May/June 2012
Robin Mardeusz and Sopheanarith Sek | CHILD SURVIVAL
credit: RHAC-ToGoH/USAID
When Sok Na, from the village of Smach Kek in rural
Cambodia, gave birth to her baby at the Ream Health Center in Sihanouk
province earlier this year, life looked very promising. However, three
hours after her delivery, Sok began to bleed excessively.
Fortunately,
she had the support of midwife Hoy Ny. Hoy suppressed the bleeding—and
knew further care was needed. Trained in emergency procedures, Hoy
contacted the referral hospital, requested an ambulance, and asked the
doctors to prepare for the patient. Thanks to coordination and a rapid
response, Sok was rushed to the hospital, where doctors were able to
save her life.
Sok’s story is more common in Cambodia now than it
was 10 or even five years ago. Hoy was able to apply the midwife skills
that she learned through the USAID-funded Together for Good Health
(ToGoH) project implemented by the Reproductive Health Association of
Cambodia (RHAC), a Cambodian NGO providing health services since 1996.
Hoy
said that she was happy to have been able to save her patient’s life.
“I used the knowledge and skills that I learned from the RHAC trainings
to suppress the bleeding. If I hadn’t learned how to do this, the
patient would have died at the local health center before reaching the
referral hospital. These trainings are important for us as they give us
the opportunity not only to maintain strong relations, but also improve
coordination between the midwives and doctors working at the referral
hospital.”
The ToGoH project has been implementing a maternal and
newborn health program for the last three years, promoting a
comprehensive package of delivery services in community health centers.
The package provides for check-ups during a woman’s pregnancy; delivery
at a health center, with a minimum 24-hour stay afterward; and
post-birth care to identify and prevent obstetric and newborn
complications. Since 2009, over 95,000 mothers and newborns have been
helped through the program. While a rigorous evaluation of the program
is currently underway, preliminary data indicate that RHAC’s efforts are
resulting in an increase in facility-based births as an alternative to
the traditional practice of giving birth at home with an untrained birth
attendant. This increase in facility-based births is recognized as a
key intervention driving the dramatic decline in maternal mortality in
recent years in Cambodia.
“The program has helped increase the
number of the poor women able to access birth delivery services in our
health center,” said Song Narin, chief of the Sralop Health Center at
the Tbong Khmum-Kroch Chhmar health district. “Before the program
existed, we typically had four to 10 deliveries a month. But since the
program started, in 2009, we have had around 40 deliveries a month. This
support helps poor women access important life-saving services.”
The
ToGoH project is active in five of Cambodia’s 24 provinces and supports
268 health centers. In 2011, skilled birth attendants managed 61,971
deliveries and conducted 42,185 post-partum visits, compared with 26,998
deliveries and 18,800 post-partum visits in 2008. In addition, 75
percent of pregnant women in the coverage area received antenatal care
and services at least four times preceding delivery, compared with 46
percent in 2008.
The 2010 Cambodia Demographic and Health Survey
reported a greater than 50 percent decline in maternal mortality rates
in the country between 2005 and 2010. In comparison to other Asian
countries, however, there is still much room for improvement.
The
public sector’s capacity to provide quality maternal, newborn and child
health services continues to be a challenge, as the knowledge and skill
levels of primary health care staff—particularly midwives—at local
health centers are limited.
Still, the effectiveness of the maternal health program is racking up positive achievements.
“In
Cambodia, low-income families still face significant obstacles to
accessing basic health care services,” said Flynn Fuller, USAID/Cambodia
mission director. “RHAC’s program reduces these barriers to link
mothers and newborns to life-saving health care.”
Hor Monika, a
midwife at Prek Romdeng Health Center in Kampong Cham province, recalled
a recent experience where she faced an expectant mother, Yat Da, with
severe bleeding. “We were able to save Yat Da’s life by using the
knowledge and skills gained from recent training. Eventually, the
bleeding stopped and as she returned to a stable condition before the
ambulance arrived, we decided not to transfer her to the referral
hospital.”
“After Yat Da returned home, I made a follow-up visit
to her home and found her in good health with no signs of complications.
Furthermore, I also advised her to start using a birth spacing method,”
she added.
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