008
Competency
•Provincial sensitisation
mission, selection of
Commune Counseling
Teams
•Focal points
identification at province,
district and commune
level.
•Outreach and referral
network established
Survey Details…
Health Coverage Plan
(MARCH 2006)
No. Province
1
Phnom Penh *
2
Sihanouk Ville
3
Banteay Meanchey *
4
Battambang *
5
Siem Reap *
6
Kandal
7
Koh Kong *
8
Pailin
9
Kampong Cham *
10 Kampong Chhnang
11 Stung Treng
12 Svay Rieng
Total
RH
1
1
4
5
1
10
38
O D
4
1
4
5
4
8
2
1
10
2
1
3
45
H C
37
11
4
75
4
89
2
5
135
2
1
3
559
RH: Referral Hospital, OD: Operational District, HC:
Health Centre, HP: Health Post
H P
2
1
53
7
60
1
13
2
34
10
37
19
3
3
10% sample
CLASSIFICATION OF COMMUNES: Anti Drug Police
Badly Affected Mod. Affected Not Affected
BLACK COMMUNES
(Badly Affected)-2
WHITE COMMUNES
(Not Affected)-1
GREY COMMUNES
(Modtly Affected)-2
24
180 60
12
25
H 83 BASELINE BEHAVIOUR
SURVEY-Q1, 2008
Cambodia-24 Provinces 12 Provincessurvey 180 Communes-selection by criteria
60 Communes- survey 25 Communes- Pilot
treatment and rehabilitation
Research Methods
3500
3000
2500
2000
1500
1000
500
0
KII
FGDs
Spot Maps
O-o-O Interviews
Geographical Coverage
500
450
400
350
300
250
200
150
100
50
0
Survey Provinces
Districts
Communes
Villages
Population Surveyed, N = 3255
Population Surveyed
3500
3000
2500
2000
1500
1000
500
0
Drug Users
Alcohol Users
Alcohol Partners
Target Group
Drug Partners
Total
Socio-demographic variables – Gender,
N = 3255
3500
3000
2500
2000
To tal
M ales
Females
1500
1000
500
0
Drug
Users
Drug
Partners
Alcohol
Users
T a rge t G ro up
Alcohol
Partners
Total
Marital Patterns - Drug Users, N = 1465
Unmarried (F)
2%
Ever Married (M)
38%
Ever Married (M)
Ever Married (F)
Unmarried (M)
Unmarried (M)
53%
Unmarried (F)
Ever Married (F)
7%
Socio-demographic variables – Gender,
N = 3255
3500
3000
2500
2000
To tal
M ales
Females
1500
1000
500
0
Drug
Users
Drug
Partners
Alcohol
Users
T a rge t G ro up
Alcohol
Partners
Total
Drug Use – Past Month use across Target Group, N =
754 / 1465
1600
1400
Ever Used Drugs
1200
Did not use in the past month
Used Once in the past month
1000
Used 2 - 3 times per month
800
Used 2 - 3 times per week
Used 4 - 6 times per week
600
Used about once a day
400
Used 2 - 3 times a day
Used 4 or more times a day
200
0
Frequency
Drug and Alcohol Use: Special Populations
300
250
Number
200
Total Number
150
Drug Using Special Populations
Alcohol Using Special Populations
100
50
0
MSM
IDU
Frequent DU
Female DU
Entertainment
Workers
Drug Use by Frequent Drug Users,
N = 300 / 1465
300
250
200
To tal
2-3 time a week
4-6 times a week
150
A bo ut o nce a day
2-3 times a day
100
4 o r mo re time a day
50
0
Frequency of Past Month Drug Use
Drug Type – (Past month use) by Frequent Drug
Users, N = 300 / 1465
140
120
100
Yama
Cannabis
Cannabis with A lco ho l
80
Hero in
Glue Sniffing
60
Ecstacy
Ketamine
40
Opium
20
0
Drug Types
Median Age Vs. Median Age of First Drug Use across Target
Groups, N = 1465
30
25
20
Age 15
Median Age of Drug Use
Age of First Drug Use
10
5
0
Drug Users
Drug Partners
Alcohol Users
Target Group
Alcohol Partners
Median Age vs. Median Age of First Use by Drug
Type, N = 1465
25
20
15
Age
10
Drug Type - Median Age of Use
5
Drug Type - Median Age of First
Use
Drug Type
ng
y
G
lu
e
Sn
iff
i
st
as
Ec
e
ta
m
in
Ka
e/
AT
S
m
a/
Ic
Ya
C
an
n
ab
is
um
O
pi
H
er
o
in
0
Substance Type by Population Groups, N = 3255
Survey Population
