For more information on any of the stories below please see the ZdravPlus monthly reports which are located under Publications in the Library of Technical Documents, or contact us at office@zplus.kz.
December 2007
“I like salty food very much! But I overcame this habit in order to maintain my blood pressure at the recommended level,” Zinaida Ushakova explained to her fellow classmates during a session of the Arterial Hypertension Patient School at Polyclinic #2 in Karaganda. Ms. Ushakova is one of over 150 individuals who have benefited from the USAID-supported Patient Schools at Polyclinics #1 and #2 since their inception in the winter of 2006. Like her colleagues, Ms. Ushakova is quick to compliment the classes, where participants learn hands-on about the lifestyle practices they can adopt to bring their hypertension under control.
In close collaboration with city and oblast health departments, the USAID ZdravPlus Project provides technical assistance to pilot health care facilities working to adopt evidence-based medical practices to address hypertension – a leading causes of illness and mortality in Kazakhstan. Having focused on training health care professionals in evidence-based diagnosis and treatment of hypertension for many years, the ZdravPlus is happy to mark the one-year anniversary of the Hypertension Patient Schools. The Schools have proven an effective tool for bringing the management of this illness to the community level, empowering patients with the knowledge and confidence they need to take personal responsibility for their treatment and the lifestyle choices they make.
With the launch of Birth Preparedness Classes at five primary care and maternity hospital pilot sites, ZdravPlus also marked the beginning of another important community education program in 2007. Developed in cooperation with the ExxonMobil-USAID Global Development Alliance and Astana City Health Department, the Birth Preparedness Classes are a follow-on to intensive ZdravPlus-delivered training for health care providers in Effective Perinatal Care – a World Health Organization program developed to improve maternal and child health.
Encouraging and preparing expecting mothers to deliver with the support of their partner or close relative is one goal of the program. Nadezhda Kharlamova – a new grandmother who attended the classes with her pregnant daughter – was enthusiastic about the new experience: “When I was giving birth to my daughter, no one except medical staff could support me. But when my daughter became pregnant I had the opportunity to attend the classes with her and I was trained on many important topics – for example the massage technique that I used to help relieve my daughter’s pain during labor.”
December 2007
When the USAID ZdravPlus Project began training Kyrgyzstani nurses in family medicine in 1997, Project staff were faced with a real dilemma: the lack of comprehensive, contemporary nursing materials in the Russian language. The vast majority of Russian language materials that were available were either outdated or overly scientific and better suited for physicians. While the Project succeeded in developing materials that suited its training curriculum and that were useful to new family medicine nurses once their days in the training program were over, the Project and its partner, Scientific Technology and Language Institute (STLI), were reminded year after year – by nurses, students, and nursing school faculty – of the need for a comprehensive reference text written specifically for family medicine nurses. With ten years of work in family medicine nursing development behind them, ZdravPlus and STLI answered the calls of the nursing community in 2007 with a two-volume Russian language text, titled Medical-Surgical Nursing.
A first-of-its kind resource in Kyrgyzstan and the wider Central Asian region, Medical-Surgical Nursing became an immediate hit after it rolled off the presses following many years of development, editing and translation. A fusion of many contemporary family medicine nursing references, the resource benefited from a great deal of input from local colleagues and members of the medical education community, who ensured that it was finely tuned to the regional context and reflective of the needs and capacities of the Central Asian nursing professionals. Financial support for development and printing of Medical-Surgical Nursing came from the USAID ZdravPlus Project, STLI, and private donors.
In March and April of 2007, ZdravPlus/STLI made trips to each oblast of the country to announce the publication of the textbook and to train key personnel on how best to use it. The Center for Family Nursing also distributed the books to other Central Asian countries, including 550 copies that were delivered to both Tajikistan and Kazakhstan where it has also been very well received. By years-end, over half of the 5000 volumes of the textbook in print had already been distributed region wide.
ZdravPlus/STLI received enthusiastic reviews for the text during a recent visit with senior faculty and current students from the Kyrgyz State Medical Academy. One student described the book as a valuable tool that builds on the fundamentals of nursing, and “carries nursing education from a theoretical to a practical level.” Having had a few months to utilize the new resource herself, Gulnara Beishenbaeva, Head of the KSMA Ob/Gyn Department, told visitors: “This is a book whose time has come… it is the only book we have seen that presents approaches to diagnosis and treatment from a nurse’s perspective. It will still be valuable ten years from now!”
December 2007
Marhabo, a postgraduate student at the Tajik State Medical University (TSMU) is currently conducting research on the prenatal health of pregnant women. When she began her research last fall, she was worried about whether the results of her investigation would be reliable because she felt she lacked a strong background in research design, information search, and critical appraisal of medical literature. Fortunately, Marhabo was introduced to the new Evidence-based Medicine (EBM) Resource Center, launched at TSMU in January 2007 with financial and technical support from the USAID ZdravPlus Project.
In an early survey conducted by the EBM Center among TSMU faculty members and researchers, 67% of respondents stated they were more likely to rely on textbooks alone in medical practice and in teaching, rather than other sources of reliable, current data like databases of peer-reviewed medical literature and the Cochrane Library. The survey also found that main barriers to information relate not only to Internet access, but also to a lack of education on literature search and critical appraisal.
To further its efforts to promote the principals of evidence-based medicine and the integration of EBM in medical education and research, the ZdravPlus Project partnered with TSMU to establish the EBM Resource Center, and – following its launch in January 2007 – conducted a series of introductory workshops for faculty and graduate researchers. Forty-two participants received training through the workshops on the key elements of evidence-based medicine, conducting information searches in key medical literature databases, and critical appraisal methodologies. Following the introductory sessions, participants also benefited from training in health research design and data interpretation, honing their ability to analyze and present data from their own research. Twenty-three doctoral students trained by the Center have since returned for support in searching for scientific articles on a wide array of research areas, including obstetrics, surgery, pediatrics and infectious disease.
