Newsletter Cambodia RH_04_v03.pub - Epos

Special points
of interest:
• Annual report 2011
• Lessons Learnt from
the field
Inside this
issue:
A word from the
Team Leader
1
Annual report 2011 2-3
Quality Assessment
(QA) and Quality
Improvement (QI)
QI by spot checks:
A story from the
real world
3
3
Latest News 4
Vouchers for Reproductive
Health Services Project
4 TH NEWSLETTER
A Happy Khmer New Year:
A Healthy, Safe, Superior and
Prosperous Year of the Dragon
2 all of you: HSSP2!
This newsle&er brings you in a
nutshell the project results of
the first full year of implementa
on with surprising ups and
some downs. Cambodian poor
women, once they have obtained
a voucher, whether for
safe motherhood or family
planning, are eager to use the
coupons. The main bo&leneck
remains the distribu on: how
SPRING 2012
A word from the team leader
to iden fy and reach all potenal
candidates?
The rush of voucher clients to
private clinics confirms previous
preferences of the Cambodian
popula on and underpins
the need for a two-pronged
strategy for quality improvement:
first by support to the
public facili es but also by
behavior change of providers
as demonstrated in the spot
check report of quality assessment.
Finally, we hope that more
clients will opt for a modern
long term family planning
method in order to decrease
the number of unplanned and
unwanted pregnancies and to
contribute to the success of
the Fast Track Ini a ve: Road
Map for Reducing Maternal
and Newborn Mortality 2010
to 2015.
Marcel Reyners, Team Leader
Annual report 2011: Preliminary results (1)
Voucher distribu on started
officially on January 25th, 2011
and ac ve use even later. The
presented figures therefore
give only a rough indica on on
the evolu on of the results of
the project's first year. The
voucher promoters distributed
16,488 vouchers to poor women
in the three provinces:
2,984 for Safe Motherhood
(SM), 13,504 for Family Planning
(FP) and 1,8391 for Safe
Abor on.
Of the 2,984 SM vouchers,
1,988 coupons (or 67%) were
used for Antenatal Care (ANC)
1 and 1,186 or 40% for normal
delivery at the health centers
(HC).
The Dragon at Wat Phnom, Phnom
Penh, April 2012

PAGE 2 VOUCHERS FOR REPRODUCTIVE HEALTH SERVICES
Annual report 2011: Preliminary results (2)
Coupon used Kampong Thom Kampot Prey Veng Total
ANC 1 460 419 1,109 1,988
ANC 2 299 293 748 1,340
ANC 3 179 195 472 846
Normal Delivery 220 261 705 1,186
PNC 158 175 465 798
Complicated delivery 3 22 82 107
Caesarean sec3on - 4 - 4
Total 1.319 1.369 3.581 6.269
67% of all women who delivered using
the voucher coupon returned for a
postnatal control with the baby, a figure
exactly the same as presented in
the Demographic and Health Survey
(DHS) 2010 for rural popula on. Of the
12,537 women who came to deliver at
public HCs in the 9 Opera onal Districts
(ODs) in the year 2011, 1,186 or 9.5%
of them were beneficiaries of the
vouchers project.
Voucher use for long term methods is
much higher in the small number of
private facili es than in the public ones
and the same observa on, although to
a lesser extent, is true for the safe
abor on interven ons.
The number of women seeking help in
case of an unwanted and unplanned
pregnancy is much higher than an cipated.
The project replies only to needs
and staff never promotes abor on, on
the contrary, women and couples are
encouraged to use reliable family planning
methods to prevent unwanted
pregnancies.
Use of Safe Motherhood Coupons
Annual report 2011: Preliminary Conclusions
1. Once a voucher distributed, an overwhelming majority of women uses the coupons
2. Voucher distribu on is lagging behind an cipa ons. The project is in the process of iden fying the possible causes and
developing appropriate strategies to palliate this situa on
3. Among the long term method, implant is by far the favorite one.
4. Many more women than expected use the safe abor on (SA) services
5. The few private facili es provide the majority of long term methods and SA services, emphasizing the need for support
to the public facili es for upgrading quality

