World Health Organisation Cambodia2014 MID-TERM REPORT

for Human Resource for Health and Collaborative Efforts between MoH, WHO and AUSAID (replaced by DFAT) in Maternal, Newborn

& Child Health01 July 2012 to 31st January 2015

EOL No. 50078/56 WHO Award 5958930 June 2014

Signed: May 21st 2012End Date: January 31st 2015Reporting period: Mid-Term Report 2014

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Table of Contents

1. Background..................................................................................................................2

2. Health Workforce in Cambodia – Developments and Progress...................................4

3. Human Resources for Health: Strategic Priorities, Objectives and Activities: Mid-

Term Progress Report..........................................................................................................6

3a. Strategic Priority One: Supporting and Strengthening of Multisectoral policy dialogue through Increased Capacity of Governance Structures...............................63b. Strategic Priority Two: Improve the Technical skills and Competence of the Health Workforce through Strengthened Pre-service and In-service Training..........73c. Strategic Priority Three: Strengthen health workforce management: Recruitment, performance management, deployment, retention and compensation.13

4. Maternal, Newborn and Child Health: Outputs of the Project (January-June 2014).16

4a. Coordination for scaling up Immediate Newborn Care implementation............164b. Facilitate the functioning of Technical Working for newborn care and IMCI....174c. Technical support for newborn and child health.................................................174d. Technical support for RMNCH Task Force.........................................................18

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1. Background

Over the past two decades, Cambodia has entered a sustainable development phase, unmatched by any other post-conflict society.1 This development has been facilitated by medium- and long-term policy directions that have helped stabilize macroeconomic conditions, encouraged large public and private capital inflows and restored peace and security. The country has registered massive gains and improvements on human development as measured by the Human Development Index (HDI). The life expectancy at birth has increased by 24.9 years, from 38.7 (1980) to 63.6 (2012). The mean years of schooling and expected years of schooling have increased by 0.8 and 4.0 years, from 5.0 to 5.8 and 6.5 to 10.5, respectively.2 Cambodia has also made impressive economic progress. The economy grew rapidly, at more than 8 percent per year, between 2004 and 2012, is expected to grow at around 7 percent in 2014, driven by strong exports, private investment and agriculture, and underpinned by a solid macroeconomic position. Poverty on a national level declined from 35 percent in 2004 to 20.5 percent in 2011.3 (Cambodia achieved the Millennium Development Goal (MDG) of halving poverty in 2009)

Cambodia has made good strides in improving health outcomes over the last decade. Between 2000 and 2010, the maternal mortality rate (MMR) dropped from 437 to 288 (per 100,000 live births) and the under-five (U5) mortality rate dropped from 124 to 54 (per 1000 live births).4 Considerable gains have been achieved in controlling the HIV/AIDS and tuberculosis (TB) epidemics. The HIV/AIDS prevalence has fallen from 3 percent in 1997 to 0.8 percent in 2012.5

Yet, in spite of these achievements, several challenges persist and new ones are emerging. Notably, the progress in reducing malnutrition has been slow - stunting showed a modest decline (from 50% in 2000 to 40 percent in 2010), but wasting increased (from 8 percent in 2005 to 11 percent in 2010) and underweight showed no change (28 percent in 2005 and 2010).3 Cambodia’s maternal mortality rate is almost four times higher than the averages for the East Asia (73 per 100,000 live births).1 The country is also witnessing an epidemiologic transition; non-communicable diseases and injuries are now amongst the leading cause of DALYs lost per 1,000 population.6

Since the turn of the century, there have been on-going efforts to strengthen the health system to address the identified challenges. The health reform process were initiated under the Government’s First Health Strategic Plan 2003 – 2007, followed by the Second Health Strategic Plan 2008-2015 (HSP2), which forms the framework for all decisions in the sector. HSP2 is guided by five working principles - social health protection, especially for the poor

