Researcher

Improving Access To and Quality of Sexual and Reproductive Health Services in

Kampong Speu Province, Cambodia

1. Introduction
Enfants&Développement has been engaged in development programmes in the fields of health and education in Cambodia since 1984.

Since March 2011, E&D has been implementing a Sexual and Reproductive Health (SRH) Project in target areas of Kampong Speu province. The overall scope of Implementation includes the Provincial Health Department (Mother and Child Health Care); Provincial Referral Hospital-Kompong Speu, Referral Hospital Kong Pissei and 35 Health Centers.This project has two main components: prevention and medical components.For the prevention component, “Intensive Community support areas” includes Health Operational Districts (OD) of Oudong (1 commune) and Kampong Speu OD (8 communes of Phnom Srouchh and Oral administrative districts). The Project “Improving Access to and Quality of Sexual and Reproductive Health Services in Kampong Speu Province, Cambodia” seeks to increase the quality of care at Referral Hospitals and 35 Health Centers of Kampong Speu province. The Project aims to increase the capacity of health workers, in particular doctors and midwives delivering obstetrical and gynecological service through training, technical assistance and mentoring on the job.

It is proposed that a consultant in conducting research into the impact of the village based doulas  on women’s health, particularly sexual and reproductive health and assimilate an appropriate training curriculum for doulas, is hired for an estimated 4 week assignment. The consultant will detail evidence based strategies for impacting women’s health.  It is envisioned that through this assignment, a doula training toolkit will be developed to facilitate the duplication of doulas training activities and sharing of good practices with other stakeholders working in sexual and reproductive health. The research will serve to lobby other NGOs, UN agencies, Ministry of Health, Ministry of Women Affairs, Ministry of Education, Youth & Sport, Medicam and the National network for Early Childhood Care and Development, in order to replicate doula activities in other parts of Cambodia.

2. Background
Kampong Speu province is among the poorest provinces of the country and faces problem of availability and accessibility of medical care in general and of access to Basic and Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) in particularly. Maternal mortality rate is very high in rural areas with a significant gap with the urban. There is a lack of in-service trainings, follow-ups after trainings, supportive supervisions and coaching. Health Centre midwives lack sufficient skills. There are problems of infrastructure and equipment/drugs and supplies and transportation systems. These barriers are caused by the far distance from the home to the health services, the availability and cost of the transport, wrong and sometimes harmful traditional beliefs and practices around maternity etc. Births attended in public health facilities remains around 44% (2009). The use of modern contraceptives is approximately 26%, and 8% of women age 15 to 49 reported having had one or more abortions in their lifetime, mostly at home with the consequent medical risks.

Public health services in remote locations of Kampong Speu province are very rudimentary and the major obstacle to finding professional help is linked to the accessibility of quality obstetrical health services. The nearest obstetrical services for pregnant women with complications are at the Provincial Referral Hospital, where special interventions are available.

Among other achievements of the current project, until now, 73 village based doulas were trained and are practicing in Aoral and Phnom Sruoch districts

3. Objectives & Assignment of Services
The main objective of this assignment is to document and evaluate success factors and weaknesses in doula activities and training curricula as implemented by Enfants&Développement since 2010 in rural areas of Kampong Speu province of Cambodia.

a.The Technical Expert (TE) will identify key success factors; assimilate pertinent information gathered by village based doulas regarding health seeking practices. He/she will compile the results of the research and develop a list of evidence-based strategies to be replicated in other areas.

b.He/she will additionally identify and study existing doula educational and training materials and will assimilate and develop further a tool-kit for training doulas.

The Technical Expert (TE) will work through the project field bases of E&D in collaboration with project staff and relevant stakeholders. The Technical Expert will provide weekly feedback of progress in summary format to the SRH prevention coordinator and will discuss issues/constraints in delivering these ToRs.

4. Methodology
The consultant will determine what is known through the scientific literature and will develop recommendations for prioritizing the doula program and policy options.

4.1 Specifically, the Technical Expert will study the current materials and methodologies used for training village based doulas. The focus will be on identifying and developing the weakest links in the training programme.  He/she will identify performance requirements and the knowledge, skills, and abilities needed by doulas to function effectively. The assessment should address resources needed to fulfill the doula profile, improve productivity, and provide quality products and services.

The development of the training tool-kit will include: 

• Obtaining information (e.g. existing training materials and methodologies) 
• Analyze information
• Define problems/issues
• Describe critical changes in doula training methodology to affect the problems/issues identified
• Determine and document the best training and development approach(es)
• Describe how the training toolkit will be used and delivered

4.2 Additionally, the Technical Expert will elicit evidence based strategies, which will include, but may not limit to,
•    The identification and documentation of success stories (anectodotal evidence) of most significant change

The following research elements may be used alone or in combinations to produce the best result:

• identifying interventions to evaluate, 
• searching for and obtaining the evidence for each intervention, 
• assessing the type and quality of the evidence, and 
• summarizing the strength of the evidence. 

The study process will combine research and surveillance evidence with the needs, values, and preferences of the population. The consultant will  utilize a systematic and rigorous way to approach the complex tasks of identifying problems, marking leverage points, and implementing the most effective and promising solutions. 

The consultant may use one or more of the following research tools:

• Observation: to gather first hand data 
• Interviews: to gauge opinions and perceptions. 
• Questionnaires: to get a big picture of the environment 
• Job Descriptions: Study of all responsibilities of the doula with expectations and responsibilities, allowing for more thorough training and supervision.
• The Difficulty Analysis: identification of the doulas duties that cause them the most difficulty, and allowing for more training in those areas.
• Appraisal Reviews: Within a performance review, questioning the doulas about their duties and training to uncover reasons for poor performance.

The outcomes of this process will summarize the evidence for replication of the doula intervention.

5. Time frame
The duration of the services will be for approximately 4 weeks during September-October 2013 and the expert will ensure that the objectives are achieved according to a Work Plan designed in collaboration with the project Prevention Coordinator and other staff.

6. Expected Outputs
6.1 Presentation of findings of the research at a workshop at national/sub national level (to be decided)

6.2 A final comprehensive report and training toolkit submitted to and approved by the SRH Prevention Coordinator with recommendations, one week after completion of the field assignment.

7. Proposed qualifications of Technical Expert  

• Social researcher with sound knowledge of investigative methods. Knowledge of public health and community empowerment will be an asset. 
• Demonstrated experience in analysis and planning with ability to analyze and anticipate situations, define problems and objectives, recognize alternatives and formulate solutions.
• Excellent analytical skills to comprehensively analyze and interpret policies, procedures and situations in a multifaceted way and possess strong problem-solving skills to develop innovative solutions to complex issues.  
• Good technical drafting and report writing skills in English and strong presentation and interpersonal communication skills.

Future detailed information:
Email: info-cambodia@enfantsetdeveloppement.org
Address: # 21, St 454, Tuol Tumpong I Commune, Khan Chamkar Morn, PP.
Tel: +855 (23) 21 21 96
Deadline: September 15, 2013

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