Action plan on Dengue Death Prevention In Battambang, Cambodia (5 years project)

Title: Action plan on Dengue Death Prevention in Battambang, Cambodia (5 years project).
Goal: Reduce dengue deaths by 50% by 2024 and achieve zero dengue mortality by 2027.
Key Points: Problem: High dengue burden, especially in children.
Causes: Late medical care, poor community awareness, limited training for health workers.
Strategies: Train doctors and nurses on dengue case management, Educate patients and families about early medical care and vector control.
Phases:
Phase I (2022–2024): Battambang Provincial Hospital.
Phase II (2025–2027): Expand to six referral hospitals.
Budget: USD 129,694.70 (five years).
Expected Results: Better clinical management, Increased community awareness, Fewer dengue cases and deaths, Stronger local health system response.
Linked SDG: Goal 3 – Good Health and Well-being
Slogan: “End Dengue: Starts with Me.”

1. Dengue Death Prevention
In Battambang, Cambodia (5 years project)
March/07/2022
NAME : PRAK VIROTH, RN, BSN
JOB TITLE: DISEASE CONTROL AND PREVENTION OFFICER
AFFILIATION: BATTAMBANG PROVINCIAL HEALTH DEPARTMENT
COUNTRY: CAMBODIA
Mentor: Prof.KIM Ju Yeong
2021-22 Dr LEE Jong WookFellowship Program
Infectious Disease Response Specialist(Policy & Epidemiology)

2. PRAK Viroth, RN, BSN
2020 ~ Present Disease control and
prevention officer
Battambang Provincial Health Department
2010 ~ 2020 Pediatric Nurse
Battambang Provincial Referral Hospital
2010 ~ 2011 ICU Nurse
Emergency Surgical Centre for War Victims
Mr.VirothhasbeenworkingasanofficialatBattambangProvincialHealthDepartmentsince2020.and
hehasbeenworkedasaPediatricNurseatBattambangProvincialHospital,since2010.Hereceivedhis
bachelor’sdegreeofScienceinNursing(BSN)fromtheUniversityofHealthSciences(Cambodia).
In2017,HehasbeenawardedafellowshipfromJICAtojointheYoungLeaderProgramandattend
threeweeksoftrainingonaCommunity-basedhealthoperationandmanagementcourseinJapan.
In2019,HewasinvitedbytheFuwaiYunnanCardiovascularHospitaltojointhetrainingonCongenital
HeartDiseaseScreeningcourseinChina.In2019,HehasbeenawardedafellowshipfromtheWestern
PacificRegionalOffice/WorldHealthOrganization(WPRO/WHO)Manila,PhilippinestojointheGlobal
HealthLearningCentre(GHLC)Program.In2022,HehasbeenawardedafellowshipfromDrLEEJong-
WookFellowshipprogramtojointheInfectiousdiseaseresponsespecialist(Policy&Epidemiology)
courseintheRepublicofKorea.
Bachelor of Science in Nursing
Personal skillsWork Experience
Computer
Photography
Hardworking
Management
Nursing

3. About presenter
•My name is PRAK Viroth From Cambodia
•I earned a bachelor’s degree of science in nursing from the University
of health sciences (Bridging course EWHA-UHS collaboration)
•I work for Battambang provincial health department
•As a disease control and prevention officer
•Over the past 10 years I worked for Battambang provincial hospital
as a pediatric nurse.

4. •My main duties are:
–Outbreak investigation and response
–Contact tracing
–Daily report to the director
–Member of rapid response teams (RRT)
–Member of emergency operation center (EOC)
About presenter

5. 1. Background and Purpose
2. Current Status and Issues
3. Improvement Strategy
4. Specific Action Plan
5. Outline of the Action Plan
6. Expected Results
Contents

