Integrating person-centered care in the community to support healthy ageing: a case study from Cambodia

Similar to demographic trends across Asia and the Western Pacific region, the Cambodian population is rapidly ageing. According to the General Population Census of Cambodia,^1,2 life expectancy has increased from 64.3 years in 2008 to 77 years in 2019 for women, and from 60.5 years in 2008 to 74 years in 2019 for men. In 2019, the number of Cambodians aged 60 years and above was estimated at 1.38 million, representing 8.9% of the total population. This percentage increased from 6.3%, or 0.84 million in 2008.² It is estimated that it will reach 11.01% of the total population, or 2.02 million by 2030.²

Population ageing signifies important new challenges to address for Cambodia. They relate to the growing prevalence of non-communicable diseases (NCDs) in the population and their impact on functional ability in later life. Population ageing combined with rapid urbanization and economic development have led to increased NCD burden in terms of incidence, prevalence and mortality in Cambodia.³ For instance, in 2019, the total economic burden of NCDs for Cambodians was estimated at US$ 1.5 billion per year, equivalent to 6.6% of the country's annual gross domestic product.⁴ The high prevalence of NCDs in later life in Cambodia, as exemplified by the STEPS Survey Country Report further indicates the important contribution of population ageing to this overall NCD burden.⁵ The prevention, treatment, and management of NCDs is an important challenge to address at national and community level for Cambodia.

It is therefore paramount for Cambodia and other countries in the region to mitigate the adverse consequences of NCDs relating to population ageing and fulfill the World Health Organization (WHO) objective of healthier older people contributing to their families, communities, and society.⁶ Together with adequate policy and community services, accessible primary healthcare tailored to older people's needs is instrumental in supporting this objective.⁶ It should be directly implemented in the community in close partnership with older people, enabling them to be treated locally while considering their specific care needs and preferences.⁷

The Integrated Care for Older People (ICOPE) guideline⁸ is a key intervention supporting this person-centered and community-based approach to care. It helps identifying risk factors for prevention and managing NCD symptoms early following onset to maintain the functional ability of older people for as long as possible.⁸

The Cambodian Ministry of Health (MoH) recognizes the worth of this approach to care and the objective of the ICOPE guideline. In April 2022, MoH's Prevention Medicine Department engaged in collaboration with WHO and the Hong Kong Polytechnic University to develop and promote the use of the ICOPE guideline at the national level.⁸ It started developing a national training curriculum for primary healthcare workers based on the ICOPE toolkit as part of this collaboration. From April to June 2022, it organized a set of consultations and technical workshops with national experts and stakeholders to adapt the ICOPE guideline to the Cambodian context. These workshops involved developing an ICOPE toolkit and training programme in the Khmer language for primary healthcare workers tailored to local healthcare configurations and needs. In June 2022, the Prevention Medicine Department team then engaged in field testing activities consisting of two pieces of trainings to ensure the adequacy of this material further. Next steps of this initiative from August until December 2022 involve one ICOPE training with approximately 200 participants in three provinces through eight training sessions to ensure that it adequately responds to local needs and leads to successful implementation. After December 2022, this iterative development process will support the adoption of the ICOPE guideline as part of the national curriculum for primary healthcare services across Cambodia, enabling more inclusive care pathways for an older population.

The Cambodian ICOPE initiative is exemplary for the Western Pacific Region. It reflects key aspects of the current WHO Regional Action Plan on Healthy Ageing in the Western Pacific.⁶ Chiefly, it addresses population ageing as one of the key priorities of the WHO For the Future vision.⁷ It is in line with the objective of community-based integrated care promoted in the Regional Action Plan on Healthy Ageing in the Western Pacific⁶ by working hands-in-hands with local communities in developing ICOPE, considering local realities and building upon existing primary healthcare services.

Overall, the Cambodian ICOPE initiative is a significant commitment to current and future generations and a step toward crafting a brighter, healthier future for ageing populations in line with WHO principles. It demonstrates the important opportunities offered by reinforcing existing primary healthcare networks through targeted, cost-effective training and capacity-building activities for the benefit of older people. This commitment is inspirational and can pave the way for other countries to implement inclusive ageing research, intervention, and policy across the region.

Contributors

KH, ES and SP conceived the commentary. All authors wrote, edited and critically reviewed the manuscript.

Declaration of interests

Cambodian Ministry of Health's Prevention Medicine Department engaged in collaboration with WHO and the Hong Kong Polytechnic University to develop and promote the use of the Integrated Care for Older Persons (ICOPE) guideline at the national level. The Department started developing a national training curriculum for primary healthcare workers based on the ICOPE toolkit as part of this collaboration. From April to June 2022, it organized a set of consultations and technical workshops with national experts and stakeholders to adapt the ICOPE guideline to the Cambodian context. In June 2022, the Prevention Medicine Department team then engaged in field testing activities consisting of two sessions of training to ensure the adequacy of this material further. WHO Regional Office for the Western Pacific provided funding and technical support to the implementation of ICOPE in Cambodian communities. The manuscript was reviewed by Cambodian Ministry of Health's Prevention Medicine Department and WHO Regional Office for the Western Pacific prior to submission.