Prepared by the “ Organization to Improve Communication and Swallowing Therapy Services in Cambodia” April 2020

What is Speech Therapy?

Speech therapy involves the assessment, diagnosis, treatment and support of people with communication or swallowing difficulties. Speech therapy aims to maximize people’s abilities to communicate and to swallow effectively, thereby improving their quality of life.

A communication difficulty refers to any difficulty, which a person may experience in expressing themselves and sending their message to others or receiving and understanding a message.

This may be caused by:

•    Difficulty moving their mouth to produce speech sounds correctly

•    Difficulty understanding what people say to them

•    Difficulty with using and ordering words to make a clear sentence

•    Difficulty understanding the social rules of communication and interaction

•    Difficulty hearing

•    Difficulty reading and writing (written language)

Communication disabilities affect individuals across all aspects of life. In Cambodia, people with communication disabilities experience barriers to community participation (attending religious ceremonies, going to the market), accessing education (including primary education) and vocational training, employment and income generation as well as establishing interpersonal relationships (OIC, 2019, Lived Experience of Communication Disability).

A swallowing difficulty (dysphagia)      refers to problems with safely and independently eating, drinking and/or swallowing food, drink or      saliva.  A person can be born with or acquire swallowing difficulties following an injury to a part of the body used for eating, drinking and swallowing or an injury to the brain.

Swallowing disabilities have both immediate and long-term impacts on the health and wellbeing of children and adults. Immediate symptoms of swallowing difficulties include choking, coughing, aspiration pneumonia. Over time, swallowing difficulties can lead to poor

respiratory health, malnutrition, gastrointestinal issues, dehydration and other poor health outcomes.

Who needs Speech Therapy?

Communication and swallowing difficulties affect people of all ages, including babies, children and adults. Common groups of people benefiting from speech therapy are listed below:

Who needs Speech Therapy in Cambodia?

 

Cambodia’s 2014 Demographic and Health Survey (2014 CDHS) reported a disability prevalence rate of 10%1. It is however worth noting that data collected using this method whereby a person is asked if he/ she has a disability is often considered unreliable, resulting in underestimates due to the misunderstandings of the term disability’ and related stigma. OIC estimates that 600,000 people have communication or swallowing difficulties in Cambodia, implying at least 1 in 25 Cambodians would benefit from Speech Therapy2. This is equivalent to 4% of the total population. Furthermore, a recent Global Partnership for Education study found that 10.1 per cent of Cambodian children had a disability, with cognitive and speech impairments the most common.3Data on dysphagia (swallowing difficulties) and stroke incidence in Cambodia is            limited4 however, global estimates suggest that 50% of people who have a stroke experience swallowing difficulty5.

 

The prevalence of both people with communication and swallowing difficulty in Cambodia warrants further research, although the current population are undoubtably underserved by the existing speech therapy resources in Cambodia (with respect to both service access and workforce with necessary expertise).


Speech Therapists

 

Speech therapists are universityqualified professionals working in
the
area ocommunication and swallowing impairments.

 

Speech therapists:

 

    Work directly with the person experiencincommunication and/or swallowing difficulties to improve their skill anfunction

 

    Work with people anplaces of significance (family, school, work, shops, temple).

 

This includes making adjustments to the environment to enable the person to participate in their society.

 

    Train others to supporpeople with communication and
swallowing difficulties

Speech therapy also has a role in public health programs, prevention of communication disabilities and swallowing difficulties through education, informational counseling and training of other community and other professionals in education, health and rehabilitation series. Speech therapy can help both children and adults at all stages of life.

 

 

 

Specific activities in Cambodia speech therapist can be involved in:

 

    Provide screening, assessment, rehabilitation and therapy directly for people with communication and swallowing difficulties in hospitals, in schools, at home and at a clinic (public and private)

 

    Provide training to teachers, medical staff, families and other community members to support people with communication and swallowing difficulties and facilitate integration of strategies in their own practice (including when to refer for specialist speech therapy skills).

 

    Develop screening tools, assessment tools and therapy resources suitable for use in

 

Cambodia

 

    Supervise speech therapy students and other rehabilitation workers in the areas of communication or swallowing assessment, therapy and other service development.

 

    Conduct research projects to measure the need for, efficacy and efficiency of speech therapy strategies in Cambodia

 

    Advocate with Government and civil society stakeholders for recognition of speech therapy profession in Cambodia and professional association and employment for speech therapists in Cambodia’s health, education and rehabilitation sectors in the future

 

 

 

 

Speech Therapy: How does someone become a speech therapist?

 

An internationally recognized speech therapist is a university-qualified health professional with a broad scope of practice working within health and rehabilitation, education, and disability sectors. The qualifications are Bachelor or Masters degree level.

 

Where and how do speech therapists work?

 

 

STs work in a range of settings and are employed by government, community and private entities. Around the world, STs work in the health, education and disability sectors in settings such as healthcare facilities, schools, community organisations and private clinics.

STs work collaboratively with:

 

●    Other health professionals including
medical
teams and rehabilitation professionals.

 

The World Health Organisation advocates that a multi-disciplinary rehabilitation workforce is available within the health sector (specifically mentioning speech
therapy, physiotherapy and occupational therapy), citing strong evidence for multidisciplinary approaches significantly improve the quality of patient care
.6

●    Teachers, educational
psychologists,
occupational therapists
and others both
for

 

individual
child goals and for capacity building of
teaching staff to support inclusion, development and participation of all students. The American Speech and
Hearing Association (ASHA) cites collaboration one of the core methods of service delivery
7

●    People with communication and swallowing disabilities and
the
significant people in

 

 

their lives
(e.g. family and community)

 

Current support for people with communication and swallowing disabilities in

Cambodia

 

 

The vast majority of
Cambodians have no access to speech therapy services. This lack of
access is influenced by:

 

    Lack of speech therapists in Cambodiathere are currently no Cambodian universityqualified
STs. There are approximately 15 qualified foreign speech therapists working in Cambodia-
the majority of whom work for non-government organisations or private clinics
based in Phnom Penh.

