Essential Obstetrics Care in Cambodia - Research Proposal Example

Essential Obstetrics care in Cambodia Name xxxxxxxxxx Course xxxxxxxxxx Instructor xxxxxxxxxx Date xxxxxxxxxx Introduction Research indicates that across the world over 500,000 girls and women die due to complication related to childbirth as well as pregnancy each year. Evidently, 99% of such reported cases occur in developing countries such as Cambodia. Family Health Division (2000) maintain that, because of war and catastrophic conflict that have hit Cambodia, the country have been slow in improving the health status of its population through creating easier access to quality health services as well as effective provision of Essential Obstetric care (EOC). Graham (2004) maintains that, slow improvement of health care within this country has made Cambodia maternal mortality rate gradually increase. 3, 000 women and girls die each year due to complications related to pregnancy with another 60,000 to 90,000 suffering from disabilities that are usually as a result of pregnancy complication (Family Health Division 2000). Aims/purposes The following paper aims at understanding the following; Critically examine the provision of essential obstetric care in Cambodia Analyze the various types of EOC provided within the country Give a broad idea on how the provision of EOC has been covered Outline the various barriers that are limiting the government of Cambodia to ensure there is better coverage as well as provision of EOC Outline various solution that will assists in the provision of effective EOC across Cambodia Types of essential obstetric care across Cambodia According to Family Health Division (2000), essential Obstetric Care is defined as a broad array of services which normally include antenatal and family planning programs, both intrapartum and postpartum care. It is further important that we understand what Emergency Obstetric Care means. EmOC is similar to EOC only that it widely includes more specific interventions such as intravenous antibiotics, blood transfusion, cesarean section, forceps or vacuum delivery and finally, management of complication which involves abortions (Family Health Division 2002). The government of Cambodia is engaged in both basic and comprehensive types of EOC to ensure that maternal mortality is greatly reduced. In its basic EOC services, the Cambodian health care administers; both parental antibiotics and oxytocic drugs, manual removal of the placenta as well as the retained products of conception as well as largely assisting in vaginal delivery. Based on comprehensive type of EOC, all procedures included in the basic EOC are performed as well as caesarean section and blood transfusion. The Cambodia government has divided the types of EOC offered through giving a clear understanding of various indicators (Family Health Division 2002). Geographical distribution of EOC services The Cambodian government ensures that it places EOC facilities in almost all geographical coverage across the country. This is very important as it enhance accessibility thus reducing the rate of maternal mortality across Cambodia. Post partum care It is estimate that across the world and especially in developing countries, large proportions of deaths occur 24 hours after delivery. According to Graham (2004), it is for this reason that the government of Cambodia is largely focusing on enhancing its postnatal care so as to widely constitute critical safe pregnancy interventions. This type of EOC services offered in Cambodia has largely helped to reduce maternal death through meaningful standards. Caesarean Sections Graham (2004) maintain that, for the Cambodian government, caesarean section as a type of EOC is considered to be a measure of access to as well as the use of a common obstetric intervention that ensures that maternal and neonatal deaths are averted as well as ensuring that complication such as obstetric fistula are greatly reduced. It is observed within Cambodia that when maternal mortality is considerably high, the rate of caesarean section tends to be low especially in the rural area within this country (Graham 2004). Intra partum care Tamang (1996) maintains that, in Cambodia, 100, 000 million infants die each year during delivery. For this reason, the ministry of health in Cambodia have ensure there is good quality care which is defined it is intra partum care programs that are both vital for mother and her infant. Through engaging in this care, research indicate that most neonatal and maternal death have greatly been reduced across Cambodia. It is quite evident that a major cause of fetal death is by asphyxia which can largely be prevented though the establishment of proper intra partum cares (Tamang 1996). It is evident from research carried out that there is no uniformity in the distribution of provision of Essential Obstetric Care (EOC) in Cambodia. This has been noted by UNICEF that has continued to advocate for every 500,000 population, a minimum of