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Cambodian Red Cross

Humanitarian Pandemic Preparedness – Accelerated Project

November 2009 - April 2010

Final Project Report

Pi

Prepared by: Cambodian Red Cross Society

Submitted to:

International Federation of Red Cross and Red Crescent Societies

Cambodian Red Cross Humanitarian Pandemic Preparedness – Accelerated Project

Final Project Report | 2

Table of contents List of abbreviations

3

Executive summary

4

Project background

6

Project results

1. CRC preparedness and response plan is developed, implemented and updated as necessary

2. Mitigation and response tools and messages are adapted and disseminated at scale.

3. Branch trainers and volunteers are trained, equipped and mobilized to deliver life-saving messages and support services.

4. CRC actively participates in and contributes to national pandemic influenza coordination

8

9

10

12

14

Reflections on project impact

15

Constraints/Challenges

15

Lessons learned and recommendations

16

Annexes

1. Compilation of pandemic preparedness and response plan/CRC

2. Training report/master facilitator training on community preparedness and response for pandemic influenza with partners

3. Curriculum for master facilitator training on community preparedness and response for pandemic influenza with partners

17 17

27

30



List of abbreviations AHI Avian Human Influenza

AI Avian Influenza

CRC Cambodian Red Cross

DHF Dengue Hemorrhagic Fever

DMD Disaster Management Department

FAO UN Food and Agriculture Organization

H2P-AP Humanitarian Pandemic Preparedness – Accelerated Project IOM International Organization for Migration

MoH Ministry of Health

NCDM National Committee for Disaster Management

NGOs Non Government Organizations

NHQ National Headquarter

NPRP National Preparedness Response Plan

PCDM Provincial Committee for Disaster Management

PMER Planning, Monitoring, Evaluation and Reporting

PNs Participatory National Societies

RCVs Red Cross Volunteers

RGC Royal Government of Cambodia

UN United Nations

UNICEF UN Children’s Fund

WHO World Health Organization



Executive summary The Cambodian Red Cross (CRC) is committed to complement and support government priorities and plans in influenza pandemic preparedness and response which intends to minimize preventable excess deaths and illnesses, as well as the impact of a potential pandemic influenza, particularly at community level. CRC implemented the Humanitarian Pandemic Preparedness – Accelerated Project (H2P-AP) from November 2009 through April 2010, in partnership with the Ministry of Health and other relevant national authorities, non-governmental organizations (NGOs) and other stakeholders, to assist communities mitigate and respond to the threats of the evolving influenza pandemic. CRC has also internally worked closely with concerned departments, particularly the Disaster Management Department (DMD), in the further development of the CRC influenza pandemic response plan which is in line with government’s influenza pandemic plans. Project goal and objectives Goal: Community preparedness to mitigate the impact of a pandemic on excess morbidity and mortality from risks related to health, food security and livelihood. Objectives and expected results: Objectives Expected Results 1. Response plans and mechanisms

are implemented. 1.1. CRC preparedness and response plan is developed,

implemented and updated as necessary 2. Staff and volunteers of CRC and

civil society organizations are able to carry out community level response activities

2.1. Mitigation and response tools and messages are adapted and disseminated at scale.

2.2. Branch trainers and volunteers are trained, equipped and mobilized to deliver life-saving messages and support services.

3. Coordination mechanisms are functional and sustained

3.1. CRC actively participates in and contributes to national pandemic influenza coordination.

Project summary Through funding from the International Federation of Red Cross and Red Crescent Societies’ Humanitarian Pandemic Preparedness (H2P) Programme, the CRC H2P Accelerated Project built on good practices and lessons learnt from its Avian Human Influenza (AHI) and Dengue Hemorrhagic Fever (DHF) Projects which have been implemented in 12 provinces in the last few years. Some 738 Red Cross Volunteers (RCV) have been trained and mobilised/involved in the AHI/DHF project, the latter being delivered as an integrated component of CRC community-based disaster risk reduction (CBDRR) programmes carried out in four of the 12 provinces. After securing approval from the national IEC material committee, CRC adapted, translated and tested generic H2P training and risk communications tools and guidelines for household and community mitigation before these were rolled-out to provinces to ensure that they are comprehensive, effective, and sensitive to local conditions. The tested training curricula were reproduced and distributed within CRC NHQ and branches, and to relevant partners. The ‘Best Defense is You’ communication campaign materials, particularly the vide spot “five key messages”, were also translated following the Cambodian context for television broadcast. Some 120 sets of protective materials, consisting of protective clothes, gloves, hand gels, and masks (N95) were distributed to all 12 project CRC branches. Within the project period, a good number of training-workshops were conducted to update knowledge, skills and capacity of staff and volunteers of CRC and its partners, while coordination meetings strengthened the network of partners and various stakeholders who have been identified



key actors during an increased risk of pandemic influenza. The roles and responsibilities of communities, national and local authorities, CRC departments and offices at NHQ and branches, including staff and RCV, for pandemic influenza preparedness and response were also considered as the main agenda of those activities. The trained RCV did not only promote community safe practices/behaviors from time to time, but have regularly disseminated the key preventive messages related to AHI, DHF, and A/H1N1. They also discussed with communities their roles and responsibilities in preparing for or responding to a pandemic influenza outbreak in own communities/villages. Based on reports of RC branch officers, the RCV reached a total of 34,009 community members (17,160 female, 11,153 male and 5,696 children) through disease prevention and health promotion activities between January – March 2010. These reports also indicate that majority of community members have adopted practices which would contribute to the reduction, if not prevention, of disease transmission. As part of strengthening the skills/capacities of project staff and RCV for better project implementation, the H2P-AP project team at NHQ regularly supervised/follow up branch project activities, provided technical support, and updated their knowledge/information related to the project and/or subject matter. Project coverage/reach Through trainings of staff and volunteers, and communication activities in 12 provinces, it is estimated that the project have reached at least 750 direct beneficiaries, 738 RCV and 14 CRC staff. Through disease prevention activities conducted by these volunteers during the project period, some 348,900 persons (64,476 families) from 325 villages, 58 communes, and 22 districts were also reached (indirect beneficiaries). Working in partnership CRC has a tradition of closely working with national authorities, UN agencies, and relevant partners in carrying out its humanitarian mandate. In addressing AHI and A/H1N1 issues, CRC coordinated and collaborated in particular with the National Committee for Disaster Management (NCDM), Ministry of Health (MoH), World Health Organization (WHO), Food and Agriculture Organization (FAO), UNICEF, CARE and a good number of civil society organisations. This enabled CRC to share information and experiences, as well as exchange resources through expertise during trainings, meetings, workshops/seminars and other events. In the implementation of this project, CRC continued to work with partners. The close collaboration between CRC’s health and disaster management departments had been essential. CRC also continues to be a member of the National IEC Committee together with MoH, NCDM, WHO, UNICEF, and other partners. CRC project team has always been attending meetings with in-country organizations like CARE Cambodia, Plan International, NCDM, IOM and World Vision Cambodia to share the progress of H2P-AP activities and to mobilize needed resources. Through regular coordination meetings with partner National Societies (PNS), information/progress of the H2P-AP project were shared, and partners have been encouraged to follow on AHI and A/H1N1 activities. Project finance1 Total project budget was CHF 70,639.26. This was increased from CHF 60,260.26 through a budget revision in October 2009 in an effort to incorporate the translation and testing of generic H2P training materials and conduct of a master training for H2P partners. These activities were earlier committed by CARE Cambodia, but have to be absorbed by the project when funding was not possible.

