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Supporting Maternal and Child Health Improvement and Building Literate Environment (SMILE)

Country Profile: Cambodia

Programme Overview

Background and Context

During the Khmer Rouge regime in the 70s, Cambodia’s education system was severely damaged. Schools were closed or demolished, and many of the educators died in forced labour camps or were killed by the Khmer Rouge. Reconstruction has been in place since the end of the regime but there is still a scarcity of schools and State schools are under-equipped. Very often, classes are conducted without textbooks for the students, and teachers are underpaid. These factors make it difficult for students to access schools and receive a quality education.

According to World Bank data, in the last decade in Cambodia, there was a sharp decrease in the number of children not attending primary school, (201,277 in 2000 to 72,886 in 2010) and a significant increase of the net intake rate in grade 1 (71 % in 2000 to 90% in 2010). Whilst these numbers are positive for Cambodian education, the number of students who reached the final grade in 2010 was only 54.4% and this number has not changed since 2000, 54.7% displaying rather discouraging picture. In addition, literacy rates among adults in 2009 were 83% among men and 66% among women, lagging significantly behind the average of East Asia and Pacific region (97% among males, 91% female). There are some concerns for Cambodia’s health conditions. According to UNICEF (2012), Cambodia’s maternal mortality rate is the fourth highest in East Asia and the Pacific, indicating the need for more support for improving maternal health.

Asia-Pacific Cultural Centre for UNESCO (ACCU)

In line with the principles of UNESCO, the Asia/Pacific Cultural Centre for UNESCO (ACCU) has been working since 1971 for the promotion of mutual understanding and educational and cultural co-operation among peoples in Asia and the Pacific, by implementing various programmes in the fields of literacy, book development, and culture.

Cambodian Women's Development Agency (CWDA)

Founded in May 1993, the Cambodian Women's Development Agency (CWDA) grew out of the Phnom Penh municipality. CWDA is a small non-profit, non-governmental organisation with no religious or political affiliation. CWDA works with women and children. It has strong links in the communities in which it operates. CWDA aims to promote self-sufficiency and self-reliance in Cambodian communities and to advance women’s economic and social rights. It seeks to address the socio-economic and psychological problems resulting from Cambodia’s civil war and political instability by empowering women in both their productive and reproductive capacities through education, organisation, and self-development, access to resources, advocacy and cooperation.

SMILE Cambodia Project

The Supporting Maternal and Child Health Improving and Literate Environment (SMILE) project was formulated by the Asia-Pacific Cultural Centre for UNESCO (ACCU) as a new model which integrates literacy and maternal and child health education, as well as creating a literate environment at home and in communities, thereby contributing to the acquisition and sustainment of women’s literacy. The SMILE project has been implemented in Cambodia since 2009. CWDA adapted this project in Cambodia as a pilot project in one district in the outskirts of Phnom Penh city and in one district in Prey Veng province. Currently, SMILE operates in 11 villages in the Phnom Penh municipality. The participants of the SMILE project are illiterate and neo literate expectant mothers and mothers with children age 0-5.

Aims and Objectives

1. To improve women’s conditions with regard to education and health
2. To build a literate environment at home and community
3. To improve the health condition of mothers and children

Programme Implementation: Approaches and Methods

Curriculum and Materials

The content of the curriculum was collected from the three literacy text books developed by the Department of Non-Formal Education in the Cambodian Ministry of Education, Youth and Sport (MoEYS). Topics were selected on the basis of being relevant to health for mothers and children. Selected topics are related to: women and child health care, hygiene, food nutrition, and disease protection. There are also topics on agriculture and community development. The curriculum, the guidebook for facilitators, and the textbook for learners were written by CWDA and approved by the Department of Non-Formal Education of MoEYS. Facilitators were given a guidebook and they are in charge of developing their own lesson plans. The text book contains information about health which is divided into topics (one topic per lesson). Learners are provided with a photocopied textbook. Each lesson includes a large picture to illustrate the topic, an introduction, key words and exercises to complete. They are also given an exercise book, a bag and writing materials.

Selection of Learners

An assessment is implemented to select learners who are

1. either illiterate or neo-literate and
2. mothers or expectant mothers. A short literacy/numeracy test is administered and an interview is conducted by the CWDA staff.

