[Interview with Dr. Bin Sakviseth, Neonatologist, Calmette Hospital, Phnom Penh, 14032025]

"Our healthcare system and quality have improved significantly lately. However, once a while, there are some critical conditions. You can imagine an image of a young mother losing her baby… it never leaves you," Dr. Bin Sakviseth, a neonatologist at Calmette Hospital, recounts with palpable emotion. His words underscore a need for further improvement of maternal and perinatal healthcare in Cambodia..

Recent efforts to address the issue of preventable maternal and newborn mortality gained significant momentum in Cambodia, and a clear example is a hands-on technical training on Maternal and Perinatal Death Surveillance and Response (MPDSR), held at Calmette Hospital from March 12-14, and co-organized by the Ministry of Health, UNFPA, and jointly supported by the Australian Government. The training aimed to equip key healthcare professionals with the updated tools and knowledge to prevent future tragedies in the lives of mothers and newborns, in line with the latest global norms and standards.

Dr. Sakviseth, who has extensive experience in maternal and child healthcare, participated in the training driven by a profound desire to prevent the heart-wrenching cases he has witnessed throughout his career from happening again. He shared the story of a 30-week pregnant mother who, in 2021, suffered severe bleeding in a province. 

"She spent two critical days there," Dr. Sakviseth explained, "before being transferred to Calmette Hospital. By the time she arrived, it was too late. An emergency C-section saved her life, but her preterm baby, weighing just one kilogram, succumbed to a severe infection."

This case highlighted critical gaps from the community to the healthcare system: inadequate expertise and resources at the sub-national level, delayed transfers, and missed opportunities for early interventions. The mother's undiagnosed syphilis, a preventable condition, further compounded the tragedy.

Cambodia’s maternal mortality ratio, at 154 per 100,000 live births, is higher than the Asia & Pacific average of 113. Contributing factors vary across different provinces, with gaps in healthcare seeking behaviours, limited infrastructure, limited life-saving skills, limited access to timely referral, and access to essential resources playing key roles.

Recognizing the urgent need for systematic monitoring, documentation, and analysis of maternal and perinatal deaths, the Ministry of Health and UNFPA, thanks to the support of the Australian Government, convened the MPDSR Training of Trainer to improve case surveillance and response mechanisms by integrating it into their existing mechanism of “hospital alliance”, through which the national hospitals can support and provide feedbacks to each other through the case findings and response plan.

"We must learn from these tragedies," Dr. Sakviseth emphasized. "MPDSR is crucial. It allows us to identify what went wrong and what went right, using available resources and local data from the community to the facilities and health system."

The MPDSR training workshop in Phnom Penh brought together key national health professionals and officials from the national hospitals to strengthen their capacity in maternal and perinatal death surveillance so that they can cascade their training to other national hospitals and provincial hospitals in the coming months.

A key innovation introduced during the training workshop was the “No Name, No Blame” approach. This fosters a culture of open reporting, encouraging healthcare professionals to share critical information without fear of reprisal. “Previously, naming names created hesitation," Dr. Sakviseth noted. “This new approach encourages open discussions and collaborative problem-solving.” 

Participants also learned to work in interdisciplinary teams, develop SMART (Specific, Measurable, Achievable, Relevant, Time-bound) response plans, and accurately classify causes of death using ICD-11, the International Classification of Diseases, 11th Revision. By using ICD-11, we ensure that data on maternal and perinatal deaths is accurate and determine root causes , which is essential for improving quality of care.

"Importantly," Dr. Sakviseth added, "we now include perinatal deaths in our analysis. Understanding the link between maternal and newborn health is vital. This collaborative approach, involving pediatricians and obstetricians, is essential."

UNFPA, in partnership with the Ministry of Health of Cambodia and other key stakeholders, is committed to developing the MPDSR system nationwide. Future plans include enhancing medical training for healthcare workers, strengthening provincial hospitals’ capacity, and fostering collaboration between local and national healthcare institutions and the community workers.

A robust MPDSR system will play a pivotal role in improving maternal and newborn health outcomes by providing timely data, identifying key risk factors, and implementing preventive measures. By institutionalizing a systematic approach to case analysis, healthcare providers will be empowered to report cases timely and correctly, analyze them thoroughly, and implement solutions effectively while maintaining confidentiality.

Reducing maternal and perinatal mortality is a core priority for UNFPA, alongside meeting unmet family planning needs and eliminating gender-based violence. Strengthening MPDSR is a key strategy in achieving these goals, ensuring that every woman and newborn in Cambodia has access to a high quality of healthcare and that preventable deaths become a thing of the past.