At present, the estimated tuberculosis (TB) incidence rate in Cambodia is 272 per 100,000 population, and TB is the leading infectious cause of morbidity and mortality globally. While Cambodia remains one of the world's high-burden countries for the disease, active case-finding and treatment programs have driven a continuous decline from previous years. The Ministry of Health's response to these high mortality rates was to incorporate the World Health Organization's internationally recommended treatment: the Directly Observed Treatment Short course (DOTS), a decision which has been met with enthusiasm by local health organizations.

RACHA has been working to combat TB in line with the Global and National Strategy and Plan by expanding and strengthening DOTS strategy in all health centers and communities (C-DOTS). The DOTS strategy, developed by the World Health Organization, has five main components: sustained political and financial commitment, diagnosis by quality ensured sputum-smear microscopy which will reliably find infectious patients, standardized short-course anti-TB treatment which ensures the right drugs are taken at the right time, a regular and uninterrupted supply of high quality anti-TB drugs, and standardized recording and reporting which keeps track of both individual patients and overall program performance. RACHA aims to increase patients' accessibility to TB services, improve the case detection rate and maintain a high cure rate.

RACHA ensures maintenance of quality services through on-going technical assistance, capacity building, and supervision to health center staff, and DOTS watchers. RACHA relies on thousands of volunteers to carry out the important work of fighting TB.

Improving the effectiveness and Efficiency of TB control is one of RACHA's objectives under the USAID-funded Empowering Communities for Health (ECH) project in five provinces. RACHA has supported capacity building for health centre (HC) staff on TB and VHSG bi-monthly meetings at the HC or CC Level.

In 2016, RACHA has conducted Semi-Active Case Finding (SACF) in 229 pagodas of 145 HCs, and Contact Investigation (CI) outreaches in 215 HCs. As a direct result of these activities, the HCs screened 29,543 people and 376 cases of TB were diagnosed, with 87 cases in children under 15 years. Over the last 12 months, a total of 361 (F: 215) C-DOTS watchers have received C-DOTS refresher training and 5,365 (F: 3,275) VHSGs received TB information as part of the VHSGs' bi-monthly meeting.

RACHA has established effective collaboration and support from VHSG/C-DOTS watchers, OD, HC, and referral hospital staff in conducting Active Case Finding (ACF) and Contact Investigation (CI) activities. Participation in CCWC trainings was a key activity that improved CCWC understanding of the need for community TB early detection and early treatment outreach.

Since May 2025, under the leadership of KHANA, and in collaboration with key local and international partners—including the National Centre for TB and Leprosy Control and the National Maternal and Child Health Centre, which provide overall project oversight, strategic planning, resource allocation, and communication with relevant authorities at the national and sub-national levels—the Cambodian Anti-Tuberculosis Association (CATA), TB-People Cambodia, the University of Sydney, the National University of Singapore, and RACHA have been implementing the Strengthening Health Systems through Integrated Risk Factor Intervention and Tuberculosis (TB) Case-Finding (SHIFT-TB) project in two provinces, funded by L'INITIATIVe/ EXPERTISE FRANCE.  

The overall aim of this project is to strengthen Cambodian health systems by implementing community-based, population-wide active case-finding for TB and integrated services for TB risk factor intervention.

Specific aims are as follows:

1. Facilitate a multisectoral collaboration at the national, subnational, and community levels to implement community-based integrated care for TB, its risk factors, and Sexual Reproductive Health (SRH)

2. Train and build the capacity of public healthcare professionals, community health workers, and key populations in delivering an integrated care strategy.

3. Implement community-based population-wide TB active case-finding by involving all community members and health systems to mitigate barriers and improve access to health services.

4. Implement integrated health services to link TB active case-finding and prevention activities, interventions to address key TB risk factors, and services for other respiratory diseases and SRH.

5. Facilitate the training of healthcare and laboratory professionals for decentralizing TB management information systems to the primary care level and their interoperation with the Ministry of Health's health information system.

The scope of the project focuses on educating, screening, and encouraging people to be evaluated for TB so they can be tested, diagnosed, and treated early. The interventions include referring individuals to health facilities and conducting sputum collection. The project also collaborates with Health Centers (HCs) and Referral Hospitals (RHs) by bringing mobile X-ray and Ultra GeneXpert machines directly to communities. This makes it convenient for villagers to be tested, diagnosed, and treated. Once confirmed as positive pulmonary TB cases, patients are immediately enrolled for treatment at local health centers. RACHA’s role includes screening for malnutrition and non-communicable diseases, such as high blood pressure and diabetes. Additionally, the role involves delivering health messages on breastfeeding, complementary feeding, childhood immunization, diet diversification, and healthy versus unhealthy food. Reproductive health is also integrated into the sessions, and identified cases are referred to health facilities for treatment  with follow-up.

The project is expected to benefit people with TB and their communities through screening activities and interventions targeting TB and its associated risk factors, other respiratory diseases, and Sexual and Reproductive Health (SRH). Early TB diagnosis and linkage to care will interrupt transmission and prevent further infections. By addressing key TB risk factors, conducting contact investigations, and providing TB preventive treatment, the project will prevent TB disease and related morbidity and mortality. Moreover, families affected by TB will see improved health and increased socioeconomic opportunities as a result of successful treatment.