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At the beginning of the 2000\u2019s, Cambodia faced alarming maternal, newborn and child health indicators. The maternal mortality ratio stood at 437 per 100 000 live births, while newborn and child mortality rate accounted for 37 and 124 per 1000 live births respectively. Limited infrastructure, a shortage of skilled birth attendants and financial constraints hindered progress. To tackle these challenges, the Cambodian government, with support from WHO and key partners, embarked on a transformative journey to strengthen maternal and newborn health services and ensure equitable access to quality care.\u00a0<\/p>\n
Today, skilled birth attendance is near universal, with 98.7% of births attended by trained health professionals and 97.5% of women giving birth in a health facility. Between 2014 and 2021-2022, neonatal and under-five mortality rates declined by 54%, from 18 to 8 and from 35 to 16 per 1000 live births respectively, far exceeding the global average reduction of 14% during 2015-2022. Cambodia achieved its Sustainable Development Goal targets for reducing neonatal and under-five mortality eight years ahead of schedule.\u00a0<\/p>\n
Strengthening health systems\u00a0<\/p>\n
Cambodia\u2019s investments in health systems and workforce capacity have been instrumental in driving progress. Midwifery training programmes have equipped health workers with essential skills to provide safe, high-quality care, including routine antenatal care, essential intrapartum care, postnatal care, and management of childbirth complications. Deployment strategies have ensured that even remote health centres are staffed with skilled birth attendants.\u00a0<\/p>\n
To incentivize facility-based deliveries, the government introduced a delivery incentive programme for health teams in 2007 and launched cash transfer programmes for pregnant women and infants from poor families in 2019, targeting the critical first 1000 days of life. These initiatives encourage families to seek comprehensive antenatal and postnatal care, ensuring access to a full package of essential health services. Financial mechanisms such as health equity funds, cash transfers and fee exemptions have alleviated economic barriers, making institutional care more accessible to vulnerable populations.\u00a0<\/p>\n
Improvements in water, sanitation and hygiene infrastructure have also contributed significantly to better health outcomes. An integrated routine primary health care delivery system has been established across provinces and districts, ensuring that essential services effectively reach communities. Health promotion and behaviour change campaigns have played a vital role in encouraging exclusive breastfeeding and antenatal care-seeking behaviours.<\/p>\n
![\"A](\"https:\/\/cdn.who.int\/media\/images\/default-source\/western-pacific-(wpro)\/countries\/cambodia\/nurse-assisting-mother-with-breastfeeding-in-cambodia.jpg?sfvrsn=75e4eee7_3\")
A nurse is assisting a mother breastfeeding in a referral provincial hospital in Cambodia. \u00a9 WHO \/ Yoshi Shimizu <\/p>\n
<\/em>Strong leadership and strategic framework\u00a0<\/p>\n A key milestone in Cambodia\u2019s progress has been the strong leadership of the Ministry of Health, which has provided clear strategies for advancing maternal and newborn health. Two main coordination platforms \u2014 the Sub-Technical Working Group for Maternal and Child Health and the Early Essential Newborn Care (EENC) Coordination Committee \u2014 were established and have convened regularly to align efforts within the Ministry and with health partners. \u00a0<\/p>\n With technical support from WHO and funding from the Korea Foundation for International Healthcare (KOFIH), the EENC Coordination Committee plays a crucial role in harmonizing national and sub-national efforts, monitoring progress through regular reviews, mobilizing resources to scale up EENC practices, and ensuring consistency in care delivery while addressing service gaps.\u00a0<\/p>\n Recognizing the need for a strategic and systematic approach to newborn care, the committee led the development and adoption of the Five-Year Action Plan for Newborn Care (2016\u20132020)<\/em>. The plan emphasizes scaling up EENC and institutionalizing evidence-based practices, integrating key life-saving and cost-effective interventions \u2014 such as routine immediate care for all newborns under “The First Embrace” approach, as well as measures to prevent and care for small or sick newborns.\u00a0<\/p>\n By 2023, EENC coaching was implemented in 89.4% of health facilities (1187 out of 1328), surpassing the 80% target. Kangaroo Mother Care for preterm and low birthweight infants has been scaled up to two national hospitals and ten provincial and district referral hospitals, while a national protocol for EENC in Caesarean sections, introduced in 2019, has standardized care nationwide.\u00a0<\/p>\n “Maternal, newborn and child health are essential components of investing in human capital. Providing quality care for mothers and newborns brings immense benefits \u2014 not just for families, but for entire communities and economies. Cambodia\u2019s coordinated approach to maternal and child health serves as an inspiring model for the region and globally. It demonstrates what can be achieved with strong national leadership, dedicated health workers and sustained partnerships,\u201dstated Dr Marianna Trias, WHO Representative to Cambodia.\u00a0<\/em><\/p>\n Remaining challenges \u00a0<\/p>\n Despite significant achievements and high coverage of antenatal care and facility-based deliveries by trained health personnel, challenges persist. While maternal mortality has declined, it remains high at 154 deaths per 100 000 live births, primarily due to haemorrhage and pregnancy-induced hypertension \u2014 both preventable causes. Greater efforts are needed to get on track to achieve the 2030 target of 70 deaths per 100 000 live births. Similarly, child malnutrition continues to impact long-term productivity, with 22% of children under five stunted and 10% wasted for over a decade.\u00a0<\/p>\n Disparities between urban and rural areas and gaps in facility capacity to provide quality essential services require targeted attention. Addressing unmet family planning needs and expanding adolescent-friendly services are crucial, particularly as rural adolescent girls aged 15\u201319 experience significantly higher birth rates than their urban peers.<\/p>\n The way forward\u00a0<\/p>\n Moving forward, further reducing maternal and neonatal mortality requires a stronger focus on enhancing the quality of care. Building on significant improvements in coverage, efforts should prioritize improving the quality of basic routine care during antenatal and intrapartum periods, including emergency obstetric care, alongside establishing robust referral systems for cases requiring higher-level care. Achieving this will require both the strengthening of quality improvement mechanisms with enhanced monitoring and the implementation of targeted improvement actions.\u00a0<\/p>\n The Fast-Track Initiative Roadmap for the Reduction of Maternal and Newborn Mortality (2025\u20132030)<\/em> aims to accelerate progress by scaling up interventions, sustaining quality care and addressing service delivery gaps. To support its implementation, WHO will assist in developing a comprehensive country action plan and support the Coordination Committee for Strengthening Quality of Care and Wellbeing of Women, Maternal, Newborn and Child Health to ensure effective coordination and execution.<\/p>\n \u00a0<\/p>\n![\"A](\"https:\/\/cdn.who.int\/media\/images\/default-source\/western-pacific-(wpro)\/countries\/cambodia\/infant-checkup-at-health-center-in-cambodia.jpg?sfvrsn=b641aeda_4\")
Infant checkup at Banteay Srey Health Center, Cambodia. \u00a9 WHO \/ Aforative Media<\/p>\n