6. 1. Background and Purpose
•Background
✓Dengue is a major public health concern throughout tropical and sub-tropical regions of the world.
According to the World Health Organization (WHO), as many as 3.6 billion people, or 40% of the world’s
population, reside in dengue-endemic areas.
✓Each year, an estimated 400 million people are infected with the dengue virus, 100 million become ill
with dengue, and 21,000 deaths are attributed to dengue.(WHO, 2019).
✓Cambodia is one of the dengue-endemic countries in South-East Asia and has been affected by a
number ofserious epidemics of severe dengue over the last decade.
✓In Cambodia (2020) 68,597 casesand 48 deaths (*CFR 0.06%) (MoH, 2020).
✓In Battambang Province (2020) 7,224 cases and 15 deaths (*CFR 0.2%) (BTB PHD, 2020).
•Purpose
✓The purpose of this project is to reduce the dengue mortality rate among children in Battambang
province by 50% in 2024*
✓Battambang province to be free of dengue deaths by the year 2027*
(* The year 2020 is used as a baseline)

7. •This project impacts the achievements of several of the 17 SDGs, and
in particular SDG 3: “Good health and well-being” and Target 3.3: Fight
Communicable Diseases
7
Project link to SDGs global goal
Source: World Health Organization (WHO)
& United Nations (UN)

8. 2. Current Status and Issues
✓Dengue remains a burden, particularly among young children in Battambang, Cambodia
✓There are delaysin:
✓Proper medical attention and care
✓Medical presentation by patients
✓Early diagnosis
✓Appropriate medical management
(Ref. Khun& Manderson, 2007).

9. 2. Current Status and Issues –SWOT Analysis
SW
OT
Strength
Opportunity Threat
Weakness
▪Strong support from Battambang Provincial health department
▪Support from public hospitals
▪Available healthcare workers
▪Available for a national guideline for clinical case management
of dengue
▪Available training materials
▪Do not have ample training and seminars on dengue
clinical management
▪Lack of community-based health education on dengue
awareness
▪Failure to perform community participation and mobilized
for sustained vector control
▪Poor health education
▪Good collaboration with national level
▪Expected support from partners and stakeholders
▪Available room for health education
▪COVID-19 outbreak overwhelming the health services
▪Low levels of public literacy
▪Poverty
▪Climate change
▪Poor environmental management and sanitation
▪Long distance to the facility
❖SO: To build the capacity of HCWs to manage dengue cases effectively and efficiently and to raise
public awareness through health education to the public.
❖WT:To avoid the lack of community-based health education on dengue awareness.

10. 2. Current Status and Issues –Gap Analysis
Proposed Overall Goals (Objectives)
Proposed Purpose
To Improve Dengue Case
Management In Health Facilities
To Be Free Of Dengue Death In
Battambang Province
To Improve Community Awareness
On Disease Burden
To Improve Public Knowledge
And Attitude Change
To
Be
As
Is
Reduce dengue cases and prevent death in Battambang province
Strengthening the capacity of HCWs on dengue case management
Change public behaviour for early and appropriate medical care
Improve public awareness on dengue fever and seek medical care sooner
Not have ample training on dengue management for HCWs
The trend of public attitude is self-treatment and medication
Low level of public knowledge on dengue fever
Dengue case and death remain a burden in Battambang province

11. 3. Improvement Strategy
Project Area:
-The project will be conducted in Battambang province, Cambodia
-This province is chosen due to the high burden of dengue.
Project sample:
This project has two intervention groups:
(a)Pediatric ward patients and relatives -to increaseawareness
on early medical care practice.
(b)Hospital pediatric and OPD staffs -to improve dengue clinical
management.

12. Health workers Training
•To improve dengue
clinical management
–Conduct training, using
National Dengue
Management Guideline
(with pre-and post-tests)
–Simulations/ practical
exercises
12
Patients Health Education
To raise awareness on
dengue symptoms and
early medical attention
3 stages: pre-oral
questionnaire, conduct
education and
awareness, post-oral
questionnaire
Leaflet, Poster…etc.
4. Specific Action Plan

13. •The steps to achieve the goals:
STEP 1
•Phase I (2022-2024): Implementation in Battambang Provincial Hospital
➢Set up a technical working group (TWG*) for this project
➢Training BTB PH staffs as TOT** (Done by the National level)
➢Doctors and nurses provide health education to patients and relatives who come to
pediatric for any reason (Done by BTB PH*** staff)
➢Monitoring and Evaluation (M&E)
STEP 2
•Phase II (2025-2027): Implementation in other six referral hospitals in BTB province
➢Training to other referral hospital staffs (Done by BTB PH TOT)
➢Doctors and nurses provide health education to patients and relatives who come to
pediatric for any reason (Done by a referral hospital)
➢Monitoring and Evaluation (M&E)
4. Specific Action Plan
*TWG: Technical working group, **TOT: Training of trainer, ***BTB PH: Battambang provincial hospital

