Midwife Puth Nary educates a woman about how to stay healthy during pregnancy in Kampong Cham province, Cambodia. Photo credit: Save the Children Cambodia.

In early 2010, Save the Children started a Newborn and Child Survival project in O’Reang Ov Operational District. The project aims to improve the quality of service delivery and increase access and utilization of maternal, newborn and child health services for pregnant women and children.

Puth Nary is the only midwife at the district health centre. When she was young, pregnant women in her village had to travel long distances to have their babies delivered elsewhere, or deliver at home with the help of a traditional birth attendant. Puth knew from a young age that she wanted to become a midwife and help reduce the difficulties pregnant women encountered.

Although she qualified as a midwife in 1985, it was 25 years before Puth would actually deliver her first baby. Following some refresher trainings offered by Save the Children she could finally put her knowledge skills into practice. She says “Before I did not know about the danger signs during pregnancy, delivery and post-delivery, but now I am very clear about those signs. Even when I had the chance to deliver the baby for the first time, I dared not do it alone. I asked my colleague to assist me since I was not confident enough. Now, I am very much confident, and I can help deliver babies on my own”. I did not know how to resuscitate a newborn, but now I am skilful. Many pregnant women now came to me to get the services of antennal care, birth spacing, delivery and postpartum. I do not want to hold a high position. I just want my health centre to function well, get many clients and patients, and become a leading health centre in the operational district.”

Neonatal mortality rate  (per 1,000 live births) (2011) 19
Under-five mortality rate (per 1,000 live births) (2011) 43
Maternal mortality ratio (per 100,000 live births) (2010) 250
Number of doctors, nurses and midwives per 10,000 people (2010) 10.1
Births attended by skilled personnel (2010) 71%
Total expenditure on health as a percentage of gross domestic product (2011) 5.7%
General government expenditure on health as a percentage of total expenditure on health (2011) 22.4%

In Cambodia, there is good progress in providing health access to the poor through financing schemes such as the Health Equity Fund, and the country is on track to meeting the health MDGs. The burden of disease appears to be shifting from communicable to non-communicable diseases: diarrhoeal disease in particular, has decreased by 80% from 1990 to 2010.

Despite these positive signs, the availability of skilled health professionals is below the lowest indicative threshold and would need to almost double to meet the lowest of these, 22.8 doctors, nurses and midwives per 10,000, by 2035. Inequities in accessibility are a challenge, with access to skilled birth attendance ranging between 50-100% from poorest to richest. On the other hand, the ratio of nurses to physicians is above the OECD average. There is evidence of good policies, including a costed HRH plan (2008-2015), although some key areas such as pre-service and in-service education may require even greater focus.

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