USAID Quality Health Services (QHS)

Overview

Quality Health Services is improving reproductive, maternal, newborn and child health and nutrition (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. These facilities account for more than half of the public health facilities in the country. 

URC is meeting 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.

Key Activities

  • Improve the quality of basic newborn care in health centers and referral hospitals through a number of inexpensive, effective, and evidence-based interventions. The project is providing immediate newborn care (INC) training, coaching, and follow up in referral hospitals and health centers, as well as supporting the introduction of early and essential newborn care (EENC).
  • Strengthen identification, referral, and management of newborn complications by 1) introducing procedures that help prevent problems from occurring through improved antenatal, delivery, and postnatal care, and 2) training and coaching health staff in the early detection of critical newborn conditions like newborn sepsis, as well as key interventions to prevent deaths from or care for prematurity and low birth weight, like kangaroo mother care and antenatal corticosteroids.
  • Strengthen the quality and utilization of emergency obstetric care; URC is strengthening and helping to expand high quality provision of basic and comprehensive obstetric care, and providing critical technical assistance to the Ministry of Health and facilities to improving the quality of delivery and post delivery care at referral hospitals and health center. URC’s approach combines facility based coaching and supportive supervision with quarterly meetings of health center midwives, district, and provincial level health managers, and referral hospital physicians and midwives in order to strengthen relationships and problem solve.
  • Improve the quality of postnatal care in health centers and referral hospitals; the team is scaling up on-site competency based quality improvements approaches and tools to provide comprehensive postnatal care to mothers and newborns.  The team is also introducing new technologies like interactive voice recorded messages (IVR) to encourage new mothers to bring themselves and their newborns for all postnatal care visits and to provide good home care for themselves and their new baby during the postpartum period.   
  • 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. 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 and newborn emergencies; stabilization guidelines and job aids; and ensuring appropriate reimbursements for the poor through the health equity fund. Triage systems previously developed by Stanford and URC are being scaled up and implemented at each referral hospital. A pre-hospital care training program, developed by Medical Teams International, is being updated to include a focus on core areas of pediatrics/ neonate care and obstetrics and scaled up in the nine provinces.
  • Strengthened prevention, identification, and management of child malnutrition and related diseases (including pediatric TB) to improve preventive nutrition care and screening for severe acute malnutrition (SAM) at health centers, as well as treatment and screening for SAM in referral hospitals. URC is continuing its close collaboration with the National Nutrition Program and the National Pediatric Hospital. The team is scaling up successful health center quality improvement efforts in all health centers in the nine provinces and a number of project approaches are already being adopted more widely.
Duration
2014 to present
Funders 
US Agency for International Development (USAID)
Partners 
Angkor Hospital for Children (AHC)
Stanford University
Marie Stopes International Cambodia
Medical Teams International
Open Institute
Partnership for Better Health
Regions/ Countries