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<p><b>Introduction</b></p><p> The Direction Office of Healthcare Activities (DOHA) started around 1998 in Vietnam offers training provision for all lower- and higher-ranked hospitals. An understanding of the factors responsible for the success of this unique training provision system can be useful in implementing appropriate human resource development strategies in the health sector. Furthermore, the reviews about the changes in the training provision styles can offer us clues on how to connect training provision with visible clinical improvement. </p><p><b>Method</b></p><p> We reviewed the policy papers from the ministry of health in Vietnam, the activity reports of DOHA in the training center of Bach Mai hospital, which is a high-ranking hospital, JICA (Japan International Cooperation Agency) reports, and NCGM (National Center For Global Health and Medicine) reports from 1997 to 2015.</p><p><b>Results</b></p><p> DOHA was founded as a government-led health provision system in Vietnam with strong policy guidelines. However, to expand their activities, strengthen the capacity of training in hospitals, and establish a financial mechanism for training, there was a need to empower lower-ranked hospitals. </p><p> To enhance the training impact of the clinical field in lower-ranked hospitals after training provision, staff of higher-ranked hospitals were dispatched to lower-ranked hospitals to provide on-the-job training (1816 project) and training provision with equipment preparation in lower-level hospitals to overcome environmental difficulties in implementing techniques that they had learned (Satellite hospital project).</p><p><b>Conclusion</b></p><p> “Strong policy commitments”, “a viable financial system”, and “bottom-up empowerment” were needed to establish nation-wide continuous medical education system in Vietnam. To connect training provision with improvement in the clinical field, “integrated approaches for multiple factors in clinical fields like clinical environment changes and extended follow-ups“ by providing training are needed.</p>
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<p><b>Objectives</b></p><p> The aim of this study was to investigate the knowledge, attitude, and practice (KAP) of healthcare providers regarding the utilization of oxytocin for induction or augmentation of labor.</p><p><b>Methods</b></p><p> A qualitative study composed of direct observation and individual interview was conducted at a national tertiary maternity hospital in Phnom Penh, Cambodia in January and February 2013. The progress of labor in women who received oxytocin for induction or augmentation of labor was directly observed to confirm the healthcare providers’ management of oxytocin infusion. The attending doctors and midwives were individually interviewed after the women delivered. </p><p><b>Results</b></p><p> During the study period, 10 women were observed, and 12 healthcare providers (three doctors and nine midwives) were interviewed individually. Indications for labor induction or augmentation seemed to be appropriate for nine women. However, we found discrepancies between the national protocol and healthcare providers’ knowledge and actual practices. For example, 11 healthcare providers had never read the national protocol for the management of labor induction and augmentation, which implied limited access to the correct knowledge. A misconception was noted in that the sudden increase of oxytocin was not dangerous during the second stage of labor, despite the establishment of a good contraction pattern. Furthermore, a lack of unified initial dose and extremely high maximum dose above that recommended by the national protocol were observed. About half of observed women were not monitored for more than 2 hours from the beginning of oxytocin infusion.</p><p><b>Conclusion</b></p><p> In the present study, lack of knowledge, misconceptions regarding the management of oxytocin infusion, and a large gap between the national protocol and the actual clinical practices were confirmed. To maximize patient safety and therapeutic benefit, dissemination of the national protocol through in-service training is required.</p>
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The Project for Improving Maternal and Newborn Care through Midwifery Capacity Development by Japan International Cooperation Agency (JICA) was initiated for capacity building through pre-and post-service midwifery training.<BR> Firstly, we have shared the concept of ideal midwifery care based on the definition of evidence-based medicine (EBM) with our counterparts, which involves the integration of the best research evidence with clinical expertise and patient values. In addition to evidence-based midwifery care, we tried to provide individualized woman-centered care. <BR> After sharing these concepts in our project sites, we tried to modify the lectures on the basic concepts of midwifery care in the Health Center Midwifery Training program, and care providers’ attitudes based on EBM in the Basic Emergency Obstetric and Neonatal Care Training program.<BR> Our trial is an essential first step towards the further reduction of maternal mortality in Cambodia.
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<B>Introduction</B><BR>The economic situation of the Republic of Indonesia has been good with 6% economic growth in 2010. The health provision was affected by the decentralization after 2001, which has caused the prominent diversity in health condition. The health system and health situation in Indonesia are overviewed.<BR><B>Health situation</B><BR>The health indicators of Indonesia have been improving in general though maternal and child health (MCH) indicators are still not good enough compared to the surrounding ASEAN countries. The health budget has been increasing though up to 2% of GDP. The efforts by the Government have increased the number of health facilities as well as health workforce through it is yet to be improved. The Public Health Security Fund has extended its coverage with the target of universal health coverage. The health strategic plan 2010-2014 shows us the master plan of health development, whose vision is to encourage autonomous efforts by the community for health and the equity of health.<BR><B>Conclusions</B><BR>Indonesia is now on the epidemiological and populational transition with double burden of diseases. With the target of universal health coverage, it is urgent need to enhance the health service provision with development of health workforce in order to meet the demand along with enhancement of the health insurance coverage.