cambodia thailand development cooperation programme on...

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Cambodia - Thailand Development Cooperation Programme on Health (2017-2019)

Overview of Health Development of Cambodia1

Cambodia has made good strides in improving maternal health, early child care,

and primary education programmes in rural areas. The maternal mortality ratio (MMR) per 100,000 live births decreased from 472 in 2005 to 170 in 2014, the under-five mortality rate (U5MR) decreased from 83 per 1,000 live births in 2005 to 35 per 1,000 in 2014. The net primary school admission rate increased from 81 percent in 2001 to 95.3 percent in 2014.

Cambodia has also been successful in combating HIV/AIDS, tuberculosis and malaria. HIV prevalence among adults aged 15-49 decreased from 0.9 percent in 2006 to 0.7 percent in 2012. In 2014, 89 percent of active AIDS patients in Cambodia had access to antiretroviral (ARV) treatment, a rate of coverage that is among the highest in the developing world. Tuberculosis prevalence rate per 100,000 population decreased from 1,230 cases in 2005 to 715 cases in 2013, and tuberculosis case fatality rates declined from 157 to 66 per 100,000 population at the same period. Malaria incidence decreased from 6.16 per 1,000 population in 2009 to 2.0 per 1,000 population in 2015, and malaria case mortality rates also decreased dramatically from 2.05 to 0.06 per 100,000 population in the same period. Cambodia is on its way to achieving its goal of malaria elimination by 2025. Challenges remain in the country for double burden of CD and NCD that need to pay more attention on them. Government Policy on Health Development The Royal Government of Cambodia launched the Second Health Sector Strategic Plan 2008-2015 (HSP2) in 2008 as the improvement in health status of all Cambodians is recognized by the Government as a priority for investing national resources in the social sector. HSP2 has clearly defined the policy agenda consisting of 15 elements which are connected with the Goal 3 of the Sustainable Development Goals (SDGs). Also HSP2 needs to be implemented by health institutions at all levels in order to achieve three main goals of the plan:

(1) reduce newborn, child and maternal morbidity and mortality with increased reproductive health,

(2) reduce morbidity and mortality of HIV/AIDS, Malaria, Tuberculosis, and other communicable diseases, and

(3) reduce the burden of non-communicable diseases and other health problems. To accomplish these goals, the health strategy has been developed and focused on five strategic areas: health service delivery, health care financing, human resource for health, health information system, and health system governance in order to direct interventions for the entire health sector in line with the “Rectangular Strategy”, and the National Strategic Development Plan of the Royal Government of Cambodia. Successful implementation of the HSP2 would increase demand for and ensure equitable access to quality health services in which all Cambodian citizens would achieve the maximum level of health and well-being. This will significantly contribute to the long-term process of poverty reduction in Cambodia, and to more rapid economic and social development of the country.

1

The World Bank, updated: October 2015

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Cambodia - Thailand Development Cooperation in Health Sector

The Royal Government of Cambodia and the Government of the Kingdom of Thailand have put high priority on the cooperation in the health sector.

1. According to the report of Bilateral Meeting between the Ministry of Health of the Kingdom of Cambodia and the Ministry of Public Health of the Kingdom of Thailand on 24th February 2016, both Sides have agreed as follow:

- Set up a Memorandum of Understanding (MOU) between the two Ministries focused on Malaria elimination, strengthening cross border referral system, capacity building and resources development for medical and public health personnel, and prevent and contorl epidemic diseases.

- Review and revise the mechanisms of MOU implementation to ensure the cooperation is successful; and set up a committee to coordinate the bilateral cooperation on health sector.

- Both Sides will select the provinces along the border to implementation this cooperation project. Cambodia Side selected Koh Kong Province, Banteay Meanchey Province and Oddor Meanchey and Thai Side selected Trat Province, Sa Kaeo Province and Surin Province.