1 Attachment 1 for the final narrative financial statement



At the end of implementation, while the project spent more on travel, communication, equipment and support/other services, expenses related to personnel and benefits, workshops/seminars and trainings were lower than anticipated. While all of the activities were carried out, the project has an unspent balance of CHF8,467.92. Please table 1 for details. Table 1. Summary of expenditures

# Activities/Description Budget (CHF)

Spent (CHF)

Balance (CHF)

1 Personnel and benefits 16,680.00 10,656.11 6,023.89

2 Travels 2,640.00 5,194.85 (2,554.85)

3 Project workshop, seminars and trainings 32,308.00 26,931.97 5,376.03

4 Communication materials 7,550.00 8,024.74 (474.74)

5 Equipment 1,560.00 1,469.81 90.19

6 Professional and consultancy 3,000.00 2,960.03 39.97

7 Support and other services 2,280.00 2,842.50 (562.50)

8 Indirect cost 4,621.26 4,091.33 529.93

Total 70,639.26 62,171.33 8,467.92



Project background The global situation2 A pandemic is a worldwide epidemic of a disease. Influenza pandemics have resulted in increased death and disease and great social disruption. In the 20th century, the most severe influenza pandemic occurred in 1918-1919 and caused an estimated 40 to 50 million deaths worldwide. Current epidemiological models project that a pandemic could result in two to 7.4 million deaths globally. The influenza pandemic (H1N1) 2009 virus started circulating in April, 2009. It appeared to be as contagious as seasonal influenza, and was spreading fast particularly affecting young people (from ages 10 to 45). The severity of the disease ranged from very mild to moderate, but also caused severe disease and even death to vulnerable people. The virus continues to be the predominant circulating influenza strain globally. Antiviral susceptibility testing shows the virus remains sensitive to the oseltamivir (Tamiflu), except for sporadic reports of resistance3. As of 20 June 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18,209 deaths4. According to the WHO, the impact of pandemic H1N1 2009 on health care services varies in different countries. In Asia it is moderate in India, Thailand and in Malaysia. The intensity of acute respiratory diseases in the population in Cambodia remains low or moderate, and the impact on health care services is low. To combat the virus, heightened surveillance, up-to-date information, early detection of cases and appropriate medical referral and care of cases are crucial. The impact of the pandemic in least developed countries has yet to be seen as it is only beginning to penetrate very poor communities. It is likely that in developing countries that are characterized by high prevalence of existing infectious diseases (HIV, malaria, dengue, respiratory infections), limited access to medical care, under-developed public health infrastructure and low annual health spending, the health impact of H1N1 will be considerably higher than has been seen to date. Data from 1918-1920 Spanish Influenza suggest the current influenza pandemic could result in global mortality of approximately 62 million, with 96% of the deaths occurring in the low- and middle-income populations of developing countries5. Avian influenza and pandemic risks in Cambodia Cambodia's first case of the new influenza H1N1 virus was confirmed by the Cambodian National Influenza Centre (NIC) on 23 June, 2009. As of 28th June 20106, there were eight cases of H1N1 found. The total cases in Cambodia are now 591 and among those there were 6 dead cases (3 female and 3 male). The A/H1N1 cases were found in 15 provinces. They are Phnom Penh, Kandal, Takeo, Kampong Speu, Siem Reap, Svay Rieng, Battambang, Kampong Chhnang, Kampong Cham, Mondulkiri, Kampot, Prey Veng, Banteay Mean Chey, Kompong Thom, and Udor Mean Chey. The threats of influenza pandemic A/H1N1 relate to human health (excess morbidity and mortality) and to the functioning of society (economic impact on vulnerable sectors, difficulty in maintaining essential services). In Cambodia with poor health status and limited resources, the pandemic may further strain the already weak health services. 2 http://www.who.int/csr/disease/swineflu/en/index.html (WHO Cambodia Pandemic Influenza A/H1N1

update for UN and Development Partners, 03 September,2009) 3 www.who.com 4 http://www.who.int/csr/don/2010_06_25/en/index.html 5 SI Khan, SMF Akbar, ST Hossain, MA Mahtab. Swine influenza (H1N1) pandemic: developing countries’

perspective. Rural and Remote Health, 9:1262, August 2009 6 Bulletin on Avian Influenza in Cambodia/UN system in Cambodia/Issue No 258 and www.cdcmoh.gov.kh

http://www.who.int/csr/disease/swineflu/en/index.html

http://www.who.com

http://www.who.int/csr/don/2010_06_25/en/index.html

http://www.cdcmoh.gov.kh



Government response Cambodia has committed and reallocated significant national resources to fight against AI and prepare for human pandemic influenza. The Cambodian National Comprehensive Avian and Human Influenza Plan (Part One - Prevention and Preparedness), has been developed through close collaboration between the MoH, ministry of agriculture, forestry and fisheries (MAFF) and NCDM with support from the UN system and other partners. This plan has built upon "the Cambodia and UN joint program for addressing AI and pandemic planning in Cambodia" which was earlier endorsed by the Deputy Prime Minister in December 2005, in the presence of the UN senior influenza coordinator. Part One of the plans brought together agriculture, health and inter-ministerial cooperation and included a national communication strategy. It formally identified NCDM as the lead coordination body for inter-ministerial pandemic planning and response efforts in the lead up to, during and in the recovery phase of an influenza pandemic. Part Two (Response) of the National Pandemic Response Plan (NPRP) was piloted in Siem Reap province. This involved the development of multi-level and multi-sector government response plans in which all ministries, governors, civil societies and non-government partners were involved. The plan is extended to include all the provinces and the NCDM is responsible for collecting all the plans and combining them to be a NPRP. The plan consists of eight components: § Health § Border Management § Economic and Finance § Food Security

§ Public Relation and Communication § Public Security § Transport § Water Systems and Energy

When influenza pandemic (H1N1) cases were reported in Cambodia, rapid response teams/working groups were activated and rapid field investigations were launched. The MoH with support of WHO, Institute Pasteur in Cambodia and other partners, is continuing to strengthen the surveillance and response system for influenza pandemic. MoH did implement containment measures7 to slow down the spread of the virus. Its surveillance activities at all border crossings were actively enhancing. Thermal scanner screening of incoming passengers at Siem Reap and Phnom Penh International Airports continued. A new thermal scanner was installed at Poipet on the Thai Cambodian border. All visitors to Cambodia were requested to fill in Health Declaration Forms on arrival and an Information leaflet on Pandemic Influenza H1N1 was given by MoH quarantine team to arriving passengers which includes MoH hotline numbers to contact in case of flu-like illness. At the community level, the collective efforts of government sectors, CRC branches and NGOs including WHO, UNICEF, and FAO, have until now built capacity of volunteers and community members to prepare for and respond to the threats of influenza pandemic, and intensive communication and public awareness campaigns. CRC involvement in avian, swine and human influenza prevention, preparedness and response8 CRC continues to contribute to the implementation of the Royal Government of Cambodia (RGC) national programme for AHI and the national pandemic preparedness planning process. Since April 2007, CRC has been engaged in community awareness-raising and mobilisation through RCV who have been considered permanent resources of communities as they are

7 http://www.who.int/csr/disease/swineflu/en/index.html (WHO Cambodia Pandemic Influenza A/H1N1

update for UN and Development Partners, 03 September,2009) 8 The CRC-2008 Annual Report Avian and Human Influenza Project

http://www.who.int/csr/disease/swineflu/en/index.html



members of the villages where they work. In controlling AI outbreaks, RCV worked with existing community structures, such as village chiefs, village animal and human health workers, farmer’s unions, women’s union, youth unions, and other stakeholders to assist communities, especially backyard farmers, in identifying ways in which they change key behaviours and practices in order to reduce AHI-related risks and develop long-term strategies to address economic impact to families. Some 548 RCV in 12 provinces also assisted communities to build capacities to prepare for, and respond to pandemic influenza and other public health emergencies, such as the recent DHF outbreaks. When the influenza pandemic virus has spread rapidly in different countries, the CRC has mobilised RCV who have disseminated key messages about the virus and prevention measures. This project did enable these volunteers to be further equipped with knowledge and skills, and relevant tools and materials that could improve their work in communities. Concerning to the pandemic plan, the CRC has become a significant player in the NPRP which also aims at reducing the risks of possible communicable and endemic/pandemic diseases. The representatives of the CRC at headquarters (HQ) and its provincial branch in Siem Reap have always participated in this Part Two process of developing the pilot provincial pandemic plan in Siem Reap, which would be hopefully finalized and endorsed in near future.



