Moeun with her five-month-old son
©UNICEF Cambodia/2016/Vanny Kong
Mondulkiri, Cambodia, December 2016 – Phyang Moeun, 35 years old, holds her ID Poor card in one hand and her youngest son in the other. This is her sixth child, but the first she delivered at the hospital. Until this child, she did not have the means, financial or otherwise, to receive proper health care during her pregnancy or labour. But the ID Poor card, which she recently received following efforts by the Commune Council, ensured her recent birth would be different – and much safer.
Moeun lives in a small house in Pu Treng village in the commune of Dak Dam, located in Mondulkiri Province, one of Cambodia’s poorest and most remote areas. Like most of Mondulkiri’s population, Pu Treng is comprised primarily of ethnic minorities that rely on rice farming to eke out a living. It is a poor, rural region where adequate health care is often a luxury and not readily accessible to most families.
Like many mothers in the area, Moeun relied on a traditional birth attendant during her first five pregnancies, preferring to stay close to home rather than travel to the health centre.
Moeun’s children range in age from 15 to the youngest, now five months. “In the past, I delivered with the traditional birth attendant,” she says. “I felt it was fine because I was still young and it was easy to deliver. The attendant just helped me to deliver.”
“After the delivery, the traditional birth attendant had no medicine and I used only traditional medicine and roasting,” she says, referring to the belief that a woman will recover more quickly from labour if charcoal is burned under her bed. Such practices put women and newborns at unnecessary risk of infection or worse. “When delivering my fifth child, I had edema on my leg and felt exhausted. I went to Dak Dam Health Centre to deliver but the staff told me that I could not deliver there and needed to be transferred to the Provincial Referral Hospital in Krong Senmonrorom, which is 20 kilometers away. But I had no money for transportation nor food that I would need during the stay at the hospital.”
That changed with her most recent pregnancy. As a mother to five and with elderly parents unable to contribute to the family income, her family was identified as ID Poor 1 during social service mapping conducted by the commune councilor and village leaders. With the commune’s help, she received an IDPoor card from the Ministry of Planning and is now eligible for free health care. The community-led social service mapping process, which UNICEF has been supporting in communes like Dak Dam since 2013, helps local-level officers identify vulnerabilities faced by families like Moeun’s and determine the best way to support them using local funds.
Social service mapping is an important component of UNICEF’s work with local government to strengthen capacities to map, collect and analyze data in order to budget for needed services. This data informs evidence-based, local-level social service planning and helps families in critical need receive support such as access to community preschools; water and sanitation; maternal, newborn and child health; child protection and birth registration.
Social service mapping at Dak Dam commune office
After mapping is completed, commune councilors allocate a budget for the so-called ‘social service envelope’, a small sum provided to families to cover urgent needs. In Dak Dam commune, 29 families have been supported in this way to promote delivery of children at health facilities. As a result, births with traditional birth attendants decreased from 52 (2014) to four households (2016), according to commune data generated by social service mapping. Envelope funds were also used for birth certificates, early learning for children aged 3 to 5, and better water and sanitation, including awareness-raising activities and the provision of water filters.
Moeun’s successful delivery greatly owed to this social service mapping initiative. Her IDPoor 1 classification provided her access to free health care; the commune also provided 100,000 Cambodian riels (US$25) for transportation to the provincial hospital and food for the seven days she stayed at the hospital after delivery.
The experience was very different to the birth of her first five children.
“I felt safe when I arrived at the hospital and the midwives had the capacity to keep my baby and myself safe from danger,” Moeun says. “Through my experience, I told my relatives and neighbours to visit the health centre and deliver there; it is safer than delivering with traditional birth attendants. If something goes wrong, our village does not have the equipment to save our life.”
Moeun with her husband and children at her home
©UNICEF Cambodia/2016/Vanny Kong