This will be the first of a three part series of guest blogs based on writings provided by Maurits van Pelt, Director of MoPo Tsyo Patient Information Centre in Cambodia. Collectively these writings will provide a roadmap for scaling up peer educator networks and developing sustainability for what is now still an intervention organized and facilitated by a Cambodian Non-Government Organization (NGO). Part 1 focuses on developing a Niche and Demonstrating value. Maurits van Pelt.
The NGO MoPo Tsyo Patient Information Centre ‘s office is located in the capital Phnom Penh. It organizes capacity building of diabetes patients to become peer educators. Once these trained patients have passed the peer educator exam, they return to their communities and begin to run MoPoTsyo Patient Information Centres from their own home using basic equipment and materials supplied to them by the NGO based on their activity reports.
The urban slums and rural Cambodia are characterized by high poverty rates and extremely limited resources to sustain a chronic disease care system.
The Peer Educators promote lifestyle changes and teach diabetes and high blood pressure self-management. The diabetic educators have learned to manage diabetes themselves and are familiar with the typical ups and downs of diabetes self-management helping them communicate effectively with the people they are supposed to assist. They are trained to provide screening services, home visits, run education courses and help navigate the complex, confusing and often costly disease management system and services. The Peer Educators (khmer “Mit Abrom Mit”) create personal contact and bring understanding to the disease. They remain motivated through social financial innovations of the patient educator networks. Their efforts provide social and emotional support that combine with the innovations to provide success stories such as 87% patient member annual retention average over the past 5 years in the urban slum areas, improved knowledge, self-care skills & lifestyle, and significantly reduced costs to the participating patients. Regular re-assessments show that levels of Blood glucose and blood pressure remain significantly reduced compared to these values at time of registration into the network among the majority of the patients who are in peer educator follow-up.
In 2005 the first MoPoTsyo project started in Phnom Penh’s slum areas as a “knowledge provider” and was not intended to become involved in medical service provision as there were already 2 charities running medical services for people with diabetes in the area. As a result, MoPoTsyo was able to concentrate on a core mission of finding and helping diabetes patients in the slums that wanted to learn diabetes self management. After a few years the charities ran out of money and ended their projects. Consequently, the prices of medical services quickly rose to unaffordable prices for MoPoTsyo members. This development put MoPoTsyo in the dilemma of deciding whether to continue working in advocacy for the lowering of prices from existing professional medical services providers or to expand the scopes of its own action and begin to organize services.
In many development sectors this is a common dilemma. Many initiatives experience ups and downs forcing organizations like MoPoTsyo to develop community action plans to try and support a marginalized community. With the closing of the two charities patients now needed affordable medical services. Consequently, it was decided to organize delivery of services for its members by selecting interested public and private partners to work with the peer educators.
Working toward to a sustainable model with impact
With a well organized group and agenda MoPoTsyo educators were able to take advantage of their resources and make an impact on multiple obstacles in the community that had previously seemed insurmountable. The peer educators were able to make many positive changes by negotiating at the local level and introducing change in a gentle low key fashion. In these negotiations MoPoTsyo utilized a system approach by establishing a proper regulatory framework and governance at multiple levels. By negotiating and drawing up contracts with its partners from the public and private sector, a set of transparent rules of engagement have been formulated that provisionally fill the policy gap. Besides clarifying relevant practical issues, this creates accountability among those who engage to abide by the rules. Local engagement and support are very strong as a result of the chosen approach. It seems inconceivable to achieve similar ownership if a top down service supply driven approach were suddenly adopted to benefit from perceived cost efficiencies. If given the chance, MoPoTsyo will continue to scale-up by supporting the existing Peer Educator Networks to replicate in response to demand from patients willing and able to take an active role.
As a result of this low key practical approach by familiar faces there were no turf wars between peer educators, local health centers and referral hospitals located within the operational districts that serve a population of 100,000 to 200,000 residents. After 5 years, the peer educator networks have shown to be a cost effective and affordable strategy to change and adapt health system relationships among local stakeholders into a more productive and more collaborative health market: One that can meet a great unmet health need for a population that would otherwise have remained excluded from a continuum of care.
Next month, I will share more about integration of Patient Educator Networks (peer support) into the primary care system in Cambodia and scaling up our program.