It’s International Day of the Midwife again.

To celebrate International Day of the Midwife we once again wish to thank all the midwives, midwifery service managers and traditional birth attendants we work with for their dedication to improving midwifery services.

In 2018 our efforts will see more health facilities opening, more continuing education for midwives and continued support for midwives from traditional birth attendants.

Together – and with the support of our donors – we will seek to provide safe and respectful maternity care giving women what they want, and should have, for themselves and their babies.

Blanketing MRKR

I had the opportunity during a recent visit to England to call in at a meeting of the Retired and Cheerful Club to say thank you for their long time support for M’day Reak Reay Kone Reak Reay.

Their latest contribution was two large boxes of hand knitted blankets for our new babies. We distributed the blankets around the 24 health centres and health posts we support just in time for the cold winter.

Cold Winter? In Cambodia? Well, for the majority of readers of this blog who live in Europe and have just experienced ‘The Beast from the East’ our early morning 10C (yes alright that’s plus 10) or even lower may seem rather tame but in Preah Vihear we are not used to this every morning for nearly two months.Two weeks maximum in December we regard as normal, but when it continues through January into February, that’s a different matter.

So a timely and welcome gift. Thank you again to the RAC.

Time up for ‘traditional birth attendant’?

Our thanks to Frank Spangler and ADRA Canada for this video.

As midwifery services grow in quantity and quality, we are changing the role of traditional birth attendants (TBAs) from being the first choice provider of maternal health information and services to a supporting role at village level for the midwives based in the health facilities, able to give complete, accurate and timely information and advice and encourage appropriate use of health facility midwifery services before, during and after pregnancy.

Not everyone thinks this is the right thing to do but almost all the women we are encouraging to use health centre midwifery services were themselves delivered by TBAs who remain influential and trusted in their villages. They cannot be overlooked or ignored and we know their help is valued by midwives who understand how much harder their job would be without that support.

So is it time to change the name? Some people think the name ‘traditional birth attendant’ is outdated, others say changing it will cause confusion since everyone in the village already knows who they are and what they do. Our view is that it will be difficult to find a new name that is clear, concise and easily translated into local languages. But we would be interested to hear about any examples where the name has been changed or where change has been considered and rejected.

Our work to promote constructive partnerships between midwives and TBAs is made possible through a co-funding contribution agreement ADRA Canada has with the Government of Canada, through Global Affairs Canada.

Celebrating the International Day of the Midwife.

Midwives, Mothers and Families – Partners for Life.

That’s theme for this year’s International Day of the Midwife. Recognition of the significant contribution midwifery care makes to healthy families and thriving communities.

But there are also other partnerships we value and recognize. The partnership between midwives and traditional birth attendants, and our own partnerships with ADRA, the provincial health departments of Preah Vihear and Kampong Thom and the Cambodian Midwives Association.

And we want to mark the occasion by saying Thank You and Goodbye (though hopefully not for the last time) to Julia Stewart who has contributed so much over many years to the development of midwife education in Cambodia.

And finally, Happy Birthday to Chhay Sveng Chea Ath, President of the Cambodian Midwives Association.

Consultancy opportunity

The Cambodian Midwives Association and the EMBRACE Project are seeking a suitably qualified and experienced local consultant to undertake the tasks described in these Terms of Reference.

It is expected that the work will take about 40 hours to complete. Apart from necessary meetings in Phnom Penh with the Association and EMBRACE project representatives, the consultant will work from their normal base location. The consultancy must be completed before the end of March 2017. The fee payable for this consultancy is USD 1,000.00 inclusive of all expenses and taxes incurred by the consultant.

Proposals should be written in English and sent by e-mail to davidawcock@gmail.com by 18.00 on Tuesday February 28, 2017. They should include:
1. Your curriculum vitae.
2. The names and contact details of at least two referees, together with a short description of the work you did for them.
3. A short summary of your experience in relation to the purpose of the consultancy.
4. A description of how the work will be done.

The Cambodian Midwives Association and the EMBRACE Project reserve the right to reject proposals without explanation and will not reimburse costs incurred in preparing proposals or attending pre-contract meetings.

Background
The Cambodian Midwives Association is the voice of midwives in Cambodia. The Association focuses on advocacy and training for its members who work in health authorities and health facilities in all provinces and municipalities in Cambodia.

