Plan © Plan Cambodia MCH needs Strong Health System vertical vs horizontal intervention in Cambodia Conference of Action for Global Health 10 th May 2011, Berlin, Germany by Dr. Chea Thy, Country Health Advisor, Plan International Cambodia

© Plan MCH needs strong Health System Health Situation in Cambodia Areas for MCH Improvement Crucial Points in Health Systems strengthening Horizontal versus Vertical Interventions Working Approach Donors’ Performance German Development Cooperation in the health sector

© Plan A Case … * ….Mrs. Pok lived in poor community in poor Samut Loe village, Ratanakiri, got married since she was16 years old, she got 6 children at the age of 25. She had never got any ANC service, nor family planning as the service was inaccessible. All of her childbirths delivered by local TBAs in unclean conditions. She died with her last new-born when, on the dusty road, referred to the hospital. In reality, she did not want to be away from domestic chores and care of her children …

© Plan Health Situation in Cambodia 1/3 of the total population live below the poverty line 1 in 12 children died before reaching their fifth birth day 1/3 of children death due to related pregnancy 1/3 of Under-5 Children faced underweight and stunt. Maternal Mortality Ratio: 461per live birth Contraceptive Prevalence Rate: 35% The poor, the poorest facing much more MCH Problems.

© Plan Government for Improving Maternal and Child Health(MCH) Fast Tract Initiative as to reduce maternal and child death: CORE Family Planning (both short terms and long terms) Safe Childbirth Emergency Obstetrical Care (both Basic and Complementary) Safe Abortion SUPPORTIVE BCC, Overcome financial barriers, Surveillance Source: RMCNHC, MoH, Cambodia

© Plan Health services delivery Promoting child health care Launch Health Center Construction Plan Cambodia strengthening Health System

© Plan Crucial Points in Health Systems strengthening Ownership, alignment, harmonization… Partnership with civil society & private sectors Legal Framework Accountability and Transparency Health Services Functioning Qualified human resources Comprehensive health services delivery

© Plan Horizontal interventions Health Sector Support Project 1 HSP Health Sector Support Project 2 HSP Contract-in OD and Contract-out OD Special Operating Agency (SOP)= OD D=Donor/Development Partner OD =Operational District RH =Referral Hospital HC =Health Center NHSP= Health Strategic Plan RHHCs community outreaches HCsRH community outreaches D-1 D-2 D-3 D-1 D-2 D-6 D-7 D-3 D-1 D-2 D-4 D-5 D-8 community outreaches community outreaches community outreaches community outreaches Community based Contraceptive distribution Community based Contraceptive distribution

© Plan Horizontal interventions Package of outreach services: basic vaccines, very basic care and treatment, deworming, health education, ANC, PNC (including FP), micronutrient (Vitamin A, Folic acid, Iron, Zinc)… etc. Low quality MCH Services are also available, accessible and delivered by private providers in community Pros: mothers can access to a range of MCH service (s) Cons: too challenging to deliver many services from one Health Service Delivery Point. Low geographical coverage.

© Plan Horizontal interventions Package of Reproductive Maternal Child Newborn Health Care Services at Heal Center: ANC (including FP), Counseling, Childbirth, PNC (including FP), birth registration, Tetanus Toxoid, BEMOC, referral, micronutrient, nutrition, immunization and health education, safe abortion… Pros: Demand side has Choices of available services; Supply side has multiple basic health care competency. Cons: Limited staff, there can not provide all services. Limited drug supply and financial supports Limited space and facility and coverage for services

© Plan Vertical interventions Family Planning HIV/AIDS Malaria Tuberculosis Global Fund Cholera

© Plan Vertical interventions: Family Planning Pros Social Marketing FP products available, affordable and accessible FP methods delivered through Public health system FP reduce population and hence reduce poverty Cons Lots of framework, human resources and attention commitments made to FP FP products smuggled to other non-target area Side effects of FP methods affect other MCH services Long terms FP methods, women can not control over their body

© Plan Which approach works best ? Both approaches support each others, there are pros and cons involved. However, It suggests that invested more than one particular health problem or single intervention. Better more comprehensive health program intervention rather than one single family planning one. Strong health system needed to respond to multiple and inter-related MCH causes and problems. Demand site/vulnerable mothers needs strong health system, close to their doors.

© Plan How do donors perform in this regard? Based on the primary duty bearers and right holders’ needs, priorities. National Health Strategies as Approaches for ‘strong health system’. However, the application of single, dual or multiple approaches, Donors have to help the government in developing countries take more accountable and commitments for MCH health intervention as ensure that the rights of children and mothers, particular the vulnerable ones, to high standard quality of care, prevention and treatment.

© Plan German Development Cooperation in the health sector? GTZ (on behalf of BMZ) has been active and in-depth appreciated in Cambodia: Social Health Protection, RD, Govern. Contributed to Clinical Practice Guideline, Quality standard for Health Services, in-service training, Model and procedures for scaling up Social Health Protection System Strengthening health system both public and private sector Modern Contraceptive methods through social marketing and public health Building/renovation of training centers Quality Management and HR development: training of nurses, midwives, public health managers Community-based health insurance/Health Financing ID Poor, General Population Census 2008……….

© Plan Maternal Health Post, in 12th Century, King Cheyvaramann VII Bayon, Angkor Thom, Siem Reap, Cambodia Thank You!