4TH NEWSLETTER
Quality Assessment (QA) and Quality Improvement (QI)
The project supports the Ministry of
Health (MOH) authori es in the catchment
area to implement the na onal
program of quality assessment, using
the QA tools developed for HCs and
RHs. The HC tool encompasses all MPA
services, not only the ones related to
the services supported by the project.
But QA cannot stand alone as iden fied
needs have to be addressed. Therefore,
the project obtained approval from
both Steering Commi&ee and KfW to
support the supply side in case of obvi-
QI by spot checks: a story from the real world
A recent spot check illustrates the value
and need of this instrument for QA and
QI.
The provincial coordinator, in collaboraon
with the central management staff,
was surprised by the high number of
referrals to the hospital of pregnant
women for delivery. A team went to
check why this happened. The results
were astonishing: the midwives did not
assure permanent services and, even
without direct contact with the pregnant
women in labor, advised them to go to
the hospital during weekends and night
me.
What is even worse, they used the delivery
voucher to be paid for services never
provided. Finally, this malprac ce contributes
to falsifica on of data as all deliveries
referred are registered as being
complicated cases. The midwives,
blamed by the spot check team, recognized
their misbehavior and promised to
improve. The Voucher Management
Agency (VMA) has sent meanwhile a
serious warning le&er to the health center
with copy to the authori es as this
kind of conduct cannot be tolerated as it
is flagrant fraud and corrup on and bad
medical behavior.
This story proves the necessity of checks
to iden fy gaps and, although we do not
exaggerate the failures, it seems by the
client sa sfac on interviews, conducted
along the visits to the facili es that ser-
ous shortages in areas such as basic
equipment and training.
Training will be supported under the
MOH umbrella and with help of
specialized organiza ons. Needs assessment
is conducted and reveals
need for Life Saving Skills training for at
least 24 midwives from the catchment
area, and for training in long term
methods such as implants and Intra
Uterine Devices (IUDs).
vice providers s ll use out-of-the pocket
payments and bribes from clients who
pay already with a voucher.
Ac3on for Health Dr. Long Leng and Financial
Controller Ms Born Sorina perform Health
Center QA visit in Kampong Thom
Quality assessment visit to Tuk Meas Health
Center in Kampong Trach district, Kampot
Province
PAGE 3

PAGE 4
Latest News
VOUCHERS FOR REPRODUCTIVE HEALTH SERVICES PROJECT
Sonja Kill Memorial Hospital (SKMH). The SKMH in Kampot opened its outpa ent department doors in April. The hospital will
provide services for mothers and children and also screening for chronic diseases. Management is assured by former staff of the
Sihanouk Hospital of Hope, Phnom Penh, which has a good fame for high quality services and social engagement towards the
poor clients. The project has established good contacts and will help to coordinate, through the provincial health department,
the ac vi es.
Cambodian German Coopera3on mee3ng in Bonn, Germany. An important delega on from the Cambodian MOH visited Bonn,
Germany, in December 2011 to a&end the joined mee ng on the Cambodian-German Coopera on. We have confirma on about
the imminent start of the project's phase two. More details will become available once the appraisal mission, scheduled for June
2012 will have completed its visit to Cambodia and needs and priori es for expansion of the financial component have been
iden fied in good coordina on with all stakeholders.
Regional Forum on Health care Financing: May 2-4, 2012. Phnom Penh will be the host of a regional conference on health care
financing, organized by the MOH with support from Nossal Ins tute for Global Health, l'Agence Française au Développement
(AFD) and the Belgian Development Agency (BTC). One of the objec ves is to establish a regional Community of Prac ce on
Health Care Financing as many countries in the Mekong Region are moving swiMly towards Universal Coverage.
Congratula3ons: Ms Kong Sinin, AFH's provincial coordinator in Kampot province, gave birth to a healthy baby boy on February
29th! Orb Or Sar Tor!
Mee3ng with Sugar Palm Founda3on management,
Dr Oum Vanna Theary and Dr. John Naponick