The EMBRACE Project aims to increase utilization of health services and consumption of nutritious foods with a focus on mothers, pregnant women, newborns and children under five years old in Cambodia, Myanmar, Philippines and Rwanda. The project is funded by Global Affairs Canada and ADRA Canada. In Cambodia the EMBRACE project is being implemented by ADRA Cambodia but some project activities are being contracted to other organizations. M’day Reak Reay Kone Reak Reay will be the lead organization for the EMBRACE project in relation to this consultancy.

Following an earlier consultancy, the Association decided to make more use of its Facebook page to disseminate information in the Khmer language about the midwifery profession, midwifery practice, Ministry of Health policies and guidelines, and the Association’s activities to all its members and to other interested people. The content can include text, diagrams, photographs, videos and links to other internet sites. The Association is a member of the International Confederation of Midwives and some site content can come from the confederation or other sources in English and will be translated into Khmer before uploading.

The number of posts by the CMA has increased and we are now seeking to further enhance the value of posts to midwives, attract more midwives to use the page (and join the Association if they are eligible), and encourage comments and greater sharing of ideas and experience.

The primary audience is CMA Members but the intention is that the platform should be of value to:
• All practicing midwives in the public and private sectors;
• People working in organizations supporting midwifery services;
• Student midwives;
• People working in midwifery education and/or continuing professional development.

Activities
The consultant will:
a) Review the posts on the CMA Facebook page since October 1, 2016 to assess progress towards the aim of disseminating information to help CMA Members in their daily work.
b) Consider ways to develop the platform as an online discussion forum in which CMA Members share knowledge, experiences and issues encountered in their daily work.
c) Identify ways in which the platform might be used as part of the activities included in CMA’s Strategic Plan 2016 – 2020.
d) Provide a short report in English covering the activities carried out by the consultant and the recommendations made.

Payment schedule
M’day Reak Reay Kone Reak Reay will pay the consultant in two equal installments. The first payment will be made when the contract is signed. The second payment will be made when the consultant’s report is received and accepted. Invoices are required for both payments. Payment can be made in cash or by transfer to a bank account nominated by the consultant.

Growing midwifery

The Cambodian Midwives Council and the Cambodian Midwives Association chose a joint workshop to launch their Strategic Plans for 2016 – 2020, a decision that underlines that they are two sides of the same coin or, since we are in Cambodia, two sides of the same bank note.

There are a number of common themes running through both plans. Competency based pre-entry and continuing professional education systems and pathways that will continue to raise midwifery education and practice towards international standards. A compulsory regulatory system that effectively mediates complaints whilst both supporting midwives and protecting them from unfair criticism. The voice of midwives heard in government at all levels and by the public alongside and in collaboration with other health professionals. Strengthened governance and management of both organizations with increasing self-financing. And, above all, that all practising and teaching midwives register with the Council and join the Association regardless of whether they work in the government, NGO or private sectors.

Ambitious? Yes. Achievable by organisations that do not have large secretariats but rely on the time and energy of their members? Well the many related and overlapping activities present a stiff challenge of timing and coordination but there was a clear sense of intention at the launch workshop. The direction is set. What is needed now is momentum.

MRKR is contributing by supporting the Cambodian Midwives Association to expand the use of their Facebook page to disseminate information about midwifery practice, Ministry of Health policies and the activities of the Association to members and anyone else who is interested. You can join on Facebook by liking Cambodian Midwives Association although the content is in Khmer.

Can’t read Khmer or don’t have anyone to translate (or don’t like Facebook)? We will have a monthly summary here in English. Just click “Follow” and you will get our new posts by e-mail.

Missing MEDiCAM

When I started work in Cambodia in 1997 there were a lot of international organizations and NGOs working in the health sector but not a lot of information about what they were doing. Although there was slow and intermittent access to the internet, only a few organizations had websites and the information on them was rather historic. Then I heard about the MEDiCAM (yes it is written like that) monthly meeting and there was the answer.

Meetings at that time were held at the World Vision building which was easy to find. “It’s the big building near the crossroads of Monivong and Mao Tse Toung. You can’t miss it”. Well times and skylines change and now “It’s the building tucked away behind……”

What has not changed is the value of sharing information and learning from the experience of others and, although MEDiCAM’s fortunes have ebbed and flowed like the tide over the years, it has remained a necessary and valued network.

