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Cambodia - Summary
Cambodia’s population of 15.1 million is 80% rural, with one-third living below the poverty level. The country has had to rebuild itself after a 30-year period of war and internal conflict and is praised internationally for its proactive leadership in development and health. Both primary and secondary midwives work in the field of midwifery. The maternal mortality ratio decreased 58% in the period 1990 to 2008, dropping from 690 deaths per 100,000 live births to 290 per 100,000. Thus, the country is making progress towards improving maternal health and achieving MDG 5. National Priorities and Policies for Maternal and Newborn Health (MNH) Since 1994, the government has decided to strengthen the health system, improve financial access to services and focus on human resources for maternal health. The 2008 Cambodian Health Strategic Plan put maternal health as a priority. For the Ministry of Health, midwives are one of the critical cadres to achieve improvements in overall heath, especially in rural and remote areas where there is a dearth of doctors. A policy of free health care for the poor is subsidised by an Equity Fund and is being tested and gradually implemented. Challenges and Bottlenecks Cambodia still has an acute shortage of midwives, nurses and doctors. The country’s five public training institutions do not currently have the capacity to increase the number of graduates to fill these gaps. Entry criteria, including the completion of secondary education also limits the pool of potential students. Another challenge is the inequitable distribution of the health cadres between Phnom Penh and the rest of the country. Many socio-cultural and economic barriers prevent women and families from accessing public health services and traditional birth attendants are still the first choice for women giving birth in rural areas. The Midwifery Council was established in 2006, but statutory registration in the midwifery profession is not yet compulsory, which makes an assessment of the attrition rate difficult. Work is underway for its development and capacity building. Opportunities and Innovations Fees are not required to receive emergency treatment. However, the Ministry of Health has a cost recovery scheme in place. The donor supported equity fund is designed to facilitate access for the poor, but not all health facilities are engaged in the scheme. Following the 2006 midwifery review, a three-year direct entry midwifery programme was introduced in 2008. The Ministry of Health plans to introduce a four-year Bachelor’s Degree in the near future. To cover the projected supply gap, several in-service training programmes have recently been implemented to upgrade competencies. There is also a new scheme of performance-based incentives to increase institutional births. External Support The Health Sector Support Programme II, jointly funded by seven donors (UNFPA, UNICEF, World Bank, AFD, AUSAIDS, BTC and DFID), pledged $15 to $20 million per year for 2009-2013. Funds will be used to provide support to the Ministry of Health in various areas, including human resource development. Other organizations, such as USAID, GTZ and JICA, have on-going programmes to support human resource development and maternal and newborn health. Child health receives the largest share. Forward Look While the country is making progress towards MDGs 4 and 5, it still faces challenges with human resources for health. Today, Cambodian midwives are highly regarded by communities. Increasing competition for enrolment in midwifery education bodes well for the profession. Prepared by Mihaela Minca

Prepared as a background document for The State of the World’s Midwifery 2011 - launched June 2011
Disclaimer: While all efforts have been made to verify the information in this document, responsibility for the contents and presentation rest with the author(s). The views and opinions expressed in the document do not necessarily correspond with those of the State of the World’s Midwifery 2011 Editorial Committee.