Cambodia

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In Cambodia, Handicap International works on the following issues:

• Health: diabetes and HIV/AIDS
• Inclusion of disabled people: inclusive education and work
• Landmines: mine clearance, mine risk education
• Rehabilitation and physiotherapy
• Rights of disabled people
• Road safety
• Rural development
• Sport

CONTEXT

• Total population: 14.1 million
• Human development index: 0.571 (130th country out of 177)
• Life expectancy: 56.2
• 75% of the population is dependent on agriculture
  Source: Human Development Reports
• Highest percentage of amputees in the world
• Highest HIV infection rate in the region (3% of the adult population)

The country is known for its dramatic history. The Khmer Rouge regime became notorious for carrying out the first ever self-genocide, resulting in the death of 1.5 to 3 million people (35% of the country’s population at the time), including almost all of the educated elite. Vietnam invaded Cambodia in 1979 and ruled for 10 years before withdrawing. Since the early 1990s, the country has remained largely dependent on foreign aid (around £345.5 million/year).

In addition to poor infrastructure, unskilled resources and the presence of mines, the country must also deal with a ruling class that shows little concern for the interests of the general population. The country is still suffering greatly from the consequences of the war.

BACKGROUND
Handicap International started working with Cambodian people in 1982, when it established rehabilitation services in refugee camps along the Thai border. Following the return of refugees, Handicap International has been working in Cambodia since 1991 focusing on the after-effects of the war and the alleviation of poverty.

The current strategy consists in making major changes in direction:

• Refocusing the multi-disciplinary programmes onto the NGO’s core activity (disability)
• Ensure the sustainability of our efforts by supporting partners’ initiatives rather than implement activities directly
• Make economies of scale through experience-sharing between the 5 South-east Asia programmes

DESCRIPTION OF ACTIONS

1) Consolidation and development of Prey Nup Polders
The Prey Nup area is a coastal zone subject to spring tides that "burn" the crops. The project aims to alleviate rural poverty by increasing agricultural production through the construction of colossal infrastructures. 100 km of dikes and 37 constructions have been built on a basin that can be up to 50 metres deep. These works protect 15,000 hectares of arable land against seawater. Maintenance work is handled by the Polder Users Cooperative (PUC), which receives training from Handicap International. Street children and disabled people are included in the project through vocational training.
Since 1995, this project has benefited 50,000 people.

2) Battambang national centre for paraplegics and tetraplegics
The Battambang centre is the only one of its kind in Cambodia. It assists around 100 patients a year in regaining basic mobility to help them cope with their disabilities in a rural environment. After 6 months' treatment at the centre, patients receive medical and social follow-up care at home. The uniqueness of the centre has made it a regional reference centre, in particular in terms of the training of health professionals.

3) Kampong Cham regional physiotherapy centre
Since 2002, the project has recorded a significant growth in its volume of activity (4 times as many beneficiaries and 10 times as many prostheses produced) and has improved the quality of its services in the fields of rehabilitation, physiotherapy and socio-economic inclusion.
Since 2002, this project has benefited 4,000 people.

4) Rehabilitation centres of Takeo and Siem Reap
Since 2004, a full range of services in the area of rehabilitation and social and economic inclusion is provided to 4,500 patients with various physical disabilities per year. This is done at the centres but it also includes patient supervision, with services extending to the most remote villages. The goal is to improve the daily lives of the patients and to ensure the long-term existence of the services and their inclusion into a national rehabilitation system.

5) Chronic disease in Phnom Penh: diabetes and HIV/AIDS
Handicap International is using its community work's experience and is running this project in partnership with local stakeholders.

• Partnership with the Cambodian Diabetes Association on epidemiological surveys in Battambang and Phnom Penh to assess the frequency of the disease in Cambodia
• Coordination of a coalition of public and private stakeholders on the preparation and implementation of a national plan for diabetes control.
• Participation in a research project into disability and HIV/AIDS
• Advocacy activity so that both aspects are taken into account in the "HIV" and "disability " sectors, currently very compartmentalised.

Around 400,000 people suffer from diabetes in Siem Reap, Kompong Cham and Battambang. There are also 140,000 HIV positive people and 196,000 disabled people.

6) Education in Samlot: from formal and non-formal activities to inclusive education
The Samlot district had no state education system at all until 1998. The first project therefore consisted in laying the foundations for primary education and non-formal education (literacy tuition and vocational training).
Since 2004, the project began to focus on inclusive education to benefit disabled people (Education for All programme).
Since 1999, 10,000 people have benefited from this project.