Project results

The project has late been started by end of December 2010 because of taking time for project document preparation and budget transfer. However, the project team members and the trained RCVs have tried all their efforts to manage completely the project activities according to the expected results as describing below, Objective 1: Response plans and mechanisms are implemented. Expected Result 1.1 – The CRC preparedness and response plan is developed, implemented and updated as necessary9 A training of trainers/facilitators on H2P project, influenza pandemic, and planning for pandemic influenza (A/H1N1) preparedness and response was internally conducted at the end of December 2009; this also signalled the commencement of project implementation.. The total participants of 35 representatives from various departments at CRC NHQ and 12 branches, and NCDM along with facilitators from NCDM and MoH were invited to attend and facilitate the sessions. The roles and responsibilities of CRC NHQ, branches, sub-branches and volunteers during different phases of an influenza pandemic openly discussed during the training. Soon after, all project officers from 12 CRC branches organized meetings with communities, local authorities, RCV and stakeholders to sensitize them on the project, and at the same time consult and validate their roles and responsibilities during influenza outbreaks, especially A/H1N1 or H5N1. Based on reports from RC branches on the outcomes of discussions with communities and volunteers, the NHQ H2P-AP team updated the roles and responsibilities table. This latter was further discussed and finalized during the Training Workshop on Community Health for 48 health focal persons of the 24 CRC branches held on 5th -7th April, 2010 at CRC-NHQ, Phnom Penh. The CRC business continuity plan which identified responsible persons, crucial activities and services which need to be continued/sustain in an influenza pandemic event were also discussed and finalized in this workshop. While the roles and responsibilities of various CRC departments, offices, staff and volunteers, including communities where CRC actively operates were totally identified and followed, the project was unable to complete the pandemic preparedness and response planning process due to time constraint. Table 2. Progress on CRC preparedness and response planning Activity Planned Implemented Achievement

Identify national society focal point and set up H2P-NHQ team.

Focal point identified

Done 100 %

Organize H2P orientation and planning workshop for branches.

1 Workshop Done 100 %

Branches develop their Pandemic Response Plan and submit to NHQ team

12 Branch plans Almost done 67 %

Compile branch plans and integrate into CRC national pandemic response plan (which is part of the government’s national pandemic plan)

Branch plans integrated into CRC plan

Partly done 50 %

Organize validation workshop and finalize the 1 Workshop Not done 00%

9 Annex 1: for The compilation of Pandemic Plan of previous meetings/workshops during the project life (November, 2009-April, 2010)



Activity Planned Implemented Achievement CRC pandemic response plan. 1 CRC Plan

Objective 2: Staff and volunteers of CRC and civil society organizations are able to carry out community level response activities.

Expected Result 2.1 – Mitigation and response tools and messages are adapted and disseminated at scale. H2P tools and messages. The generic H2P mitigation and response tools and messages, developed by H2P initiative working groups, were shared and approved by the National IEC Committee, and were eventually adapted, translated and disseminated. Some 400 sets of the H2P community planning and response curricula for community leaders and responders were also reproduced and distributed to selected staff and volunteers of CRC, H2P partners and project communities. These were also used as guide for the master facilitator workshop for CRC and H2P partners which was co-organised with CARE Cambodia. A flipchart on 'Pandemic Influenza, what people should know?’ along with t-shirts and caps were distributed to 738 RCV from 12 RC branches. These served as dissemination kits after RCV received refresher trainings. A video spot “Five key messages” from the Federation’s Your Best Defence is You global communication campaign was also adapted to the Cambodian context and was broadcasted in nine local TV channels.

H2P Materials and kits provided to RCV H1N1 prevention and mitigation campaigns. Along with the existing Avian Human Influenza (AHI) and Dengue Hemorrhagic Fever (DHF) Integrated Project, RCV with assistance of H2P project officers in 12 RC branches, have not just promoted the community safe practices/behaviours but also have regularly disseminating the key preventive messages related to AHI, DHF, and A/H1N1. They also have discussed with communities about their roles and responsibilities when an influenza pandemic outbreak erupts in their own communities/villages. Equipped with IEC materials, RCV conducted household visits, led small group discussions, and integrated H1N1 prevention messaging during village meetings and other events/campaigns which were organized in their own communities. A compilation of activity/progress reports submitted by all CRC branch officers from January to March 2010 indicate that a total 34,009 persons (17,160 female, 11,153 male and 5,696 children) were reached by RCV through various H1N1 prevention and health promotion activities, and a majority of whom have ‘stepped in’ onto RCV shoes and have modified behaviours which were believed to contribute to the reduction, if not prevention, of H1N1, and other infections. In terms of technical support and strengthening the capacities of project staff and RCV for better project



implementation, the H2P-AP project team at NHQ/CRC has regularly supervised/followed up project activities at target branches.

Table 3. Progress on mitigation and response tools and messages

Activity Planned Implemented Achievement

Determine how districts in country will be informed of the situation and what sources of information and guidance related to local response will be used.

Consultation with partners on the matter

Done 100 %

Print and distribute pandemic communication/ advocacy messages based on agreed distribution plan and mechanism (include in planning workshop)

Completed Completed 100 %

Conduct advocacy activities via monthly and coordination meetings.

Participate in monthly meetings

Done 100 %

Disseminate/promote four key preventive messages within the communities which are motivated to adapt four preventive messages and practice safe behaviours through Red Cross volunteers.

Dissemination kits, materials produced

Done but in smaller quantity

75%

Keep districts and communities informed, through Red Cross volunteers.

RCV mobilised in communities

Done but in shorter period

45 %

Response to the current avian influenza and diarrheal outbreak Having received reports of avian influenza outbreaks in poultry in Takeo province in February 2010 and acting on the request of provincial departments for health and agriculture, ten H2P-trained RCVs together with the IEC materials were, in four days, mobilized to promote key preventive messages related to AI outbreak in the affected areas. Parallel that event, eight H2P-trained RCV in Kampong Speu province were also mobilized to contribute to local hygiene promotion activities to fight against the Severe Acute Watery Diarrhoea occurring in the part of the province.

MoH Diarrhoea prevention IEC materials



Objective 2: Staff and volunteers of CRC and civil society organizations are able to carry out community level response activities

Expected Result 2.2 – Branch trainers and volunteers are trained, equipped and mobilised to deliver life/saving messages and support services.