1 Fujita N, Zwi AB, Nagai M, Akashi H (2011) A Comprehensive Framework for Human Resources for Health System Development in Fragile and Post-Conflict States. PLoS Med 8(12): e1001146. doi:10.1371/journal.pmed.10011462 Human Development Report: The Rise of the South - Analysis on Cambodia. UNDP, 20133 Cambodia Country Profile. World Bank, 20134 Cambodia Demographic Health Survey, 2005 and 20105 Cambodia Country Profile. UNAIDS 20126 Global Burden of Disease Profile: Cambodia. IHME, 2013

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and vulnerable groups; client focused approach to health service delivery; integrated approach to high quality health service delivery and public health interventions; human resources management as the cornerstone for health system; and good governance and accountability. These cross-cutting principles are being applied to improve health outcomes in three strategic priority areas: reproductive, maternal, neonatal, and child health; communicable diseases; and non-communicable diseases.7

The reform process has helped achieve dynamic maturation of the health system, with incremental gains towards achieving universal access to quality health services. However, a widely acknowledged limitation of the health system is the lack of well-trained, motivated and adequately-compensated staff, providing quality assured services. Although there has been a huge increase in the size of the workforce, health sector analyses in Cambodia point towards the need for improving governance and quality management of the health workforce.

2. Health Workforce in Cambodia – Developments and Progress

Cambodia still suffers from significant human capacity gaps, a vestige of the years of decimation of the educated population under the Khmer Rouge regime, followed by a decade of instability. Re-building of the skilled workforce, in particular in critical areas such as health, is a national priority and has been outlined in the National Strategic Development Plan 2006-2013 as well as sector-specific plans (First and Second Health Strategic Plans). HSP2 2008-2015 outlines the importance for service delivery of having appropriately skilled health staff who are adequately motivated, proficiently trained and equitably deployed.

To prioritize the rebuilding of the health workforce, the Ministry of Health invested in the Health Workforce Development Plan 1 (1997-2005), which focused on adequate production and equitable distribution of health workforce according to the then newly adopted Health Coverage Plan. Building on the achievements from the first plan, the second Health Workforce Development Plan (2006-2015) aimed to further address the issues of improving the competency and management of the health workforce. The specific focus granted to health workforce under these Plans resulted in impressive gains. For instance, the size of the health workforce increased substantially. The number of doctors increased from fewer than 50 doctors in the early 1990s to a current strength of over 2,500 working in the public sector.The growth in the workforce was enabled to a large extend by the expansion of the tertiary education sector in the last decade, particularly in the private sector. (Table 1) As of April 2012, there were 7 public (includes military) and 7 private higher education institutions offering health professional training courses. Total enrollment in both public and private institutions was little over 20,000 in 2013.

7 Health Sector Strategic Plan 2008-2015. Ministry of Health

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Table 1. Growth in the size of the workforce working in the public health sectorHealth Professionals 2004 2013 % ChangeMedical Doctor 2'120 2'540 20%

Medical Assistant 1'340 763 -43%Dentist 139 239 72%

Dental Assistant 84 73 -13%Pharmacist 395 525 33%

Assistant Pharmacist 146 86 -41%Nurse, Secondary 4'498 5'870 31%

Nurse, Primary 3'356 3'312 -1%Midwife, Secondary 1'756 2'870 63%Midwife, Primary 1'063 2'367 123%

Lab Tech, Secondary 340 475 40%Lab Tech, Primary 91 74 -19%Physiotherapist 42 167 298%

Others 1'694 1'163 -31%Total 17'064 20'524 20%

Source: MTR HWDP 2011; Annual HRH Report 2013

A Mid-Term Review (MTR) of the Health Workforce Development Plan 2006-2015 was conducted in 2011 to review progress and refocus efforts. The MTR identified four strategic priority areas for further investment and action. (See Box 1) The MTR also provided recommendations that centred on these strategic priorities, which were ratified by the Ministry of Health.

