Plan

© Plan

Cambodia

MCH needs Strong Health System

vertical vs horizontal intervention

in Cambodia

Conference of Action for Global Health

10th May 2011, Berlin, Germany

by Dr. Chea Thy, Country Health Advisor, Plan International

Cambodia

© Plan

MCH needs strong Health System

• Health Situation in Cambodia

• Areas for MCH Improvement

• Crucial Points in Health Systems strengthening

• Horizontal versus Vertical Interventions

• Working Approach

• Donors’ Performance

•German Development Cooperation in the health sector

© Plan

A Case …* ….Mrs. Pok lived in poor community in poor Samut Loe village, Ratanakiri, got married since she was16 years old, she got 6 children at the age of 25. She had never got any ANC service, nor family planning as the service was inaccessible. All of her childbirths delivered by local TBAs in unclean conditions. She died with her last new-born when, on the dusty road, referred to the hospital. In reality, she did not want to be away from domestic chores and care of her children …

© Plan

Health Situation in Cambodia

•1/3 of the total population live below the poverty line

•1 in 12 children died before reaching their fifth birth day

•1/3 of children death due to related pregnancy

•1/3 of Under-5 Children faced underweight and stunt.

•Maternal Mortality Ratio: 461per100 000 live birth

•Contraceptive Prevalence Rate: 35%

•The poor, the poorest facing much more MCH Problems.

© Plan

Government for Improving Maternal and Child Health(MCH)

Fast Tract Initiative as to reduce maternal and child death:

CORE

•Family Planning (both short terms and long terms)

•Safe Childbirth

•Emergency Obstetrical Care (both Basic and Complementary)

• Safe Abortion

SUPPORTIVE

•BCC, Overcome financial barriers, Surveillance

Source: RMCNHC, MoH, Cambodia

© Plan Health services delivery

Promoting child health care

Launch Health Center Construction

Plan Cambodia strengthening Health System

© Plan

Crucial Points in Health Systems strengthening

•Ownership, alignment, harmonization…

•Partnership with civil society & private sectors

•Legal Framework

•Accountability and Transparency

•Health Services Functioning

•Qualified human resources

•Comprehensive health services delivery

© Plan

Horizontal interventions

Health Sector Support Project 1

HSP-12003-2007

Health Sector Support Project 2

HSP-2 2008-2015

Contract-in OD and Contract-out OD

Special Operating Agency (SOP)= OD

D=Donor/Development Partner

OD =Operational District

RH =Referral Hospital

HC =Health Center

NHSP= Health Strategic Plan

RH HCs

communityoutreaches

HCsRH

communityoutreaches

D-1D-2 D-3D-1D-2

D-6D-7

D-3D-1D-2

D-4D-5 D-8

communityoutreaches

communityoutreaches

communityoutreaches

communityoutreaches

Community based Contraceptive distribution

Community based Contraceptive distribution

© Plan

Horizontal interventions

Package of outreach services: basic vaccines, very basic care and treatment, deworming, health education, ANC, PNC (including FP), micronutrient (Vitamin A, Folic acid, Iron, Zinc)… etc.

Low quality MCH Services are also available, accessible and delivered by private providers in community

Pros: mothers can access to a range of MCH service (s)

Cons: too challenging to deliver many services from one Health Service Delivery Point. Low geographical coverage.

© Plan

Horizontal interventionsPackage of Reproductive Maternal Child Newborn Health Care Services at Heal Center: ANC (including FP), Counseling, Childbirth, PNC (including FP), birth registration, Tetanus Toxoid, BEMOC, referral, micronutrient, nutrition, immunization and health education, safe abortion…

Pros: •Demand side has Choices of available services;

•Supply side has multiple basic health care competency.

Cons:•Limited staff, there can not provide all services.

•Limited drug supply and financial supports

•Limited space and facility and coverage for services

© Plan

Vertical interventions

Family Planning

HIV/AIDS MalariaTuberculosis

Global Fund

Cholera

© Plan

Vertical interventions: Family PlanningPros

•Social Marketing FP products available, affordable and accessible

•FP methods delivered through Public health system

•FP reduce population and hence reduce poverty

Cons

•Lots of framework, human resources and attention commitments made to FP

•FP products smuggled to other non-target area

•Side effects of FP methods affect other MCH services

•Long terms FP methods, women can not control over their body

© Plan

Which approach works best ?•Both approaches support each others, there are pros and cons involved.

However,

•It suggests that invested more than one particular health problem or single intervention.

•Better more comprehensive health program intervention rather than one single family planning one.

•Strong health system needed to respond to multiple and inter-related MCH causes and problems .

•Demand site/vulnerable mothers needs strong health system, close to their doors.

© Plan

How do donors perform in this regard?

•Based on the primary duty bearers and right holders’ needs, priorities.

•National Health Strategies as Approaches for ‘strong health system’.

•However, the application of single, dual or multiple approaches, Donors have to help the government in developing countries take more accountable and commitments for MCH health intervention as ensure that the rights of children and mothers, particular the vulnerable ones, to high standard quality of care, prevention and treatment.

© Plan

German Development Cooperation in the health sector?GTZ (on behalf of BMZ) has been active and in-depth appreciated in Cambodia: Social Health Protection, RD, Govern.

• Contributed to Clinical Practice Guideline, Quality standard for Health

Services, in-service training, Model and procedures for scaling up Social

Health Protection System

• Strengthening health system both public and private sector

• Modern Contraceptive methods through social marketing and public health

• Building/renovation of training centers

• Quality Management and HR development: training of nurses, midwives,

public health managers

• Community-based health insurance/Health Financing

• ID Poor, General Population Census 2008……….

© Plan

Maternal Health Post, in 12th Century, King

Cheyvaramann VII

Bayon, Angkor Thom, Siem Reap, Cambodia

Thank You!