Preparatory Survey Report on the Project for Expansion of National Maternal and Child Health Center in the Kingdom of Cambodia

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Preparatory Survey Report on the Project for Expansion of National Maternal and Child Health Center in the Kingdom of Cambodia The Ministry of Health The Kingdom of Cambodia PREPARATORY SURVEY REPORT ON THE PROJECT FOR EXPANSION OF NATIONAL MATERNAL AND CHILD HEALTH CENTER IN THE KINGDOM OF CAMBODIA February 2014 JAPAN INTERNATIONAL COOPERATION AGENCY THE CONSORTIUM OF NIHON SEKKEI, INC., AND FUJITA PLANNING CO., LTD. HM JR 14-011 Preparatory Survey on the Project for Expansion of National Maternal and Child Health Center Preparatory Survey Report PREFACE Japan International Cooperation Agency (JICA) decided to conduct the preparatory survey and entrust its execution to the consortium consist of Nihon Sekkei, Inc. and Fujita Planning Co., Ltd. The survey team held a series of discussions with the officials concerned with the Government of the Kingdom of Cambodia, and conducted a field investigation. As a result of further studies in Japan, the present report was finalized. I hope that this report will contribute to the promotion of the project and to the enhancement of friendly relations between our two countries. Finally, I wish to express my sincere appreciation to the officials concerned of the Government of the Kingdom of Cambodia for their close cooperation extended to the survey team. February, 2014 Ms. Nobuko Kayashima Director General, Human Development Department Japan International Cooperation Agency (JICA) Preparatory Survey on the Project for Expansion of National Maternal and Child Health Center Preparatory Survey Report Summary 1. Introduction The Kingdom of Cambodia (hereinafter referred to as "Cambodia") is located in the Indochina Peninsula and surrounded by Vietnam, Thailand and Laos. It covers approximately 180,000 square kilometers, and its total population is 14,860,000 people (in 2012), of which the Khmers make up about 90%, and its total number of births is 282,000 (in 2010). Many people were killed in Cambodia, and the social infrastructure was destroyed by the organized purges launched by the Pol Pot regime during the civil war between the 1970s and the 1980s. In particular, the medical and health care systems had been seriously damaged by the systematic genocide of medical human resources and by the serious deterioration of medical facilities and equipment. The country’s medical and health care system could not even provide basic, fundamental services to its people for a substantial period of time. Work to rebuild Cambodia started after the signing of the Paris Peace Agreement in 1991, and it accomplished a satisfactory revival with help from foreign government assistance. The country’s average annual GDP growth rate for ten years (1998 to 2007) increased to 9.4% as a result of social and political stability, a result of the Hun Sen Administration, founded in 1998. Although the GDP temporarily dropped for a while after this period, it recovered back to 6.9% in 2011. Despite this progress, Cambodia is still included among the Least Development Countries (LDCs), and its Human Development Index rank is 139th out of 187 countries. Insufficient social and economic infrastructure and a shortage of human resources caused by the civil war are major issues of the country’s future development. Organized and combined polices to develop private industries led by private and foreign investments, and technology transfers with foreign economic assistance are necessary in order to solve the economic challenges of the country. The Government of Japan has extended economic assistance to provide infrastructure as well as to develop human resources and political, social and economic systems in Cambodia to enhance socioeconomic foundations. The Government of Japan also assists in developing the investment environment of Japanese companies in Cambodia through the Bilateral Investment Treaty between Japan and Cambodia (effective since 2008) and the Cambodia-Japan Public-Private Sector meetings. 2. Background and Overview of the Project The major MCH care indicators in Cambodia have significantly improved in the last decade. The maternal mortality rate has improved from 470/100,000 births in 2000 to 206/100,000 births in 2010 (according to the Cambodia Demographic and Health Survey, CDHS 2010). At this rate it is expected to accomplish the Cambodia’s Millennium Development Goal (CMDGs) of 250/100,000 births by 2015. - i - Preparatory Survey on the Project for Expansion of National Maternal and Child Health Center Preparatory Survey Report Although overall medical and health care services have significantly improved, the key indices of maternal and child health (hereinafter referred to as “MCH”) care services, including the maternal mortality rate, need further improvement when compared to other neighboring