2. General Border Committee - GBC Meeting focuses on the cooperation in prevention and control of communicable diseases, development of health service quality and promotion of health coverage for Cambodian nationals who may seek health care services in Thailand. In addition to the above commitments, the Joint Declaration of the Second

Thailand - Cambodia Joint Cabinet Retreat on 19 December 2015 in Bangkok stated the cooperation

on Public Health as follows; (a) Both side agreed to intensify cooperation on public health, especially along

the border area. The authorities concerned of both countries will discuss possible area of cooperation, which will include:

- Development of a simplified cross border referral system to facilitate transfer of patients across the border;

- Setting up of “Sister Hospital” arrangements between Thai and Cambodian hospitals along the border area to strengthen cooperation on capacity building, human resources development of medical and public health personnel, to develop referral system and to prevent and control epidemic diseases;

(b) The Thai side will provide technical support, particularly capacity building of Cambodian medical professionals and public health workers, to Cambodia on a project-based basis during 2017-2019

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Cambodia - Thailand Development Cooperation Programme on Health (2017-2019)

Overall Programme Goals:

1. To enhance prevention and control of communicable diseases and emerging and re-emerging diseases across Cambodia – Thailand borders,

2. To strengthen capacity of health personnel and referral system between Cambodia and Thailand in order to provide effective medical services between the two countries. Target Areas: Sa Kaeo Province – Banteay Meanchey Province Trat Province – Koh Kong Province

Programmes Objectives Strategies Projects/Activities Key Result Indicators

1. Communicable disease surveillance, prevention and control in border area; including emerging, re-emerging disease

1.1 To contribute to Malaria elimination by 2025 and control of parasitic resistance along border; including outbreak of communicable diseases

1.2 To have timely and

effective notification for emerging and re-emerging

1.1.1 Increase disease surveillance coverage including active and proactive surveillance, case management and vector control to encourage malaria elimination through strengthening disease surveillance system and health care provision, Conducting active and proactive malaria surveillance 1.2.1 Strengthening surveillance and outbreak notification

1.1 Project on Malaria Elimination along Cambodia – Thailand borders 1.2 Project on Public Health

Emergency Response

1.1 Reduction in malaria incidents should be less than 2.0 per 1,000 population by 2019 1.2 Notification of events to national IHR focal point within 24 hours. (Article 6th

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outbreak

1.3 To be able to detect

communicable diseases and all health risks

1.4 To promote 'One-health' approach

including health information sharing along Thailand-Cambodia borders by using IHR Framework

1.3.1 Strengthening surveillance, prevention and control measures for disease and health threats at the point of entry,

1.4.1 Improve

coordination mechanisms among concerned Ministries and key partners,

1.4.2 Educate people residing in the border areas to avoid risk behaviours,

1.4.3 Establish health networks for surveillance, notification, prevention and control of CDs.

1.3 Project on Point of Entry development 1.4 Project on Promoting 'One

Health' approach

of IHR)

1.3 Diseases and health risks are detected within 48 hours. 1.4 "One Health" approach is implemented, and Emerging Infectious Diseases are effectively prevented.

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1.1 Project on Malaria Elimination along Cambodia - Thailand borders

Narrative Summary Objectively Verifiable Indicators Means of Verification Important Assumptions

Overall Goal

To increasing coverage of case management, vector control and surveillance to effectively eliminate parasite resistance along The Thailand-Cambodia border

Number of malaria interrupted districts

Malaria programme annual report

Policy commitment from both sides

Project Purposes

Case management between two countries using MOU/consolidated activities by two countries

Harmonize Behaviour Change Communication (BCC) strategy/activities /materials and tools in collaboration of the two countries,

Utilizable and agreed data sets for the two countries,

Percentage of patients receive radical treatment according to national guideline,

Percentage of population in endemic area slept under ITNs in previous night

Case management report

Annual Malaria survey


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Outputs

To improve case management quality for community networks (VMWs),

To increase accessibility to malaria diagnosis and treatment for Mobile Malaria Populations,

To support malaria elimination activities in Behaviour Change Communication (BCC),

To increase collaboration of business owner/ private sectors for malaria elimination related- activities,

To improve performances/ implementation of the project in data sharing,

To increase personal protection

Number of DOT completeness from malaria diagnosis and treatment at VMWs

Case management report

Vector control report


Activities

Establish/maintain Malaria post and Border malaria post at selected areas,

Scale up and improve DOTs activities (3 days for PF and 14 days for PV) for MMPs,

Encourage following up of malaria patients (PF day 3, 7, 28 / PV day 7, 14, 28)

Explore possibility and sustainable way for patients to follow up for PF and PV malaria

Number of MP and BMP established/maintaining

Number of guideline produced and utilized

Training for Strengthening MHV / MHW on malaria prevention, case management, treatment and DOTs.

