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
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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 …
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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.
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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
Plan Cambodia strengthening Health
System
Launch Health Center Construction
Plan
Promoting
child health care
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Health services delivery
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
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D=Donor/Development
Partner
Horizontal interventions
D-2 D-3
D-1
D-2 D-3
D-1
D-4 OD =Operational District
D-5
D-7 D-8
RH =Referral Hospital
D-6
HC =Health Center
NHSP= Health Strategic Plan
Health Sector
Support Project 1
HSP-1
2003-2007
Contract-in OD and
Contract-out OD
RH
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Community
based
Contraceptive distribution
HCs
Health Sector
Support Project 2
HSP-2
2008-2015
Special Operating
Agency (SOP)= OD
RH
HCs
community
outreaches
community
outreaches
community
community
community
community
Community based
outreaches
outreaches Contraceptive distribution
outreaches
outreaches
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)
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Cons: too challenging to deliver many services from
Horizontal interventions
Package 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.
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• Limited drug supply and financial supports
Vertical interventions
Global Fund
HIV/AIDS Tuberculosis Malaria
Cholera
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Family
Planning
Vertical interventions: Family Planning
Pros
• 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
Plan
©
• Long terms FP methods, women can not control
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.
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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.
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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
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• Community-based health insurance/Health Financing
Thank You!
Maternal Health Post, in 12th Century, King Cheyvaramann
VII
Bayon,
Angkor Thom, Siem Reap, Cambodia
© Plan