five basic Essential Obstetric Cares (World Bank 2002). However, the criterion has been evident in some cities for example, Phnom Penh. Majority of the towns have questionable facilities and quality care. The urban areas have well established EOC facilities and the services provided are excellent. This has been made possible by the private health institutions that are able to provide these services. The number of the health facilities functioning is good and the quality and type of the care offered are excellent. Basically, the plans to monitor safe motherhood programs have been put in place. However, in the rural areas the reverse is observed. The access and utilization of essential obstetric care is lower as compared to the city. For example, Kandal province has nine districts and each district has a referral hospital. However, it has only one facility at which caesarean section is performed. This is devastating considering the population of the province of approximately 1.5 million. Data obtained from various hospitals have clearly indicated that obstetric intervention rate in the rural areas is wanting. For instance, obstetric intervention rate for Phnom Penh residents was about 13% while for the rural resident was 30%. This implies that complications during delivery were common among the rural residents and the obstetric care services were unavailable (National Institute of Public Health-Cambodia 2002). Barriers to essential obstetrics care in Cambodia The Cambodian health care sector is faced with a myriad of challenges, similar to other South East Asian countries. However, there are barriers to EOC provision that are unique to the country. There are 1,700 deaths of women relate to reproductive health issues (Ministry of Health 2010). These are challenges emanating specific to various stakeholders such as the government, health care providers, organizations and health care seekers. In Cambodia, a study identified 5 barriers hindering effective provision and utilization of maternal healthcare services: financial, physical, cognitive, organizational, psychological and socio-cultural barriers (Matsuoka et al 2010). The ministry of health is indicated as prioritizing improvement of maternal and child health care. One of the key challenges relates to financing. This is relative to the growing population rated at 1.54% (as at 2008) now to over 13 million whose 51.4% are women. Despite the indication that there has been improvement with reference to specifics such as antenatal care the concerns in delivery and post natal care need be addressed. The concern of finances is reflected in the number if trained obstetrics and facilities distribution, nationally. A closely related challenge is in donor funding conflict which accounts for a major share in national health budgets in developing economies. There are issues with lack of predictability and concentration on some diseases with external aid being not closely related with the national health focus (Langenbrunner & Somanathan 2011). Only about a half of births in Cambodia take place in approved facilities (54%) while 45 percent occur at home (National Institute of Statistics 2011). In addition to this, the distribution is unequal with the urban areas almost having a universal coverage. The rural areas lag behind with fewer facilities, and less skilled practitioners leading to reliance on unskilled traditional EOC. The health care seekers also show low empowerment in health care provisions. The 2010 Cambodia Demographic and Health Survey revealed that 72 percent of women aged 15-49 have serious problems barring them from accessing health care. They related their concerns to lack of funds to pay for services, as well as distance to the health facilities. There are stills concerns related to poverty which is now at 31% with more rural uneducated women being at a higher risk. As such, not only are they incapacitated, some of them do not understand the importance or when there is need to seek medical health. This also affects their attitudes about EOC. A greater challenge facing services provision is related to conflict. This is an important cause of maternal and child mortality and morbidity. This is due to inflictions, instability and disruption of health care systems with reference to personnel, supplies, programs and initiatives. Over time, the Cambodian state has been turbid with the greatest impact being felt by women and children who are more highly dependent on health services. This has a weakening effect on the pursuit of Millennium Development goals (MDGs). In places where obstetric complications kill many even in peacetime, a mere loss of access during conflict kills even more. Solutions to challenges This paper cannot fully engage in the multifaceted issues surrounding EOC provision. However, it explores generalized solutions or framework to tackle them. To begin with, there is need for a policy approach solution. This relates to the government through its agencies creating an enabling