United Nations Interagency Task Force on the Prevention and Control of Noncommunicable Diseases Joint Country Mission to Cambodia

The United Nations Inter-Agency Task Force on the Prevention and Control of NCDs (UNIATF) conducted a one week joint mission to Cambodia, 7–11 August 2017. The goal was to advocate a whole-of-government and whole-of-society response to noncommunicable diseases (NCDs). The mission also aimed to advance an effective United Nations response to support the Cambodian Government’s goal of reducing NCDs.

The Joint Mission witnessed the Royal Government of Cambodia’s significant commitment to universal health coverage, to protecting the poor and vulnerable populations, and its notable efforts to tackle NCDs. The Government has developed a National Multisectoral Action Plan for the Prevention and Control of NCDs 2018–2026, which is a clear framework for action across several areas and identifies different roles for multiple ministries.

During a meeting with His Excellency Yim Chhay Ly, the Deputy Prime Minister stressed his commitment to tackling NCDs and recognized the need for a multisectoral response. He agreed on the need to target multiple risk factors and diseases and included a new focus on air pollution.

His Excellency, Minister of Health Dr Mam Bunheng said, “The spread of NCDs in Cambodia cannot be tackled by the Ministry of Health alone.” Dr Bunheng pointed out that many major causes and health determinants of NCDs lie outside the health sector, including the availability and type of food and the environment in which Cambodians live and work.

NCDs are a growing threat to social and economic stability

Cambodia has achieved strong economic development and has enjoyed sustained growth in the last two decades. At the same time, Cambodia is now undergoing an epidemiological transition. Chronic diseases are imposing an ever greater health and socioeconomic burden on countries coping with the rising cost of treatment, and on families through loss of income, out-of-pocket and catastrophic health-care costs. Poor people face the greatest hardship. There is growing recognition that failing to control NCDs could threaten the attainment of national health targets and the Sustainable Development Goals (SDGs).

NCDs now account for 61% of deaths in Cambodia, and the risk of premature deaths from NCDs is 23% in 2017. According to 2014 data, a third of Cambodian men currently use tobacco; 17.6% of adults were overweight; 3.2% were obese; 8.2% had raised blood glucose; and 21.1% had raised blood pressure. Between 2010 and 2014, overweight prevalence has nearly doubled among women in rural areas from 9.6% to 17.3%, signalling a problem that has extended to rural areas from cities. Drunk driving due to harmful use of alcohol is the second leading risk factor for road crashes, accounting for 14% of road traffic fatalities.

WHO Country Representative, Dr Liu Yunguo highlighted that, “Significant health improvements since the 1990s among Cambodians could be reversed by the ever growing burden of NCDs.”

Country progress

The Task Force noted that there is high-level of recognition and understanding of NCDs and its adverse impact on health and development. Cambodia has demonstrated commitment and leadership in addressing NCDs. The government has adopted the National Strategic Plan on NCD Prevention and Control 2013-2020; has a National Multisectoral Action Plan for the Prevention and Control of NCDs 2018-2025 that is awaiting adoption; a comprehensive Tobacco Control Law and Sub-Decrees that bans smoking in most public places, tobacco advertising, promotion and sponsorship, and requires pictorial health warnings; and has a Sub-Decree and Prakas that regulate marketing of products for infant and young child feeding. The Task Force also observed Cambodia’s commitment to robust data collection and has an emerging NCD risk factor surveillance system.

Recommendations to reduce NCDs

The Joint Mission provided a set of cost-effective and other recommended interventions to address NCDs and these are related to governance, prevention of NCDs, health system strengthening, monitoring system and awareness-raising, including:

  • Adopting the national Multisectoral Action Plan for NCDs and associated coordination, accountability and financing mechanisms.
  • Developing and enforce legal and regulatory mechanisms and policy frameworks for tobacco, alcohol, nutrition/diet.
  • Scaling up quality, accessible, affordable preventive health services in the public and private sectors.
  • Ensuring sufficient government investment in NCD surveillance.
  • Increasing awareness about NCDs, its risk factors and their causes.

Next steps

As the UN Resident Coordinator, Ms Claire Van Der Vaaren, indicated, “… the 2030 Agenda for Sustainable Development offers multiple avenues for cross-sectoral NCD responses.” and “… reducing NCD risk factors requires collaboration across sectors and stakeholders including the private sector, under the strong leadership of the government.”

The Joint Mission discussed a series of next steps with the Royal Government of Cambodia to expand NCD prevention and control across the country and to strengthen multisectoral coordination. A key step would be the adoption of the NCD multisectoral action plan and having in place coordination, accountability and financing mechanisms. To support prioritization of resources and interventions, the 2016 NCD STEPS survey report will be published soon and the Global School Health Survey will be conducted in 2018.

Furthermore, as a WHO Framework Convention on Tobacco Control (FCTC) 2030 participating country, the UN will support the Royal Government of Cambodia to develop an investment case to estimate the economic burden of tobacco use, the returns from investing in priority interventions, and the costs of inaction.

The current UN Development Assistance Framework for Cambodia (UNDAF 2016-2018) is harmonized with the national planning process. The UNDAF reflects the growing challenge of NCDs and commits the UN to respond through a multisectoral plan of action and to support strengthening of the legal and policy environment. The next UNDAF is currently under development.