REPORT

On

Delivering Into Good Hands

National Midwifery Forum

December 13-14, 2005 Raffle Hotel Le Royal, Phnom Penh, Cambodia

The Midwifery Forum aimed at reviewing the progress and challenges to achieving the target of skilled birth attendances in order to reduce maternal mortality as agreed to in the National Health Strategic Plan (2003 – 2007), the Cambodian Millennium Development Goals and the National Population Policy. The Forum brought together policy makers, midwives and development partners to review the overall midwifery situation and discuss three specific topics in more detail: (1) training and skills development, (2) recruitment and deployment, and (3) sustainability and financing of skilled attendances.

This two-day National Forum was jointly organised by the National Committee for Population and Development (NCPD) of the Office of the Council of Ministers and the Ministry of Health (MoH) with financial support from the United Nations Population Fund (UNFPA). H.E. Sok An, Deputy Prime Minister and Minister in Charge of the Office of the Council of Ministers, chaired the meeting, and there was high level participation from the Office of the Council of Ministers, The Council for Administrative Reform, The State Secretariat of Public Function, The Ministry of Health, The Ministry of Education, Youth and Sports, the Ministry of Economics and Finance, and multilateral and bilateral agencies. Additional participants included Provincial Health Directors and one hundred and fifty five rural midwives.

OPENING

H.E. Prof. Eng Huot welcomed the participants. He noted that progress had been made in the health sector, but that improvements could not yet satisfy the health care needs of the population. 117 centres remain to be constructed, and there are still shortages of health staff, especially midwives, to accommodate needs.

Ms. Bettina Maas, UNFPA Representative, stressed the importance of reducing maternal and infant mortality rates through provision of safe delivery and other key reproductive health services and information. She noted that UNFPA, together with other partners, will continue to cooperate with the government and civil society to improve the reproductive health status of the population.

H.E. SENG LIMNOEU emphasized the vital roles of midwives in helping to achieve the government plan to reduce maternal and child mortality in accordance to commitment made internationally and nationally. He noted that the government must pay close attention to the lack of health staff, especially midwives. Without enough skilled midwives, the problem of infant and maternal mortality can not be addressed.

VOICE OF CAMBODIAN MIDWIVES

Midwives from rural areas of Kratie, Kampong Cham, Steung Treng, Odar Meanchey and Battambang spoke about the difficulties of working alone in a health center and excessive workloads. They also raised the difficulties of locating accommodation while studying to become a midwife at a Regional Training Center. They also noted that continuing education for midwives continues to be a great challenge, due to poor living conditions, and lack of a supportive environment, especially in rural and remote areas. Their specific recommendations are noted in the recommendations section below.

RECOMMENDATIONS

The key three specific topics above were discussed through presentations of local, regional and international experiences; voices of midwives; panel discussions; and feedbacks from participants. Fore more details on the agenda please refer to annex 1, and on the presentations annex 2.

Below is a summary of recommendations made by midwives and the participants of the Forum.

Recommendations from midwives to the Royal Government of Cambodia:

· Provide more opportunities for continuing education;

· Provide some kind of incentive for those who work in rural areas;

· Provide means to go for outreach activities.

Recommendations to the Ministry of Health

· Compare proportion of medical officials, especially midwives, to total population figures and review issues of mal-distribution of staff.

· Propose recommendations to other relevant government institutions for:

o Reclassifying degree certificates for health professionals to be in line with levels agreed for other ministries (Degree certificates to be reviewed include: primary and secondary midwives/nurses, and medical doctors)

o Revising salary grades and scales based on reclassification of degree certificates

o Developing special incentives and allowances for health staff, particularly midwives working in rural and remote areas (allowances for high-risk occupation and remote location)

· Review midwifery training curriculum (both primary and secondary/registered midwives) and standardize student recruitment, entry selection, and civil servant recruitment examination following rules and regulation of the government.

· Recruit more local students to study at Regional Training Centres (RTCs) and to provide priority to local graduates to become government staff.

· Consider support for rural/remote midwifery students (allowances, accommodation, etc.) to ensure students can complete training course.

· Undertake annual civil servant recruitment examination in first 6 months of every year.

· Increase training facilities and student accommodation, and develop additional teaching hospitals for practice purposes.

Recommendations to other Ministries/Institutions of the Royal Government of Cambodia

· Increase the number of midwives following a clear-set frameworks, principles and necessities in order to reduce the maternal and infant mortality rate. [1]

· Consider recommendations from MoH for :

o Reclassifying degree certificates for health professionals to be in line with levels agreed for other ministries (Degree certificates to be reviewed include: primary and secondary midwives/nurses, and medical doctors);

o Revising salary grades and scales based on reclassification of degree certificates;

o Developing special incentives and allowances to health staff, particularly midwives working in rural and remote areas (allowances for high-risk occupation and remote location);

· Recruit more local students to study at Regional Training Centres (RTCs) and to provide priority to local graduates to become government staff.

· Consider support for rural/remote midwifery students (allowances, accommodation, etc.) to ensure students can complete training courses .

· Provide resources for building more training facilities and student accommodation, and for setting up teaching hospitals for practice purposes.

CLOSING

H.E. Ms. Chamroeun Kaktika, Deputy Secretary-General of NCPD, made a summary report of the Forum, and H.E. Prof. Eng Huot concluded the Forum as a successful and fruitful event. The Forum offered a chance for all stakeholders to get a better understanding on the difficulties related to midwifery issues in Cambodia.

The Forum was officially closed by H.E.SOK AN, Deputy Prime Minister, and Minister in Charge of the Office of the Council of Ministers. In his closing remark, he expressed his high appreciation to the organizers for making this Forum a success. The Government committed itself to enhancing the health status of the Cambodian people, and noted that it is working hard to solve health problems through highlighting the health issues in many national strategic papers, and through cooperation with many national and international partners, organizations, and UN agencies, etc.. As a result, progress has been achieved, and the health of mothers and babies is gradually improving. However, these achievements still fall short of the needs of the Cambodian people, and more work remains to be done.

H.E. SOK AN acknowledged the shortage of midwives as a critical issue. He agreed that each health center requires at least two midwives. Therefore, the Government will support more training for and recruitment of midwives. However, midwives should be recruited locally, and a strict contract should be made with them after they have finished their study. More incentives should be given to midwives who work in rural and remote areas. He noted that the Government is trying its best to reduce workplace transfer from rural to urban areas, and he emphasized that it should be compulsory for all trained midwives under the Ministry of Health to go to work in the rural area.

H.E. SOK AN also called for support and cooperation from all relevant government institutions and health partners to solve this critical problem, so that the CMDGs, can be reached.