Facilitator Selection and Training

The facilitators were selected on the basis of the following factors: is literate, is willing to help the community, has commitment, is self-confident, and has recognition from the local authority and people in the village. They were first volunteers receiving some monthly incentives from CWDA, but they have recently become government-contracted teachers. Facilitators were taught the necessary skills and knowledge to successfully deliver SMILE classes. The project orientation workshop for teaching methods and monitoring were organized for three days at CWDA office and attended by facilitators, chiefs of villages and commune council members. The workshop covered theory and hands-on practice (e.g., discussion groups on making lesson plans, teaching demonstration). In addition, 20 days of training in pedagogy was provided by Department of Education Youth and Sport in municipality (DoEYS).

SMILE Classes

SMILE classes are delivered by the facilitators for 10 months in their villages (2 hours per day and twice a week-the total instruction hours for class is 160 hours). For each class, there are 15 to 20 learners. Those classes take place in the communities (e.g., in the villages’ ceremony hall or in the facilitator’s house, wherever most appropriate, and is chosen by the facilitator, village chief and commune council members with advice from the CWDA staff). Most of the learners are farmers and require time off from learning to plant and harvest rice in June, July, August, December and January so that they have extra classes in the other months to ensure that the course is completed. The classes cover basic literacy in Khmer, and numeracy combined with health information specific to mothers and children. In each class, the facilitator introduces a health related topic to discuss with learners. This activity is followed by reading and writing activities on the topic. The learning is student-centred (i.e. learners talk more than the facilitator; activities which facilitate learners’ active participation are used) and learners are provided an opportunity to apply the knowledge they gained in real life scenarios.

In addition to the textbook, supplementary materials are also used to promote the learned literacy skills in daily life. Those materials include vaccination and child development records, income and expenditure checklist, and children’s school books where teachers and parents communicate in writing.

Learners are also encouraged to

1. read books and other materials about health, which they can borrow from the libraries maintained by the facilitators, at home,
2. read and tell stories to their children and other family members as well as to help children with school work and learning, and
3. visit their health centre for check-ups and to use vaccination and child development records. Facilitators visit learners’ houses to follow-up learners’ learning and to encourage those who missed classes to keep attending the class.

Certificate

A certificate is provided to the learners who achieved passing score from literacy tests administered during the project. The certificate is issued by the Department of Education, Youth and Sport in the Municipality.

Programmes Impact and Challenges

Monitoring and Evaluation

Regular monitoring and documentation of project activities are conducted throughout the project implementation period. CWDA staff visits each class on a weekly basis and hold monthly meetings with learners, facilitators, and community members. Commune Council members and village chiefs monitor classes 2-3 times a month.

Monitoring and documentation include:

1. records of learners’ attendance at SMILE classes
2. progress and performance of facilitators and progress and performance of learners
3. facilitators’ and learners’ feedback on the curriculum and teaching learning materials
4. number of learners using health care services
5. learners’ feedback on gift packages they received (e.g., Khmer alphabet poster, books relate to mothers and child care)
6. usage of reading corners
7. evidence of community support for the class

The evaluation of the project outcomes is conducted at the mid-way point and at the end of the project. It includes the following activities:

1. interview the target group, facilitator and stakeholders (chief of village, commune women affairs officer, commune council member); and
2. check any evidence of performance of learners which they mentioned they have done (e.g., income and expenditure check list, children’s school book, health card).

Impact

The average number of participants reached annually was 150. From 2009 until 2012, 710 participants attended the SMILE classes. The impact of the project on learners’ literacy level, their attitude toward the reading and learning activities, the health condition of mothers and children, practice of maternal and child health care are assessed in comparison with baseline data collected from the beginning of the project. These comparison data show a clear benefit for the learners in the SMILE. Recently, three additional literacy skill achievement tests developed by the Department of Non-formal Education (DNFE) are incorporated. The scores from these achievement tests will be used in the future to accredit learners’ achievements which are equal to the fourth grade level in formal school. The impact on learners and the community, based on observations from project stuff and community members and reports from learners, is described below.

Learners

Literacy skills

After attending the SMILE class, the learners were able to read, write, and calculate. They now:

1. use children’s school books (understand teachers’ comments on children’s work, and reply to the teachers),
2. make income and expense checklist, and
3. understand written record in the health card.

Learner’s testimony:

“After attending in the SMILE class, I can now read a religious book of Buddhism and picture books…I borrow books from a reading corner in the SMILE class. I can now write easy words.”

Knowledge of Health Care

The participants learned how to take care of themselves during pregnancy and after the birth of a child and recognize the importance of attending regular checkups at the health centre. They have taken the knowledge they gained in the SMILE classes to practice with their family members at home (e.g., educating their children about sanitation and taking their children for treatment at the health centre when they were ill rather than buying medicine from a shop).