Box 1. Overview of the strategic priorities and recommended action 1. Strategic Priority One: Governance, planning and management of Human Resources for Health1. 1 Human Resource for Health (HRH) Committee1. 2. Capacity building for strengthening HRH governance at national and subnational levels

2. Strategic Priority Two: Improve the Technical Skills and Competence of the Health Workforce through strengthened pre-service training2.1. National Licensing and Registration Exam2.2. National Health Professional Registration Board2.3. The Centre for Educational Development of Health Professionals (CEDHP)2.4. The Nurse Bridging programme for Faculty development in Public Schools2.5. In-service training and continuing education maintains the skills of the health workforce of Cambodia

3. Strategic Priority Three: Health Workforce Management; recruitment, performance management, deployment and retention

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3.1. Health Workforce Recruitment, Deployment and Management3.2. Scholarships

4. Strategic Priority Four: Staff Remuneration, salaries, performance incentives4.1. Health labour market Analysis

Some of the above recommendations are being implemented by the Ministry of Health with technical support from the World Health Organization (WHO) and funding support from the Department of Foreign Affairs and Trade (DFAT) Australia.

This Mid-Term Report 2014 updates on the progress in the past six months (January – June 2014) and builds on the Annual Report 2013 submitted by WHO to DFAT in January 2014.

3. Human Resources for Health: Strategic Priorities, Objectives and Activities: Mid-Term Progress Report

3a. Strategic Priority One: Supporting and Strengthening of Multisectoral policy dialogue through Increased Capacity of Governance Structures

Supporting and strengthening multisectoral policy dialogue through the Human Resource for Health (HRH) Committee

The Minister of Health established the Human Resource for Health Oversight Committee (HRH Committee) to monitor and support the implementation of the MTR of the HWDP. The Committee chaired by HE Prof Eng Huot, Secretary of State for Health, includes membership of the Director Generals Admin/Finance and Health and all relevant department directors including Human Resource Development (HRD), Personnel, Planning and Health Information (DPHI) and Hospital Services (HSD). The Committee is co-chaired by the WHO Representative and includes, subject to rotation, JICA Project Leader as representative of development partners.The Committee has provided an effective platform for dialogue on HRH issues. On-going efforts are being made to enhance its role in strengthening inter-Ministerial dialogue and facilitating work with other TWGs on HRH issues such as TWG Public Private Partnership and RMNCH.

Key Achievements:o The HRH Oversight Committee met twice during 2013 and focused its

deliberations on the monitoring of the implementation of the MTR of the HWDP. It provided a platform for sharing information and for setting priorities for action. The first biannual meeting of 2014 was waived, as the members had met and discussed during the Health Congress.

o The Secretariat of the HRH Committee has produced two Annual Health Workforce Reports (2012 & 2013), which provide descriptive information about the progress of HRH problems and reflects the achievements, the constraints and

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the required further steps. (Please find attached an endorsed copy of the Annual Health Workforce Report 2013 – Appendix 1)

o The HRH Oversight Committee had an opportunity to review and endorse the Roadmap for the formulation of the next Health Workforce Development Plan 2016 – 2020 (see later section of this report for details) and it expected to continue to contribute to this process.

Proposed next steps:o The HRH Committee will continue to monitor and guide developments in HRH

policy, planning and management. It is envisioned that the Committee will play a vital role in the formulation of the next Health Workforce Development Plan 2016 – 2020 (implementation of the agreed roadmap).

o Continued support to the Secretariat of the Committee will be necessary to ensure timely and evidence-based response to priority HRH issues.

o Directed efforts to garner support to continue the Committee beyond 2015, to ensure sustainable effort in coordination of HRH issues.

o Broaden the membership of the Committee to ensure adequate representation of key stakeholders and development partners.

3b. Strategic Priority Two: Improve the Technical skills and Competence of the Health Workforce through Strengthened Pre-service and In-service Training

Strengthening the implementation and quality of the National Exit Examination (NEE) The National Exit Examination (NEE) is designed to test the competencies of health professional graduates, to ensure that they have adequate knowledge and skills for practice. The examination assesses both knowledge and skills through written MCQs and OSCE. The National Examination Committee (NEC) that was established to guide the NEE employed working groups of selected experts who were charged with the responsibility to identify disciple-based competency frameworks for Medicine, Nursing, Dentistry and Pharmacy and to develop valid and reliable tools to test the core competencies. The NEC has the authority to set the exams and determine the standards for successful completion of the exam.