Training with partners10 In collaboration and cost-sharing with CARE Cambodia, the CRC H2P project team conducted a master facilitator workshop on community preparedness and response for pandemic influenza on 29-31 March, 2010. The objective of the training was to strengthen the capacity of community responders, volunteers, staff, and commune and district leaders to plan and respond effectively for possible community influenza pandemic and improve collaboration/coordination with operational partners

Refresher trainings for RCV The CRC-NHQ/branch project team, in cooperation with provincial health departments and local partners, completed 28 refresher trainings for 738 RCV from 12 provinces. Completed in February 2010, the refresher courses applied the adapted H2P community planning and response curricula. Through participatory training approaches, all updated RCV had the opportunity to learn how to use flipchart, to practice following the guidance, as well as got constructive feedback among participants and facilitators. The compiled pre-post test results of training showed that RCV knowledge on H2P and pandemic preparedness have on average increased by 72% of good, 20% of fair and 8% of poor. At the end of training, RCV were also provided with flipcharts, T-shirts and caps to be used during H1N1 prevention activities in their communities. Some of the training activities were also broadcasted through national TV channels. The training schedules were shown as table below:

No Branch/Province Date Number of RCV

Number of Course Location

1 Kampong Cham 28/01/2010 02/02/2010

32 2 We have two target districts

2 Kampong Speu 08-09/02/2010 12-13/02/2010

60 2 Target districts

3 kampot 25-26/02/2010 28-29/02/2010


4 Kandal 11-12/02/2010 17-18/02/2010


5 Kratie 02-03/02/2010 04-05/02/2010 06-07/02/2010


6 Mondulkiri 07-08/20/2010 17-18/02/2010

54 2 Primary School at target district

7 Oddor Mean Chey 01-02/02/2010 16-17/02/2010


8 Prey Veng 22-23/02/2010 24-25/02/2010 26-27/02/2010


9 Pursat 16-17/02/2010 20-21/02/2010

95 3 Two of course per time

10 Annex 2 for Report of Master Facilitator Training on community preparedness and response plan for

pandemic influenza.



No Branch/Province Date Number of RCV

Number of Course Location

10 Siem Reap 08-09/02/2010 12-13/02/2010


11 Svay Rieng 17-18/02/2010 22-23/02/2010

95 3 Target District Office

12 Takeo 10-11/20/2010 13-14/02/2010


Total 738 28

Personal protection materials. Following CRC procurement procedures, 120 sets of protective clothes, gloves, hand gels, and masks (N95) were distributed to 12 target RC branches for staff and volunteers who are in the frontline in responding to influenza pandemic outbreaks. Table 4. Progress on training and mobilisation of branch trainers and volunteers

Activity Planned Implemented Achievement

Decide on role and scale of volunteers' involvement in pandemic mitigation and response, such as in dissemination of prevention messages, and caring for the ill and referral or counselling for families with influenza.

In meeting/ workshops and monthly activities of RCVs (at 2-5 times per month per RCV)

Done 100 %

Adapt, translate and finalize training curriculum for community leaders and volunteers

One time Done 100 %

Train master trainers of CRC and H2P partners on adapted curriculum for community leaders and responders

1 Training Done 100 %

Conduct a 1.5-day training of trainers (ToT) for branch trainers.

1 Training Done 100 %

Conduct 28 one-day updating/refresher trainings for community volunteers in 12 provinces.

28 Trainings Done, see above table

100%

Mobilize support and follow-up community volunteers in the conduct of advocacy, communication and other preparedness activities in assigned villages.

Monthly basis Done, but not according to plan

16 %

Provide PPE (gloves, masks and hand gel) for volunteers and staff who are to be involved in caring for the ill.

120 sets for 12 branches

Done 100 %



Objective 3: Coordination mechanisms are functional and sustained:

Expected Result 3.1 – NS actively participates in and contributes to national pandemic influenza coordination.

• CRC is an active member of the National IEC Committee. In the implementation of the H2P-AP

project, the project team regularly attended Committee coordination meetings which facilitated sharing and updating of relevant experiences/information, particularly on influenza (H1N1 and H5N1) but also DHF and diarrhoea outbreaks. CRC also utilised this platform in introducing the H2P and IFRC tools and guidelines.

• The H2P project team also held a number of meetings with a number of organisations which attended the Regional H2P Workshop in Hanoi in September 2009, and which committed to continue to coordinate on influenza pandemic matters.

• It also collaborated with CARE Cambodia in the conduct of the Master Facilitator Training with

Partners on Community planning and responding for Pandemic Influenza, which was help on 29th -31st March 2010. Please see Expected Result 2.2 for details.

• Reviewing the existing disaster preparedness and response plan of CRC-Disaster Management

Department, NCDM and the CRC internal discussions, in particularly with DMD team during the workshop/trainings, the CRC business contingency and preparedness/response plan for influenza pandemic had been started its development processes by prior discussion of roles and responsibilities for influenza pandemic at various levels from community up to national headquarter (Refer to ANNEX 1). The project team did not yet complete the national preparedness and response plan for such pandemic because of time limitation.

Table 5. Progress on national coordination for influenza pandemic Activity Planned Implemented Achievement

Organize meeting to sensitize the community leaders on pandemic influenza preparedness and response and H2P accelerated project.

At least two times of each branch

Completed 100 %

Participate regularly in coordination meetings organized by AHI steering committee (National IEC committee, AHI working group, DRR working group) and other relevant coordination mechanisms at various levels

Monthly/ quarterly basis

Done, though not in all meetings which sometimes collided with project activities

70 %

Coordinate and explore collaboration with relevant NGOs in the implementation of the H2P accelerated project.

Monthly/ quarterly base

Done, though not in all months due to slower project start

80 %



Reflections on project impact

A participatory system has been developed following Federation guidelines. The monitoring and review activities had taken into account the participation of stakeholders and beneficiaries. One of the achievements at community level was increased awareness of communities through the mobilization of and dedicated support/follow up provided by RCV. After RCV were updated on influenza pandemic prevention and mitigation, they worked with villages they were assigned to (based on CRC volunteer policy, this is estimated to be 12 hours per month). Following the clear project management structure and making it to be well function, the NHQ project team along with RC branch directors and officers provided supports to volunteers through regular monthly monitoring and supervision visits, and meetings with RCV where their progress activity reports have been received and challenges have totally been discussed/tackled, for future sustainable project within CRC.

Constraints/Challenges

• Delays in the transfer of project funds to CRC resulted to delays in project implementation.

Implementation of the short-term project between1st November 2009 to 30th April 2010 was hampered by the time needed to process the transfer of funds to CRC NHQ and to project branches. To address delays, the H2P project team focused on supporting branches in the conduct of refresher trainings for RCV, but this also resulted to the slower progress in the preparation of the CRC influenza pandemic preparedness and response plan. The planning component could have been completed should CRC have been given a month-long no-cost extension; incidentally, this did not materialise due to programme funding issues.

• Limit project staff, RCVs and communities capacities have been the main causes affecting the project implementation and development of preparedness and response plan for pandemic influenza.

• Lake of time had also been affected to majority of target Red Cross Branches submitting late

their preparedness and response plan for a possible pandemic influenza, their report of the progress activity and their financial report to NHQ/CRC project team. That why the development process of the national preparedness and response plan for a possible pandemic influenza has delayed and not yet been completed (Except the identified roles and responsibilities for pandemic at different levels from top down to the communities).