Workshop & meeting of Harmonize BCC strategy/ collaboration of business owner/ private sectors

Annual Report Training Report


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Enhance management of treatment failure (e.g. improving referral mechanism, guideline, HMIS)

Strengthening MHV / MHW on malaria prevention, case management, treatment and DOTs

Harmonize BCC strategy/activities /materials and tools

Enhance collaboration and coordination between public & private sectors (business owners) for net distribution, DOT, FU and BCC related activities for their workers

Workshop & meeting of collaboration of business owner/ private sectors

Platform developed and utilized Meeting

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1.2 Project on Public Health Emergency Response

Narrative Summary

Objectively Verifiable Indicators

Means of Verification Important Assumptions

Overall Goal

The communicable diseases and emerging and re-emerging diseases among Cambodian people along Thai – Cambodian border will be set up and able to detect any abnormal or emerging events.

Communicable diseases and emerging and re-emerging diseases detection and situation across Cambodia-Thailand borders

Disease surveillance data and events would be analysed, reported, and disseminated.

Disease surveillance system has been established for Cambodian people along Thai - Cambodian border

Project Purposes

1. To set up the Health worker networking for event-based surveillance among the selected population group

2. To educate the selected population group in basic disease prevention and control issues.

1. Event-based surveillance procedure among the selected population group

2. Selected population group has trained in basic disease prevention and control issues

Surveillance procedure and report

The selected population group is willing to be a part of the event-based surveillance programme

Outputs

1. The event-based surveillance among the selected population group

2. The selected population group gain

knowledge in basic disease prevention and control issues.

- Project meeting - survey for the surveillance

infrastructure - Disease prevention and

control training programme

- Event-based surveillance system procedure training

- Abnormal event and outbreak detection report workshop

- Monitoring and evaluation

Monthly report

Activities

Human capacities on disease surveillance, prevention and control response are the main resources. Strengthening the capacity building on

Activity report Pre-Conditions Cambodian and Thai sides agree to implement the project

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Narrative Summary



laboratory control, Personal Protective Equipment (PPE) and sample collection method and packaging.

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1.3 Project on Point of Entry Development

Narrative Summary



Overall Goal

Improved surveillance and detection of communicable/ Infectious diseases and health hazards to control the outbreak at Thailand and Cambodia’s Points of Entry (PoEs).

Percentage of information exchange between Point of Entries (PoEs) on both countries for the surveillance of communicable/ Infectious diseases and health hazards.

Surveillance and detection reports of outbreak and health hazards at Point of Entries (PoEs) on both countries

Designated policy between Thailand and Cambodia.

Project Purposes

Document of exchange information activities on communicable/ Infectious diseases and health hazards between Point of Entries on both countries.

The level of success in the information exchange between the Point of Entries on both countries.

Regular report of information exchange between Point of Entries on both countries.

- Sufficient personnel for the operations.

Outputs

1. Effective information exchange system between the Point of Entries on both countries. 2. Quarantine personnel can use information exchange system

Information exchange system between the Point of Entries on both countries at least 1 system is developed.

Having the guideline of information exchange between Point of Entries on both countries.

- Sufficient personnel for the operations.

Activities

1. Prepare a well-developed information exchange for Surveillance and prevention of international diseases at Point of Entries in both countries 2. Held a meeting for the Preparation and development about guideline for information exchange of Point of Entries on both countries and regularly information exchange meeting/ report for Point of Entries on both countries. 3. Prepare and Develop a manual of information channel, process, etc. in Thailand, Cambodia and English languages.

