Addressing the human resources crisis: a case study of Cambodia’s efforts to reduce maternal mortality (1980–2012)

Abstract

ObjectiveTo identify factors that have contributed to the systematic development of the Cambodian human resources for health (HRH) system with a focus on midwifery services in response to high maternal mortality in fragile resource-constrained countries.DesignQualitative case study. Review of the published and grey literature and in-depth interviews with key informants and stakeholders using an HRH system conceptual framework developed by the authors (‘House Model’; Fujita et al, 2011). Interviews focused on the perceptions of respondents regarding their contributions to strengthening midwifery services and the other external influences which may have influenced the HRH system and reduction in the maternal mortality ratio (MMR).SettingThree rounds of interviews were conducted with senior and mid-level managers of the Ministries of Health (MoH) and Education, educational institutes and development partners.ParticipantsA total of 49 interviewees, who were identified through a snowball sampling technique.Main outcome measuresScaling up the availability of 24 h maternal health services at all health centres contributing to MMR reduction.ResultsThe incremental development of the Cambodian HRH system since 2005 focused on the production, deployment and retention of midwives in rural areas as part of a systematic strategy to reduce maternal mortality. The improved availability and access to midwifery services contributed to significant MMR reduction. Other contributing factors included improved mechanisms for decision-making and implementation; political commitment backed up with necessary resources; leadership from the top along with a growing capacity of mid-level managers; increased MoH capacity to plan and coordinate; and supportive development partners in the context of a conducive external environment.ConclusionsLessons from this case study point to the importance of a systemic and comprehensive approach to health and HRH system strengthening and of ongoing capacity enhancement and leadership development to ensure effective planning, implementation and monitoring of HRH policies and strategies.

Impact of Performance‐Based Financing in a Low‐Resource Setting: A Decade of Experience in Cambodia

“…The trauma and devastation wrought by the Khmer Rouge and years of war left Cambodia with untold need for medical care and no healthcare system to speak of (Fujita et al, 2013). The scale of this imbalance created the impetus for contracting the provision of district health services to NGOs.…”

“…It offers incentives intended to redress the underperformance, notably high worker absenteeism, frequently observed in poorly funded public health systems that lack accountability (Meesen et al, 2011;Gertler and Vermeersch, 2012). It is spreading rapidly, particularly in sub-Saharan Africa, where more than 30 countries have linked or are linking the payment of healthcare providers to their performance, mostly in relation to delivery of maternal and child health care (Fritsche et al, 2014).…”

Building the capacity of nursing professionals in Cambodia: Insights from a bridging programme for faculty development

“…Since the 1990s, the Cambodian Ministry of Health (MoH) has adjusted its focus from an acute care model to address the acute health personnel shortages by tackling quantity and quality issues via policy development and planning. 1,2 Despite this effort, a substantial health personnel shortage remains; Cambodia has the lowest staffing levels, with 0.2 doctors and 0.9 nurses and midwives per 1000 population. 3 Cambodia also has the greatest subnational inequalities in the distribution of doctors, which affects task sharing and role substitution among nurses, other co-medicals and families.…”

Cross-country analysis of strategies for achieving progress towards global goals for women’s and children’s health

“…Cambodia has dramatically improved its rate of skilled birth attendance ( Table 4 ). 29 The Chinese government trained large numbers of additional health personnel, including village doctors (barefoot doctors) to strengthen primary care delivery. 30 Peru improved access to emergency obstetric care in rural communities by training health providers to respond better to local beliefs and expectations.…”