Until now.

Now MEDiCAM is no more, a victim of, well what exactly?

Was it the allegations of financial irregularities made by Global Fund which certainly worried many people even though all that was really proved was how important is it for all of us to follow donor rules very carefully?

Was it because the widening scope of ‘health’ meant that the two or three subjects covered in each meeting would have relevance for only a proportion of members? This seems true for the monthly general meetings and, to a lesser extent, to the quarterly specialist RMCH group and the regional meetings. We did not need to go because there was nothing new we needed to know about.

Was it the cost and time of travelling to meetings? Perhaps MEDiCAM should have moved more towards being an online community.

Was it because Provincial Technical Working Groups have become more effective and there is less need for a national level ‘bridge’ between government and NGOs which has been the rationale for MEDiCAM for many years?

Was it simply that there are now only a few people who remember what life was like before MEDiCAM and why it was invented in the first place? Is this why it seems the majority of members were not enthusiastic towards the efforts of a few to try to reorganize the organization?

Maybe a bit of each. But it is too late now and all we can say is thank you to the former MEDiCAM staff for all the help you have given us over the years.

If the members would not support the revitalization of MEDiCAM, will they agree to contribute actively and financially to a replacement? We may not have to wait long to find out. A meeting on 11th November will consider whether the HIV/AIDS Coordinating Committee (HACC) should take on MEDiCAM’s general information and experience sharing role. The meeting is at 09.00 at the RACHA office which happens to be right next door to World Vision. “It’s the building tucked away behind….”

MRKR is recruiting midwives

M’day Reak Reay Kone Reak Reay is recruiting three midwives with at least two years experience in rural health settings and community facilitation as Midwifery Network Coordinators for a project in Preah Vihear and Kampong Thom provinces that will continue until June 2020.

The main responsibility is to promote cooperation between health center midwives and traditional birth attendants, with the active participation of commune councils, to improve maternal and newborn health and nutrition.

The people appointed will be based in Krong Preah Vihear but will be expected to work anywhere in the project area. The salary will be in the region of USD 450 per month.

Main activities:
• train and provide continuing advice to traditional birth attendants to support midwifery services in accordance with Ministry of Health policies and guidelines;
• coordinate and facilitate regular midwifery network meetings at health centers and health posts;
• work with midwives and traditional birth attendants to plan and deliver awareness raising activities in villages;
• liaise with commune councils to ensure that maternal and newborn health and nutrition issues are included in commune development plans and activities;
• participate in the planning and delivery of training courses for health staff and assist the Midwife Training Coordinator develop teaching and learning materials;
• participate in project planning, reporting and evaluation including data collection and data entry;
• collaborate with the staff of other NGOs carrying out community development and health system strengthening activities;
• represent M’day Reak Reay Kone Reak Reay in meetings with government and NGOs;
• other activities related to the job as specified by the Head of Program.

Essential requirements:
• Midwife registered with the Cambodian Midwives Council or meeting the criteria for registration.
• Clinical experience in health centres and community outreach.
• Able to ride a motorbike to rural health centres and health posts on bad roads and stay overnight in villages.

Desirable requirements:
• Knowledge of the components of the MoH Fast Track Road Map for Reducing Maternal and Newborn Mortality.
• Knowledge of the components of the MoH Fast Track Road Map to Improve Nutrition.

Interested applicants should send their CV and a letter explaining how their training and experience relate to the responsibilities by e-mail to touthkoeun@gmail.com or deliver to M’day Reak Reay Kone Reak Reay, Phum Koh Beng, Sangkat Kampong Pranak, Krong Preah Vihear before 17.00 on Monday 16 May 2016. Please do not send certificates or other documents. Only short listed candidates will be contacted for interview.

Midwives and TBAs

“TBAs live directly with the people in the village and know them better than we do. Women trust them more than us”. Midwife at Bos Sbuv HC.
“TBAs can see problems from the health centre staff and villagers points of view”. Midwife at San Dek Chas HC.
“The TBA is a good channel of communication with people in the village”. Midwife at Koh Ker HC.

Recently, in a series of semi-structured interviews and focus group discussions with MRKR midwives, forty-six midwives working in health centres and health posts took the opportunity to reflect on the experience of working closely with traditional birth attendants. Their comments illustrate how the relationship between midwives and traditional birth attendants changed as a result of MRKR’s work and confirms the value of collaboration.

