There are many barriers to reducing maternal and newborn deaths in rural Cambodia. Poverty, lack of education, distance to a health facility, road conditions, cultural practices and poor decision making forces mothers to give birth at home without a skilled birth attendant risking the lives of both the mother and the baby. By 2013, nearly half of births still were happening at home in Kratie province of north east Cambodia. Samaritan’s Purse launched a Maternal and Child Health (MCH) intervention to address several critical gaps of MCH in Kratie province. This multi-tiered approach recognized that one of the key barriers to accessing perinatal care was the lack of facilities that provide a safe environment for women to give birth. It was also evident that the presence of a female support person such as the mother or an aunt is a crucial element for decision making whether a women’s preference for delivery will be at home or at a health center. Among many other factors, having enough room for the family to be around during the time of birth was critical to overcome the fear barrier for many women.
In conjunction with the maternal and child health project, Samaritan’s Purse built birthing centers at commune health centers in Snuol district. The goal of the project is to increase skilled birth attendance and perinatal care which would decrease maternal and neonatal deaths. The project was multifaceted; communities were sensitized and educated about the importance of pre and postnatal care and skilled birth attendance, expecting mothers were educated about the facility and the services through safe-motherhood campaign, and a small baby gift package was given to mothers as an incentive and encouragement.
The design of the building and the services provided followed the MOH guidelines for ‘waiting room facilities’ to provide practical ways to meet the needs of pregnant women.
Although the birthing rooms are equipped to provide basic obstetric care for uncomplicated pregnancies, these facilities bridges the chain of comprehensive maternity care from home to a higher level facility where advance obstetric care is available. This is achieved by training the healthcare staff at the birthing centers to recognize potential complications and initiate transfer to a facility with advance care minimizing the risks of death.
The design of the buildings followed basic Ministry of Health preferences with several added features to improve quality. A ramp that connects the health center to the birthing facility allows easy access even with a wheelchair. The delivery room connects with the consultation room and the ward for easy access. The kitchen space helps families to prepare a basic meal during their stay. A wall separates the toilet form the inpatient area to maintain good hygiene. The high roof and vents provide better ventilation. Glass blocks in the delivery room ensure adequate lighting for examination and delivery during day time.
Community level promotion activities educate mothers about the facility and the services provided through the new birthing centers. Key message of this promotion campaign is to build trust between women and the healthcare workers. Samaritan’s Purse also facilitated several skill building trainings such as Antenatal and postnatal care, Partogram, Immediate newborn care, management of postpartum hemorrhage, etc for staff at the health centers. The combination of infrastructure, capacity building training, equipment, and community level promotion activities made the birthing center project a holistic approach for improving maternal and newborn health.
Both qualitative and quantitative information gathered in 2015 shows remarkable improvements in accessing health facilities for delivering babies along. These are a two fold increase in skilled birth attendance. Significant improvement in other MCH indicators such as Antenatal and postnatal visits are also observed. These changes are attributed not only to the facility and the improved capacity of attending staff but also to the homely safe environment women get to experience during their stay. The positive experiences of women who delivered babies and had other services at the new birthing centers are eager to share their experience with other women in the community. This multiplying effect makes Samaritan’s purse Birthing center project a promising intervention for reducing maternal and neonatal deaths in Cambodia.
Samaritan’s Purse, 2016