Pathways to Progress: A Multi-Level Approach to Strengthening Health Systems

This report synthesises findings from five country case studies from the health dimension of this project, which focus
on maternal and child health (MCH) (Mozambique,Nepal, Rwanda) and neglected tropical diseases (NTDs)(Cambodia, Sierra Leone). MCH was selected given its centrality in two of the Millennium Development Goals (MDGs) and its ability to act as a proxy for strengthened health systems.

Can Vouchers Deliver? An Evaluation of Subsidies for Maternal Health Care in Cambodia

This paper will evaluate the effect of vouchers for maternity care in public health-care facilities on the utilization of maternal health-care services in Cambodia. The study involved data from the 2010 Cambodian Demographic and Health Survey, which covered births between 2005 and 2010. The effect of voucher schemes, first implemented in 2007, on the utilization of maternal health-care services was quantified using a difference-in-differences method that compared changes in utilization in districts with voucher schemes with changes in districts without them.[adapted from abstract]

Strengthening District Health Service Management and Delivery through Internal Contracting: Lessons from Pilot Projects in Cambodia

This study assesses the internal contracting, an approach where contractors work within the ministry of health but do not hire or fire health workers, as a means for improving the management of district health services and strengthening service delivery. [adapted from author]

Integrating Child Health Services into Malaria Control Services of Village Malaria Workers in Remote Cambodia: Service Utilization and Knowledge of Malaria Management of Caregivers

This study aimed to identify determinants of caregivers’ use of village malaria workers services for childhood illness and caregivers’ knowledge of malaria management. [adapted from abstract]

Addressing the Human Resources Crisis: A Case Study of Cambodia's Efforts to Reduce Maternal Mortality (1980-2012)

The objective of this article was to identify factors that have contributed to the systematic development of the Cambodian human resources for health system with a focus on midwifery services in response to high maternal mortality in fragile resource-constrained countries. [from abstract]

Achieving the Twin Objectives of Efficiency and Equity: Contracting Health Services in Cambodia

The Cambodian experience of contracting out for health workers discussed in this document suggests how a move away from the traditional government-provided health services model to government-financed and monitored contracts for health services can be an effective approach to expand coverage especially for the low-income groups. [adapted from author]

Early Detection of Tuberculosis through Community-Based Active Case Finding in Cambodia

This paper examines the differences in the demographic characteristics, smear grades, and treatment outcomes of pulmonary tuberculosis cases detected through both active and passive case finding to determine if active case finding from health workers in mobile radiography units could contribute to early case finding, considering associated project costs. [adapted from author]

Valuing Health Workers in Cambodia

The objectives of the research are to come to a better understanding of why health workers adopt behaviours that impact negatively on patients and to look for solutions in policy and practice to improve staff motivation and morale. [from author]

Scale-Up of Community-Based Malaria Control Can be Achieved without Degrading Community Health Workers' Service Quality: The Village Malaria Worker Project in Cambodia

Cambodia recently scaled up their Village Malaria Worker (VMW) project by substantially increasing the number of VMWs and expanding the project’s health services to include treatment of fever, diarrhoea, and acute respiratory infections in children under five. This study examined if the scale-up interfered with VMWs’ service quality, actions, and knowledge of malaria control, and analysed VMWs’ overall achievements and perceptions of the newly added health services. [from abstract]

Comprehensive Framework for Human Resources for Health System Development in Fragile and Post-Conflict States

The purpose of this paper is to present a comprehensive, engaging, and visible framework of HRH system development. This has been further developed from the lessons distilled from Japanese experiences of supporting HRH system development in three fragile and post-conflict health systems: Afghanistan, the Democratic Republic of Congo, and Cambodia. [from author]

Human Resources for Health in Maternal, Neonatal and Reproductive Health at a Community Level: A Profile of Cambodia

This profile summarises the available information on the cadres working at community level in Cambodia; their diversity, distribution, supervisory structures, education and training, as well as the policy and regulations that govern their practice. [from summary]

Review of Health Leadership and Management Capacity in Cambodia

This review describes the current situation of health leadership and management capacity in Cambodia after its efforts to rebuild its health system following years of conflict that decimated the country’s health infrastructure. [from summary]