countries. At the same time, Cambodia chronically suffers from shortages of physicians, nurses, midwives and other co-medical staff, in particular severe shortages of midwives in rural areas. Most maternal deaths are caused by severe bleeding or complication during the perinatal period, and ensuring the required number of the MCH staff and improving their clinical abilities to deal with those cases properly are therefore important to further reduce the country’s maternal mortality rate. The National Strategic Development Plan 2009-2013 (NSDP) focuses on the health sector as a priority mission, and the Health Sector Strategic Plan 2008-2015 (HSP2) emphasizes MCH care as a top priority mission. The National Maternal and Child Health Center (hereinafter referred to as "NMCHC"), which was constructed by the Grant Aid of the Government of Japan in 1997, has contributed to the qualitative and quantitative improvements of MCH care services in Cambodia with the support of subsequent Technical Cooperation Projects. Although the number of premature babies accepted at NCU increased from 979 in 2000 to 1,220 in 2009, the prematurity mortality rate was improved from 167 to 150. On the other hand, in unavoidable situations or due to some abnormality, the ratio of cesarean deliveries out of total deliveries increased from 9% in 2000 to 19% in 2009, therefore more advanced perinatal medical care services, including emergency obstetrics care, are required to cope with these situations. As more diversified, practical and longer period training courses are required to respond to the advanced MCH care services (such as emergency obstetrics care), the NMCHC’s current facilities face difficulties in providing the appropriate training programs, making expansion of its facilities an urgent mission. The Government of Cambodia requested a Grant Aid Project for the “Project for Expansion of National Maternal and Child Health Center” in order to respond to these circumstances and to allow NMCHC’s functions as a top MCH clinical and training institution in Cambodia. Key components of the request are listed below: Facilities (applicable site area: 1,385 square meters) Construction of a new training center (3,058 square meters, five-story building) Renovation work of the existing facilities of NMCHC Equipment - ii - Preparatory Survey on the Project for Expansion of National Maternal and Child Health Center Preparatory Survey Report 3. Overview of Preparatory Survey and Contents of the Project To respond to the aforementioned requests, JICA determined to implement a Preparatory Survey (Basic Design) (hereinafter referred to as “Preparatory Survey”) and sent the Preparatory Survey (Basic Design) Team from August 4 to August 24, 2013. The survey team had discussions with the Cambodian side, surveyed the NMCHC’s existing facilities and equipment as well as other related facilities. They studied the proposed construction site, reviewed the contents and viability of the requests, and finally drafted the project implementation plans. Furthermore, the survey team finalized the schematic design and preliminary cost estimate through further studies in Japan, and explained the Draft Final Report on the Preparatory Survey (hereinafter referred to as “Draft”) to the Cambodian side from December 22 to December 28, 2013. From this the final Preparatory Survey report was compiled. The survey team reviewed and confirmed the functions of NMCHC as “clinical care”, “training” and “policy/administration (National MCH Program Offices)” during the field survey. They verified the current activities and utilization status of the NMCHC’s existing main buildings (hereinafter referred to as “the existing Center”), and assessed the current issues that NMCHC faces. The study team also reviewed and confirmed the contents of the original requests through discussions with the Cambodian side, and finalized the requests to reflect the country’s MCH policies and plans. As a result of the above discussions and studies, the team redefined the final requests. 3.1. Construction of a new Training Center Because the National MCH Program offices, which were not included in the original design, occupy a substantial portion of the third floor of the South Building in the existing Center, the training functions (which used to be located in the same area) did not have enough rooms and sufficient amount of training space. Furthermore, practical training functions including the Problem Based Learning (PBL) and Clinical Simulation Lab (CSL) cannot be conducted effectively due to a lack of appropriate rooms. Because the existing library is currently used as a management office, it does not allow students and trainees to study or engage in self-study and research. To improve these situations, it is highly necessary to construct a new Training Center to provide in-service training for the medical staff attached to MCH
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