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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


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Rapid Appraisal Study in Chui and Mother and Child Care

Issyk-Kul oblasts, Kyrgyzstan

Prepared by

Kyrgyz-Swiss Health Reform Support Project

on behalf

of UNICEF, Kyrgyzstan


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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


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Family planning the tradition of PRA

  • Not enough information on family planning

  • 71% of women have IUD (100-150 som for placing)

  • 48% of women use contraceptives


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Laboratory examinations in pregnancy the tradition of PRA :

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)


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Iron supplementation the tradition of PRA

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


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Duration of breastfeeding the tradition of PRA

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%)


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Maternity departments the tradition of PRA

  • Complains for bad service and conditions «everything is missing»

  • Informal payments in between 225-425 som


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Friendliness of PHC staff the tradition of PRA

  • 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


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Staff availability at working hours the tradition of PRA

  • 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.


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Access in emergency cases the tradition of PRA

  • 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.


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Pharmacies and Outpatient Drug Package (ODP) the tradition of PRA

  • 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).


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Health promotion the tradition of PRA

  • 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.


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Workshop with PHC staff (FGP/FAP) the tradition of PRA

There were 26 participants from 26 PHC units of 2 oblasts 26

- 8 FGP nurses

- 7 FAP nurses

- 8 FGP doctors

- 3 FMC doctors


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Availability of family planning material the tradition of PRA

FAP – 7, FGP – 14, FMC – 3. Total - 24


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Emergency care the tradition of PRA

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)


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Emergency obstetric care the tradition of PRA

  • 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


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Medical equipment the tradition of PRA

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).


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