Key Achievements:o High-level political commitment for the implementation of the NEE. The NEC

was established by the Prime Minister, to oversee the NEE for all institutions.o Development of an agreed upon competency framework for each health

professional group, developed in consultation with key representatives from the concerned professions.

o Development of MCQ Question Bank and OSCE scenarios for the NEE, for each health professional group.

o NEE for key health professional groups (medical doctors, dental doctors, associate degree nurses and pharmacists) were held in 2013-2014. The Table 2 &

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3 below shows the total number of graduates who have taken the NEE in April-May 2014 along with the aggregate results.

o Equipment required for the NEE such as manikins for the OSCE, examination scanners for the MCQ tests etc. have been procured.

o To ensure that examination is reliable, valid and appropriate for the Cambodian context, the performance of the candidates as well as the MCQ Items and OSCE case scenarios was analysed for each health professional group to derive lessons learnt.

Figure 1. Students taking the NEE – MCQ Component

Figure 2. Students taking the NEE – OSCE Component

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Table 2. Total Number of Graduates Taking the NEE April – May 2014

Institution 

Medicine Pharmacy Dentistry BSc. Nursing

TotalNew Grad Retake Total

New Grad Retake Total

New Grad Retake Total

New Grad Retake

UHS 135 135 0 183 180 3 39 25 14 164 144 20IU - - - 51 47 4 - - - 17 15 2LU - - - - - - - - - 32 32 0Total 135 135 0 234 227 7 39 25 14 213 191 22

UHS: University of Health Sciences; IU: International University: LU: Life University

Table 3. NEE Results April – May 2014

ResultsMedicine Pharmacy Dentistry BSc. Nursing

Num. % Num. % Num. % Num. %ABSENT 0 2.2 2  0.9

 0  0.0

 7 8.5

FAIL 3 0 0 11PASS 132 97.8 232 99.1 39 100.0 195 91.5Total 135  100.0 234  100.0 39  0.0 213 100.0

Proposed next steps:o The NEC will be encouraged to engage with stakeholders to ensure mandatory

participation of all health professional training institutions in the NEE, and acceptance of this process in determining the competence of graduates for practice as a basis for registration and licensing of health professionals.

o The NEC will encouraged to guide the development of standard operating procedures regarding the examination implementation framework and administration, declaration of examination outcomes, policies on re-examinations, re-evaluations, appeals etc.

o The NEC will take into consideration the findings from the analyses of performance of the candidates, MCQ Items and OSCE case scenarios to adjust the test design, to ensure that the NEE assesses the core competencies of graduates with greater objectivity and precision.

o The implementation of the NEE is labour intensive and requires an intensive and continuing support from both MOH officials and technical experts. With the anticipated participation of all health professional training institutions in the coming years, the number of candidates will increase substantially. The NEC will have to identity an institution that will be handed over the administrative responsibility of conducting the NEE.

o Given the new focus on competencies and examination of clinical skills, the health professional training institutions will be required to make major reforms to the curriculum and prepare both teachers and students to the new approach.

o To improve the reliability and validity of the NEE, the feedback will be provided to the OSCE examiners. In addition, the OSCE scenarios will be further adapted to match the competency framework of each health professional group and commonly encountered clinical problems in Cambodia.

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o The technical capacity for analysing the exam results (use of the exam scanner) will be further developed.

