Make every child count

SAMARKAND, Uzbekistan, 14 May 2010. – A newborn son of Fatima Kulmurodova – Islombek - is only 5 days old. He sleeps quietly in a small cot near his mom’s bed. Appearance of unexpected guests in the room seems not to disturb him.

It is a second child of a 25-year old teacher from Samarkand lyceum #1. Fatima’s first delivery occurred in the Taylak district maternity five years ago and left the feeling of fear and pain.

“There were too many people around me, putting an ice on my stomach, giving lots of anesthetics. I felt lost”, recalls the young woman.

This time all went differently. Fatima decided to go to Samarkand-based maternity # 3. Her family relied on “the word of mouth” when making the choice and had no clue that the hospital was officially recognized as baby-friendly. It were workmates who told Fatima that it’s warm, the doctors and nurses were good and attentive. They also knew that family members would be admitted to delivery rooms.

Fatima’s expectations turned true. She and her little son feel well and are waiting now only for a birth certificate to come.

“It’s a pity there were no such a place in our times,” admits Fatima’s mother-in-law Rukhsora Normamadova, 48. The mother of four, she lived through that and knows how crucial it is to create the right conditions for pregnant women. Rukhsora-opa has stayed with her daughter-in-law during the delivery and says Fatima will get full support at home.

Fatima Kulmurodova with her newborn son Islombek and mother-in-law Rukhsora Normamadova.

Life-saving techniques are within reach

Not all stories about childbirth in Uzbekistan would have the same happy ending. Nearly every delivery takes place here in maternities with skilled attendance. Yet, medical support is often inadequate or poor. The country’s maternal and infant mortality rates are therefore high compared to those of the middle-income countries. Poor health of women also serves as a contributing factor. According to MICS 2006, half of the mother and child mortality cases in Uzbekistan are caused by complications before, during and after the delivery.

“Many situations that have led to the death of newborns could be prevented or handled without complex and expensive technologies. There are new “low cost-high impact” strategies that help save more and more babies’ lives all over the world. The main thing is to change the maternal and newborn care practices inherited from Soviet times,” says Dr Hari Krishna Banksnota, MCH Specialist at UNICEF Uzbekistan.

He leads a nationwide project on improving maternal and child health, which is being implemented by the Ministry of Health and UNICEF with the European Union’s funding since 2008.

One of the key goals is to scale up application of the universally recognized standards in emergency obstetric care, neonatal resuscitation, and essential newborn care. Some of them are simple and do not require high-tech equipment: keeping babies warm and with mothers, feeding with breast milk, avoiding over-medication. Training of health specialists is complemented by advocacy at the policy level so that upgraded knowledge and skills sustain over time.

Leading by example

Samarkand maternity # 3 is one of the many beneficiaries of the EU-funded project. Few years ago this institution set an example in the region by supporting safe motherhood principles and the Baby-Friendly Hospital initiative. It also began promotion of exclusive breastfeeding ahead of other local health facilities. It’s not surprising then that the very same maternity took the chance of training its staff in effective perinatal care. Opening of a training centre and a new department on neonatal resuscitation followed.

“Our staff attended different workshops on safe motherhood in the past and felt well prepared. However, the training on neonatal resuscitation turned out very useful and timely. It brought up to our attention lots of nuances we didn’t know about, “says Sayyora Sobirova, Chief Doctor.

For example, they used to underestimate the role of temperature in saving the life of a newborn. Now they know: if it’s below the set minimum, no other invention will help a baby survive. Besides, the old school of medicine placed too much value on drugs in neonatal resuscitation. As a result, prescribing long lists of medicine was rooted in the practices of local neonatologists.

“All medical interventions for neonatal survival should be well justified. Otherwise, they can bring more harm than good,” says Sayyora.

The team she leads is determined to keep adopting the new techniques that proved effective. It doesn’t matter what it will cost them if babies’ lives are at stake.

 

Improving day care for children

JOMBOY, Samarkand region, 10 May 2010. – “It’s a challenging but fulfilling job. I’m always among people and keep in close touch with families. I feel important and useful as I’m helping their kids grow healthy,” says Muborak Tursunkulova, 38, patronage nurse from the "Tut" village medical point.