14. ❖Implementing Organization
➢Name of the organization: Battambang Administrative Provincial Health Department
➢Nature or type of the organization: Government Organization
➢Major functions of the organization:
•Responsible and accountable to provincial council and provincial governors
•Estimate and propose the yearly need of human resources
•Set up annual operation plan (AOP) and strategies to make things done and achieved the target set
•Set up the financial plan and budget strategic plan for appropriate AOP
•Planning, managing, directing, and evaluating all health activities and health resources to ensure
the health services provision
•Implementing the national program such as MCH, TB, Malaria, HIV/AIDS, Infectious disease and
control, Health Promotion
❖Duration of the Project : (5) Year(s)
➢Date of commencement : June 01
st
, 2022
➢Date of completion : June 30
th
, 2027
5. Outline of the Action Plan

15. •Battambang provincial health department
–Support/Staff available/Space
•Public Hospitals
–Hospital staffs (PediatricWards and OPD)
–Pediatricward equipment for dengue care (Patient
monitor, Centrifuge, Syringe/Infusion pump, etc.)
•Community
–Patients, guardians, and relatives
•International organizations & NGOs
–Financial and other logistics support
15
Resources

16. •Duration: (5) Year(s), First Year Work Plan: 2022
No Item JanFebMarAprMayJunJulAugSepOctNovDec
Fund
US$
1 Set up technical working group for this project
2 Action Plan reviewand presentation
3 Report anddissemination
4 Feedback from stakeholders
5 Internal submissionand administrative approval
6 Workshopto framework of activities
7 Micro planning
8 Prepare and produce IEC material
9 Review action plan
10 Training BTB PH as a TOT
11 Monitoring and Evaluation (M & E)
※Action Plan –Timetable

17. •Duration : (5) Year(s), Second Year Work Plan: 2023
No Item JanFebMarAprMayJunJulAugSepOctNovDec
Fund
US$
1 Prepare material and plan for training to other hospital
2 Micro planning
3
Training to other hospitals
4 Health education
5 Monitoring and Evaluation (M & E)
※Action Plan –Duration
•Duration : (5) Year(s), Third -Fifth Year Work Plan: 2025 -2027
No Item JanFebMarAprMayJunJulAugSepOctNovDec
Fund
US$
1 Training BTB PH as a TOT
2 Micro planning
3
Training to other hospitals
4 Health education
5 Monitoring and Evaluation (M & E)

18. ❖Grand total estimate of this project is: 129,694.7 USD/5 Years
❖Cost per patient that will benefit from the project: USD 3.6
❖Approximately 50% of dengue death will be averted by 2024 and
zero dengue death by 2027
❖The project invests USD 3.6 per case averted
*
※Project budget and Cost-effectiveness
* Assumptions

19. ※Outline of the Action Plan –Budget estimation
DESCRIPTION QUANTITY UNIT PRICE USD $ TOTAL AMOUNT USD $
Expert from national level 6/3days 45 810
Training for BTB PH Staffs 30/2days 10 600
Training for 6 other hospital Staffs 120/2days 10 2,400
Patient education 3Ps/240 times x 7RHs 10 50,400
Booklets, poster, and reporting tools3000 pieces 1 3,000
Micro-planning 5 times 500 2,500
Allowance for TWG 6Ps/12Ms/5Ys 150 54,000
Operation costs 25 200 5,000
Monitoring and Evaluation 5 times 500 2,500
Sub total 121,210
Recovery costs (7%) 8,484.7
Grand Total 129,694.7

20. 6. Expected Results –Outputs/Outcomes
•Economic Effects
✓This will reduce morbidity, mortality and keep the population healthy and productive
✓This will reduce government expenditure on health
✓This will reduce poverty due to reduced the individual health expenditure
•Technical Effects
✓All physicians and nurses at Battambang provincial hospital and referral hospitals
are trained to manage dengue cases effectively and efficiently
✓The use of National Guideline on dengue management is promoted
✓This project will be a modelfor other provinces to train hospital staff to manage
dengue cases effectively and efficiently
•Social and Environmental Effects
✓Patients and relatives become more aware and will change their behaviour for
early medical care seeking
✓Patients and relatives will not only change behaviour about early medical care
seeking but also for vector controlthrough reduction of mosquito breeding sites.

