Improving Maternal and Newborn Care in Cambodia

Image Credit: GIZ Cambodia\Nora Sorn

Introduction
CMNH has global expertise in providing Emergency Obstetric and Newborn Care (EmOC&NC) training. This programme builds on our expertise, and aims to improve the availability and quality of EmOC&NC in Cambodia by conducting training and establishing skills laboratories (labs) to provide safe and protected learning environments where users can practise, maintain and enhance clinical skills. This programme is part of The Muskoka Project which is funded by GIZ and implemented by GFA with technical support from the Centre for Maternal and Newborn Health.

Brief background
Cambodia has made great strides in achieving the Millennium Development Goals (MDGs) on maternal and child health. Maternal mortality decreased from 320 deaths per 100,000 live births in 2005, to 170 in 2013. Neonatal mortality dropped in the same period from 25 deaths per 1000 live births to 18. More than 80% of women deliver in the health facility. The Caesarean section rate stands at 6%, and is much lower in the periphery.

To continue the work in reducing maternal and neonatal mortality, national attention is now focussed on quality improvement and improving the EmOC&NC skills of midwives and doctors.

Project activities
Under this programme, CMNH has:

  • Set up three Skills laboratories (labs) to provide safe and protected learning environments where users can practise, maintain and enhance clinical skills.
  • Delivered 7 EmOC&NC training courses for all skilled birth attendants (midwives, nurses and doctors) working in 25 supported Basic Emergency Obstetric Care (BEmONC) and Comprehensive Emergency Obstetric Care (CEmONC) facilities
  • Conducted 4 Training of Trainers courses to train local ‘Master Trainers’
  • Conducted 4 Extended EmOC&NC training courses on improving decision making and practices related to caesarean sections 

On-going activities

  • Monitoring and Evaluation of the use of skills labs through observational visits and review of users’ feedback forms
  • Implementation Research to understand the effect of using “skills and drills” training in a maternity setting in improving the skills and confidence of healthcare providers to manage obstetric and neonatal emergencies.

Outputs to date
Three skills labs have been set up at the Provincial Referral Hospitals of Kampot, Kampong Thom, and Kampong Speu, Cambodia. The labs are stocked with equipment to support training in adult and neonatal resuscitation, obstetric emergencies such as shoulder dystocia, postpartum haemorrhage and eclampsia as well as management of complicated births e.g. twins and breech births. Using the skills labs enables midwives and doctors to practice the skills needed when a mother or baby needs emergency care. These skills are essential to save lives, and the skills labs provide opportunities to practice skills in a safe environment with the support of a trainer, therefore helping to improve the quality of care for mothers and their babies. Open days and teaching sessions were held at the three skills labs in March 2018. Over 100 healthcare workers took part in the open days, which involved teaching sessions, group training and role play.

Research conducted through this programme will explore the views of the healthcare providers and their managers on the value, ease of access and potential use of skills laboratories as well as documenting the factors that assist and/or challenge access i.e. lessons learnt. This information is important to the international community and ministries of health as more attempts are made to train healthcare providers locally and improve quality of care.