Objectives
To assess national and sub-national implementation, monitoring, and enforcement of Sub-Decree 133, the national code regulating the marketing of breast milk substitutes (BMS) in Cambodia.
Methods
Interviews were conducted with 45 national and sub-national government officials in Phnom Penh, Battambang, Sihanouk, Kampong Thom, Siem Reap, and Kandal. Officials were purposely selected from the four government ministries responsible for implementing and enforcing Sub-Decree 133 (Health, Commerce, Information, and Industry and Handicraft) and were asked about their knowledge of the Sub-Decree, including key responsibilities, monitoring procedures, and penalties for violations.
Results
Only 12 out of the 45 officials said they were “very knowledgeable” on the content of Sub-Decree 133; 15 respondents, mostly at the sub-national level, reported they were “not knowledgeable.” There was confusion over the roles and responsibilities of each ministry, along with poor inter-ministry communication and coordination: Twenty eight respondents mentioned not receiving any technical support on enforcement of Sub-Decree 133 from other ministries, departments, or partners. Experience of reporting violations on BMS promotions was low, with 40 respondents having never written a violation report; most found the lack of standard reporting mechanisms, a barrier to reporting violations. Violations appear to be handled inconsistently across the ministries, with limited application of fines and increased penalties for repeat violators.
Conclusions
There is a need to strengthen the implementation and enforcement of Sub-Decree 133 to support and protect breastfeeding practices in Cambodia. Clearly designated responsibilities, an accountability structure, and well-articulated guidelines for monitoring and enforcement could lead to improved coordination and regulation of BMS promotions and marketing.