She is one of the primary health workers from Samarkand region, who went to five-day training on mother and child care last year. It was organized by the Samarkand Multi-Profile Medical Centre with UNICEF support.

Muborak has been working for the "Tut" medical point since its opening in 2005. It serves five villages where almost six thousand people live. Children under the age of 14 make up one third of the local population. Out of that, more than 500 are children under five.

In the mornings she helps a paediatrician receive patients. Then she goes to families with children. There are 74 families which she sees at least once a week or more often if needed.

“Many families have become accustomed to my visits and wait for me,” smiles Muborak.

Bridging the gap

Village medical points, commonly known as SVPs, are a new type of facilities that have been established in Uzbekistan within a large scale health reform. Scattered all over the country, the 3,000 SVPs are meant to bring proper and affordable medical care closer to rural populations.
In recent years, the Government also made strides to staff and furnish the SVPs with modern equipment. Yet, would-be patients continued to head towards big district clinics instead of using services available at a door step. Building trust of the communities they served turned out to be a more difficult task. It required more than just funding. Better skilled and knowledgeable health workers would make a real difference.

Capacity building of medical staff at all levels, including SVPs, is one of the ways UNICEF is helping the Government of Uzbekistan to improve the quality of mother and child healthcare. Last year, several thousand maternal and child health workers were trained within the project on Improvement of Mother and Child Health Services funded by EU and implemented by the Ministry of Health and UNICEF.

New knowledge, new skills

The new setup of primary care also put additional responsibilities to patronage nurses like Muborak. They are not just doctors’ assistants who help monitor the status and living conditions of pregnant women or children and can provide timely medical assistance. Educating families to prevent and detect childhood illnesses at an early stage has become an important part of their job

Muborak shows the handbook "If you want your child to be healthy" that she received after last year’s training.

“With this manual, it is much easier now to guide families on the issues concerning child development or health. I also give them a mother’s card where they can find useful information and basic tips on childcare. For example, mothers often didn’t not know what to do if their child got diarrhea. Some might even decide to put him or her on a diet or stop giving fruits – believing that will only worsen the situation,” recalls Murobak.

The family of Sojida Jumanova is one of the families that patronage nurse Muborak Tursunkulova visits regularly. With two small children - Sevinch, 4, and Nazarbek, 18 months, Sojida is one of the mothers who is benefiting  from accessible  primary care..

© UNICEF Uzbekistan/2010/Pirozzi

Muborak also says before some young mothers used to complaint about the inconveniences they faced when breastfeeding a baby. Now they know that they just need to properly place a child.

“People are becoming more careful of the health of their children. I see that mothers I had talked to followed my advice: the number of diarrhea cases in our territory is decreasing,” she adds.

“Muborak-opa is a very nice and energetic person. I’ve learned a lot from her, especially on child nutrition, though completed a medical college,” says Sojida Jumanova, 26. She lives in the same village where the “Tut” health point is located. With two small children - Sevinch, 4, and Nazarbek, 18 months, she is one of the mothers who have benefited from improved primary care. “Now we shouldn’t go far away from home and the whole family can be served in one place”.

 

Maternal and child healthcare: quality matters

UNICEF and Ministry of Health pilote the Continuous Quality Improvement (CQI) system in Uzbekistan

TASHKENT, Uzbekistan, 16 April 2010. – Maternity clinics in eight regions will now be able to continuously assess their day-to-day actions to make them more effective. The new tool at their disposal - called “The Quality of Hospital Care for Mothers and Newborn Babies” - will now help them track progress on using effective perinatal technologies.

This assessment tool has been originally developed by WHO and brings international standards for maternal and child healthcare to more than 20 countries. With WHO’s technical support, the Ministry of Health of Uzbekistan has recently adapted it to the country situation. With UNICEF’s assistance, the tool has been introduced in three maternity hospitals of Tashkent, Samarkand and Djizzak and a pilot team of assessors trained.

The quality assessment tool consists of check lists and questionnaires that cover the key areas of hospital care for mothers and newborns in an integrated manner. Various information gathering techniques help assess a maternity hospital against different performance indicators. Conditions in delivery rooms and maternity wards, equipment and drug availability, organization of services and case management, treatment methods, patients’ feedback – there are many factors that come into play to assess the overall quality of care at a given hospital. Scoring is done on a three point scale. The highest score – 3 is an indication that this facility meets required standards, while 2 means there is a need for improvement.

