Access and Quality of Primary Health Care with focus on Mother and Child Care. Kyrgyzstan CARC MCH Forum. Tolkun Jamangulova. Rapid Appraisal Study in Chui and Issyk-Kul oblasts, Kyrgyzstan Prepared by Kyrgyz-Swiss Health Reform Support Project. on behalf of UNICEF, Kyrgyzstan.
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Access and Quality of Primary Health Care with focus on Mother and Child Care KyrgyzstanCARC MCH Forum Tolkun Jamangulova
Rapid Appraisal Study in Chui and Issyk-Kul oblasts, Kyrgyzstan Prepared by Kyrgyz-Swiss Health Reform Support Project on behalf of UNICEF, Kyrgyzstan
In the focus groups with young mothers visual instruments in the tradition of PRA (Participatory Rural Appraisal) Study was carried out in June 2003 Session locations: 4 rayons in 2 oblasts - 7 FGP areas (out of them: 4 villages and 3 cities) - 7 FAP areas 26 group session with 261 mothers in 14 villages
Family planning • Not enough information on family planning • 71% of women have IUD (100-150 som for placing) • 48% of women use contraceptives
Laboratory examinations in pregnancy: There are 4 exams which a pregnant woman should undergo two times during pregnancy, free of cost. • 100% of women undergo these exams • In average the amount of 100 som is paid twice during pregnancy for 4 exams.Transport expenditures are about 50 som (only few FGPs have the laboratories)
Iron supplementation Out of 261 women during the pregnancy • 187 (72%) never took any iron supplement • 48 (18%) were taking iron supplement for less than one month • 26 (10%) were taking iron supplement between 1-3 months Out of 214 children < 3 years old • only 8 (4%) had ever been given iron supplement
Duration of breastfeeding Months of breastfeeding of last child No. mothers (n=145) 0 – 5 months 15 (10%) 6 – 12 months 15 (10%) > 12 months 115 (79) Time of beginning supplementary food Time No. mothers who have started (n=196) supplementary food for their last child 0 – months 63 (29%) 5 – 7 months 83 (39%) 8 – 2 months 29 (14%) > 12 months 23 (11%)
Maternity departments • Complains for bad service and conditions «everything is missing» • Informal payments in between 225-425 som
Friendliness of PHC staff • Staff from all FAPs and 4 FGPs out of 7 was assessed as friendly Trust • Mothers trust completely to the FAP staff • 19 groups out of 26 expressed overall trust to FGP doctors
Staff availability at working hours • PCH staff is always or almost always available at working hours. Except for 2 FGP which are open only in the morning. • The working hours of FGP and FAPs are convenient.
Access in emergency cases • All FAPs and 4 FGP are available during the night time in emergency cases. • In the cities people call ambulances at night. • Almost everywhere emergency drugs must be paid.
Pharmacies and Outpatient Drug Package (ODP) • There are no pharmacies in all FAP areas. • There are pharmacies available in all FGP areas. • Never heard about ODP (in 17 sessions out of 26).
Health promotion • Information on health promotion is received almost exclusively at time of treatment for an ailment. • PHC staff does not undertake any activities on health promotion.
Workshop with PHC staff (FGP/FAP) There were 26 participants from 26 PHC units of 2 oblasts 26 - 8 FGP nurses - 7 FAP nurses - 8 FGP doctors - 3 FMC doctors
Availability of family planning material FAP – 7, FGP – 14, FMC – 3. Total - 24
Emergency care Emergency care for children • Parents bring children to doctor in time (in case of pneumonia, diarrhoea, etc). • Big confusion about reparation of rehydration solution at home (many doctors do not know the components and dosage). • There are no necessary emergency drugs in many FGPs and all FAPs (antibiotics, antihistamins, rehydration solution)
Emergency obstetric care • PHC staff feels comfortable in situation of normal deliveries (without complications) • But everywhere oxytocine and clonidin are missing • In case of obstetric emergency, the transport to the hospital is organised
Medical equipment FAP: • The most elementary medical instruments are lacking (for example: 2,1 thermometers per1 FAP) FGP: • Not enough manometers (0,6 per doctor) • Not enough thermometers, tongue spatels, hemoglobinemters, etc).