Successfully reported this slideshow.
Your SlideShare is downloading. ×

Obstetric Referral in the Cambodian Health System - What Works?

Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Upcoming SlideShare
Nurse career day powerpoint
Nurse career day powerpoint
Loading in …3
×

Check these out next

1 of 11 Ad

Obstetric Referral in the Cambodian Health System - What Works?

Download to read offline

Presentation by Gillian Dalgetty (University of Leeds) on ReBUILD Responsive Fund project on Obstetric Referral in the Cambodian Health System given at internal programme webinar, 9th Sept 2015.

Presentation by Gillian Dalgetty (University of Leeds) on ReBUILD Responsive Fund project on Obstetric Referral in the Cambodian Health System given at internal programme webinar, 9th Sept 2015.

Advertisement
Advertisement

More Related Content

Slideshows for you (20)

Similar to Obstetric Referral in the Cambodian Health System - What Works? (20)

Advertisement

More from ReBUILD for Resilience (20)

Recently uploaded (20)

Advertisement

Obstetric Referral in the Cambodian Health System - What Works?

  1. 1. Obstetric Referral in the Cambodian Health System - What Works? 9th September 2015
  2. 2. Cambodia The legacy of conflict
  3. 3. Maternal Health in Cambodia  One of highest MMR rates in Asia  Weak referral identified as one cause  Policy priorities  Reducing maternal mortality  Improving quality of health service delivery  Ongoing reform of the Operational District system
  4. 4. Obstetric Referral in the Cambodian Health System – What Works?  4 objectives  Investigate delivery journeys to and back from public healthcare facilities for pregnant rural women  Identify existing positive resources in the public system  …
  5. 5. Adapting Appreciative Inquiry
  6. 6. Investigating Positive Journeys  What works NOW  Birth experiences < last 2 years  Rural province ….  30 interviews with stakeholders involved in referral  Pregnant women  Their family members (husbands, mothers)  Community based volunteers  Midwives and doctors  Health centre / hospital leaders  Snowball recruitment  Thematic Framework analysis
  7. 7.  (Husband’s story). His wife was pregnant with their first child, contractions started at around 9:00am. He brought his wife to the HC, arriving around 10:00am. He called the midwife via the number posted on the wall. When she arrived, she examined the woman and said that the cervix was just 1cm dilated so the couple should wait at the HC. The midwife allowed him, his mother-in-law and sister-in-law into the delivery room and the baby was born at 6:00am the next morning... Suddenly, the woman had so much bleeding. The midwife phoned DRH to inform them of a referral at around 7/8am. Two midwives stayed with his wife and the HC director drove the (HC) ambulance. The midwives constantly checked his wife’s condition and kept calling DRH to prepare to stop the bleeding when they arrived. DRH staff used a wheelchair to greet his wife – he lifted his wife from the ambulance to put her in it. His mother-in-law carried the baby. Both entered ICU with staff, who called to a more skilled midwife to assist. Had that midwife not come on time, the DRH staff were planning to refer further. Staff didn’t inform the family about his wife’s condition but taught him how to clean his wife and what medicine to buy for her. During the stay at the hospital, the family was not asked to fill any form except to pay 50,000Riel ($12.5) room fee. Before discharging the woman, staff advised them to take the given medicine and not have fire-roasting. Many relatives came to visit the woman at home.
  8. 8. Existing Positive Resources…  Facilities exist and function  Awareness of where to go to give birth  Staff follow a philosophy of care  Proactive referral: community HC onward  Effective teamwork within and between facilities  Active partnership between health system and family  Strong support provided by husbands, brothers  Community wide collaboration at time of/after birth  Proactive, confident and transparent hospital leadership  SOA status?
  9. 9. Limitations  Can be read as examples of ‘best practice’ – can’t say its widespread  Subject to usual caveats on interviews
  10. 10. So What?  Important balancer to referral literature in LIC that emphasises barriers, problems and deficits  Necessary to acknowledge and recognise that procedures are followed, medical staff can be wonderful, co-operation and teamwork can be found  Interviewees made some very specific recommendations (e.g. on facility design)  Need to disaggregate SOA/non SOA - may be an implication that don’t need to pay for performance

Editor's Notes

  • When talking about Cambodia certain aspects of the country’s history and daily life tend to be emphasised over other things – these include

    Genocide 75-79
    Vn occupation 79-89
  • Obstetric Referral in the Cambodian Health System - What Works?
  • What do YOU think AI is?

×