Mixed Progress towards Cambodia's MDG Targets

A baby’s cry pierces the afternoon air at a maternity hospital in Cambodia’s capital Phnom Penh. In an important way, that is the sound of success. Cambodia has cut the rate of infants dying before their first birthday from around 95 per 1,000 live births a decade ago to 60. The target is 50 per 1,000 live births. It is one of nine MDG targets that Cambodia has signed up to.

Dr Lo Veasnakiry, head of planning at the Ministry of Health, says progress towards meeting the MDG on child and infant mortality is in part due to the government’s commitment to maintaining health sector spending despite the global economic crisis.

It has also made efforts to improve access to child health services, and has received cash and technical assistance from health partners such as UNICEF, the United Nations Children’s Fund.

Malalay Ahmadzai is the mother and child specialist at UNICEF. She credits other factors too: "One has been the strong performance of the national immunisation programme. Second has been the improvement in breastfeeding practices, and that goes back to a lot of community work plus support to the health centres and so on."

No progress on maternal mortality

But with just a few years to go, Cambodia could well miss six other MDG targets, including the one on maternal mortality. A decade ago 460 women died in childbirth in Cambodia for every 100,000 births. The target is 140 and yet the rate has not come down. Why?

Dr Lo explains that, to begin with, the target is very ambitious. "From the global viewpoint, not only Cambodia but a lot of countries have not made significant progress in terms of maternal deaths", he says.

More resources needed

A study found that more than half of the women who die in childbirth in Cambodia succumb to massive blood loss. Another fifth die from eclampsia, that is high blood pressure. They require a rapid response - and any delay can result in death.

"The first delay is decision-making in the family whether to seek care or not", says UNICEF's Malalay Ahmadzai. "The second is costs, roads and access. And third is the quality of care."

Cambodia needs more resources and more trained staff, and Dr Lo says that is starting to happen, but it won’t be enough. That’s why he recently proposed that the government revise the target. Shifting the target is a controversial way of reaching it – but as Dr Lo points out, if Cambodia can reach the revised target of 250 deaths per 100,000 births that would still mark a big improvement.

Author: Robert Carmichael
Editor: Grahame Lucas