Strengthening and mobilizing the Centre for Educational Development of Health Professionals (CEDHP)

The CEDHP was established as a national resource for the development of health profession education, to address the urgent need to improve the quality of education through better teaching capacity and curriculum development. The CEDHP is expected to conduct a degree program in education for the health profession; to offer relevant short courses; to develop resource materials and guidelines; and to provide technical advice and support as may be required.The Centre has recently been re-designated as the Health Profession Education (HPEd) Unit under the Office of the Rector of the UHS. The HPEd Unit will be reporting directly to the UHS Rector and implement an agreed annual plan of work that includes:

o Regular short courses offered on an as per need basis to teachers from UHS. The courses will focus on,

Introduction to health profession education (this course will serve as an orientation for new teachers)

Preparation of lesson plans Teaching in clinical settings Formative and summative assessment of students Use of simulation in health profession education

o Specially designed workshops at the Faculty level based on need assessment and agreement with each faculty about their priority educational development requirements for the year.

o Regular educational development services to the UHS based on priorities identified by the UHS Education Committee. For example,

Analysis of examination results to strengthen validity and reliability Mapping the curriculum to ensure coverage of key competencies and

identify unnecessary duplications and/or major gaps. Development and implementation of teacher evaluation tools and

approaches including regular interview with students about their learning experience (for example, focal group discussions with a group of students from each year of the curriculum.

At present, the scope of activity of the HPEd Unit has been limited due to the lack of managerial and financial support. The Unit currently has only two dedicated staff members, who also attend to other commitments in their respective faculties. The involvement of other faculty members in the activities of HPEd Unit is often limited, as they have existing commitments to their respective faculties.

Key Achievements:

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o The CEDHP has provided a platform for participation of two cohorts of selected faculty members in the Master Degree in Health Professional Education (MHPEd) program offered by the University of Philippines (UP), Manila.

o The CEDHP has provided administrative support to the Nurse Bridging Program.o Since its establishment the CEDHP has been conducting workshops for the

University of Health Sciences (UHS) faculty, focusing primarily on development of lesson plans, micro teaching and clinical teaching. As per the CEDHP Work Plan for 2014, more workshops will be conducted on topics such as microteaching, development of course syllabus, MCQ exam design and analysis etc.

Proposed next steps:o The HPEd Unit will continue to draw on the two cohorts of faculty members who

are currently enrolled in the UP Manila MHPEd program, as resource persons for its workshops.

o At present, the education development activities of the HPEd Unit are limited to the UHS. It is expected that efforts will be made to liaise and support the educational resource people in the Regional Training Centres (RTCs).

o A strategic goal in the draft Strategic Plan of the UHS 2014 – 2018 is to improve the academic skills of both UHS faculty and students. This includes a commitment to train all faculty members by 2018 in a basic course on health professional education. The HPEd Unit is playing an important role in the development of the curriculum for this basic course and in conducting the trainings for the faculty members of UHS.

o With regard to the CEDHP, further consideration will have to be given to its staffing, organizational placement, funding and technical assistance that will be required to ensure it has the capacity to act as an effective national resource center and respond effectively to the urgent need to improve the quality of health professional education in Cambodia. The performance of CEDHP will be reliant on adequate investment and intensive support, to improve its credibility and acceptance as an effective resource centre of national relevance.

Masters in Health Professional Education Program (MHPEd)The University of Philippines (UP), Manila has been commissioned to deliver its ladder-type Masters in Health Professional Education (MHPEd) program that enables participants to exit with a certificate/diploma or undertake a thesis leading to a Master’s degree. The participants for the course were selected primarily from faculties of the UHS and include a mixed group from the faculties of Pharmacy, Dentistry, Medicine, Nursing and Midwifery. Both the French Cooperation and WHO (through funding support from DFAT) have supported this program. The program is based on concentrated blocks of teaching of one week per month in Phnom Penh by visiting UP faculty and continued online support.

Key Achievements:

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o The status of the students of the first and second batches is shown in Table 4 & 5 below.

o Two students from the first batch have successfully completed all course requirements and have been awarded the Master’s degree.

o Of the second batch, 10 (13) students have completed the first 27 units of coursework and taken the comprehensive examination.

o The students have performed well in the course work component of the program, but have experienced major difficulties in completing the thesis component. To address this, the “Enhancement Program on Thesis Writing” has been especially designed for the student, to assist them in completing the thesis requirements for the Master’s degree. Under this program two intensive thesis writing workshops have been held followed by online consultations with the enrolled students.

o The students of the MHPEd course have been successfully used as resource persons for trainings/workshops within the UHS.

