Quality Health Services (QHS)

The Challenge

Cambodia has achieved remarkable health outcomes in the past few decades. Improved antenatal and postnatal care and skilled birth attendance are some of the driving factors behind the improvements. Nonetheless, preventable maternal and child morbidity and mortality remain high, especially in rural areas.

Overview and Objectives

The project sought to improve 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 centers and referral hospitals in Cambodia.

URC achieved 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 for 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 played a supportive role to government programs and staff to respect local ownership, accelerate capacity development, and foster long-term sustainability. Key project approaches included training and coaching health staff in the early detection of critical maternal conditions like post-partum hemorrhage and newborn conditions, as well as key interventions to prevent deaths from or care for obstetric emergencies, prematurity, and low birth weight.

Non-pneumatic anti-shock garments, kangaroo mother care, and antenatal corticosteroids; introduction and coaching in key clinical practice guidelines – including for severe acute malnutrition, childhood tuberculosis, and neonatal sepsis; and triage and referral systems strengthening were emphasized. QHS facility-based coaching and supportive supervision approaches at health centers and referral hospitals were reinforced through team building and systems strengthening approaches between staff at different health system levels. These included quarterly meetings of health center midwives, district, and provincial level health managers and referral hospital physicians and midwives to strengthen relationships and problem solve. Together, these approaches strengthened clinical and management skills and fostered a culture of respect, trust, and teamwork.

Achievements

During the five years of the project, the quality of RMNCHN services improved steadily from a relatively low ~30% level to a consistently high ~65-70% score on quality assessments as measured by Level 2 Quality Assessments and other assessment tools. Increasing numbers of women giving birth received uterotonics in the third stage of labor, mothers and newborns received postnatal care within two days of delivery and at least three postnatal visits, and children under five years of age had their nutritional status assessed and acted upon.

Quality improvement and on-site coaching approaches developed by QHS were adopted as key parts of the Ministry of Health Third Health Sector Strategy 2016-2020 and the Minimum Package of Activities Guidelines 2016-2021 for health centers. Approaches such as provincial referral system improvements, updates to nutrition indicators, innovations like the non-pneumatic anti-shock garment, and many others were officially approved by the Cambodian Ministry of Health for nationwide scale-up.