• Community participation. Motivating community leaders and members to participate in village

H1N1 prevention and health promotion sessions was a big challenge for RCV. The conduct of community prevention activities was incidentally the period when villagers were mostly in their rice fields, and attending to their businesses. While most RCV managed to reach most communities via different communication approaches, they also felt that the level of awareness and behaviour change may have been affected negatively.

• Too much reporting requirement and the different format/requirement between the project report

and IFRC reporting standard. • The project sustainability was strongly recommended from all level, especially from the

community. However, CRC not ready yet to contribute financial to the project, while CRC very much depend on and appeal through/to IFRC to seek for potential external donor in order to keep project for the long run and widely reach to the most vulnerable people in Cambodia.



Lessons learned and recommendations Ensuring the implementation of effective, efficient and sustainable influenza pandemic projects/programs in the future, we would like to share our lesson learnt, considerations and recommendations gained from the H2P-AP. To wit:

• Getting experiences from previous AHI project, this project had been great successes through

early participation of the existing target communities especially at design phase and so on. Being successful and sustainable project in the future, the promotion of the community participation has been the key factor of the sustainable project/program activities at community levels. So the communities should initially involve in the process of project design and planning because they know exactly the situation, the resources and the needs of their communities. At the same time, they are ready to learn about the project and ready to contribute to the project as well.

• Learning from the project implementation, the collaboration/Partnerships /multi-sectored

approaches have also been a key successes of project implementation because we could mobilize immediately the resources (both local and external), in particularly during the increasing of any kind of pandemic or disasters, as mentioning early about RCV/material mobilization during outbreak of AI and acute watery diarrhoea in Takeo and Kampong Speu provinces.

• The RCVs and staff capacities/skills/knowledge related to PMER have to be strengthened

because they have also been the key player to make the smooth running the project activities and to ensure the sustainability of the project at community levels as well.

• It would have no delay or postponement of any project activities, if the operational cost would

have been available at the beginning of the project. So the project/program managers should, at the same time of project/program design and planning, considered the availability of project operation costs at the starting point of the project.

The compilation of Pandemic Preparedness and Response Plan/CRC ( ANNEX I) Roles and responsibilities for pandemic/disaster preparedness and response at different levels

Red Cross Volunteer/community, Red Cross Sub-Branch/District, Red Cross Branch/Province and National Headquarter/CRC (Based on previous meetings/workshops during the project life: November, 2009-April, 2010)

Roles and Responsibilities of Red Cross Volunteers, Red Cross Branches/sub-branches and CRC National Head Quarter During Influenza Pandemic Response

No Target Preparedness Stage Pandemic Response Stage In Different Place (Not in our place yet) Local Response

1 Red Cross Volunteers (RCVs)

• Promoting the public awareness and enhancing the community practices/habits/behaviours to overcome a possible influenza pandemic.

• Improve community participation through mobilizing them to do clean up their house/village compound regularly.

• Mobilizing communities to develop the community preparedness and response plan for a possible pandemic influenza.

• Identify task forces among Red Cross Volunteers such as report team, education team, mobilizing community team, information sharing team, etc)

• Keep close relationship/ collaboration/ coordination with local authority at village, commune and district levels.

• Observe and do surveillance activities on a possible pandemic situation.

• Report immediately the suspect cases/events related to influenza pandemic to local authorities, Red Cross Branches and other involved partners/stakeholders working at the same communities, for an immediately and appropriate intervention.

• Continue to promote the public awareness and community practice change and identify the most vulnerable affected people within the communities.

• Working closely with local health authorities and local authorities (Village, commune and district levels) to ensure, in advance, the safe and appropriate the hospitalization patients (including referral and case management).

• Observe/doing surveillance activities on the pandemic situation.

• Keep update and report regularly the pandemic situation to the communities and Red Cross Branch, local authorities and involved partners/stakeholders, especially local health authorities.

• Educate the affected communities to prevent, control and respond the AHI pandemic, in collaboration with VHSGs, VAHWs and local authorities.

• Facilitate/coordinate with local authorities and health staff to mobilize communities and refer the pandemic affected people to hospitals/health centers.

• Continue it observe/doing surveillance activities on the pandemic situation.

• Keep update and report regularly the pandemic situation to the communities and Red Cross Branch, local authorities and involved partners/stakeholders, especially local health authorities.

• Participate in controlling villager movement (prohibit the villagers travel from one village to another village).

• Keep regularly follow up the pandemic situation and report immediately the suspect cases to professional/technical response teams

2 Sub-Branch • Mobilize communities and Red Cross Volunteers to develop the appropriate community plan of action for

• Encourage Red Cross Volunteers to promote the public awareness and community participation.

• Motivate and provide supports to Red Cross Volunteers as response operation, esp. promotion and secured activities.




preparedness and response to a possible pandemic.

• Ensure the close collaboration/ coordination and information sharing with local authorities, local health authorities, and other stakeholders working at the same target areas.

• Participate in identifying the possible community pandemic/hazard areas and evacuation place within the communities.

• Assist the Red Cross Volunteers to do the surveillance activities.

• Supervision/monitoring visits the Red Cross Volunteer activities.

• Report regularly the update situation to local authorities and Red Cross Branch.

• Ensure the good collaboration with all stakeholders working at same areas. Be ready to assist the local health authorities as needed.

• Keep updating the pandemic situation and report on time to local authorities and health authorities including Red Cross Branch for an appropriate intervention.

• Assist local authorities and local health authorities as requirement for relief/response operation.

3 Branch • Strengthen Red Cross Volunteer capacities through providing them trainings and refresher courses.

• Provide regularly supervision and monitoring visits.

• Participate in the process of development of the provincial preparedness and response plan of action for a possible pandemic.

• Organize regular monthly follow up meeting with sub-branch and Red Cross Volunteers for update situation and information sharing.

• Ensure safe stocks (Materials/equipments)

• Ensure the good collaboration and coordination with partners/ stakeholders from governments and related NGOs/IOs.

• Keep reporting the update situation.

• Strengthen the capacity of staff and RCVs for preparedness and response for a possible A/H1N1 and its Pandemic, in close collaboration and coordination with provincial department for health and agriculture (technical support).

• Motivate RCVs, who have usually encouraged the target communities to modify their practices (hygiene promotion, promotion of poultry raise via bio-security, keep environment clean), to disseminate regularly all A/H1N1 key messages and to put communities ready on to prepare and respond for an A/H1N1 and its pandemic.

• Regularly follow up RCV activities (monthly base) and encourage them to keep watching permanently the A/H1N1 situation in their communities and to report all the encounter cases/events.

• Ensure the good collaboration and

• Collected data and recap and share with related departments, especially provincial governors for emergency relief and response operations.

• Deliver safe stock (emergency kits including food) to A/H1N1 pandemic affected areas.

• Distribute protective clothes, shoes, masque, soap, gloves, to RCVs for intervention operation.

• Mobilize RCVs to A/H1N1 pandemic affected areas for appropriate intervention such as education, social supports, if needed.

• Collaborate and coordinate especially with local authorities, PHD, PDAFF, and PCDM to mobilize all collective efforts, to facilitate the transportation of the materials, equipments, food, approaching to the most affected areas.

• Warning and appeal for assistances and supports from national, international,




coordination with related provincial departments, local authorities, and other partners/ NGOs via coordination meeting...etc.

• Coordinate with partners and provincial departments, especially provincial health and agriculture departments to ensure stock of the protective clothes, medicines and needed materials for staff and volunteers

partners /NGOs.