Table 4. Status of first batch students (as of May 23, 2014)Status of Students Number of Students Inclusive dates

Graduated with the degree of MHPEd

Two As of October 2013As of April 2014

Graduated with title of Diploma in HPEd

Two As of October 2013

Successfully defended their thesis proposals and are now completing data analysis and manuscript preparation

Three June 2014

Successfully defended thesis proposals and now revising manuscript for submission to thesis panel and Research Ethics Board of Cambodia and UP Manila

Three February 2013May 21, 2014May 21, 2014

Thesis proposal submitted and undergoing final revisions

One May 23, 2014

No thesis proposal submitted yet

Four Passed comprehensive examination in November, 2012

Table 5. Status of second batch of students (as of May 23, 2014)Status of Students Number of Students Inclusive dates

Satisfactorily completed the first 27 units of coursework and have taken the comprehensive examination

Ten May 23, 2013

With incomplete grades in 1-2 courses

Three As of March 27, 2014

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Proposed Next Steps:o The students of the MHPEd course are faculty members of UHS and have

additional responsibilities at the UHS. They find it challenging to devote time towards the course requirements, especially the thesis writing component. The “Enhancement Program on Thesis Writing” program will continue to support the students to complete this requirement.

o The students of the MHPEd course will be provided with the required further support including mentoring and encouragement to get them to the point of completion.

o The students of the MHPEd course will form the critical mass of faculty to bring the required and recognized change in health professional education in UHS and beyond.

o The students of the MHPEd course will continue to be used as resource persons for trainings/workshops within UHS but also be available to provide these services to other interested institutions.

The Nurse Bridging Programme from Associate Degree to Bachelor Nurse for Faculty in the Public SectorThe Nurse Bridging Programme provided an opportunity for the TSMC and RTC nurse faculty to upgrade their qualification to a Bachelor degree. Under the programme, faculty from UP Manila will visit Cambodia for one week a month to deliver the bridging programme with the Bachelor faculty.

Key Achievements:o There are 29 participants in the program (15 from UHS/TSMC, two from

Battambong's RTC, four from Komport RTC, four from Kompongcham RTC and four from Stengtreng RTC)

o The program is being delivered by one or more professors from UP Manila with support from three local faculty members, a translator and one coordinator.

o The participants undergo clinical rotation in hospital settings and are provided support from a minimum of six hospital-based preceptors. The clinical rotations include training on critical care for patients with heart disease, neurology dysfunction, emergency and intensive care unit at Calmatte hospital. 

Proposed Next Steps:o In view of the success of the first batch of the nurse bridging program, the

Department of HRD, Ministry of Health have indicated the need to support a second batch.

o The creation of a critical mass of faculty members with Bachelor’s degree in the Bachelor of Science Nursing faculty at both UHS/TSMC and the four RTCs that will then train and guide the new generation of nursing students will continue to be important to improve quality of services.

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3c. Strategic Priority Three: Strengthen health workforce management: Recruitment, performance management, deployment, retention and compensation

Roadmap for Revision of Health Workforce Development PlanThe Ministry of Health (MOH) is currently preparing input for the next Health Strategic Plan 2016 – 2020 (HSP3). The MOH has identified human resources for health as one of its priorities. Additionally, the MOH is committed to the formulation of the next Health Workforce Development Plan (HWDP) 2016-2020 to address emerging requirements of government policies and plans towards the achievement of highest level of health and well-being, for all Cambodians. The development of this Work Plan will be guided by a detailed a road map that outlines the key steps and activities. The draft road map was developed in consultation with key MOH officials, including the Secretaries of State and technical departments, and representatives of private training institutions, Military health training institutions, Professional Councils and development partners. The Department of Personnel, MOH has been designated as focal point for the development of the HWDP 2016-2020, with support from other relevant MOH departments and related Ministries. WHO will continue to collaborate and provide the required technical assistance to MOH in the development of the HWDP.

