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CAMBODIANs Successful Efforts to Reduce maternal mortality and its challenge

Presented by H.E. Yim Chhay Ly Deputy Prime Minister, Chairman of council for Agricultural and Rural Development, Cambodia

24 Provinces about13.4million

Cambodia background
located in the SEA, members of ASEAN Land of 181035 square kilometer Population 13.4 millions In 2005: MMR 472/100000LB Infant Mortality: 89/1000LB Low ANC rate 42% one visit Home delivery high 85% 56% assist by TBA( traditional Birth attendant) Caesarian section rate very low 0.5%

Cambodia background
Main causes of maternal deaths are: ante natal and post natal bleeding, bleeding during childbirth, obstructed labor, eclampsia, infection, abortion and anemia due to malnutrition.

Political commitment
Suggestions of the First National Midwifery forum 13-14 December 2005
1)Increase the number of midwife with appropriate civil servant carder for better staff distribution. 2) have the special constitution for midwife to motivate the midwife recruitment 3) Revise the midwifes motivation especially who work at the rural and remote area 4)continue to support for the opportunity to the midwife skill through scholarship improving the teaching environment, incentive, and accommodation

RG Cambodia commitment 02 February 2007 to motivate the midwives to provide services :


giving the financial incentives of 60000riels for midwife assisted a live birth at the Health Center and 40000 riels at the Referral Hospital and National Hospital. Samdech Decho HUN SEN, Prime Minister of The RGC has committed and supported these recommendations. In 2007 the RGC revise the constitution of the civil servant carder by giving a special accreditation to the midwife qualification through the Royal Kret in 13 June 2007.

Political commitment cont.


In February 21, 2011, on behalf of the United Nations, the Asia Pacific Director of the United Nations Population Fund (UNFPA) acknowledges the Cambodian First Lady lok Chumteav Bun Rany-Hun Sen, head of Cambodian Red Cross, as National Champion for Cambodias commitment to the UN Secretary Generals Action Plan for womens and children Health.

The main purposes of the FTIRM are: 1. To outline major areas and evidence-based interventions which, if provided at scale, have a potential to dramatically reduce maternal and newborn mortality 2. To identify resources needed for rapidly expanding recommended interventions and to highlight funding gaps which could inform resource mobilisation strategy 3. To suggest specific maternal health activities to be included in the annual operational plans of various implementing units at the national and sub-national level
7 Source: Fast Track Initiative Road Map for Reducing Maternal & Newborn Mortality, 2010-2015

Core Components
1) Emergency Obstetric and Newborn Care 2) Skilled Birth Attendance 3) Family Planning 4) Safe Abortion

Enabling Environment Components


5) Behaviour Change Communication 6) Removing Financial Barriers 7) Maternal Death Surveillance & Response
8 Source: Fast Track Initiative Road Map for Reducing Maternal & Newborn Mortality, 2010-2015

Key successful factors


1. 2. 3. Political commitment from the government and development partners. Policies, guidelines and strategies developed, updated and revised according to the current requirements of the national programs. Participative development of Annual Operational Plan from the national programs, sub-national levels and health development partners. Technical and financial supports from the MoH and health development partners. Leadership and commitment of national and sub-national levels. Participation of local authorities and communities to improve the accessibility and utilization of health care facilities and referral of emergency situation.

4.

5. 6.

Interventions for Maternal Health In Cambodia


Peace, growth, education Roads, phones Health centers, midwives

Source: National Health Statistics MoH 2002-2011. Mainly public sector

Interventions for Maternal Health In Cambodia


Peace, growth, education Roads, phones Health centers, midwives Removing financial barriers: - Health equity funds, vouchers - Live birth incentive ($15)

Source: National Health Statistics MoH 2002-2011. Mainly public sector

Maternal Mortality Ratio in Cambodia

MMR development in Cambodia 1990-2010. Estimates for 1990 and 1995 from WHO, the remainder from CDHS For 2005 and 2010 with 95% confidence intervals

Challenge

Move forward from Quantity to Quality

Thank you for your attention