4 CRC National Head Quarter

• Support branches to build branch staff and Red Cross Volunteer capacities. • Ensure the technical and needed material/equipment support to branches as needed and requirements for preparedness and

response operation. • Strengthen structure/networking from the top down to community levels. • Keep good coordination and collaboration with all partners/ stakeholders (Governments and NGOs/IOs) • Appeal for any possible supports/assistances from the external and internal donors.

Roles and Responsibilities of Red Cross Volunteers, Red Cross Branches/sub-branches and CRC National Head Quarter for Influenza Pandemic responding during disaster?


1 Red Cross Volunteers (RCVs)

• Identify the vulnerable people and places.

• Surveillance the pandemic situation and report it to village chief and Red Cross staff via the existing networking.

• Promote community awareness with a special focus on preparing for and responding to a possible pandemic.

• Be ready to the response operation

• Public Awareness Promotion focus on preparing on and responding for a possible pandemic (A/H1N1, H5N1..)

• Follow up the situation of pandemic and hazards and diagnosis them.

• Strengthen the collaboration and coordination among Red Cross Volunteers, Village Health Support Groups, Village Animal Health Workers and Local

• Conduct health education at the affected places.

• Provide Care and Supports to the affected people/victims

• Participate in the disaster repose operation as requirement of professional departments/Ministries, esp. provincial health department...

• Follow up the disaster situation and collect




activities as needed. Authorities.

data, then do report to related departments/Red Cross sub-branch and branches…

2 Sub-Branch • Meeting with local authorities to identify the vulnerable affected areas.

• Strengthen the capacity of Red Cross Volunteers focus on Pandemic and Disaster preparedness and response.

• Ensure the availability of materials/equipments for disaster response operation (Up to their own ability and capacity)

• Keep regularly update the pandemic and disaster situation (size of disaster) to Red Cross branch and local authorities.

• Resource mobilization (Local and External)

• Strengthen the capacity of Red Cross Volunteers focus on Pandemic and Disaster preparedness and response.

• Encourage the Red Cross Volunteers to perform their tasks.

• Follow up the pandemic/disaster situation. • Do report to Red Cross branch and local

authorities the modification situation of the possible pandemic and disaster.

• Participate in Red Cross Volunteer activities for disaster/pandemic response.

• Follow up the situation and collect data (victims, and damage…)

• Do report to Red Cross branch and local authorities.

3 Branch • Keep update and report about pandemic/disaster situation to national head quarter.

• Do priority encounter problems (Disaster and Pandemic)

• Strengthen the skill/capacities of branch and Red Cross Volunteers for effective disaster/ pandemic preparedness and response activities.

• Motivate branch and Red Cross Volunteers to perform their duties.

• Ensure safety stock responding to any kind of possible disaster/pandemic.

• Improve the collaborate and coordination with sub-branch, Red Cross Volunteers, local authorities and partners / stakeholders working at the same communities for the better preparedness and response for possible pandemic and disaster.

• Ensure safety stock responding to any kind of possible disaster/pandemic.

• Keep follow up activities and situation in communities.

• Report to national head quarters.

• Participate in sub-branch/Red Cross Volunteer activities for disaster/pandemic response.

• Follow up the situation and collect data (victims, and damage…)

• Working closely with partners/local authorities to update the pandemic/ disaster situation.

• Do report to National Head Quarter.




• Strengthen the collaboration and coordination with all operational partners.

• Appeal for donors and resources. 4 CRC National

Head Quarter • Support branches to build branch staff and Red Cross Volunteer capacities. • Ensure the technical and needed material/equipment support to branches as needed and requirements for preparedness and response

operation. • Strengthen structure/networking from the top down to community levels. • Keep good coordination and collaboration with all partners/ stakeholders (Governments and NGOs/IOs) • Appeal for any possible supports/assistances from the external and internal donors.

Continuity Plan: What are services needed of function during pandemic? Who should be involved and what activities should be completed No Pandemic Period

Services How/activities? Who (Responsible person)? 1 Broadcasting Service • Promote Key prevention messages through

TV and Radio, IEC materials such as leaflet, posters…

• Promote Key prevention messages through events/campaigns

• Cambodian Red Cross (NHQ, Branches, Sub-branches, Red Cross Youths and Volunteers)

• Ministry/ department for Health and for Agriculture. • Ministry of Information • Ministry of Post and Telecommunication • Local Authorities, • Militaries/Police

2 Transportation Services (Food and materials)

• Foods, water, Relief materials/equipments delivering to the disaster/pandemic affected areas.

• Ministry of Public Works and Transports • Cambodian Red Cross (NHQ, Branch, Sub-branch and

RCVs) • Military and polices • Local authorities • Related private sectors

3 Care and treatment Service • Refer patient from affected areas to care and treatment places.

• Ministry of Health and Provincial Health Department. • Cambodian Red Cross (NHQ, Branch, Sub-branch and



No Pandemic Period Services How/activities? Who (Responsible person)?

• Provide care and treatment to the victims. • Conduct health education (Hygiene, water and

sanitation, disease prevention and psychological…)

RCVs) • Local authorities

4 Security Services

• Ensure safe security at the disaster/pandemic affected areas.

• Military and Police with assistance of all Ministries/departments and local authorities.

Continuity Plan: Roles and responsibilities of RCVs and Red Cross Branches/sub branches related to needed service delivery,

No Description Preparedness Stage Pandemic Response Stage In Different Place (Not in our place yet) Local Response

1 Food and water: 1. How the communities

ensure food safety stock?

2. How to distribute food to the victims in the affected areas?

3. Does the communities have develop plan for to assist the sick persons during the harvest season?

• Set up community management committee for food safety stock and transparent deliverer/ distribution to equal victims.

• At least 10% of food/resource of community people/households should be contributed to ensure safety stocks being sufficient to the needs of the people affected by pandemic or disaster.

• The communities have usually kept update all the related progress/information and encounter concern problems.

• The community management committee for safety stock organizes the meeting to develop response operation plan and promote community participation and contribution as well.

• Strengthen the existing rapid response team/task forces (for food and water delivery during pandemic/disaster).

• Identify safe water sources ensuring having enough safe water (drinking and daily use)

• Review community rapid response team/task forces, and assign them be at the pandemic/disaster affect areas to ensure enough food/water responding to real needs of the affected people.

• Assess the needs of communities and the situation of pandemic/disaster.

• Promote the food contribution among communities themselves, partners, and donors as well.

• Collaborate and coordinate with local authorities to organize meeting identify the place where appropriates for food/water distribution on time.

• Promote the communities to pay more attention to the food shortage.

• The task forces surveillance the

• Collaborate and coordinate with local authorities and concern departments/organizations to conduct the rapid response operations (food and water distribution) up to the assessment and the existing community plan.

• Continue promoting the water and sanitation public awareness.

• Keep evaluating and reporting the update situation of the encounter pandemic/ disaster among communities and local authorities.

• Seek for the more appropriate response intervention of local and external agencies/ professional organizations, (if needed).



No Description Preparedness Stage Pandemic Response Stage In Different Place (Not in our place yet) Local Response

during any possible pandemic/disaster. • Ensure the water purification materials in

community stocks/ warehoused. • Promote public awareness on water and

sanitation. • Appeal for local and external donors.

situation and keep inform to the related department/organizations via RCV networks.

• Appeal for donors.

1 Psychological and First Aid 1. What is the community

mechanism for identifying and caring for the families that their members affected by pandemic /disaster (disability and, unconsciousness)?

2. Have RCVs been trained on psychiatric and first aids yet?

• Create networking and village committee composed by village chief, village volunteers, local health staff, and senor people for providing the care and first aid services to the victim/ patients affected pandemics/ disasters.