1. Information exchange system between the Point of Entries on both countries as plan 2. Meeting report on guideline development. 3. Meeting report on prepare and Develop a manual of information channel, process, etc. in Thailand, Cambodia and English languages

1.Having progress report of information exchange system 2.Held a meeting as plan and have completed version on guideline of information exchange system 3.Having a manual of information channel, process ,etc. in Thailand, Cambodia and

Pre-Conditions Cambodian and Thai sides agree to implement the project.

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Narrative Summary



4. Strengthening collaboration quarantine post at check points.

English languages

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1.4 Project on Promoting 'One Health' Approach

Narrative Summary



Overall Goal

Provinces along Thailand-Cambodia border have capability to detect, prevent and respond to emerging infectious diseases (EID) using 'One Health' approach

Percentage of border provinces that has simulation exercise on EID

Annual report Coordinating mechanism among multi-sectors for disease detection, prevention and control is in place along Thailand-Cambodia border

Project Purposes

- To develop skill on coordination and responses to emerging infectious diseases among public health staff, healthcare workers, veterinarian and animal/ wildlife husbandry/ zoo keepers etc.

- To improve coordination mechanism among multi-sectors for outbreak response along Thailand-Cambodia border

- Numbers of multi-sectoral organizations participated in simulation exercise

- Guideline for outbreak response among multi-sectoral partners

Monitoring and evaluation

Coordination mechanism among multi-sectors in place for timely outbreak response

Outputs

Public health staff, healthcare workers, veterinarian and animal/ wildlife husbandry are capable to coordinate and respond to emerging infectious diseases with One Health approach

An update contact list and responsibilities of each multi-sector involving in responding to EID

Quarterly Report Role and responsibility of each relevant multi-sectors in responding and notification to outbreaks is clear and actionable

Activities

- Simulation exercise among multi-sectors along Thailand-Cambodia border on EID preparedness and responses,

- Workshop on strengthening capability to detect, prevent and respond to emerging infectious diseases using 'One Health' approach.

- Numbers of simulation exercise among multi-sectors along Thailand-Cambodia border on EID preparedness and response

- Numbers of workshop on strengthening capability to detect, prevent and respond to emerging

- Simulation exercise report - Workshop report

Pre-Conditions Cambodian and Thai sides agree to implement the project

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Narrative Summary



infectious diseases with One Health Approach

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2. Medical and public health staff capacity building

2.1 Increase medical and public health staff's capacity in health service provision, nursing, MCH, communicable disease management, and disease surveillance along Thailand-Cambodia border areas.

2.1.1 Training course development for medical and public health staff in border area

2.1.3 Site visit and health staff exchange

2.1 Health workforce capacity building in health service, nursing and communicable disease management

2.2 Training for Trainer on Field Epidemiology Short course training

- Prevention and control of communicable disease training

- Application of community based learning to prevent and control of NCDs

- Emergency medical service and referral system training

- Maternal and child health care training

Capacity and knowledge of medical and public health staff improved.

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2.1 Health workforce capacity building in health service, nursing and communicable disease management

Narrative Summary



Overall Goal

To strengthen leadership competencies and management competencies in order to reduce communication diseases and emerge and re-emerge diseases across Cambodia -Thailand borders

To Measures leaderships competencies and management competencies among participants before and after training.

The leadership competencies questionnaire, The management competencies questionnaire

Project Purposes

1. To develop leadership competencies among nurse administrators across Cambodia and Thailand borders 2.To developed management competencies among nurse administrators across Cambodia and Thailand borders

1. Participants increase their leadership competencies at least 80%. 2. Participants increase management competencies at least 80%. 3. Participants conduct their nursing administration plan at least 1 plan.

1. Leadership competencies scores measured by using the leadership competencies questionnaire. 2. Management competencies scores measured by using management competencies Questionnaire. 3. A nursing administration plan

Health policies from both countries

Outputs

Ninety nurses working across Cambodia and Thailand borders and finishing this training during 2016-2018 increase leadership and management competencies in order to deal with communicable diseases and emerging and re emerging diseases.

