‘Our Health Center Midwife’ – Safer deliveries and improved quality of care at the Chey Health Centre

08 December 2014

The situation in 2009 / 2010

Chey Health Center
Location: Kon Thnot village, Chey commune, Kampong Thom
(rural Cambodia)
Population: 9,803 persons (15 villages)
Poverty rate (date): 25%
Staff in 2010: 5
Founded in: 1990

When Ms Sun Phany, a 24 year-old and newly graduated primary midwife started working at Chey Health Centre in 2009, she experienced challenges like many other midwifes all around rural Cambodia.

Gaining the trust and acceptance of the community and particularly pregnant women is a long process that takes time, effort and commitment. They have to compete with Traditional Birth Attendants (TBAs) and people’s deep-rooted distrust in the health system, due its low quality and unreliability. Chey Health Centre was quite typical for rural Cambodia; it was poor and remote, the infrastructure and hygiene inadequate, services and equipment were of low quality. Accessing public basic health services was a challenge for most villagers, due to poverty or the long distance to travel to reach the facility. Moreover, if they sought services, there was often no staff to attend to their needs. Hence, utilization of health services was low in the community.

At Chey Health Centre, the roof was damaged, the rooms needed renovation and the road leading to the village was of poor condition. In 2010, there were only 5 people working at the health centre, 1 midwife, 3 primary nurses and 1 worker (non-technical); hence, deliveries in the community were mainly attended by TBAs. Most patients at the health centre were pregnant or suffered of diarrhoea, acute respiratory infections, and malaria.

Social Health Protection Programme Intervention

In 2010, the provincial health advisor of Social Health Protection Programme (SHPP) passed by Chey health centre and met Ms Sun Phany. It was about 7.30 am and she was helping a woman through delivery since 4 am. The baby girl was delivered safely and the mother’s relatives were grateful and relieved. However, Phany’s shift continued as she had to clean the delivery room, washing it with a small bucket of water and prepare it for the next delivery. The room had no light; it was dirty and lacked basic equipment.

After a meeting of GIZ staff with the health centre chief and Phany, it was jointly decided to improve the quality of the health centre by implementing Quality Improvement (QI) tools. The quality assessment base-line score was 44% in 2010. Based on the assessment, a QI plan was developed with the health centre team and the Provincial Health Department. Resources were mobilized, not only from the SHPP, but also from CARITAS, to improve the health centre’s infrastructure. The roof and rooms were renovated, a water supply system and sanitary facilities were set up and solar panels and batteries were installed. Staff was trained to use the Health Center Quality Assessment Tool and other QI measures. The SHPP focused mainly on supporting the delivery services through on the job training by a development advisor as well as renovating the delivery room and purchasing better equipment.

Results

In 2014, the QI assessment score was 93%, a clear improvement compared to initially 44% in 2010. Phany has contributed a lot to this development. She became a very active member of the health centre team and clearly made a difference in the maternal and child health service. She is well known and respected by the community she serves. One village chief said, “Ms. Sun Phany is our Community Midwife. We always ensure her security even she has to travel by night for a delivery.” The chief of the health centre is also very proud of Phany and the team, which now works together more closely and is committed to improving the quality in the centre even further.

New staff has been hired; two newly graduated secondary nurses and one secondary midwife. They were teamed up with Phany to learn from her experience. “I am working to transfer my skills to other midwife colleagues so that we can serve the community better”, Phany proudly states. Now, the health centre is also staffed during night and the utilization of basic health services has increased. For example, the number of deliveries increased from 12% in 2011 to 40% in 2013.

Additionally, CARITAS is facilitating access to the health centre by supporting the community to organise transport to the health centre, using Tuk Tuks financed through community resources.

All in all, Chey health centre proves that a midwife like Phany can make a difference. She is an inspiration for the health centre team and the community. The story shows, that commitment from the chief of the health centre and the whole team is an important factor for improving health care services.