• Develop and enhance the village plan for first aid and psychological support during pandemic/disaster.

• Identify and inform in advance the places where the health services will be provided among communities/villagers.

• Strengthen the RCVs, villager’s skill /capacities related to psychiatry and first aids via various trainings, simulation exercises, study tour, etc.

• Keep strengthening networking and promoting public awareness.

• Enhance the concern skill/ capacities of village committee members and RCVs as well as reinforcement of their roles and responsibilities.

• Keep follow up and update the communities, local authorities, concern department/ NGOs working at the same areas about the evolution of people expose to the possible pandemics/ disasters.

• Ensure enough protective materials (both staff/RCVs and victims) available at district/ provincial levels.

• Keep inform/report via networking.

• Mobilize resources (human, and materials) responding to the real basic needs of the affected people.

• Seeking for more supports from the professional department/organization, if needed.

• Conduct health education providing consultation and first aid services to people at the affected areas.

• Refer the sever patient to hospitals nearby.

• Report the update situation via networking for further appropriate intervention.

2 Management of dead bodies 1. How manage the death

bodies during the pandemic/disaster?

• Set up the village death management committee.

• Inform communities about the place for keep death bodies and funeral within the communities.

• Keep inform and encourage the villager to prepare for and ready response to any kind of pandemic/disasters.

• Mobilize resource to do response activities with support by professional staff/volunteers.

• Provide psychiatric consultant services to death’s family members.

• Report via networking.



What should you prepare for a possible pandemic in advance? What will be the possible problems/constraints? How to solve those constraints/problems?

No Target Group Pandemic What should be prepared for a possible pandemic in advance?

Possible encounter constraints/problems? Problem Solving

1 Red Cross Volunteers

• Strengthen existing networking at community level (Village Rapid Response Committee).

• Keep close communication with local authorities and stakeholders working at the same communities for update and information sharing

• Develop community mapping with the participation of community members.

• Ensure the local resources (materials/equipments) for any kind of pandemic response.

• Strengthen response capacity and skill for a possible pandemic.

• Identify the role and responsibilities for pandemic response among Red Cross Volunteer, Village Health Support Groups, and related stakeholders from different organizations and Local Authorities.

• Limit capacity of Red Cross Volunteers. • Lake of materials/equipments (IEC

materials) and transportation. • Low level of community livelihood. • Limit community knowledge and

practices related to health and hygiene.

• Branch and Sub-branch support the IEC materials.

• Red Cross Volunteer capacity building through training, study tour to model areas.

• Promote community awareness/practices through trained Red Cross Volunteers.

2 Sub-branch • Organize immediately meetings with Red Cross sub-branch and related sub-department around the districts to make sure the roles and responsibilities and resource mobilization as well.

• Make the resources (human, materials and budget) available for the possible needed intervention at affected areas.

• Appeal for donors and operational partners.

• Regularly changing sub-branch committee members.

• Lack of materials and budget. • Lack of community participation. • The existing plan has not been applied.

• Strengthening sub branch management structure with clear assigning responsible staff for each unit.

• Appeal for local and external donors/partners.

• Strengthening community awareness by inviting villagers to attend in meetings, campaign, simulation exercises.



No Target Group Pandemic What should be prepared for a possible pandemic in advance?

Possible encounter constraints/problems? Problem Solving

3 Branch • Enhance the collaboration and coordination with related departments in term of sharing information/joint planning, and resource mobilization as well.

• Assist sub-branch to promote public awareness by collaboration with local authorities.

• Ensure having enough materials and budget responding to the needs of sub-branches based on their request.

• Enhance the planning, monitoring, evaluation and reposting systems from branch through community levels.

• Limit communication among concern provincial departments.

• Limit resources (human, materials and budget).

• Limit public awareness promotion. • Limit Red Cross branch staff/RCVs

capacities in term of responding to possible pandemics.

• No donor.

• Continue promoting public awareness. • Capacity building through providing

related trainings, study tours and simulation exercises to branch staff and RCVs.

• Appeal for local and external donors/partners.

4 NHQ • Provide technical, and budget (if needed) supports to assist Red Cross branch/sub-branches to accomplish preparedness and response activities against possible pandemic/disasters.

• Appeal for donors/partners.

• Receiving late the information/reports related the event/pandemic/disaster from the branches/sub-branches.

• Support communication materials to Red Cross branches and sub-branches.

• Enhance capacities of branch/sub-branch staff.

TRAINING REPORT (ANNEX II)

Master Facilitator Training on Community Preparedness and Response for Pandemic Influenza with Partners,

At Raffles Hotel Le Royal in Phnom Penh, Cambodia; On 29th – 31st March, 2010

Introduction: A pandemic is a worldwide epidemic of a disease. Influenza pandemics have resulted in increased death and disease and great social disruption. In the 20th century, the most severe influenza pandemic occurred in 1918-1919 and caused an estimated 40 to 50 million deaths world wide. Cambodia's first case of the new influenza H1N1 virus was confirmed by the Cambodian National Influenza Centre (NIC) on 23 June, 2009. Update to 31st March 201011, there were 566 confirmed cases, including six deaths (3 males, 3 females). The laboratory-confirmed A/H1N1 cases came from 14 out of 24 provinces of Cambodia. As an auxiliary to the government, the Cambodian Red Cross (CRC) is, with a network of Red Cross Volunteers, committed to complement and support government priorities and plans in pandemic influenza preparedness and response which intends to minimize preventable excess deaths and illnesses, as well as the impact of a potential pandemic influenza, particularly at community level. The CRC has implemented the Humanitarian Pandemic Preparedness – Accelerated Project (H2P-AP) within six months, in partnership with national authorities, non-governmental organizations (NGOs) and other stakeholders, to assist communities mitigate and respond to the threats of the evolving influenza pandemic. Responding to that kind of pandemic, the CRC H2P-AP team and CARE had jointly organized the training above for strengthening collaboration and coordination among operational partners as well as achieving the objective as highlighted below,

Objective: To strengthen the capacity of community responders, volunteers, staff, commune and district leaders to plan and respond effectively for possible community influenza pandemic. Facilitators:

• Ms Jacqueline Pinat/CARE/Reg.Programme Manager, • Ms Cecilia Dy/CARE/AI Project Coordinator, • Dr Lysovann/CDC/MoH, • Dr Sok Long/CRC, • Mr HangChanSana/CRC/H2P-AP, • Mr Lim Kim Seng/CRC/H2P-AP.

Participants: 33 representatives from CRC, CARE, World Vision, PCDM (Provincial Committee for Disaster Management), PHD/MoH/Rapid Response Team, IOM and H2P different partners closely working with community in the field of preparedness and response for a pandemic influenza. The majority of the participants were men only three women were participating. Arrangements: All practical pre-arrangements for the training were successfully carried out by Cambodian Red Cross and CARE International in order to ensure good conduction of the training. Simultaneous translation was provided throughout the training as part of the training sessions were conducted in English and part of in Khmer language. Training materials: Specifically selected training materials were used throughout the training. Including a workbook translated in Khmer-language that was provided to all of the participants. This workbook was developed in collaboration by USAID and H2P as well as all other training materials used in the training such as Videos; flipcharts; posters. Contents of the training: As indicated in the attached schedule (ANNEX 1) all sessions were conducted and all successfully completed as planned during the training. The contents and the curriculum for the training had been designed and adapted by CRC and CARE in collaboration following the manual as produced by USAID and H2P. The modules used in the training were selected in order to provide technical/ scientific and practical information for the programme and development officers and those who work at community level. Both technical and practical issues were in balance and well covered.