21. •Challenges and Risks
✓Population uninvolved
✓Religious norms toward a health topic
✓Poverty and low level of literacy
✓Population not practicing healthy behavior
✓One-time training and health education
✓None of the media influence
✓Inadequate equipment in the pediatric ward
✓Partner less interested in the dengue disease
•Solutions
✓Provision of incentives
✓Promote awareness reached to worship, pagoda, etc.
✓Conduct refresher training
✓Extended health education to school-based and community-based
✓Health education and vector control campaign
✓Promote media influence
✓Provision of material and equipment
✓Fund rising
6. Expected Results –Challenges/Solutions

22. Annex 1 Logical Framework
OBJECTIVES INDICATORS MEANS OF VERIFICATION ASSUMPTIONS
Goal
Zero dengue mortality in Battambang Province
Impact Indicators
% (percentage) of dengue mortality in
Battambang province by 2027
Record from Battambang Provincial Health
Department
Record from Battambang provincial hospital
Outcome 1
Reduce death case of dengue in Battambang
hospital through early medical care seeking
Outcome Indicators
% (percentage) of reduction in dengue death by
2024
Record from Battambang Provincial Health
Department
Record from Battambang provincial hospital
Civil war / hostilities don not return
Improved access to clinical health facilities
Outputs
Dengue patient seeking medical care early
Output Indicators
# (number) of severe cases of dengue attend to
hospital early.
Battambang provincial hospital report The economy remains stable, and food shortages
do not become acute
Serous civil unrest
Activities
Organize health education about dengue to
patient and relative who come to pediatric
hospital for any reasons
Process Indicators / Resources
Space to hold education, trainers/peer facilitators,
training materials, awareness raising materials
Costs & Resources
Locally raised funds, NGOs, Volunteer time,
donated space for health education
Patient and their relative have no new demands
on their time preventing them from participating
Outcome 2
Improve dengue clinical case management
Outcome Indicators
% (percentage) of dengue death patient declined
Record from Battambang Provincial Health
Department
Record from Battambang provincial hospital
Outputs
Physicians and nurses knowledgeable on
dengue clinical case management
Output Indicators
# (number) of physicians and nurse trained in
dengue clinical case management using CPGs
Households survey Old practices do not go against practices
prompted
Activities
Training physicians and nurse on dengue using
clinical practice guideline
Process Indicators / Resources
Space to hold training, trainers/peer facilitators,
expert, training materials
Costs & Resources
Locally raised funds, NGOs,
Training report
Physicians and nurses continue to have sufficient
time to attend training
22

23. 23

24. Problem Tree Analysis
Effects
Core problem:
Not practicing healthy
behavior/service/
Lack of Treatment
Direct cause from
beneficiary side: Lack of
knowledge/skills/attitudes/
perceived barriers
Direct cause from Supply
side: Lack of
knowledge/skills/attitudes
Indirect cause: Barriers for accessibility and
availability of the service (ie. Policy; lack of
equipment; long distance to the facility; lack of
human resources; budget; Media influence, etc.)
Underlying cause: Actual or Perceived
social/cultural/gender/religious norms toward a
health topic

25. 25

26. 26

27. •Korea Foundation for International Healthcare (KOFIH)
•Dr LEE Jong-WookFellowship Program
•Yonsei University
•Professors
•Prof. YONG Tai-Soon (PM), Prof. YOON Moonsoo(Deputy PM), and
Dr FARZAN Mansoor (Student communication)
•Dr KIM Ju Yeong (Mentor)
•Dr VOEURNG Bunreth(Director of BTB PHD)
Last but definitely notleast, I would like to thank all my classmates for the
stimulating discussions, working together, and for all the fun.
27
Acknowledgments

28. 28
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“END DENGUE: STARTS WITH ME”
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