Key Achievements:o The roadmap outlining the key steps, the main activities, the responsible entities,

the timelines as well as the requirements to fulfil the activity has been developed and endorsed. The overarching themes of the proposed Roadmap are;

Whole of Sector approach, including other ministries, military and private sectors in both production and employment of HRH.

Capacity building and institutional strengthening at all levels with particular attention to MOH and the education institutions.

Improved Information System through better integration of existing data systems and use of additional sources

Ensuring the workforce plan is driven by the policies and plans for attainment of Universal Health Coverage.

Proposed Next Steps:o Continued support will be provided to the MOH for the timely accomplishment

of the key steps and activities outlined in the roadmap, in order to avoid any delays in the formulation of HWDP 2016-2020.

o The MOH will ensure that the HWDP is aligned with the goals and objectives of the Health Strategic Plan (HSP3), which will also be simultaneously developed within the same timeframe.

o The HWDP will try to consolidate recent advances, and continue to strengthen oversight, coordination, training quality and health workforce performance.

o Efforts will be directed towards leveraging the required technical and financial resources for the development of the Plan will be critical for the MOH. Further, a

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multistakeholder approach will be used in the development of the Plan to that it is comprehensive and maintains a whole health sector focus.

o The HWDP 2016-2020 will focus on addressing some key/new areas. For instance, it will include steps to improve and strengthening of the HRH Database i.e. inclusion of the private sector, details on specialist medical doctors, consistency in information maintained by different MOH departments etc.

Strategic Plan for University of Health Sciences (UHS) The Strategic Plan for UHS was developed as a comprehensive and detailed institutional plan that re-affirms UHS’s mission to work in cooperation with national and international institutions, to improve the health of the people of Cambodia through contribution to education, research, and service to the community.

Key Achievements:o The draft Strategic Plan was developed based on several consultations and a

series of workshops with the Rector, Deans and senior staff of the UHS. The draft Plan was circulated and discussed with the faculty. It was structured around the agreed domains and submitted for the consideration of the Rector. The draft Strategic Plan was adjusted and refined by the Rector and Deans of UHS, and presented for further discussion in a series of workshops culminating in a retreat of the entire UHS Academic and Administrative staff.

o The Rector of UHS is leading the process with a strong commitment to dynamic engagement of the faculty members in the planning process.

o The Strategic Plan has been successful in articulating the University's vision, mission and guiding principles.

o The draft Strategic Plan was presented and discussed amongst a wider group of stakeholders including representatives of UHS faculty, national hospitals, professional groups, development partners etc. on the 23 rd of June 2014 for recommendations and comments.

Proposed Next Steps:o It is anticipated that following the approval of the Strategic Plan by the UHS

Board of Directors, it will be implemented with the objective of meeting the outlined indicators.

o UHS will have to be provided with the required support and technical assistance for the successful implementation of the strategic priorities outlined in the Strategic Plan 2014 - 2018.

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4. Maternal, Newborn and Child Health: Outputs of the Project (January-June 2014)

The DFAT funding was almost exhausted by the mid-2013, so other funding sources were used to support the activities of reproductive, maternal, newborn and child health. The remained DFAT funding was allocated to support a National Technical Officer (NPO) for newborn and child health who was recruited in October 2012. His TOR is to monitor and evaluate the implementation of the continuum of prevention, care and treatment for newborns; mainly support to scale up INC coaching for health workers. He also provides the support to activate Child Survival Management Committee to strengthen child health care provision including Integrated Management of Childhood Illness (IMCI). His contract is valid till September 2014 and will be renewed till 2015.

4a. Coordination for scaling up Immediate Newborn Care implementationWith technical support from WHO/Cambodia and funding support from AusAID through WHO, the training of trainers of immediate newborn care (INC) coaching were conducted at the National Maternal and Child Health Center (NMCHC), then INC coaching sessions were scaling up to 24 provinces in 2012-2013 for health care workers of delivery services at provincial hospitals. For expanding INC to district level especially health centers, INC coaching were scaled up by the MCH team of provincial health department (PHD) with technical support from NMCHC and WHO/Cambodia and with funding support from local NGOs. The data collection on INC coaching need assessment (staff trained and need to be trained) was

conducted by NMCHC with technical support from WHO/Cambodia and the consolidated data was informed to health partners and local NGOs in the annual workshop of MCH organized by NMCHC on 23-24 June 2014 for continuing scaling up INC coaching to cover all health centers in each province in 2015. According to the report collected in June 2014, 50% of health center staff who should be trained on INC (at least 2 midwives/HC) were coached. The remained staff will be coached on INC in 2014-2015.

