Universal HIV/AIDS Treatment in One of the World’s Poorest Countries

While successful public-private partnerships have remained elusive to many, Cambodia, one of the poorest and least developed countries in the world, has been quietly using the strategy to provide universal HIV/AIDS treatment. In a country that not too long ago had no functional healthcare system—wiped out by decades of the Khmer Rouge regime and civil war—this is a success story worth noting.

I was just in Neak Loeung District Hospital, about an hour and a half outside the capital of Phnom Penh. There I met a 12-year-old boy named Bara, who had lost both of his parents to AIDS before Cambodia’s care and treatment program was launched in 2003. He was put on antiretroviral (ARV) treatment six years ago and is thriving.

Bara lives with his uncle, and regularly makes his way 9 kilometers to the hospital for treatment. The system appears to work, even for orphans in rural villages like Bara. It is an intricate one comprised of over 150 NGOs, innovative businesses, and a remarkable government team called NCHADS (National Center for HIV/AIDS, Dermatology and STD) lead and coordinated by Dr. Mean Chi Vun. 

There is much to learn from NCHADS. One lesson is the country ownership of the program.  Anyone who has worked in development knows that there is a complex tension between NGOs and governments. But for programs to work long-term, in-country government must be involved and take a leadership role. While international NGOs play a vital role in disaster relief and provide life-saving services across the globe, ideally they are set up to gradually hand over programs to in-country organizations, as consistency of leadership is generally found with local citizens.

In Cambodia, all involved parties are clear—from NGOs to donor institutions to USAID—that NCHADS is in charge, and the organization has earned its leadership position. The NCHADS team is exemplary in its ability to create clear standard operating procedures (SOP) for almost every possible task and post their SOPs online.

Transparency is a top priority. NCHADS regularly posts program objectives, budgets, and progress reports, and makes this information available to all partners. NCHADS also makes great efforts to include all partners in decision-making. The process might take longer and be more complex, but allowing everyone a voice means that people feel a sense of ownership.

Last fall, the United Nations recognized Cambodia with a Millennium Development Goal Award for achieving its universal access target for HIV/AIDS treatment. Currently, more than 90 percent of adults and children are being offered antiretroviral therapy. Simply put, Cambodia is keeping people alive and healthy.

Of course, there are challenges. One of the biggest is that over 90 percent of funding for the program comes from foreign donors. Although this might seem large, it is not an uncommon scenario for poor countries dealing with high rates of HIV/AIDS. As donor money dries up following the global financial crisis, Cambodia increasingly will need to stand on its own.

Read more stories by Stephanie Wolcott.