7) National Rural Development Programme (NRDP) 
Cambodia suffers from the effects of cultural models that are demeaning of poor people (of which many disabled people and victims of chronic diseases). Vulnerable households are given very little consideration in public policies.
This project, funded by the Ministry of Rural development via a loan for the Asian Development Bank, focuses on the country’s decentralisation process to encourage the newly elected local authorities of 43 villages to implement local policies that take the needs of the poorest members of their community into consideration. We provide training, support and follow up to 12 communal councils, 86 village development committees (2 per village), 444 community organisations and construction companies on environmental issues and the management of human resources. As part of the prevention of disability and chronic diseases, Handicap International provides health education to the companies’ staff and advises these companies on the application of the labour code.
Since 2004, 31,000 people have benefited from this project.

8) Socio-economic inclusion project 
This project consists in assisting with disabled people's employment and income through the creation of income-generating activities. This is done through:

• Theoretical management and technical training, literacy 
• Social and psychological follow up of the beneficiaries
• Creation of a system of micro-credit adapted to the socio-economic situation and the low level of experience of the beneficiaries

Since 2004, 1,000 people have benefited from this project.

9) Socio-economic inclusion of young disabled workers project
This pilot project aims to create methodology for the vocational inclusion of young disabled workers through employment. It has the following objectives:

• Making young disabled workers more able to adapt to the labour market via an inclusion programme of up to 18 months, which includes confidence-building, professional knowledge and techniques for finding and keeping a job.
• Improving how disabled people are perceived in the world of work and in civil society via campaigns with the media and events with the chambers of commerce and large companies in the capital.
• Increasing the involvement of partners to ensure the sustainability of the action. A guide presenting the project’s methodology will be developed in collaboration with project partners  and offered to employers.

10) Capacity Building of Disabled People in the Community (CABDIC)
81.5% of disabled people live in the countryside. Because CABDIC is active in the community, this initiative promotes the timely intervention among disabled children and the development of the care capacity of the community itself. Via house calls, the establishment of self-help groups, awareness raising and pointing out the availability of specially adapted structures, CABDIC improves the autonomy and the inclusion of disabled people and their family into the community.

11) Sport for disabled people
Handicap International actively supports two sport clubs of disabled people in Battambang and Siem Reap. They perform at a high level: several members have been selected for the national volleyball team. 

12) Mine/UXO Victim Information Sytem (CMVIS)
CMVIS receives support from both Handicap International and the Cambodian Red Cross, and collects, analyses and distributes extensive information regarding victims of landmines and unexploded ordnance (UXOs) throughout the entire country. CMVIS, as vital source of information and planning for all concerned with mine clearance, is often praised as a model unique in the world.

13) Mine/UXO Risk Education
The campaign around reducing the risks of landmines and UXO is the result of the collaborative effort with the Cambodian Mine Action Centre. The most important activity is removing the danger to people directly affected by landmines and unexploded ordnance. Mobile, flexible and multidisciplinary teams ensure that mine clearance is accompanied by the marking off of areas and awareness raising, always in cooperation with the local population. Thousands of people are thus able to again live an ordinary life.

14) Research into humanitarian mine clearance
Despite the efforts of the last 15 years, the presence of millions of landmines and UXOs remains an enormous obstacle for the development of the country and a constant source of accidents (almost 900 in 2004). In August 2004, together with Norwegian People's Aid and MAG, we published the results of a thorough study into the increase in deliberate contact with unexploded ordnance by poor inhabitants who—despite the danger—hope to obtain a secondary source of income from the scrap metal. Another research also took place into so-called 'informal' mine clearance. Both studies contribute to identifying more flexible strategies in which the local communities and authorities are more closely involved.

15) Road safety
The road safety project aims to assist the Cambodian government in its fight against the road accidents that result in countless deaths, injuries and serious disabilities. The programme consists of the following:

• A national database of traffic accidents and victims
• National educational curriculum for road safety in the primary schools
• Raising the awareness of the general public via media campaigns and activities within the community. The gracious collaboration of actor Jackie Chan, immensely popular in Cambodia, as well as prestigious sponsorship by His Majesty Norodom Sihamoni, King of Cambodia, have contributed to the success of these campaigns. The use of more bicycle helmets is already noticeable.

TARGET PUBLIC
Handicap International promotes actions on behalf of disabled people and victims of chronic diseases. Wherever possible Handicap International uses an inclusive approach: the services are essentially for disabled people or those suffering from a chronic disease, but may also be open to their families or even to the community in general. The Cambodia programme therefore has three types of target population: the population in general, disabled people and people infected with HIV/AIDS.

Since 1995, our work in Cambodia has benefited around 830,000 people.

Working in partnership with local organisations is the only way to reach such a large number of beneficiaries. To ensure the sustainability of the actions engaged, we work closely with the ministries concerned and over 50 local organisations.

RESOURCES
In Cambodia, Handicap International has 289 staff, only 16 of whom are expatriates.