Social and Cultural Dimensions of Hygiene in Cambodian Health Care Facilities

This report provides some insights on the social and cultural factors that shape hygiene practices in Cambodian health care settings that need to be considered when designing interventions to improve infection control practices. [adapted from abstract]

Helping Cambodians Plan Their Families

This video resource shows how midwives and community volunteers are helping more Cambodian women to increase the time between births, thereby contributing to healthier pregnancies, infants and families as well as to a better chance of escaping poverty. [adapted from synopsis]

Reaching The Poor With Health Services: Cambodia

Contracting NGOs to manage the primary health care system was found to be an effective means to increase service coverage and achieve a more pro-poor distribution of services in rural areas of Cambodia. The Ministry of Health (MOH) proposed contracting NGOs to manage the public health care system at the district level using a results-based contract to monitor progress.

Evaluation of Immunization Knowledge, Practices, and Service-delivery in the Private Sector in Cambodia

A study of private-sector immunization services was undertaken to assess scope of practice and quality of care and to identify opportunities for the development of models of collaboration between the public and the private health sector. A questionnaire survey was conducted with health providers at 127 private facili¬ties; clinical practices were directly observed; and a policy forum was held for government representatives, private healthcare providers, and international partners. [from abstract]

Reaching the Poor with Health Services: Cambodia

This brief reports on a project through Cambodia’s Ministry of Health which contracted health services to NGOs. Contracting NGOs to manage the primary health care system was found to be an effective means to increase service coverage and achieve a more pro-poor distribution of services in rural areas of Cambodia. [adapted from introduction]

How Labour Intensive is a Doctor-Based Delivery Model for Antiretroviral Treatment (ART)? Evidence from an Observational Study in Siem Reap, Cambodia

Funding for scaling-up antiretroviral treatment (ART) in low-income countries has increased substantially, but the lack of human resources for health (HRH) is increasingly being identified as an important constraint for scaling-up ART. ART is labour intensive. Important reductions in doctor-time per patient can be realized during scaling-up. The doctor-based ART delivery model analysed seems adequate for Cambodia. However, for many districts in sub-Saharan Africa a doctor-based ART delivery model may be incompatible with their HRH constraints. [from abstract]

Birth Spacing

To improve birth spacing services in Cambodia, the development of the communication and counselling skills of all providers is critical. A a large part of this issue focuses on these skills. [editor’s description]

Documentation and Assessment of the Reproductive and Child Health Alliance (RACHA) Program: an External Assessment

This assessment evalutes the RACHA program in Cambodia which was intended to strengthen the capacity and sustainability of the public and private sectors to deliver quality reproductive health and child survival services. The five technical intervention areas were birth spacing, STD/HIV prevention, safe motherhood, childhood diarrhoeal diseases and micronutrient deficiences. One of the key intermediate results identified within these areas was inproved human resource capacity to address these issues. [adapted from author]

Contracting for Health: Evidence from Cambodia

In 1999, Cambodia contracted out management of government health services to NGOs in five districts that had been randomly made eligible for contracting. The contracts specified targets for maternal and child health service improvement. The program increased the availability of 24-hour service, reduced provider absence, and increased supervisory visits. There is some evidence it improved health. The program involved increased public health funding, but led to roughly offsetting reductions in private expenditure as residents in treated districts switched from unlicensed drug sellers and traditional healers to government clinics.

Attitudes Towards Immunization in Cambodia: a Qualitative Study of Health Worker and Community Knowledge, Attitudes and Practices in Kompong Chhnang

Childhood immunization is a major public health concern in Cambodia. Given the high infant and child mortality rates and the low uptake rate of immunizations, a study of knowledge, attitudes and practices (KAP) of communities and health workers was conducted to identify barriers to immunization and inform future information, communication and education (IEC) strategies. Quantitative and qualitative research was conducted to discover the KAP of communities and health workers towards immunization services and the introduction of hepatitis B vaccine.

Treating Tuberculosis in the Private Sector: Cambodia

The Quality Assurance Project undertook a national assessment of private sector tuberculosis (TB) services in Cambodia to improve understanding of private sector practices and the sector’s willingness to participate in efforts to improve TB services. Over 500 respondents, including doctors, pharmacists, drug sellers, and TB patients, participated. In addition, mystery shoppers visited private pharmacists and drug sellers so that the surveyed groups’ reports could be compared to actual experiences.