1 Te challenge In Cambodia, thirty years of civil conict, war and genocide, ac - companied by chronic malnutri on, the destrucon of health ser - vices, and the spread of over 10 million land mines has led to a high number of people with disabili es. The Cambodian Socio-Econom- ic Survey (CSES) 2009 esmates the disability prevalence at 6.3%. Today, the most common causes of disability in Cambodia are old age, disease, congenital condions, trac and work acci - dents. The most common impairments include vision, mobility and hearing, although intellectual impair ments are likely to be underesmated. Recent research conducted by Handicap In- ternaonal and the Cambodian Ministry of Educaon, Youth and Sports found a 15.6% impairment rate in children between two and nine years old, with cognive/learning, hearing and speech disabilies being most prevalent. Since most disabili- es are acquired over a lifeme and not limited to congenital factors, it is likely that the prevalence rate in the general pop- ulaon is much higher than the prevalence rate found by the CSES 2009, which is based on self-reported data. It is esmated that almost half of all impairments in Cambodia are preventable. Vision and hearing impairments, oen developed from complicaons of ear and eye infecons, can be easily and cheaply prevented, if detected early and treated properly. Serious childhood illnesses (e.g., acute respiratory illness, fever and diar - rhoea) are oen untreated by health providers. Undernourishment and malnutri on are prevalent in 40% of Cambodian children, causing stunng and contribung to child mortality and morbidity. The implicaons of malnutrion can last into adulthood and lead to physical, sensory and intellectual disabili es. Although maternal and child health care has improved, substanal gaps between rich/poor and urban/rural populaons persist in Cambodia, pung children born to poor families in rural areas at parcular risk for disability. Maternal and child undernutrion also increases the risk, es- pecially for the poor, of developing cardiovascular disease and diabetes later in life. In addion, with life expectancy rising and ferlity rates de- creasing, Cambodia is undergoing a demographic transion to a more mature society. The elderly, accounng for 6.6% of the Cambodian populaon in 2012, are expected to reach 19% by 2050. The ageing of society entails an epidemiological tran- sion from infecous, nutrional and maternal condions to chronic and degenerave diseases. With communicable diseases remaining substanal threats to health and an upsurge in noncommunicable and chronic diseases, Cambodia faces a “double-disease burden”. The shi in disease burden and cause of death is clearly progressing in Cambodia, with noncommunicable diseases (NCDs) such as diabetes, hyper- tension and cancer coming to the fore (NCDs already account for 46% of annual deaths in Cambodia), and a persistently high prev - alence of mental disorders. Mental disorders are considered one of the leading causes of disability globally. In addion, people in developing countries develop NCDs at a younger age than those in high-income countries. As NCDs progress, a large number of people are likely to develop im- pairments, such as amputaon as a result of diabec neuropa- thy , visual impairment due to diabec renopathy , or paralysis due to stroke. 35.6% of Cambodians over 60 years old have one or more disabilies. Although NCD-related disabilies ac - count for 66.5% of all years lived with disability in low-income and middle-income countries, this issue is oen neglected by governments and development agencies alike. Making Health Services Inclusive People with disabilies and the elderly Project name Social Health Protecon Project Commissioned by German Federal Ministry for Economic Cooperaon and Development (BMZ) Project Region Cambodia Lead execung agency Ministry of Health Overall term 2011 to 2014 Photos: © GIZ/Ursula Meissner Published by
