Primary Health Care Center Model

1. Friends may meet but mountains never Primary Health Care Center Model Donetsk City Hospital 25

2. Take care of the pence and the pounds will take care of themselves Goal of the Center IN ORDER TO EFFICIENTLY USE HEALTH CARE RESOURCES IT’S NECESSARY TO CREATE A MODEL COMMUNITY-BASED PRIMARY HEALTH CARE CENTER ON THE BASIS OF CITY HOSPITAL #25 AND DELIVER MEDICAL SERVICES TO ALL FAMILY MEMEBERS WITH AN ACCENT ON HEALTH PROMOTION OF MINERS, WOMEN AND CHILDREN.

3. Little is better than non Key Achievements in 2000 • On the basis of Decree #989 of Cabinet of Ministers Ukraine integrated actions were developed to take place on Oblast and city levels aimed at Family Medicine integration into Health Care. • With Executive authorities offices there were Oblast and City Coordination Committees established on integration of Family Medicine. • With the purpose to study medical and social aspects of family there was a questionnaire distributed in the community, its results reviewed and priorities established. • Out of nurses who were retrained some started to work as practicing nurses on their own on an experimental basis and cover age groups of patients who do not work. 3 nurses who graduated from «Leadership School» entered higher educational establishments: 2 - Medical University (Health Care Administrators), 1 - Management Academy.

4. As a cockroach on a hot stove • A patient questionnaire was developed for the Family Ambulatory which is used by a practicing nurse. • In order to provide psychological and social support to families a mechanism of interaction with social services was developed. • Hospital staff have worked out a «Provision on Family Medicine Center» and currently developing job description for physicians and nurses of Family Ambulatory • There was a Community Council created under the auspices of the Hospital which includes members of different community groups, public organizations, professional associations of industrial enterprises, public education system, sponsors in order to promote community-oriented family medicine and attract non-budget funds. • Learning Resources Center was opened, special program to train medical staff in computer use was developed and training is on-going

5. Each bird loves to hear himself sing PHC Center Characteristic Features • Catchment area population(total-19500 people,including 7640-miners,11860-their family members) Morbidity Profile: occupational diseases of miners and general morbidity of miners and their family members; Specificity: «black lung», dust bronchitis, peripheral nervous system diseases, hearing disorders, acute carbon monoxide poisoning; • Opening date: 27 February 2001

6. As the tree, so the fruit Organizational Structure Primary Health Care Center city of Donetsk Center «Women and Children Wellness» Center «Family Medicine» Center «Miners’ Health» Center «Women and Children Wellness» Kramatorsk

7. Center « Women and Children Wellness» 1) Center Director -1 2)Senior midwife-1 3)OB-GYN-1 4)Ultrasonography doctor-1 5)Gynecol.-mammologist -1 6)Family plan. physician-1 7)Internist-1 8)Pediatrician-1 9)Psychologist-1 10)Exam. office midwife-1 11)District midwife-3 12)Family plan. midwife-1 13)Pediatric nurse.-1 14)Receptionist-1 15)Junior nurse-2 TOTAL:18 Center «Miners’ Health» 1) Center Director -1 2) Senior nurse-administrat -1 3)ENT doctor-1 4)Oncology surgeon-1 5)Neurologist-1 6)Ophthalmologist-1 7)Dermatologist-1 8)Funct. Diagnostics speclst-1 9)Lab doctor-1 10)Radiologist-1 11) Feldsher-labtech -3 12)Nurse -10 13) Health promotion nurse -1 14)Receptionist-2 15)Junior nurse-4 TOTAL:30 Center «Family Medicine» 1)Center Director-1 2)Senior nurse-administrat.-1 3)Family physician-6 4)Family nurse-12 5)Lab doctor-1 6)Feldsher-labtech-3 7)Social worker-1 8)Procedure room nurse.-1 9)Health promotion nurse 10)Receptionist-2 11)Junior nurse-3 TOTAL:33

8. In every beginning think of the end Priorities:- Shift to family medicine through mechanisms of hospital shop and district services - Training of physicians and nurses, team building - Increasing role of a nurse in treatment, diagnostics and prevention of diseases by expanding her authority and increasing responsibility - Delivery of accessible, quality, timely consultation and diagnistics services to miners and their family members at center «Miners’ Health» -Carrying out a mutual project together with University of Illinois on program «Black Lung» (pneumoconiosis) - Partnership expansion- Accent not to treatment but prevention of diseases by increasing community medical awareness and family responsibility for their own health - Implementation of principles, forms and methods of professional activity of physicians and nurses taking into account social-demographic, medical-and-biological, psychological and hygiene characteristic features of each family