1. Participants increase their leadership competencies at least 80%. 2. Participants increase management competencies at least 80%. 3.Participants conduct their nursing administration plan at least 1 plan.

1. Leadership competencies scores measure by using the leadership competencies questionnaire. 2.Management competencies scores measured by using management

Health policy from both countries

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Narrative Summary



competencies questionnaire. 3. A nursing administration plan

Activities

1st phase; Preparing; personnel, courses, evaluation 2nd phase; Training in Thailand ; training time 2 weeks 3rd phase; Apply participants' knowledge and experiences to strengthen their works as nursing leader and administrators in order to deal with communicable diseases and emerging and re-emerging diseases. 4th phase ; Site visit at participants working areas. 5th phase; Summarizing and Evaluating.

Pre-Conditions Cambodian and Thai sides agree to implement the project.

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2.2 Training for Trainer on Field Epidemiology

Narrative Summary



Overall Goal

To produce Field epidemiology trainer for Cambodia Applied Epidemiology Training (AET) Programme

1-2 trainers on field epidemiology

Certificate of achievement

Limited Capacity on AET program - Trainers need to be

refreshed.

Project Purposes

- To increase quality of mentoring and quantify of mentors for Cambodia AET

- knowledge and skill of field epidemiology mentor/trainers will be increased

Requirement of the training program accomplished

The training process will increase competency.

Outputs

- 1-2 mentors/trainers on field epidemiology per year / per province

- curriculum - work requirement - manuscript of outbreak investigation and surveillance

Report and output according to the requirement

The participants can produce some output benefit to the AET

Activities

Activities: Scholarship for Cambodian trainees

2 months training course on IFETP Trainer which separate into 2 components

1st component: - Class-room teaching (15 days) on TOT methodology, theory, learning centre, etc. 2nd component: - Field work on outbreak investigation and surveillance (1.5 months)

Input: - Training centre; - Full time advisors; - Consultants.

Pre-conditions: Cambodian and Thai sides agree to implement the project

Requirement from applicant: - Graduate from FETP or applied epidemiology training programme - Have experience in field epi. at least 1 year English proficiency skill to speak, listen, read and write - able to stay in Thailand for 2 months

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3. Referral system improvement

3.1 Improve quality of both in-country and cross-border referral systems of Cambodia

3.1.1 Current situation analysis

3.1.2 Enhancing capacity and

quality of referral hospitals in Cambodia

3.1.3 Mapping health service

networks and their referral systems

3.1.4 Capacity building for Cambodian health personnel on referral practices

3.1 Strengthening Cambodian's Referral System

Increase Live saving rate for patients referred to other health care providers both in Cambodia and cross borders to Thailand

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3.1 Strengthening Cambodian's Referral System

Narrative Summary



Overall Goal

Improved quality of and access to in-country and cross-border referral systems as well as networks of health care services

-Cambodian patients received timely essential health services. - The decrease in the number of preventable or avoidable deaths.

Referral Systems Assessment Reports

Cross-border political and socio-economic situations are conducive for supporting access to health care.

Project Purposes

To develop capacity of referral system and emergency medical services of Cambodia and to improve cross-border referral system.

Increase rate of survival of emergency patients both in Cambodia and cross border to Thailand

Good and continue cooperation from authorities concerned.

Outputs

1. Capacity of Cambodian health personnel in Emergency Medical Services (EMS) is enhanced. 2. Necessary medical equipment for referral system is improved 3. Data base for referral system is established 4. Standard Operation Procedure; SOP is developed. 5. The existing cross-border referral system in 2 border areas are improved (Banteay Meanchey-Sa Kaeo, Koh Kong-Trat)

Quality of in-country and cross-border referral systems improved.

