Cambodia

Cambodia’s health care system—shattered by decades of civil war that ended in 1993—relies heavily on local health care providers, who often lack formal training. During the war an entire generation of health care professionals was lost. Seventy percent of Cambodian women still deliver their babies at home, typically aided by a traditional birth attendant. Because these local health workers do not have skills or equipment to manage obstetric emergencies, too many women die when complications occur. The poor condition of roads in rural Cambodia compounds the problem by limiting access to health centers, especially during the rainy season.

EngenderHealth’s holistic approach takes advantage of existing community resources while bringing high-quality health care services to families throughout Cambodia. After starting in three provinces in 1997, EngenderHealth now works throughout the country to:

• Encourage community involvement in health care
• Provide tools to improve quality health care
• Make motherhood safer

 
Encouraging Community-based Health Services
To ensure the safety of home births, EngenderHealth has trained midwives and traditional birth attendants in vital life-saving skills. Buddhist nuns and monks, another group of highly respected and influential community workers, extend the reach of health services, disseminating information to mothers about proper breastfeeding techniques, treatment of diarrheal diseases, and birth spacing. Village shopkeepers provide the needed supplies, selling oral rehydration solution, oral contraceptives, and condoms.

 
Providing Tools to Improve Health Care Services
EngenderHealth works with a local nongovernmental organization, the Reproductive and Child Health Alliance (RACHA), to provide a comprehensive range of maternal and child health services, such as postabortion care, counseling and testing for HIV, creating links with maternity care and more. In the clinics it supports, RACHA uses EngenderHealth's COPE® process to improve the quality of services in public health facilities. COPE®, which stands for client-oriented, provider-efficient services, helps health care workers identify problems, find the root causes, and develop effective solutions.

 
Making Motherhood Safer
To ensure that women have access to postabortion care, EngenderHealth is assisting Cambodia's Ministry of Health as it designs and implements a new postabortion care initiative, which includes the following components:

• Integrating postabortion care into routine maternal care services;
• Providing emergency treatment of complications of incomplete abortion;
• Offering family planning counseling and supplies;
• Treating sexually transmitted infections;
• Providing HIV counseling and referral for HIV testing;
• Engaging the community through awareness and mobilization.