The past, present and future of medical education in Cambodia.

This paper describes the past, present, and future of medical education in Cambodia. Although doctor training began in 1902, the first medical school was not founded until 1946. Since the colonial era, the curriculum and teaching strategies have been strongly influenced by the French system, dominated by didactic lectures and the apprenticeship model. Three chronic issues have plagued medical education in the country following the Khmer Rouge regime: a shortage of doctors, poor-quality training, and lack of relevance to the current and future population needs. An increasing number of medical schools and yearly student enrollment have addressed the first issue. Today, the fundamental challenges have shifted from quantity to ensuring the quality and relevance of medical education. Competency-based medical education (CBME) has been adopted as a new curricular model to tackle the latter two issues. Active collaboration between government institutions, public universities, and development partners drives this curricular reform at the national and institutional levels. This paper further examines the challenges associated with medical education and proposes recommendations.

Women's perspective of maternity care in Cambodia.

BACKGROUND: Consideration of the needs of pregnant women and their ability and willingness to attend maternal services and pay for them is central to the provision of accessible and acceptable maternal care. Women's satisfaction with maternal services is poorly understood in many developing countries, including Cambodia in South East Asia. The objective of this study was to investigate women's perceptions and experiences of private and public skilled birth attendants, including midwives, during childbirth in Cambodia. METHODS: A qualitative design using a naturalistic inquiry approach was undertaken to seek sensitive personal issue. Thirty individual in-depth interviews were conducted with women who had recently given birth at private and public health facilities in one province in Cambodia. Data were analysed using a thematic approach. FINDINGS: Women's choice of health facility was influenced by their perceptions of safety and staff attitudes. Reported barriers to the effective utilisation of public maternity services were costs associated with the birth, staff attitudes and a lack of supportive care during labour and in the postpartum period. Although private health care is more expensive than public health care, some women reported a preference for private birth attendants as they perceived them to provide safer and more supportive care in labour. CONCLUSION: Women expect, but do not always receive humane, professional, supportive and respectful treatment from public skilled birth attendants. While the removal of unexpected costs and geographical barriers are important to increasing public maternity care and service utilisation, improvements in maternity services should focus on addressing provider attitudes and enhancing communication skills during labour, birth and the immediate postpartum period.

Practices of skilled birth attendants during labour, birth and the immediate postpartum period in Cambodia.

OBJECTIVE: maternal and perinatal morbidity and mortality rates in Cambodia are high. The provision of quality care by skilled birth attendants (SBAs) in a supportive working environment is an important strategy to reduce morbidity and mortality. There has been little emphasis on examining this issue in Cambodia. The objective of this study was to establish SBA reported practices during labour, birth and the immediate postpartum periods and the factors affecting this. METHODS: a descriptive qualitative design was employed using in-depth interviews and focus group discussions with midwives, nurses and doctors with midwifery skills in two health centres and three referral hospitals in one province of Cambodia. Data were analysed using a thematic framework. FINDINGS: SBA practice is not always consistent with evidence-based standards known to reduce morbidity and mortality. Ten inter-related themes emerged, which described patterns of SBA practice, were identified. These were: skills in the care of labouring women; provision of support in labour; interventions in the second stage of labour; management of the third stage of labour; cleanliness during birth; immediate care of the newborn infant and immediate postnatal care; lack of policy and authority; fear of litigation; workload and lack of human resources; and financial incentives and socio-economic influences. CONCLUSIONS: a gap exists between evidence-based standards and current SBA practice during labour, birth and the immediate postpartum care. This is largely driven by the lack of a supportive working environment. IMPLICATIONS FOR PRACTICE: the findings of this research provide maternal health services, workforce planners and policy makers with valuable information to contribute to the continuous quality improvement of maternity care. The findings highlight implications for practice that may improve the quality of maternal health care. Recommendations for decision makers were made and further research is needed in order to develop theories and recommendations to improve SBA practice in Cambodia, to the benefit of the Cambodia women and newborn babies.

Quality of maternity care practices of skilled birth attendants in Cambodia.

BACKGROUND: The World Health Organization's recommended package of interventions for the integrated management of pregnancy and childbirth provides guidance for the use of evidence-based interventions to ensure the best outcomes for mother and newborn. However, the extent to which skilled birth attendants (SBAs) follow evidence-based guidelines is not known. There are few studies into childbirth practices of SBAs in Cambodia. The aim of this study was to observe practices of SBAs during labour, birth and the immediate post-partum period and their consistency with evidence-based guidelines. METHODS: A structured non-participant observation study was undertaken. Data were collected using an observational checklist of evidence-based practices adapted from the Cambodian clinical assessment tools for associate degree in midwifery. Maternity care settings in one provincial hospital, two district referral hospitals and two health centres in one province of Cambodia were purposively selected. RESULTS: Twenty-five SBAs who attended 40 women during labour, birth and the postnatal period were observed. The results showed that the use of the partograph was low; birth companions were not permitted; cleanliness during birth was lacking; management of the third stage of labour was inappropriate; monitoring of mother and baby in the early postnatal period was lacking; the SBAs lacked skills in neonatal resuscitation; skin-to-skin contact with the newborn and early breastfeeding were rare; and intramuscular injection of vitamin K varied. CONCLUSION: The findings suggest that the current SBA practices during labour, birth and the immediate post-partum period in one province of Cambodia are not consistent with evidence-based guidelines. Service improvements that address evidence-based practices are likely to have an impact on clean and safe childbirth, thereby enhancing outcomes for Cambodia women.