Date post: | 13-Dec-2015 |
Category: |
Documents |
Upload: | erik-young |
View: | 216 times |
Download: | 0 times |
KyrgyzstanKyrgyzstanCARC MCH ForumCARC MCH Forum
Access and Quality of Primary Access and Quality of Primary Health Care with focus on Health Care with focus on Mother and Child CareMother and Child Care
Tolkun JamangulovaTolkun 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 supplementationOut 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
115 (79) > 12 months
15 (10%) 6 – 12 months
15 (10%) 0 – 5 months
No. mothers (n=145)Months of breastfeeding of last child
Duration of breastfeeding
23 (11%)> 12 months
29 (14%)8 – 2 months
83 (39%)5 – 7 months
63 (29%)0 – months
No. mothers who have started (n=196) supplementary food for their last child
Time
Time of beginning supplementary food
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
Most of the time
Sometimes Never
FGP FAP FGP FAP FGP FAP
Condoms 15 2 - 5 - -IUD 13 3 4 1 - 3Contraceptive pills
13 3 3 3 - 1
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 equipmentFAP:
– 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).