environment for better access to EOC equitably across the country. A good policy will ensure an increased health care spending that is more result oriented. The policy should remove financial barriers to health care provision and eradicate poverty and ensure equity. It should tackle the highly privately sponsored healthcare with enhanced exemptions for public facilities services (Ir, et al 2008). Such a policy will also address the need for additional professionals in the area in addition to additional new and modern facilities marching the growing need. This will enhance emergency obstetric and new born care and skilled birth attendance (Ministry of Health 2010). These two have been indicated to be among the key components of interventions against complication-related deaths. The policy should also focus on educational empowerment and knowledge. This surrounds such areas of concern as attitude change also related with behavior change communication on reproductive health and practices. It is also vital that the policy enables development of better health insurance schemes. These are vital in enhancing accessibility. The current health care schemes should be tailored to match the ability of the poor rural women. This is by both public and private health scheme providers in the country. The previous social health insurance 2003-2005 adoption set pace for national policies under which there was development of social health insurance, community-based health insurance, and health equity funds in pursuit of MDGs by 2015 (Annear 2009). They have been indicated as successful. However, there is need to improve the frameworks and structures of the agencies implementing the schemes to ease disparity. There is an urgent need to address human resource deficiencies especially in rural areas. The country is only 20 percent urbanized with a greater concentration of health care being in urban areas. As such, the government needs to roll out local training programs to empower care givers. The current obstetrics is coupled with a myriad of other health complications such as HIV. The care givers need to be well capacitated. In addition to this, the health professionals in the areas also require additional skills and enhanced working environments. This is to address issues with maternal health indicators on deliveries by skilled attendants (Ir, et al 2008). Conclusions According to various national health surveys, there have been remarkable developments in EOC provision and other health areas. However, there are a myriad of challenges in providing various types of EOC. These challenges revolve around policy development and implementation. There is prevailing disparity and inequality between urban and rural areas, and between the rich and the poor. There are also issues of attitude. The government has rolled out several policy and development initiatives towards MDGs, key among them being maternal and health care. The paper recommends the need for a relook into the frameworks and structures supporting these initiatives. Such is needed for the nationwide health equity funding. Apart from these, the challenges can also be tackled from the point of view of health seekers. They need to be empowered so that government interventions are met with better perception and use by the women and children References Family Health Division. 2000. National Adolescent Health and Development Strategy. Kathmandu, Nepal: Department of Health Services, Ministry of Health Family Health Division. 2002. National Safe Motherhood Plan: 2002–2017. Kathmandu, Nepal: Department of Health Services, Ministry of Health. Graham, W. 2004. The familiar technique for linking maternal deaths with poverty’. Lancer 363(9402): 23-27 Ir, P., Horeman, D., Narin, S., & Van Damme, W. 2008. Improving access to safe delivery for poor pregnant women: a case study of voucher plus health equity funds in three health districts in Cambodia. Studies in HSO&P, 24 , 225-255. Langenbrunner, J., & Somanathan, A. 2011. Financing health care in East Asia and the Pacific : best practices and remaining challenges. Washington DC: World Bank. Matsuoka, S., Aiga, H., Rasmey, L., Rathavy, T., & Okitsu, A. 2010. Perceived barriers to utilization of maternal health services in rural Cambodia. Health policy, 95 (2) , 255-263. Ministry of Health . 2010. Fast Track initiative: Road map for reducing maternal and newborn mortality 2010-2015. Phnom Penh: Ministry of Health. National Institute of Public Health (Cambodia).2002. National Health Statistics, 2001. Phnom Penh: The Institute National Institute of Statistics, Directorate General for Health, and ICF Macro, 2011. Cambodia Demographic and Health Survey 2010. Phnom Penh: National Institute of Statistics, Directorate General for Health, and ICF Macro. Tamang, A. 1996. “Induced Abortion and Subsequent Reproductive Behaviour among Women in Urban Areas of Nepal.” Social Change 26(3–4). World Bank. 2002. World Development Indicator 2001. Washington D.C: The World Bank. Read More