Reports conducted by Receiving and sending hospital

Provincial Authority remains committed to support the referral system

Activities

1. Capacity of Cambodian health personnel in Emergency Medical Services (EMS) is enhanced. 1.1 Training in clinical assessment and referral systems for medical and public health staff in all levels of Cambodia health systems 1.2 Training Cambodian medical personnel on EMS

1. Number of participants attended the joint discussion. 2. Number of stakeholders and contact persons. 3. Tools and documents for referral patients 4. explore the possibility in using Smart phone

1. Minute of joint discussion

2. Flow chart and list of referral focal point

3. Publication of SOP 4. Mobile application 5. Tools and

documents for

Pre-Conditions - Cambodian and Thai sides agree to implement the project

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Narrative Summary



1.3 Training Cambodian health personnel on using medical equipment in Ambulance 1.4 Training workshop for hospital staff on the referral systems. 2. Necessary medical equipment for referral system is improved 2.1 Need survey 2.2 Provision of necessary medical equipment for referral system 3. Data base for referral system is established 3.1 Survey on baseline data of Cambodian referral system 3.2 Set up information centre for referral system 3.3 Set up referral network to cover all level of health service providers 3.4 Meeting to improve information sharing for referral system 3.5 Explore the possibility of using application online for the referral systems 3.6 Introduce hotline for emergency patients 4. Standard Operation Procedure; SOP is developed. 4.1 Joint discussion amongst representatives from various departments (Non-health and health sector) 4.2 Review current situation of in-country referral systems and establishment of cross-border referral Collaboration mechanisms, 4.3 Develop of SOP referral system, 4.4 Evaluation of both in-country and

application 5. Referral system evaluation is conducted. 6. 80 Hospital staff of Banteay Meanchey-Sa Kaeo, Koh Kong-Trat received training on referral system

referral patients 6. Training evaluation

report

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Narrative Summary



cross-border referral system, 5. The existing cross-border referral system in 2 border areas are improved (Banteay Meanchey-Sa Kaeo, Koh Kong-Trat) 5.1 Regular meetings between Thai and Cambodian sides to review the problems and challenges of referral cases 5.2 Set up SOP for cross border referral system 5.3 Introduce on-line application for cross border referral system

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4. Sister hospital development

4.1 Increase quality of health services in border areas:

1) Koh Kong– Trat; 2) Banteay Meanchey– Sa

Kaeo.

- Short course trainings: 4.1.1 Improved quality of

hospital services; 4.1.2 Hospital staff capacity

building to provide better services for patients;

4.1.3 Medical equipment support;

4.1.4 Building confidence for patients;

4.1.5 Medical laboratory development;

4.1.6 Hospital infectious control;

- Staff exchange programs.

4.1 Development of Sister hospital co-operation and networks between Koh Kong – Trat 4.2 Development of Sister hospital co-operation and networks between Banteay Meanchey – Sa Kaeo

1. Improved quality of health services provided by Kho Kong, and Banteay Meanchey Hospitals, 2. Regular communications and strong networks between the targeted hospitals.

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4.1 Development of Sister hospital co-operation

Narrative Summary



Overall Goal

Sister Hospitals along Cambodian-Thailand border build up a strong network and collaboration to improve quality of health services and cross-border referral systems

- Improvements in health care services provided by Sister Hospitals, better networking and cross-border referral systems

- Number of meetings, training, study visits, and staff exchange

-

Project Purposes

Improvements in collaboration and partnership in health service provision and cross-border referral systems of Sister Hospitals

- Skills and capacity of medical and public health staff improved

- Assessment on clinical skills and capacity before and after implementation of the project

Outputs

1. Improved capacity and skills of medical and public health staff through short-course and on-the-job trainings, study visits, and staff exchange, 2. Regular meetings and communication between Sister hospitals

- Staff are trained and gained experiences in providing medical services and public health activities

- Number of meetings, short-course and on-the-job trainings, study visits, and staff exchange

- Development of the training courses, study visit, and staff exchange

Activities

- Regular meetings and communication, - Short course and on-the-job trainings, - Study visits, - Staff exchange

Inputs - Operation plans, - Establishment of the focal points and contact persons of the Sister Hospitals,

- Minute of the meetings, - Summary reports on training programs, study visits, and staff exchange

Pre-Conditions Cambodian and Thai sides agree to implement the project

cambodia thailand development cooperation programme on...

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