Outline of the Project

Project Name

Project for Improving Continuum of Care with focus on lntrapartum and Neonatal Care (IINeoC Project)

Country

Cambodia

Date R/D Signed

December 25,2015

Term of Cooperation

From May 16, 2016 to May 15, 2022

Implementing Organization

National Maternal and Child Health Center (NMCHC), Provincial Health Departments (PHDs) and Provincial Hospitals (PHs) in Kampong Cham (KCM) and Svay Rieng (SVR) Province

Background

In Cambodia, since the end of the civil war, major maternal and child health indicators has improved dramatically with tireless efforts of the government to rebuild its deteriorated health system as well as continuous assistance of the government of Japan and other international development partners. However, maternal and child mortality levels in Cambodia are still high compared to regional standard. Especially, there is big room for improvement in neonatal mortality rate (18/1000), with newborn deaths making up more than half of the under-five child deaths. Aiming to improve the maternal and child health status with focus on newborn health, the government of Cambodia requested to the government of Japan to implement technical cooperation.

Maternal and child health has been one of the priority areas for JICA's health sector assistance for Cambodia since 1992, and remains to be the important area of JICA's cooperation. In addition, the efforts to improve maternal, newborn and child health will contribute to achievement of Universal Health Coverage, which the government of Japan promotes in its global health policy, by strengthening health systems for expanding coverage and effectively delivering quality services to all women and newborns.

The Overall Goal

Reduce the neonatal mortality at target provinces

Project Purpose

Continuum of Care with focus on intrapartum and neonatal care is strengthened at target provinces

Output

1. Training and supervision on intrapartum and Immediate Newborn Care (INC) for MNCH staff is strengthened.
2. Management of sick newborns and preterm/low birth weight (LBW) infants is improved.
3. Follow-up for neonates (especially those showing danger signs) is strengthened.
4. Health systems, which are essential to improve Continuum of Care for better MNCH services, are strengthened.
5. Findings, lessons learned and evidence for MNCH services focused on intrapartum and newborn care are reflected on national policies/strategies/guidelines.

Project Activities

0. Baseline and Endline survey

Output 1

1-1.	Develop a plan for scaling up the coverage of INC training to Referral Hospitals (RHs) and Health Centers (HCs) in KCM and SVR
1-2.	Conduct Training of Trainers (TOT) on INC for Maternal Child Health (MCH) staff of SVR PH, on intrapartum care for MCH staff of NMCHC, KCM PH and SVR PH
1-3.	Conduct INC training for remaining and new staffs at HCs, RHs, PHs in KCM and SVR by trainers of each province
1-4.	Conduct training of Intrapartum care for remaining and new staffs at HCs, RHs, PHs in KCM and SVR by trainers of NMCHC or each provinces
1-5.	Review and revise existing supportive supervision tools for intrapartum and INC
1-6.	Support PHD and PH to conduct supportive supervision on intrapartum and INC in KCM and SVR
1-7.	Support KCM and SVR PHD to conduct MCAT after Supportive Supervision system is established

Output 2

2-1.	Develop and implement the NMCHC manual for managing sick, preterm/LBW newborns in NCU
2-2.	Conduct essential trainings for NCU and relevant staff at NMCHC and target provincial hospitals (For usage and maintenance of medical equipment, infection control, 5S etc.)
2-3.	Trainers conduct training on management of sick and preterm/LBW newborns for NCU staff from KCM and SVR PHs at NMCHC
2-4.	Develop a checklist to monitor implementation according to the manual.
2-5.	Conduct periodical monitoring with the checklist and if necessary refresher training for NCU staff in KCM and SVR PHs
2-6.	Support SVR and KCM PHs to conduct OBGY and Ped joint case conference to improve communication among maternity/delivery, neonatal care unit and other related units
2-7.	Train NCU staff to conduct the newborn physical checkup with the checklist at NMCHC and PHs
2-8.	Train staff to conduct KMC according to KMC manual at NMCHC and in PHs
2-9.	Identify obstacles to provide follow-up OPD for high-risk babies who were discharged from NCU and suggest possible solutions

Output 3

3-1.	Review/revise existing IEC materials for awareness raising on better home care, danger sign, reminder for service uptake, and birth registration and/or develop new tool if necessary
3-2.	Train staff on usage of revised/developed IEC materials
3-3.	Support regular EENC Review Meeting to discuss status of the neonates with danger signs, neonatal deaths and care for and follow-up of sick newborns
3-4.	Develop the guideline on response of neonates showing danger signs outside of facility (1. Community education on danger signs of neonates and identification of danger signs, 2. Appropriate referral criteria, 3. Mutual information sharing among neonates' parents and health facilities in referral case)
3-5.	Identify the way to promote Post Natal Care (PNC) and follow-up for neonates showing danger signs

Output 4

4-1.	Information Management on Intrapartum and Neonatal Care is strengthened
4-1-1.	Conduct activities, which contribute to strengthen Information Management on Intra partum and Neonatal Care at NMCHC
4-2.	Neonatal Death Audit is implemented
4-2-1.	Support MOH to develop Neonatal Death Audit Guidelines
4-2-2.	Support the committee to conduct pilot Neonatal Death Audit in NMCHC and KCM/SVR provinces.
4-3.	Training Unit at target provincial hospitals is strengthened
4-3-1.	Support organizing TU in Svay Rieng
4-3-2.	Enhance implementation of relevant trainings by KCM/SVR TU
4-3-3.	Enhance implementation of relevant training by KCM/SVR TU
4-4.	Others
4-4-1.	Identify causes of patient overflow at obstetrics in Kampong Cham provincial hospital and suggest possible solutions

Output 5

5-1.	Compile the existing MNCH policies/strategies/guidelines
5-2.	Support revision and/or development of new MNCH policies /strategies /guidelines based on findings of the project
5-3.	Share lessons learned, findings and evidence of the project at relevant technical working groups
5-4.	Make recommendations on pre-service training for intrapartum and neonatal care to the MoH

Inputs

[Japanese side]

[Expert]
Chief Adviser
Midwifery Care
Community Maternal and Newborn Health
Project Coordinator
Other short term experts

[Project staff]
Local staff

[Facility Renovation]
KCM PH NCU renovation

[Equipment]
Equipment necessary for project activities

Inputs

[Cambodian side]

[CP]
Project Director
Project manager

[Facilities]
Project office space

[local cost]
Project office equipment and the management cost
Space for meetings at NMCHC other necessary cost