Country Team Action Plan Cambodia

Tracks 1 & 2 2 Where are we now? Key program/country needs and challenges –MMR of 472 / 100,000 hasn’t budged in 15 years! –Trained providers are not practicing AMTSL, etc. Current levels of accomplishment/Progress and challenges since Bangkok 2007 –National assessment of key practices of SBAs –Developed training package of key interventions to address maternal and neonatal mortality (AMTSL, PE/E, Neonatal resuscitation, newborn care) –Safe Motherhood Protocols revised

Tracks 1 & 2 3 Where do we want to be? GOALS Desired levels of Accomplishment Nation wide coverage of Key Interventions in Maternal and Newborn Care Country Team Goal Scaling-up Key Interventions in Midwifery Maternal and Newborn Care to four provinces in Cambodia within one year Best Practices for Scale-Up AMTSL, PE/E, neonatal resuscitation, newborn care

Track 1 4 What are the gaps? Trained providers are not providing correct practices Reasons for the gap Lack of supportive supervision Lack of correct job aids Lack of supplies Lack of human resources

Track 1 5 What interventions can we use to close the gap? List best practices and key interventions that can close the gap; describe how the interventions will address the gap List activities to carry out the interventions

Track 1 6 What are the possible challenges to the intervention? List potential challenges to the intervention and ways to address the challenges

Track 1 7 Who are the possible partners, allies, and stakeholders? List possible partners, allies, and stakeholders and their respective roles and responsibilities

Track 2 8 What is the evidence to support this best practice? What actions, if any, are needed to provide/collect additional evidence? After training: New delivery and postnatal registers to be used for monitoring and data analysis Conduct regular supportive supervision; unannounced spot checks Bimonthly Midwifery Alliance meetings at district Breakthrough Collaborative

Track 2 9 What are the modifications needed to improve the intervention’s scalability? None needed

Track 2 10 Who will be involved in scaling-up? MoH supported by RHAC, RACHA, URC, UNICEF Describe the capacity of the organization(s) to scale-up and what implications this has for scaling-up. –MoH and partners have trained 30 MoH master trainers Who will be part of the team to support the process of scaling-up? –Provincial MoH trainers (to be trained) What needs to be done to ensure that this team is large enough and has the resources to support scale-up? –NGO partners will provide additional trainers and budget as needed

Track 2 11 What are the opportunities and constraints of scaling-up? OpportunitiesConstraints Key stakeholders are on board, momentum to address MMR Possibility of resistance at facility level to change Safe Motherhood Protocol (SMP) revised Possible delay in SMP finalization Primary midwives may not be able to practice some of the changes Shortage of commodities (eg. MgSO4) need to be in clinics Large geographic coverage of USAID partners

Track 2 12 What policy, regulatory, budgetary, or other institutional steps are needed? List/describe policy, regulatory, budgetary, or other institutional action steps that are needed Finalization, approval and dissemination of Safe Motherhood Protocols If Breakthrough Collaboratives are used, budget will be needed Who will advocate for these? When? How? USAID partners

Track 2 13 Where, when and how will the best practice be expanded? Phase one: Train 25 provincial trainers from four provinces Phase two: Train, supervise, monitor 120 midwives How fast (in what timeframe) will scale up take place? One year How will the best practice be disseminated to new areas or populations? Possibly through Breakthrough Collaborative

Track 2 14 What will be the costs of expansion and how will needed resources be mobilized? Costs of training already budgeted Breakthrough collaborativeTBD

Track 2 15 How will the process, outcomes and impacts be monitored? How will results be fed into decision-making? Use of registers, data analysis by partners with MoH Supportive supervision by MoH with partners Spot checks

Tracks 1 & 2 16 What are our action steps? Action StepResponsible Person Timeline 1. Advocate for finalization of Safe Motherhood Protocols (SMP) for referral hospitals and health centers Development partners Immediately, on- going 2. Launch and disseminate SMP to all facilities MoH with USAID, UNICEF, etc As soon as finalized 3. Strengthening stock management of MCH commodities RACHA, RHACNow and on- going

Tracks 1 & 2 17 What are our action steps? Action StepResponsible Person Timeline 4. Training of provincial trainers MoH master trainers with support of partners Within one month of approval of SMP 5. Training Health Center Staff MoH provincial trainers with support of partners Within one month of approval of provincial training 6. Monitoring and supervision MoH provincial and OD staff with support of partners One year