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INC coaching for health center staff conducted by Battambang INC coaching facilitators.

First meeting of Technical Working Group for Newborn Care and IMCI at the MoH in April 2014

4b. Facilitate the functioning of Technical Working for newborn care and IMCIWith good communication between WHO/Cambodia and the high officials of the Ministry of Health, the Technical Working Group (TWG) for Newborn Care and IMCI was revised and started functioning in February 2014 at the Ministry of Health. It also coordinates with other groups, e.g. RMNCH Task Force and Sub-TWG for MCH. It aims to provide strategic and policy guidance and

promote coordination for accelerating progress in reducing neonatal mortality, addressing preventable causes of illnesses and death in children under-5, strengthening the health system to expand and sustain achievements and institutionalize change and enhancing coherence of intervention among MoH programs, health partners and private providers as well as ensuring the continuum of maternal, neonatal and child health care.

The first TWG meeting was conducted in April 2014 to discuss on the Terms of References of TWG and the second meeting on June 2014 focuses on the newborn situation analysis and the assessment plan on newborn care in 3 selected provinces: Battambang, Kampong Cham and Takeo.

To emphasize the newborn care within RMNCH programme, the three interventions for improving newborn care: routine immediate newborn care, care for preterm and low birth weight newborn and care for sick newborn, were presented and recommended by NMCHC in the MCH symposium which was conducted in March 2014 and in the Annual Workshop of MCH which was conducted in June 2014.

4c. Technical support for newborn and child health In coordination with TWG for newborn care and IMCI and UNICEF, three provinces: Battambang, Kampong Cham and Takeo were selected to visit for collecting information on newborn care at health facilities. The visit will be held on July-August 2014. The purposes of the visit are to brief managers and staff in PHD, ODs and key health facilities on the current neonatal policies and strategies; to better understand the situation of the newborn care including general information on services, access barriers and health outcomes; to elicit

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suggestions to address problems identified and to select facilities and ODs to be targeted by the quality improvement initiative for newborn care.

The team consists the Chair of TWG for newborn care and IMCI, 3 TWG members from NMCHC hospital, Calmette hospital, National Pediatric hospital, WHO and UNICEF technical officers.

4d. Technical support for RMNCH Task ForceTo accelerate the reduction of maternal and newborn mortality rate towards achieving the Millennium Development Goals (MDG) #4 and #5, the Ministry of Health established four Task Forces. The RMNCH Task Force is responsible to coordinate and monitor implementation of this initiative along with the Child Survival Strategy and other-related strategies aimed to improve reproductive, maternal, newborn and child health and nutrition. To ensure the defined tasks of RMNCH Task Force are implemented effectively, WHO/Cambodia has provided technical assistance. It is included in the additional task of the National Professional Officer (NPO) of newborn and child health. This Task Force plays an important role in cross-cutting coordination within the MoH institutions, departments and national programmes and health development partners and NGOs.

The meetings of RMNCH Task Force were conducted in February and May 2014. During the meeting RMNCH indicators (target and achievement) were reviewed for preparation of the Joint Annual Health Sector Review and the Health Congress 2014. The terms of references of RMNCH Task Force (membership, roles and responsibilities, meeting frequency…)

were revised. In June 2014, a 1-day consultative meeting was organized, followed by a 2-day workshop held by the Task Force and the National Maternal and Child Health Center (NMCHC) to discuss on the development of RMNCH-AOP 2015 template based on the new format of Ministry of Economy and Finance.

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RMNCH Task Force meeting conducted at the National Maternal and Child Health Center in May 2014