9. He deserves not the sweet that will not taste of the sour Difficulties during PHC Center Creation • Attracting funds for reconstruction of an out-patient facility building • Family physicians and nurses lack work motivation • Inadequate practical training of physicians and nurses in the course of their retraining at Medical University and College • Nurses are not ready for expansion of their authority and increasing role and responsibility • Little medical awareness of community and little responsibility of a family for family members’ health

10. Bind the sack before it is full Regular Assessment of Center’s Priorities of Work • Prospective needs of the catchemnt area population (assessment before Center opening): In order to collect initial medical data about community health there was an anonymous questionnaire distributed among miners and their family members, and the following needs were established as a result of this effort: : - Desire of the community to improve their health; - To have accessible, skilled medical care with capacity to provide up-to-date diagnostics in a comfortable setting; - Medical providers need to have better attitude towards their patients - To increase level of medical awareness of the community

11. Proof of the pudding is the eating Indicators of Good Performance • Increased level of medical personnel clinical practice knowledge in the area of PHC, health of miners and women through development treatment protocols and guidelines • Increased number of medical providers who can deliver maximum care in the setting of Family Ambulatory and Consultation-and-Diagnostics Center «Miners’ Health» • Increased number of PHC Center medical providers who routinely use computers in their work • Assessment of current patient satisfaction with medical services and specialists by obtaining results of anonymous questionnaire from community once every 6 months • Improved access of patients to medical knowledge through development and carrying out educational programs and patient involvement into these programs

12. Things past cannot be recalled Levels of Health Care Delivery to Community at City Hospital #25.Out-patient facility №1 at city hospital №25 Family Ambulatory 1 Level 2 Level 2 Level 3LevelIn-Patient Wards at №25 Hospital Administration Center «Miners Health» Center «Women and Children Health» Neurology Oncology Cardiology Internal Diseases

13. Every cock sings in his own manner Scheme of Financing Levels of Medical Care at City Hospital #25 of Donetsk 1 LEVEL: Family Ambulatory Family physician –holds and distributes funds Budget allocations per capita Non-Budget Funds Funds attracted through insurance companies Payment from family physician fund for each patient on a completed visit basis 2 LEVEL: Consultation-and- diagnostic centers Consultations by subspecialists without refferal by family physician through purchasing insurance polices Diagnostic examinations are provided through purchasing insurance policies Payment from family physician fund per diesease groups requiring involvement of a clinic 3 LEVEL: Specialized in-patient care Funds attracted by insurance companies Click for larger picture

14. It is easy to swim if another holds up your head Social Sustainability:- Primary health care has to be transformed with active participation of community and regional public organizations with support of Community Council authority .Management (organizational sustainability):- With limited resources it’s important to distribute them correctly as well as correctly distribute assignments between personnel. Increased competency, expanded responsibilities and leadership of nurses shall bring down the cost of in-hospital medical services. .Technical Sustainability:- Equipment provided by Partners shall improve accessibility, quality of medical services and shall raise the hospital rating

15. There is safety in numbers Cooperation with Others • Oblast, City and District Power Authorities (executive authorities) • Project «Donetsk-Pittsburg-Twin Cities» • Administration and Trade Unions of Coal Mines named after E.T. Abakumov, A.A. Skochinskiy and «Lidiyevka» • American Miners’ Union • Scientific-Research Institute of Ecology and Problems of Donbass Coal Industry (Donetsk) • Academy of Medical Sciences Ukraine, Institute of Occupational Medicine (Kiev) • University of Illinois (Chicago)

16. There is safety in numbers Cooperation with Others • Medical University and Medical College (Donetsk) • Business and Professional Women League, Center «Women for Women» (Donetsk) • Women Council of Kirovskiy district (Donetsk) • Trust «Donbasstransstroy» • Donetsk Regional Educational Center under the auspices of «Communities Partnership» Program • International Volunteers Center (Pittsburg) • Company «Carelift International» • «Centerville Clinics» (Western Virginia)