MRKR set out to change the role of traditional birth attendants from being the first choice service provider of maternal health information and services to a supporting role at village level for the midwives based in the health facilities. In their new role traditional birth attendants are trained by MRKR and health centre midwives to give information and advice, watch for signs of complications and encourage appropriate use of health centre midwifery services before, during and after pregnancy.

What the midwives said

Initially, midwives had seen the training of traditional birth attendants and the regular meetings with them primarily as opportunities for them to ‘tell’ traditional birth attendants what to do and what not to do. However, for the majority, the meetings were now more about sharing information and gaining mutual understanding.

The midwives learned from the traditional birth attendants about the determinants of health in individual villages and the physical, financial and cultural barriers that prevent or discourage women from using midwifery services. The specific information about individual villages was cited as very useful in finding solutions for problems. Equally important was the information traditional birth attendants could give midwives about individual pregnant women, especially those who were nervous when meeting a midwife for the first time.

Just over half the participating midwives also reported that their own knowledge and understanding of some aspects of midwifery practice had increased or been updated through the contributions of MRKR midwives to the discussions which took place at the meetings.

“I would like the trainer to continue to attend meetings because HC staff have limited experience and knowledge”. Midwife at Koulen HC.

The midwives were also asked about the benefits they saw for communities as a result of their closer cooperation with traditional birth attendants. They reported that increased trust and confidence in midwifery services had led to increased utilization of health services and also helped families avoid unnecessary expenditure.

Is there still a role for traditional birth attendants?

More health centres, more midwives, improving transport infrastructure and less poverty all make it much easier for people to access effective and affordable midwifery services. Young women no longer follow their mothers or aunts into the traditional birth attendant role and their numbers will gradually decline. But many people still value the traditional birth attendants who live and work in their village and we are well aware that most of the women we are trying to persuade to use health centre midwifery services were themselves delivered by a traditional birth attendant, as were their husbands.

The Ministry of Health recognises the existence of traditional birth attendants but does not give them a formal role as ‘community health workers’. They prefer to focus on increasing access to skilled health staff whilst using community health volunteers in a range of health promotion and citizen representation roles. Traditional birth attendants support and supplement but do not replace the roles of qualified midwives, especially delivering babies. It is now illegal for a traditional birth attendant to deliver a baby by herself and she can be fined 50,000 riel (about USD 12 or UKP 8.5) if she does so.

MRKR’s work demonstrates that good cooperation between midwives and traditional birth attendants provides an effective and sustainable linkage between health centres and the villages they serve. There are benefits for midwives, traditional birth attendants and communities by facilitating the updating of information and skills and providing opportunities for midwives and traditional birth attendants to share experiences and learn from each other.

MRKR’s new project

In a new collaboration with ADRA Cambodia, for the next four years MRKR will be part of an exciting multi-country health and nutrition project called EMBRACE funded by the Canadian Government, through Global Affairs Canada, and ADRA Canada. The new project builds on our previous successful collaboration with ADRA Cambodia which, among many other things, saw deliveries at target health facilities increase from 46% to 71% and satisfaction among pregnant women with the maternity services they received increase from 50% to 79%. It also extends MRKR’s activities in Preah Vihear into the Sandan District of Kompong Thom Province for the first time.

Here’s the press release.

“ADRA Canada is pleased to announce the signing of its most recent co-funding contribution agreement with the Government of Canada, through Global Affairs Canada. Named EMBRACE, the program will run until March 2020 and serve people living in remote regions of Cambodia, Burma (Myanmar), Philippines and Rwanda. EMBRACE will also raise the awareness of the Canadian public through its public engagement component which will work with agents of change from remote areas in Canada.
“EMBRACE will focus primarily on improving and saving the lives of women of reproductive age, newborns, and children under five. The program will achieve these objectives through instruction on health and nutrition, the building of health clinics and training programs for community health volunteers, traditional birth attendants, nurses and midwives. Agricultural instruction will teach mothers how to grow nutritious fruits and vegetables close to their homes in kitchen gardens.
“Over 20 million Canadian dollars will be contributed by the Government of Canada through Global Affairs Canada, and 5 million Canadian dollars will be contributed by ADRA Canada and its partners.