Learner’s testimony:

“After I attended the SMILE class for 3 months, I came to know that my past habits on health were not correct…I have not had good health and my facilitator encouraged me to go to the health centre… As a result, I have discovered I have tuberculosis and now I take tablets prescribed by the doctor…”

Others

There is an increased participation in the community and family life. Participants reported increased self-esteem, confidence, and earning potential. Furthermore, they became themselves educators through sharing knowledge with other members of the community.

Community

The community also gained knowledge about the value of a literate environment and solidarity. The learning was disseminated to the members of the community who have not participated in the SMILE class (e.g., neighbours, husbands, children of non-participant mothers). Several learners are now teaching their children how to read and write and encourage children to go to school. By using income and expenditure checklist, some learners saved money to send their children to school. It was witnessed that there was a decrease in absence rates from local schools.

Learner’s testimony:

“I joined the SMILE class, because I wanted to get more knowledge and teach my daughter…I can now read, write and calculate and teach my daughter. Sometimes we read the alphabet chart together and I feel that her reading has improved”

The project was also a learning opportunity for village chiefs. In one of the villages, with the village chief’s suggestion, after a lesson covered in SMILE class about the importance of cleaning and repairing roads for hygiene and security purpose, learners , facilitators, and village chief went out to the community and improved their communities’ road conditions.

Challenges

• One of the challenges is the capacity of facilitators. They have been out of school for a while and one of the facilitators needed to upgrade her literacy skills. They also did not have prior teaching experiences and knowledge regarding health related issues; therefore, in addition to the 3 day orientation workshop, more training (follow-up) was necessary.
• Some learners unfortunately did not make as much progress as anticipated. Exact reasons for this occurrence needs to be investigated; modifications to the methodology needs to be made.
• Limited funding is one of the major challenges. Although the current private donors are aware of the importance of supporting literacy, it has been difficult to secure funds for the project.
• The expansion of this project to more remote areas, where there are greater numbers of women who are illiterate or neo-literate, would be of great benefit. However the accessibility of those locations would make it difficult for our staff to reach those places in order to implement the projects and to monitor them and provide ongoing support.

Sustainability

Currently, support from CWDA is provided to each SMILE class for 10 months. After the 10 month period, CWDA refers each class to local authorities who continue to run the classes. This initial 10 months only just allows enough time for the stakeholders (e.g., chief of village and commune council) to begin understanding the project, therefore, provision of additional support from CWDA would be ideal in order for the programme to be fully sustainable and to continue in villages. Despite this limitation, some actions have made to promote the sustainability of the programme, such as meeting with commune council to ensure that funding for SMILE classes is written into the community development plans. Also, all facilitators, who were volunteers, are now government contracted teachers and receive payment from the government. CWDA is considering including the topic on the programme’s sustainability into the orientation training so that the facilitators, village chiefs and commune council members know how to make plans for the continuation of the programme after CWDA’s withdrawal. Learners, their families, and members of the community are profoundly interested in seeing the project continue. CWDA will hold discussions with the commune councils regarding the continuation of the activities.

Lessons Learnt

CWDA requested that local officials/commune council members provide support for monitoring. However, they were not provided reimbursement for the travel expenses; therefore, their monitoring visits were less regular than was hoped. It became clear that their travel must be compensated for more effective monitoring. In order to fully embed the programme into the community and become sustainable, provisions for longer term support (two years, instead of one year for each location) of SMILE classes need to be considered.

References

• CWDA annual report 2010, accessed on June 18, 2012
• World Bank: World Development Indicators database, June 2012
• UNICEF (2012). The state of the world’s children 2012. Children in an Urban World.

Contact

Hun Phanna
Acting Executive Director, CWDA
Street 242, number 19 Sangkat Boeung Prolit, Khan 7 Makara
Phnom Penh, Cambodia
Tel: 855-23-210-449
Fax: 855-23-210-487
Email:User: cwda
Host: (at) online.com.kh
Website: http://www.pub22.net/cwda/

Rie Koarai
Programme Specialist, Education Cooperation Division, ACCU
6 Fukuromachi, Shinjuku-ku, Tokyo 162-8484 Japan
Tel: +81-3-3269-4559
Fax: +81-3-3269-4510
E-mail: User: koarai
Host: (at) accu.or.jp
Website: http://www.accu.or.jp/jp/en/index.html

Last update: 14 January 2013