 

    Limited number of organisations whose work supports people with communication
or swallowing difficultiesthere are currently 13 organisations who selfidenitfy as providing ST services

 

    Limited number of Cambodian ST practitioners (we found 26 people in our mapping study)

 

A speech therapy Practitioner is a health or education practitioner who has received speech therapy capacity building and delivers services in
one or more aspects of the scope of speech therapy, typically related to their current area of
work. For example: medical staff who have received dysphagiaspecific training or speech therapy assistants with excellent skills in aspects of
child
speech or language
ar
eas.
They do not yet have
the full range of ST skills to be called speech therapist.

 

 

 

ST practitioners vary greatly in their:

 

    Understanding of speech therapy (only 35% of
ST accurately identified both communication and swallowing in
their definitions of speech therapy)

 

    Training
which they have received (54% of practitioners had received ST capacity
building through workshops and
onthejob training with foreign STs)

 

    Level of ongoing support which they receive (majority of
practitioners do not have
access to regular clinical supervision or professional development to ensure maintenance and ongoing
development of
knowledge and skills)

 

 

 

 

    The wide range of ST-specific experience and support contributes to significant variability across many areas such as:

 

    Aspects of ST they are
able to address- practitioners are
limited in
the
ST needs and populations which they can support (e.g. training and skills
are only relevant to supporting adults with non-complex dysphagia in
an acute setting)

 

    Quality of service being providedObservations highlighted limitations in
practitioners’ clinical decision making in
the planning, delivery and monitoring of intervention, online clinical skills,

 

    Current scope of ST services being provided is limited and does not meet the needs
of specific populations such as adults with communication difficulties and children with dysphagia. These include:

 

o Supporting children with Autism, intellectual disability or
physical
disabilities
in their general communication development

 

o Speech and language development for a small number of children without disabilities who have communication delays or disorders (provided mostly via
fee
for service provision through private clinics
in Phnom Penh)

 

o Basic dysphagia screening and
support

 

o A small number of medical professionals have received training and support through a local organization; Speech and Swallowing Therapy Cambodia
(SSTC). There are approximately 10 qualified
professionals actively working as dysphagia clinicians. These dysphagia
clinicians
conduct basic
swallowing screening and therapy across three national hospitals in Phnom Penh
Calmette Hospital, Khmer Soviet Friendship Hospital
and
Preah Kossamak Hospital.

 

    Services which
are
b
eing provided are done so in
an extremely limited capacity:

 

o Limited geographic coverage (mostly based in
Phnom Penh)

 

o Limited numbers of clients (children and
adults accessing services)

 

 

 

 

Meeting speech
therapy needs in
Cambodia

 

Ongoing research into the
prevalence of communication and swallowing needs in Cambodia
is required, to determine the number of speech therapists needed to meet the needs of the
po
pulation.
Additionally, the
recommended ST workforce density (number of
therapists needed based on
the
population) will be influenced by
the model of service provision
adopted by Cambodia’s health, education and rehabilitation services. For example, adopting
a public health approach to the provision of speech therapy services will include prioritisation of community-based rehabilitation services.
8

 

o Cambodia’s population is approximately 16 million and growing. Half of
the
population is under 20 years.

 

o ST workforce density in countries such as Australia, USA and the UK are around 1 ST

 

per 2,500 to 4,700 people.

 

For comparison Australia with a population
of 24.6 million has around 10,000 speech
therapists.

 

 

 

OIC Cambodia recommends the following key elements to grow the profession of speech
therapy in Cambodia:

 

o Establishment of a Working Group focusing
on the development of ST in Cambodia

 

o Awarenessraising and advocacy to increase demand for ST

 

o Development of Cambodian-specific research and
Khmer resources

 

o Engagement with
current ST practitioners (future ST students)

 

o International NGO engagement and support

 

o Development of a Cambodian ST
University program

 

o Creation of local ST jobs

 

 

 

For further discussion please
contact OIC University Strategy Manager
ruth@oiccambodia.org

 

__________________________________________________________________________________________

 

1 National Institute of Statistics, Directorate General for Health, and ICF International (2015)
Cambodia Demographic and Health Survey 2014. Phnom Penh, Cambodia, and Rockville, Maryland, USA: National Institute of Statistics, Directorate General for Health, and ICF International.

 

2 Yeoh, W (2013) Situational analysis Speech therapy in Cambodia, available from www.oiccambodia.org

3 Global Partnership for Education (2019) Summative GPE Country Program Evaluation

 

4 Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Martino R, Foley N, Bhogal S,
Diamant N, Speechley M, Teasell R Journal of Stroke. 2005 Dec; 36(12):275663.

5 Burden of stroke in Cambodia
International Journal of stroke
Volume: 8 issue: 6, page(s): 475-478 Article first

 

published online: September 13, 2012; Issue published: August 1, 2013

 

 

 6 World Health Organization. (2017). Rehabilitation in health systems.

7 OIC. “The Scope of Practice of Speech Therapy in Cambodia: Current Speech Therapy Initiatives and Future

Opportunities.” 2020.

 

8 Wylie, Karen, Lindy McAllister, Bronwyn Davidson, and Julie Marshall. Changing Practice: Implications of the World Report on Disability for Responding to Communication Disability in underServed Populations.”