11 Bulletin on avian influenza in Cambodia/UN system ( issue number 246)



Didactic Methodology: Participatory and maximal interactive methodology was used throughout the training. Even the technical session on medical aspects of H1N1, that contained more technical and medical details produced a lot of discussions and relevant questions, being an important indicator of interest from participants. Several group exercises were carried out and the results were presented through compiling the outcomes into posters. Appropriate amount of time was given for the participants to allow and encourage their interactive participation and to ask questions and facilitators to answer them. All the PowerPoint presentations of the facilitators were compiled and provided in the form of CDs to all the participants in the end. Conduction of the training: The entire training was conducted by facilitators encouraging full participation of the participants. Various group works were used in order to encourage the participants to use their experience and knowledge by practically exercising the techniques (such as behavioural change communications in using the IEC material, to do the mapping, matrix for communication plan, infection control window in “flu-fighters” section etc.). During the group exercises the role play was very effective way for promoting the good IPC techniques when sensitizing the community members. All the groups showed great commitment and dedication to be innovative in their ways of addressing community members. Visible progress could be identified throughout the 3 training days. All the participants/master facilitators showed high level of participation and interest to both technical issues and practical issues. All the sessions resulted in good and relevant questions and discussions. Future prospects: The work established and done at the community level for the pandemic preparedness by all the participating officers in the training should become integrated as part of the big national pandemic preparedness plan. This could be facilitated through CRC disseminating the national Cambodian pandemic preparedness plan with all CRC officers so that everyone would be familiar with it. This is a multi-sectored plan and should be encountered as such. The role of these participants/master facilitators will be to function as catalysts in order to motivate and mobilise communities for self-directive and sustainable preparedness and response within the communities.. Networks for pandemic preparedness and communication within this network of the trained participants should be established. This could be conducted and supported by CRC. This would be important in order to respond efficiently but also to ensure adequate and timely information sharing. As mentioned in the opening remarks by Dr Lysovann from CDC/MoH, Cambodian Red Cross is a significant and recognised auxiliary for MoH in any health emergencies and other emergencies. Recommendations: 1. CRC to ensure the dissemination of the national pandemic preparedness plan with all the CRC branches

and officers working with H1N1. 2. CRC to develop a communication plan and establish a network between all the branches and officers

involved in H1N1 in order to ensure continuous and efficient information exchange and quick mobilisation and right actions for the response. Same at the community level to help Red Cross volunteers to become integral part of the chain of VSTs in order to support community leaders in becoming prepared to respond in case of pandemic.( Listing key players, all the actions to be taken in the case of response. It is a collective product that you need to implement it at certain period of time and certain amount of resources that is needed).

3. In the communities to use the available IEC material innovatively, motivate the community to participate

in maximum, to ask questions, show right behaviours in practice, let the community practice. 4. Before making the communication plan, facilitate the community to prepare a detailed community

mapping in order to indicate the infrastructure and the important gathering points, health centres, collective centres such as markets, chicken/duck farms, houses, rivers, roads, transportations within the



community. This is a tangible/real touchable thing for the community to get to know and plan their systems for communication plan in case of a pandemic but also in much larger scale for any emergencies. Include all that might be relevant when preparing a communication plan.

Conclusions: The Cambodian national action plan for the pandemic was developed by NCDM & MoH & MAFF together. In order to support the authorities in case of pandemic, the humanitarian organisations and NGOs has started to build the capacities from within the community level (VST =village surveillance team/CARE for instance) in order to meet the governmental authorities in the midway to respond effectively in case of a pandemic. The future prospect is to include Cambodian Red Cross volunteers to become integral part of this chain of the Village Surveillance Team. Prepared by, Mr. Hang Chan Sana Project Manager, H2P-AP Cambodian Red Cross

ANNEX III

TRAINING CURRICULUM Master Facilitator Training on Community Preparedness and Response for Pandemic Influenza with Partners,

At Raffles Hotel Le Royal in Phnom Penh, Cambodia; On 29th – 31st March, 2010

Objective: To strengthen the capacity of community responders, volunteers, staff, commune and district leaders to plan and respond effectively for

possible community influenza pandemic. Participants: 33 representatives from CRC and H2P different partners (They should be closely working with Community in the field of Preparedness and

Response for a pandemic influenza). Duration Description Methodology Materials Resource Person Day 1: 29 March 2010 07:00-13:00 The participants travel to Phnom Penh SESSION 1: What is Pandemic Influenza?

14:00-15:30

1. Opening & Session Objectives (15 mn) 2. Pre test (15 mn) 3. Card sorting: Learning about pandemic influenza (15

mn) 4. Presentation and discussion (60mn)

Speech Card sorting activity, presentation, discussion, pre- and post-test

Paper, Flipcharts, Maker pen, and role play material (if needed), Pre-post-test questionnaires, Card sorting

• CRC H2P-AP project team

• Partners (CARE, WHO, FAO…)

SESSION 2: Teaching Preventive Messages about Influenza 5 hour

15:30-17:30

1. Opening and Session objective (5 mn) 2. Pre-test (20 mn) 3. Charades game (20 mn) 4. teach-back: Learning about five flue fighters (80 mn) 5. Mapping: How do we need to reach? Where can we

find them? (60 mn) 6. Brainstorming: Making a community communication

plan (75 mn) 7. Final review and post test (30 mn)

Pre- and post-tests, Charades game, teach-back, mapping, brainstorming, and group discussions.

Paper, Flipcharts, Maker pen, and role play material (if needed), Pre-post-test questionnaires



Day 2: 30 March 2010

SESSION 3: Infection Control for Community Responders 2 hour

08:00-12:00 1. Opening and Session Objectives (5 mn) 2. Pre-test (20 mn)

Interactive lecture, guided vision exercise,

Paper, Flipcharts, Maker pen, and role play




Duration Description Methodology Materials Resource Person 3. Interactive Lecture: Influenza Infection Control (45 mn) 4. Guided Vision: Imagine your day (60 mn) 5. Post-test (30mn)

paired review, pre- and post-tests

material (if needed), Pre-post-test questionnaires


SESSION 4: Home-Based Care of Persons Ill with Influenza 3 hours

14:00-17:30

1. Opening and Session Objective (10 mn) 2. Review of important information on Prevention, Need

for home care, and Infection Control (60mn). 3. Symptom of Influenza (30 mn) 4. Home care of the person sick with influenza (60 mn) 5. Small group work: Caring for the caregivers (30 mn) 6. Watching out for our neighbours (30 mn) 7. Closing/wrap up (10 mn)

Interactive presentations, brainstorming, small group work, story.

Paper, Flipcharts, Maker pen, and role play material (if needed)



Day 3: 31 March 2010 SESSION 5: Actions Local Leaders Can Take to Fight Pandemic Influenza (Commune/district leaders) 3.50 hours

08:00-12:00

1. Opening and Session objectives (15 mn) 2. Role play and discussion: You have to play to win (60

mn) 3. Presentation: action to fight a pandemic in the

communities (90 mn) 4. Discussion: Two special situations in a severe

pandemic (60mn). 5. Small Group works: Sustaining community response

strategies (120mn) 6. Closing/Wrap up (15 mn)

Role play, interactive presentation, discussion, brainstorming, small group work, story.

Paper, Flipcharts, Maker pen, and role play material (if needed)



14:00-18:00 The Participants travel back to provinces

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