Number
Substance Most Used
Total DUs
1465
Yama/Ice/ATS, Cannabis
Female DUs
127
Yama/Ice/ATS, Heroin
IDUs
51
Heroin, Yama/Ice/ATS
MSMs
54
Yama/Ice/ATS, Cannabis
Entertainment
134
Alcohol, Yama/Ice/ATS
Sex Worker/Karaoke
82
Alcohol
Alcohol Abuse among Frequent Drug Users, N = 300
300
250
200
To tal
No A lco ho l A buse
150
M o re Serio us A buse/ Dependence
A buse / Dependence
100
P o ssible A buse
50
0
CAGE Category of Alcohol Abuse /
Dependence
HIV Test Rate, by at-risk group
80%
N = 134
70%
68 %
N = 127
60%
53 %
50%
40%
N = 54
35 %
98
29 %
30%
24 %
20%
10%
0%
MSM
Freq DU
IDU
FDU
EW
Distribution of Frequent Drug Users (N= 300) and Injecting Drug
Users ( N= 51) across Survey Provinces
60
50
40
Number of FDUs
Number of IDUs
30
20
10
BA
NTE
Y
ME
AN
CH
AY
BA
TAM
BA
NG
KA
ND
AL
KG
CH
AM
KG
CH
HN
AN
G
KO
HK
ON
G
PA I
L IN
PH N
OM
PEN
H
SIE
M
RE A
SIH
AN
P
OU
KV
ILL
ST U
E
NG
TR E
NG
SV A
YR
IE N
G
0
Province
Time-line: Phase C
February 2009: Intervention
January 2009
Q2
Clarity
• Outreach activity
schedule
• Identification of 176
focal points to
manage, monitor &
intervene.
August 2009: Evaluation
Q3
March 2010: End of Project
Q4
Confidence
• Reaching out &
Referring
• Aftercare & Relapse
prevention
• Formation of SHGs
Q1
March 2010
Competency
• More DUs reached
• Active interest in
change of situation on
ground
• Reduced DUs beyond
project life
From Baseline Survey (Q1, 08) to Initiating Treatment Services (Q1, 09)
Sr No.
Prov.
1
BMC
2
3
BTB
4
5
PNP
6
7
SRP
8
9
10
SHV
Commune
Total No. of DU- Q 1 2008
Rapid Survey (quota sampling) in
all villages of the commune
Behaviour Baseline
No. of
FrDU - Q1 2009
(4-6 times /wk to
4-6 times /day) in
50 most badly affected villages of the
commune
Treatment Baseline
No. of
FrDU- Q1 2008
(4-6 times /wk to
4-6 times /day)
POI PET ***>
40
14
40
PREAH PONLEA*>
29
6
23
ROTANAK
35
6
35
TA MOEUN*
34
7
73
TUL SANGKE**
38
15
48
TONLE BASAK***>
43
27
36
POUK*
36
1
13
SALA KAMREURK**
37
2
49
SANGKAT NO.4**>
56
24
47
SANGKAT NO.3**>
34
17
20
382
119
384
Total
Trend
can be
studied
over time
Note: * represents 1-5 Female Drug Users (FDU), ** represents 6-10 FDU, *** represents 11-15 FDU,
and > represents Injecting Drug Users (IDU), Frequent Drug Users are those who take drugs in the last
month 4-6 times a week to 4-6 times per day (FrDU). The trend indicates a need to have evidenced
based services within a short time frame as drug use patterns change rapidly on the ground and needs
repeated rapid assessments to monitor countrywide change in pattern. It needs an integrated
surveillance system planned at monitoring drug use and its consequences such as HIV.
25 HEALTH
REFERRAL
PRACTITIONERS
5
PROVINCES
10
COMMUNES
10 COMMUNE COUNSELING
TEAMS
32 FIELD OUTREACH
PRACTIONERS
-
MENTORED BY 6 PROVINCIAL
TRAINERS
Commune based treatment
Comprehensive
Package of
Assistance
Operational
District
Hospital
Health Center
Health
Centre
Chief
Health
Management
Committee
Team leader (CoC)
Drug Treatment
Centre
Outreach should provide
better access and
accessibility than treatment
centres. Outreach should
also be better positioned to
serve vulnerable
populations such as sex
workers and drug users
with HIV. The difference is
medical response vs.
Providers of minimum
social response. The
package of assistance
current challenge is piloting
for scale
Drug users and those who are
affected (family, community,
outreach
especially women
Referral
Hospital
Fostering Ownership