During its founding year, the EBM Resource Center also organized a roundtable for 30 TSMU Department Heads on the topic of Health Research and Evidence-based Medicine, which served to foster discussions on such topics as research ethics and the use of ineffective treatment strategies. The roundtable also advanced faculty interest in establishing a formal curriculum for TSMU doctoral students on the design of clinical trials and statistics.
All TSMU EBM Resource Center materials and publications are regularly posted to the website of the Central Asian Republics EBM Center Network: www.carebmc.net.
December 2007
Large families are a tradition in Turkmenistan – and the Turkmen love children. Turkmenistan also has a tradition of maternal and newborn health care practices that are much like many of the best practices encouraged by doctors around the world today, included partnership delivery (with a close family member present to comfort and support the mother during delivery) and close contact between mother and child following birth. Unfortunately, during the Soviet era, perinatal care was overly medicalized in Turkmenistan, and a number of ineffective maternal and newborn healthcare practices became the norm. Examples of such practices include prohibiting anyone but hospital staff in the delivery room, the separation of mother and baby after birth, and regimented feeding schedules for the newborn. Regrettably, many of these practices persist in Turkmenistan and in other former Soviet Republics today. However, Turkmen health care workers and families alike are welcoming a new era of evidence-based perinatal care practices.
2007 marked the launch of Turkmenistan’s National Safe Motherhood Program, based on two years of preparatory work by partners including the Government of Turkmenistan, Ministry of Health, USAID, WHO, UNICEF, UNFPA. In June and July 2007, USAID’s ZdravPlus and Healthy Family projects conducted four antenatal care trainings and a “Making Pregnancy Safer/Promoting Effective Perinatal Care” training for 134 Turkmen health workers. Developed in collaboration with the WHO, the Ministry of Health and Medical Industries, the MCH Institute, and Regional Health Departments, these first-of-their-kind trainings formed an important foundation for the Government’s 2007-2011 National Safe Motherhood Program, providing Ob/Gyns, neonatologists, midwives, nurses, and family physicians with evidence-based training in perinatal care. The courses also served as an impetus for developing a plan of action to pilot birth preparedness classes for pregnant women and their partners – initiated successfully by ZdravPlus in other Central Asian countries.
By year’s end, it was clear that the trainings had affected a great deal of positive changes in medical practice at participating ZdravPlus pilot facilities, which include maternity hospitals and Houses of Health in Mary, Sakarchaga, and Yoloten etraps. Follow-up monitoring revealed improvements in the availability of individual delivery rooms, increases in the proportion of deliveries with partner present, increased skin-to-skin contact between mother and newborn, active management of the third stage of delivery, and the ready availability of liquid soap, individual towels, and hand washing instructions in delivery rooms. Health care staff at the pilot facilities also expressed their enthusiasm and pride in the improvements they brought about at their facilities in 2007 – ensuring a safe and comfortable delivery for mothers and a secure and healthy start for Turkmenistan’s youngest generation.
December 2007
In 1999, the USAID ZdravReform Project initiated a modest pilot initiative on per capita financial and management (F&M) reform in 43 rural primary health care (PHC) facilities in three districts of Ferghana Oblast. By the end of 2007 – with ongoing support from USAID’s follow-on ZdravPlus I and II Projects – almost the entire rural PHC sector has been brought under the domain of Uzbekistan’s per capita provider payment system, which now finances a massive total of 2,867 facilities in 143 districts across all 13 of Uzbekistan’s oblasts. The ZdravPlus Project eagerly looks forward to the coming year – when complete national rollout of the reforms will be achieved following the extension of the reforms to 220 remaining facilities in Samarkand Oblast. 2008 will bring one of the Project’s greatest milestones, and the culmination of years of successful partnership between ZdravPlus, the Government of Uzbekistan, World Bank, Asian Development Bank, and many other national and international partners.
At the heart of the F&M reform model is the introduction of 1) a per capita provider payment system and 2) increased management autonomy for PHC facilities. The model promotes cost-effective primary care and preventive treatment (over more resource-intensive specialized care and hospital services) in addition to the treatment of ill patients. Management restructurings have enable PHC facilities nationwide to evolve as independent legal entities with their own budgets and bank accounts – receiving direct financing (versus the pre-reform practice of being financed through hospitals) as well as the right to reinvest savings back into facility and staff development. In short – this means that money follows the patient. Facilities are financed based on the number of individuals assigned to them, with adjustments made for the sex and age make-up of the assigned population. Consequently, providers are paid for keeping patients well – i.e. preventive care – and not simply for maintaining facilities and treating ill patients. If primary care facilities keep their patients healthy, they are able to generate savings that be invested in further enhancing services.
World Bank and independent assessments of the per capita F&M reforms point to a number of exciting results, including:
Prompted by the success of the per capita F&M reforms of rural PHC facilities, the Government of Uzbekistan decided not only to roll out these new approaches nationwide beginning 2006, but also to undertake pilot projects for urban PHC facilities (polyclinics) using similar principles. With technical assistance from ZdravPlus, a per capita F&M reform model was designed and has been implemented in 24 urban PHC reform pilot polyclinics in Tashkent, Marghilan, Guliston and Samarkand cities. ZdravPlus looks forward to finalizing a demonstrative model of per capita F&M reform for urban polyclinics by the end of 2009.