Evolution and chronology of health system, human resource system and midwifery-related issues in Cambodia (1946–2012)
| Year | Health and human resource system development | Midwifery-related issues |
|---|---|---|
| 1946 | First modern school of health professionals in Cambodia established in Phnom Penh10 | |
| 1953 | National Independence : Sihanouk regime Royal school for Medicine established; commenced education of medical doctors and health officers10 | |
| 1961 | Royal School for Nurses and Midwives created under the MoH10 | Two levels of nurses and midwives trained (State Nurse and State Midwife, Auxiliary Nurse and Rural Midwife)10 |
| 1970 | Lon Nol regime (1970–75) Political instability. Educational programmes became irregular.10 | |
| 1975–1979 | Khmer Rouge regime Genocide and destruction of institutions; educational system changed as two categories of health professionals trained at hospitals.10 | |
| 1979 | Vietnamese-led liberation. State of Cambodia | Provincial Training Centre set up, provided 6 month training of Primary Nurse and Primary Midwife working at primary level health facilities or health centres, without standardised curriculum10 |
| Rebuilding the state along the lines of the Vietnamese health system (Lanjouw S, Macrae J, Zwi A. The role of external support for health services rehabilitation in ‘post’-conflict Cambodia. Unpublished report, 1998)10 | ||
| 1980 | Technical School for Medical Care (TSMC) established in Phnom Penh; provided training for nurse/midwife and allied health personnel; Besides primary level, Secondary Nurse and Secondary Midwife training, for hospital-based work, started at TSMC10 | |
| 1987 | All provincial training centres absorbed into four Regional Training Centres (RTCs); these provided training of nurses and midwives both at primary and secondary level with standardised curriculum.10 | |
| 1989 | Primary Nurse and Midwife course ended (academic year 1987/1989)10 | |
| 1991 | Bridging course from primary level to secondary level started and continued until 200110 | |
| 1991 | Paris Peace Accord and UN Transitional Authority in Cambodia (UNTAC) | |
| 1993 | First General Election—First Mandate (1993–1998) | |
| Health workforce survey (by MoH and WHO) revealed overwhelming number of workers of varying abilities, unregistered and without career structure (Lanjouw S, Macrae J, Zwi A. The role of external support for health services rehabilitation in ‘post’-conflict Cambodia. Unpublished report, 1998). Coordination Committee (COCOM) established as a coordination mechanism with development partners, NGOs and MoH at central and provincial level with subcommittees (Sub COCOM) according to technical areas (Lanjouw S, Macrae J, Zwi A. The role of external support for health services rehabilitation in ‘post’-conflict Cambodia. Unpublished report, 1998) | ||
| 1995 | Health Coverage Plan (Health sector reform) | |
| 1996 | Human resources development policy and health workforce plan (1996–2005)11 Rationalisation of 59 categories of health workers trained; MoH sought to rationalise these into 29 equivalents (Lanjouw S, Macrae J, Zwi A. The role of external support for health services rehabilitation in ‘post’-conflict Cambodia. Unpublished report, 1998) | Secondary Midwife course ended; no production of new midwives until 2003, both primary and secondary level12 |
| 1998 | Second General Election—Second Mandate (1998–2003) | |
| 2000 | Health workforce plan, midterm review13 | Midterm review identified alarming shortage of midwives13 |
| 2002 | Diploma of Nursing and Midwifery (3 year nursing+1 year midwife) (3+1 course) started at TSMC and RTC12 | |
| 2003 | Third Mandate (2003–2008) Health Strategic Plan I (2003–2008) | Stakeholders’ meeting, organised by MoH/HRD, decided 3+1 course and primary midwife course as a strategy to address the shortage of midwives.12 Few candidates applied to 3+1 course because of little advantage of attending 1 more year to become midwife.12 Primary Nurse/Midwife (1 year, direct entry) course started in remote northeast region by provincial health departments (PHD) and provincial trainers along with local recruitment and deployment mechanism14 |
| 2004 | Survey result revealed ‘Not enough skilled midwives, poor working environment and little motivation, girls do not want to be midwives’15 | |
| 2005 | Health Sector Support Project (pooled fund mechanism) started16 | Demographic and Health Survey 2005 revealed MMR of 472 per 100 000 live births; very high and little changed over time; evoked major concern within MoH.17 Primary Midwife/Nurse course shifted from PHD to RTCs and covers whole country because of the unsatisfactory quality of training at PHD, local recruitment and deployment system continued.12 First Midwifery Forum (Dec 2005)28 |
| 2006 | Health Workforce Development Plan 2006–2015 | Comprehensive midwifery review identified the target number of midwives to reduce MMR.7 Stipend was provided for 3+1 course students until Associated Degree of MW (3 years course) started in 2008 (personal communication; UNFPA program manager) |
| 2007 | High Level Midwifery Taskforce established and developed a multi-year plan.18 19 Live-birth incentives for health centres and referral hospitals,20 associated with MW recruitment and improved salary scale21 | |
| 2008 | Fourth Mandate (2008–2013) Health Strategic Plan II (2008–2015)22 | The strategy prioritised midwifery, with target of staffing level at health facilities, revision of training content, increased student intake, quality of training and trainers, and salary reform.22 New Health Minister declares ‘Fast track initiatives to reduce maternal and newborn mortality’ with a target of ‘midwives in all health centers’. |
| Midwifery deployment task force established at MoH to prepare strategies to reallocate midwives to meet the target23 24 | ||
| 2009 | Reproductive, Maternal, Newborn and Child Health (RMNCH) Taskforce established as one of four taskforces under Health Strategic Plan 2 (2008–2015)22 | Achieved ‘Midwives in all health centers’, but around 60% of health centres only have primary midwives. Second Midwifery Forum25 |
| 2010 | RMNCH taskforce prepared roadmap for the fast track initiatives to identify priority areas and interventions, mobilise financial support, identify policy issues and guide implementing units of MoH26 | Delivery incentives continued New monitoring indicators set up (at least two midwives in all health centres, of which one is secondary midwife)26 |
| 2011 | Health Workforce Development Plan 2006–2015, midterm review27 | Demographic Health Survey 2010 revealed MMR reduction (206 per 100 000 live births)6 |
HRD, Human Resources Development; MMR, maternal mortality ratio; MW, midwife.
References as per reference number.