Improving maternal and newborn care in Cambodia

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KT/Mai Vireak

Cambodia has accomplished major successes in improving maternal and child health. Maternal deaths decreased from 427 in 2005 to 170 per 100,000 live births in 2014.

Newborn deaths dropped in the same period of time from 28 to 18 per 1,000 live births.

Despite these successes, maternal and neonatal mortality are still high by international and regional comparison.

High rates of maternal and neonatal mortality are associated with inadequate and poor-quality maternal health care, including antenatal, delivery and postnatal care. Antenatal care is considered as a key maternal service in improving a wide range of health outcomes for women and children.

To further decrease maternal and neonatal mortality and to improve delivery, postpartum and newborn care, the Royal Government of Cambodia has renewed its Emergency Obstetric & Newborn Care (EmONC) Improvement Plan and extended the Fast Track Initiative Roadmap for Reducing Maternal and Newborn Mortality until 2020.

Between 2009 and 2015, the number of Comprehensive Emergency Obstetric and Newborn Care (CEmONC) facilities increased from 25 to 37. The CEmONC centre is equipped with both the manpower and the infrastructure required to care for mothers and their newborns. Round the clock, the centre has obstetricians, paediatricians, doctors, staff nurses, lab technicians and support staff on duty and anesthetists on call.

The number of Basic Emergency Obstetric and Newborn Care facilities (BEmONC) at district health centres and provincial hospitals, in Cambodia, to avert maternal and newborn mortality and morbidity also increased from 19 to 110.

Although improvements have been made, further efforts are required to address remaining challenges. Towards this end, the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, on behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ), has implemented the project “Improving Maternal and Newborn Care in Cambodia” to support the Royal Government of Cambodia in addressing these challenges.

The project’s official partner is Cambodia’s Ministry of Health.

There is a need to further qualify midwives, to continue raising standards of healthcare services and to improve access to healthcare for vulnerable groups, including persons with disabilities.

The current GIZ Improving Maternal and Newborn Care in Cambodia project is in its second phase, with the first phase having run from 2012 to 2015. The project is part of the Cambodian-German Social Health Protection Programme that strengthens healthcare financing, health service delivery, health system governance and the inclusion of vulnerable groups.

The project’s objective is: “Families with small children are increasingly benefitting from improved quality health services for mothers and children”, and is active in four provinces of Cambodia: Kampong Thom, Kampot, Kep and Kampong Speu.

The project focuses on three keys areas. First, the project works for quality improvement of maternal and neonatal emergency care services by working closely with provincial health departments to strengthen monitoring, supervision and strategic planning capacities.

In addition, the project assists in developing referral pathways for emergency cases and contributes to a better understanding of birth preparation and newborn care among the population.

It should be possible to reduce maternal deaths (and the deaths of babies during pregnancy, childbirth and early life) by ensuring that pregnant women are referred to emergency obstetric services quickly when the need arises. In Cambodia, referral to emergency obstetric care can be beset with problems such as difficult geographical terrain, transport costs, lack of vehicles and suboptimal location and distribution of healthcare facilities.

Second, the project improves EmONC staff qualifications and skills through on-the-job-training. Medical doctors work in close collaboration with midwives and the provincial health department in order to strengthen the link between emergency obstetric and newborn care facilities and their supervisors.

Thirdly, the project supports the inclusion of persons with disabilities by introducing tools and competencies to adapt health services to disability-related needs. Previously developed tools for early detection of disabilities in children are revised in order to provide the Ministry of Health with a validated package of instruments that is ready to be officially adopted.

The project takes account of human rights principles by fostering non-discrimination and equality of opportunity for persons with disabilities.

In the previous phase of the project, maternal healthcare indicators have improved through improved midwifery skills, particularly during emergency care. The number of deliveries per month in emergency facilities has increased from 854 to 1,343 per month on average between 2012 and 2015.

In addition, the number of complicated deliveries attended by skilled health staff increased in absolute and relative terms: from 2,032 (17 percent of total deliveries in 2013) to 3,129 (19.4 percent of total deliveries in 2015).

Reductions in maternal mortality can have far-reaching benefits. Risk of impoverishment is reduced by the prevention of maternal mortality and the promotion of care provision in public health care facilities.

Phase II of the Improving Maternal and Newborn Care project has the potential to reduce impoverishment as it is directed predominantly at people below or close to the poverty line.

According to a World Health Organization report on Cambodia, children in the poorest quintile are three times more likely to die before their fifth birthday than those in the wealthiest quintile. Children born in rural areas are three times more likely to die in the newborn period than those born in urban areas.

Inequity is a key challenge that must be addressed to ensure that all population groups in the country see health gains.

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