1. Project title
Pathological capacity and system improvement for cervical cancer in Cambodia
2. Country nameCambodia
3. Background
Cervical cancer is the number one cause of cancer death among women in Cambodia. Screening andearly-stage treatment are proven to be effective in reducing cervical cancer mortality, but theseeffective interventions are not widely implemented in the country. Furthermore, few development
partners are willing to assist in implementation of these interventions, as it requires highly
technical skills and specialized experts.
In view of this situation and increasing needs of cervical cancer prevention, the Japan Society ofObstetrics and Gynecology (JSOG) and Cambodian Society of Gynecology and Obstetric (SCGO)
agreed on a launch of a project for early diagnosis and treatment of cervical cancer (Cambodia
Cervical Cancer Project), which started in 2015, co-funded by this program and JICA. The National
Center for Global Health and Medicine (NCGM), Japan has been assisting in management andimplementation of this project. So far, the project has offered health education and HPV test-based
screening and provided series of training sessions on early treatment for Cambodian gynecologists.
The outcomes include development of SCGO cervical cancer clinical protocols, implementation of theprotocols in three national hospitals, and increased number of patients with cancer screening andtreatment. It has also revealed that the bottleneck for scale-up of the screening program lies in thelimited capacity of pathological service with only 4 pathologists, 5 residents, and about 15
technologists working in the whole country. The recent global trend to compensate scarce
pathological service is to utilize telediagnosis, but the capacity of technologists to prepare adequate
specimens is still limited and there is much to be improved before telediagnosis can be used. Basicpathological equipment is already set up in the three main national hospitals. Technical transferfrom Japan will help improve the capacity of pathological technologists in preparing higher quality
specimens and pathologists in making better diagnosis. It will also provide guidance to nurture
future pathologists and technologists in the country.
4. Objective
・To improve technical capacity of pathology staff (technologists and pathologists)
・To strengthen pathological service system in Cambodia
5. Program outline
This project targets pathologists, residents, and pathological technicians in four national hospitals(Khmer Soviet, Calmette, Preah Kossomak, National Maternal and Child Health Center(NMCHC) )and University of Health Science through training program at hospitals in Japan and on-sitetraining/lectures in Cambodia.
This is the third year of capacity buidling for pathologists and technologist, based on theachievement so far, Ministry of Health made a decision to expand a pathology laboratory in NMCHC
as the forth public hospitals.
6. Implementation structure
6-1. Japanese side

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NCGM Bureau of International Health Cooperation will be the focal of this project and assist incommunication and coordination among project members in both countries. Japanese Society ofClinical Cytology (JSCC) and Japanese Society of Pathology will recommend Japanese experts andtraining facilities.
6-2. Counterpart country side
The main counterpart will be the SCGO. Target hospitals for capacity development will be the four
national hospitals in the capital (Khmer Soviet Friendship, Calmette, Preh Kossomak) and andUniversity of Health Science. SCGO will coordinate with pathologists and pathology technologists
for regular clinical pathological conferences (CPC).

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7. Indicator

7-1. Output<Technologists>
1) Standard operational procedures (SOP) are made in the three national hospitals
2) Adequate staining slides are prepared based on SOP (more than 80% of slides inthe three national hospitals
3) Quality of slides are self-evaluated by standard format in three hospitals (3 timesper year)
4) A new pathology department start functioning at NMCHC.
<Pathologists>
1) Case conferences of common pathological slides with Japanese experts (10 cases
each for GI tract, uterine and brest diseases)
2) Clinical pathological conference (CPC) is conducted (four times)<Technologists>
1) Number of slides self-evaluated for the quality (12 cases per hospital)
2) Evaluation of slides by Japanese experts (score more than 70%)
3) Pathology department at NMCHC will function (30 cytolpogies and 10 pathology
cases per month)7-2. Outcome

7-3. Impact<Pathologists>
1) Diagnostic concordance rate between Camboian and Japanese pathologists (morethan 70%)2) Presentation was selected from CPC, abstract prepared and accepted, andpresented<Both Technologists and Pathologists>
1) Specialty courses open and continue to nurture pathology technologists andpathologists
2) Society of pathology is established3) Pathology telediagnosis is started between Japan and Cambodia

8. Main activities
8-1. Training in 20191)
2)

Training in Cambodia (Dispatch 4 Japanese experts and NCGM staff for 1 week in May,June, September, December, and Kanuary)
Training in Japan back to back with JSCC annual conference (site visit for 3 days) in Juneand November.

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