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Survey Finds Significant Improvement in Maternal/Newborn Care in Cambodia
A 2011 survey by URC's Better Health Services (BHS) project in 16 hospitals and a health center has found significant improvements in the quality of maternal and newborn care. The US Agency for International Development (USAID) is funding the five-year BHS project to work with the Ministry of Health and other partners in five USAID-supported provinces to increase demand for and equitable access to quality health services. Systematic implementation of correct, evidence-based, and timely diagnosis and treatment is still a problem, but many indicators of quality care are improving. Project goals recognize that Cambodian women need skilled care at delivery and that providers must be able to 1) provide high-quality care for normal births and 2) identify and respond quickly and effectively to complications.
Based on data from a 2009 baseline assessment, BHS—along with USAID partners Reproductive Health Association of Cambodia and Reproductive and Child Health Alliance—focused clinical improvement work on a few key, life-saving areas: reducing bleeding after birth by applying the Active Management of Third State Labor (AMTSL) and by improving the management of severe pre-eclampsia and eclampsia, newborn resuscitation, and essential newborn care. In collaboration with the Ministry of Health's National Center for Maternal and Child Health and UNICEF, the partners developed a "key interventions workshop," which was presented in five regions of the country in 2010. Follow-up with job-aids, coaching, and focused trainings followed.
The survey's objective was to assess progress and identify remaining gaps in the quality of care: Were midwives doing the right things? If so, were they doing them correctly? Was quality of care improving? At each of the 17 facilities, one BHS staff and one specially trained (external) government midwife followed a specially designed protocol to observe and document all deliveries during three days and two nights. They also interviewed the chief midwife to get information on less-frequent events and procedures and conducted client exit interviews.
Survey results include:
- The proportion of deliveries with correct AMTSL—an intervention to prevent postpartum hemorrhage/complications during the period from the completed delivery of the newborn to the completed delivery of the placenta—rose from 17% in 2009 to 71% in 2011.
- While no hospitals in 2009 were correctly treating severe pre-eclampsia/eclampsia (i.e., by using effective regimens of magnesium sulfate), half of the surveyed hospitals did so in 2011.
- Improvements were reported in social support during labor; that is, women were allowed to move around and walk during labor and to have a labor companion.
- Improvements also occurred in immediate newborn care, including drying, skin-to-skin contact, provision of vitamin K and eye ointment, correct cord care, and breastfeeding within the first hour after delivery.
- Client satisfaction was high in 2011, with most women either very satisfied or somewhat satisfied.
- These findings show the effectiveness of BHS's approach, particularly in implementing a broad partnership in maternal and newborn health care and family planning and in taking a multipronged approach to changing clinical behavior. BHS shared the findings with national and provincial leaders, as well as staff in surveyed hospitals, who are already using those findings to further improve the quality of care.
BHS builds the capacity of public and private service delivery systems; expands models for health financing; improves the quality and impact of maternal, neonatal, and child health services; and strengthens the control of infectious diseases. It is based on the work of the USAID Health Systems Strengthening in Cambodia Project, which was managed by URC from 2002 to 2008.
April 25, 2012