|Malen and her mother show the growth monitoring report from the health centre, which they now regularly visit for growth monitoring; ©UNICEF Cambodia/2017/Som Sophorn|
Siem Reap, Cambodia, June 2017: Malen is a spirited young girl who lives in Chambak village, a small collection of thatched roof homes located in Cambodia’s Siem Reap Province. She turns 5 this October. Malen lives with her 11-year-old brother and her parents. Her father, So Chreng, is a construction worker. With an impaired left hand, he is limited to certain types of work and manages to bring home only 200,000 Cambodian riels (US$49) per month. Malen’s mother, Soun Mao, looks after the children and earns a little extra through irregular small jobs such as peeling garlic for a local business.
The family’s economic situation means that at times, they struggle to have enough food. Malen has not been able to benefit from early childhood education because her mother has not managed to take her to the community pre-school. And due to Chreng and Mao’s limited knowledge of proper health care for their children, their health has been at risk.
Malen’s parents bring her to the health centre only when the little girl is sick, a common practice in Chambak, where other families share the day-to-day challenges of intense poverty. But in a country where one in every three children under 5 are stunted (low height for age), regular growth monitoring and standard check-ups for children like Malen are essential. Stunting has been shown to negatively impact cognitive and physical development, limiting a child’s full potential to be a productive, thriving adult.
Malnutrition is particularly acute among the poor: children from the poorest families are more than twice as likely to be stunted compared to children from the richest families. In many cases, their food consumption does not meet nutritional standards and proper hygiene practices are not followed, which leads to frequent preventable diseases, particularly among young children.
Nutrition poses a difficult challenge for current and future human development in Cambodia, especially among children and pregnant women. The 1,000 days between pregnancy and a child's second birthday are the most critical for a child's cognitive and physical development, while the health and well-being of pregnant women and breastfeeding mothers are directly connected to the growth and health of their babies. The right nutrition and health services for the mother and for the child during this time can have a profound impact on the child's growth and development with long-term positive economic impact for the entire society.
The Government of Cambodia has introduced several measures to improve health and nutrition services through the public health system. However, with the exception of Health Equity Funds, a government-funded financing package for disadvantaged Cambodians to access health care free of charge, provision of social services has not fully addressed barriers faced by poor households. Utilization of necessary health and nutrition services among the poor remains low.
In response, the Government’s Council for Agricultural and Rural Development (CARD), supported by UNICEF, designed a cash transfer programme targeting pregnant women and children under 5 living in poverty. The project distributes small monetary amounts to pregnant women and children under 5 who live in poverty, coupled with education sessions on issues like health care and nutrition.
In November 2014, CARD, with UNICEF financial and technical support, launched a pilot of the programme in the eight communes of Prasat Bakong District, Siem Reap Province. Prasat Bakong was selected based on the number of government-recognized ‘ID Poor’ households, geographic location, project financial coverage, commitment of the district administration, and service availability.
Families like Malen’s were able to register and enroll in July 2015; the first cash delivery took place in May 2016. To date, six distributions have taken place and the final transfer will take place in October 2017. A total of 1,298 recipients, or 1,148 households representing 59 pregnant women and 1,239 young children, are benefiting from this programme. The experience of the pilot and other similar initiatives will be used to inform the design of a national cash transfer programme.
The education sessions began with the second distribution, conducted jointly by commune and health centre staff (mostly midwives) on a bimonthly basis to an average 20 mothers per session. Five sessions have taken place thus far. They focus on essential maternal and child health issues like antenatal and postnatal care; delivery; proper breastfeeding; complementary feeding; water, sanitation and hygiene; common diseases and care of sick children and birth registration.
Malen’s family has been registered in the project since it began. Her mother has received a total of 240,000 riels (about US$60) and attended the education sessions three times.
“I used the money to buy food and clothing for my children,” she says. “I have been practicing what I learned from the sessions, such as hand-washing with soap, boiling water before drinking and preparing good food for my children.”
Malen has been seen at the health centre three times for growth monitoring. “My daughter’s health has improved since we joined the project,” her mother reports.
Ny Sokhone is a midwife at Prasat Bakong Health Centre in Rolous commune. She actively supports and co-conducts the cash distribution programme’s education sessions with the commune focal person. “I found there to be active participation,” she says. “Knowledge and skills have been gradually increasing from session to session.” Sok also notes that more poor families are visiting the health centre to have their children’s growth monitored. Like Malen’s family, in the past children came to the health centre only when they were ill.
“I have seen that the cash transfer project is increasing the basic health and nutrition services utilization by poor pregnant women and young children,” Sokhone says.
Midwife Ny Sokhone shows a complementary feeding education flipchart at the health centre; ©UNICEF Cambodia/2017/Som Sophorn
It is hoped that through this social protection programme, poor families in rural Cambodia will be able to fight their way out of the cycle of poverty—and take steps toward a healthier, happier existence.