My Work with the Cambodian Midwives Association

I cannot start this post without first explaining a little bit about midwifery and how midwives are trained in Cambodia  so that there is some context to my role here.
Despite a lot of investment in maternal and child health services in Cambodia the maternal and infant mortality rates remain some of the highest within the region and maternal mortality have remained static for the past 10 years.MM 470/100,000 whilst Infant Mortality rates have reduced at 28/1,000 they are still unacceptably high.This is a great concern for the Royal Cambodian Government and for the Non Government Organisations (NGO's) working with it in this area.
26% of maternal deaths occur through unsafe abortion practices and investment in services in the area of safe abortion services and those for adolescent sexual health family planning or birth spacing as it is known here have been widely promoted.
The other main causes of maternal deaths are Post Partum Haemorrhage and Eclampsia both of which are preventable when there are sufficient numbers of well trained and skilled health professionals and resources in place.
It has now recognised that midwives are essential to the delivery of safe reproductive health services and that investment needs to be made in increasing their numbers ie by training more and by improving the clinical skills and competence of the existing workforce.
As with all professions because of Cambodia's past there are big gaps in the workforce which will take many more years to fill.
How Midwives are trained is both interesting and complex there are two types a bit like the UK used to have with the old Enrolled Nurse role there is a primary nurse/midwife these practitioners have done a years combined training in nursing and midwifery and they work to a national job description.They were introduced to address a shortage of midwives in the North East of the country which is largely rural but are now more distributed across the country.They have a restricted range of duties commensurate with their skills but can still be the sole care provider in many of the remote areas of Cambodia.
Secondary midwives are either nurses who have undertaken a years post basic training known as a 3+1 or more recently Cambodia has introduced a 3 year direct entry midwifery programme and this has almost doubled the numbers of midwives in training.
There are 5 public training centres 1 in PP the others at Regional Training Centres (RTC's) across the country.
Teaching and learning facilities and student support seems to vary in each centre. Some have received a lot of support from either the govt or NGO's whilst others less so what they do have in common though is a shortage of space and teachers to accommodate all the additional students.
This is also the case in clinical practice with a shortage of high quality placements [now where have I heard that before] Interestingly VSO and other NGO's are doing some great work in the RTC's on developing preceptor ship and other forms of student support with very little.
From what I have gathered so far non of the courses meet international standards so the Govt has commissioned a new 4 year bachelors level curriculum to be developed but this is at the very early stages of development.
Cambodia is also in the process of developing its regulatory framework for both nursing and midwifery laws have been passed to establish both a Nurses Council and The Cambodian Midwives Council this is a very exciting and essential development and I am really pleased to be sharing an office with the Cambodian Midwives Council as there is so much potential for collaboration between the CMA & CMC to strengthen the midwifery workforce.
The pay and reward schemes for public servants in Cambodia are going through reform so it is hard for me to understand exactly what midwives are paid here I have gleaned that they have recently had a pay rise and incentives added to their pay per hospital/health centre based deliveries they perform
In addition to the "approved" midwifery workforce there are also traditional birth attendants [TBA's] who have had little or no formal training but have been delivering babies within local communities for years and years. Many women and families either because of poverty/tradition or other factors still look to TBA's in preference to accessing mainstream services
My role with the Cambodian Midwives Association is to help build its capacity to work as strong voice for women in the area of reproductive health there is evidence which supports a strong correlation in countries which have effective professional midwifery associations and a reduction in maternal mortality rates.The CMA has been through some challenging changes over its 16 year history it now has a new elected President and executive team and it is my job over the next year to help and support these very committed midwives to strengthen membership and activity  in ways which helps to raise standards of midwifery practice and the personal and professional development of midwives for Cambodia.
We have a CMA conference in two weeks when I will get to meet over 70 midwives from all provinces in Cambodia and this is their opportunity to contribute to the future development of CMA as a democratic organisation. I will let you know how it goes and what I get up to in future.
Please feel free to comment on what I am doing help and advice is always welcomed
Kath