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URC to Lead Quality Health Services Project in Cambodia, Continue Improving Systems for Maternal and Newborn Health
USAID has awarded URC the USAID Quality Health Services project in Cambodia. With this five-year, $16.5 million cooperative agreement, URC will build on more than a decade of work in Cambodia to strengthen reproductive, maternal, newborn and child health and nutrition care and systems. The URC-led project team—Angkor Hospital for Children, Stanford University, Marie Stopes International Cambodia, Medical Teams International, Open Institute and Partnership for Better Health—will draw on and scale up successful initiatives started under USAID Cambodia's recently ended Better Health Services (BHS) project, which was also managed by URC. In addition, the team will apply the knowledge and systems built during BHS to create new capacity-building activities in areas where critical gaps remain.
The Cambodian Government has succeeded in building a comprehensive network of public health facilities from the ground up; Quality Health Services will complement previous work and address the next level of challenges in the ongoing process of elevating Cambodia's standard of care to its most vulnerable populations. URC's extensive experience with the Cambodian health care system, from health centers to hospitals to national programs at the Ministry of Health, will ensure that Quality Health Services can meet these challenges with no loss of time, expertise or relationships.
Quality Health Services aims to improve RMNCHN services in all health centers (550) and referral hospitals (38) in nine Cambodian provinces: Banteay Meanchey, Battambang, Kampong Cham, Tbong Khmum, Kampong Speu, Pailin, Prey Veng, Pursat and Siem Reap. URC intends to meet the project's goals through a comprehensive, sustainable health systems strengthening approach to improve the quality of basic newborn care; the detection, referral and management of neonatal complications; the timeliness and quality of care provided to women with obstetric complications; the availability, quality and use of family planning, especially long-acting and permanent methods; referral linkages for obstetric, newborn and postnatal care; and the screening, counseling, referral, prevention and treatment of child malnutrition and related diseases.
URC and its partners recognize the importance of a team-based approach to improving the quality of RMNCHN services. A holistic, encompassing program of training, coaching and mentoring, supported by health systems strengthening approaches, is necessary to affect sustainable, replicable results in improved patient health. The Quality Health Services project, designed to generate positive, permanent changes in health care for vulnerable populations, is an important component in Cambodia's goal of high-quality national health services. URC is committed to developing and implementing sustainable solutions to improve systems and empower providers.
- Strengthen capacity-building efforts in close collaboration with both the Cambodian Ministry of Health and development partners at all levels of participation to further RMNCHN goals.
- Introduce evidence-based practices appropriate to the context: URC will employ replicable, scalable models for improvement and build on the successes of BHS and other programs to bring quality improvements to the Cambodian health care system.
- Develop client-focused, cross-disciplinary teamwork through a continuation of team meetings of the maternity coordination alliance, proven successful under BHS, and the introduction of a parallel, pediatric alliance to support nurses and physicians. Knowledge and skills learned will be reinforced and monitored in training, follow-up sessions, mentor programs and hands-on training.
- Improve health center and hospital quality through leadership orientations; on-site continuing medical education programs; follow-up coaching and assessments of health centers; clinical skills practices in regional hospitals; technical assistance and improvements in the use of health management information; appropriate reimbursement for RMNCH services under Cambodia's social health protection schemes; and monitoring and evaluation of project results, annual quality surveys of delivery practices in regional hospitals and national, Level 2 quality assessments in all hospitals and health centers in the target provinces.
- Improve the quality of basic newborn care in health centers and referral hospitals through a number of inexpensive, effective, evidence-based interventions. The project will analyze the need for immediate and/or essential newborn care training and follow up in referral hospitals and addressed it in a manner that supports team-based participation.
- Strengthen identification, referral and management of newborn complications by 1) introducing procedures that help prevent problems from occurring through improved antenatal and postnatal care and specific interventions and 2) educate health staff in the early detection of critical newborn conditions and the use of interventions, like kangaroo mother care, to improve health outcomes.
- Strengthen the quality and utilization of emergency obstetric care to eliminate life-threatening delays in medical care for time-dependent emergency conditions; URC will focus on strengthening in-facility care, as well as the identification and referral of critically ill maternal and newborn patients. Triage systems previously developed by Stanford and URC will be scaled up and implemented at each referral hospital; working with the National Maternal and Child Health Center, the team will provide technical assistance to establish level-specific protocols covering common critical complications in mothers and newborns before, during and after childbirth.
- Improve the quality of postnatal care in health centers and referral hospitals; the team will scale up quality improvements approaches and tools, using best practices developed from URC's prior support of 50 health centers in Pursat and Siem Reap provinces, to provide comprehensive postnatal and combined mother/newborn care.
- Increase the use of a full range of family planning methods by making them available in public health facilities to meet a high, unmet need for long-term family planning (over half of women in a 2010 national survey reported not wanting more children). The team will address challenges to the uptake of family planning, including availability, health care provider training in long-acting and permanent family planning methods and appropriate reimbursement levels for providing these services.
- Strengthen referral linkages for obstetric, newborn and postnatal care to reduce deaths from maternal and newborn complications. The entire referral system, from home to facility to referral hospital to the national level, requires improvement. URC's systematic approach, already tested and scaled up in two Cambodian provinces, includes the standardization of referral forms; clinical hotlines to respond to obstetrical emergencies; improved availability of transportation through the health equity fund; and the creation of a national hotline based in the National Maternal Child Health Center. An emergency triage training program, developed with Stanford University under BHS, will be updated to include a focus on core areas of pediatrics/ neonate care, obstetrics, and cardiology and trauma care.
- Strengthened prevention, identification and management of child malnutrition and related diseases (including pediatric TB) to improve preventive nutrition care and screening at health centers, as well as treatment and screening for severe acute malnutrition in referral hospitals. URC will continue its close collaboration with the National Nutrition Program and the National Pediatric Hospital. The team will scale up health center quality improvement efforts in all health centers in the nine provinces. It will also support clinical skills practice in the identification and treatment of severe acute malnutrition in children under five at the referral hospital level.
March 25, 2014