“This tool is very much action oriented and calls for our attention to the areas that need strengthening. It also encourages our staff to think, reflect, and act upon, as they get engaged in a continuous process of self-assessment,” says Adelina Lyubchich, director of the Republican Perinatal Centre in Tashkent. Her facility was evaluated among the first just two months ago and received 2.6. “It was a real learning experience. As soon as we got the final report, we reviewed its findings and drew a long “to-do list”. By using the quality assessment tool, we get a clear idea what needs to be improved and how.”

Introduction of the Continuous Quality Improvement (CQI) system in Uzbekistan is an integral part of the “Improvement of Mother and Child Health Services” Project, which is implemented by the Ministry of Health with UNICEF’s technical support and funding from EU.

The project focuses on long-term interventions, such as adoption of international standards and clinical guidelines, training of medical professionals, so that the health sector could introduce and sustain positive changes over time. The quality improvement assessment tool is thus one of the essential means to monitor the project’s impact and ensure that health facilities and their staff follow new policies and standards on maternal and child care.

Securing better health for kids

Few simple steps to saving children’s lives

Samarkand, Uzbekistan. - A 6 month old Lorchinbek has been brought to Samarkand multi-profile Children’s Centre in a critical condition, with complicated pneumonia. He was immediately sent to the Resuscitation Department. Lorchinbek is now under intensive care and is getting oxygen through a small nasal plug. His therapy also includes antibiotics that are used in moderate dozes so as not to have any adverse effects.

Zamira Hudoyberdieva with her little son Lorchinbek.

Communication Award - Project of the Year goes to Uzbekistan

The joint project of the Ministry of Health of Uzbekistan, European Commission and UNICEF on improving mother and child health care wins the EuropeAid Communication Award for Asia

The Project for the Improvement of Mother and Child Health Services in Uzbekistan is a two and half year project launched in 2008 to improve the quality of health care for children and their mothers. The European Commission contributed 3.5 million Euro to the project.

The Communication Award has been given in recognition of both its exemplary communication’s work and successes on the ground.

A central feature of this project is the training of health workers at hospitals, maternities and primary health care facilities on newborn and child survival techniques. To date, more than 7,500 health professionals across Uzbekistan have upgraded their skills and knowledge and are able to provide better mother and child care. By introducing new practices and care methods, the project is contributing to the improvement of the health of young children and mothers in eight regions.

To ensure continuity, a pool of trainers was also created and 16 regional training centres were renovated and equipped. The work is under way to amend the curricula of eight medical institutions so that fresh medical graduates are familiar with and can apply modern international standards on child and maternal health care. Strong commitment of the Ministry of Health to introduce changes at the policy and service delivery levels is yet another factor contributing to the success of the project. 

“Our attitude towards a baby has changed. We feel more confident when come across difficult cases. We know that it is in our hands to save a newborn,” says Nigora Rusimuradova, head of the Neonatal Resuscitation Department from Samarkand maternity # 3. She is one of the many beneficiaries of the project, who has also been certified as a trainer.

The partnership of the Government of Uzbekistan, UNICEF and EU in the health sector has brought positive results in improving the quality of child and maternal health care. It marked a big breakthrough in advancing the government’s health sector reform agenda that focuses on the strengthening of the primary health care system. The partnership also paved the way for policy changes in such areas of the maternal and child health system as the adoption of international live birth definition (ILBD), nationwide revision of the medical curriculum system, introduction of the quality assurance system and institutionalization of the certification process.

For the EuropeAid Communication Award 2009, 15 projects on the issues ranging from environment to education and childcare were presented in the Asia category.

The communications portfolio of the Uzbekistan’s project included two videos, a website, leaflets and other publications geared for various target groups. The project got into a short list after the online voting of two thousand EU staff. The final round, which took place offline at the EU Headquarters in Brussels, has brought it 53% winning votes.

The EuropeAid Communications Award was presented to Francesco Buscaglia, Programme Manager for Centralized Operations for Asia and Central Asia of the European Commission’s EuropeAid Co-operation Office at a special ceremony held at the EU Headquarter.

Child deaths in Samarkand hospitals drop rapidly through joint EC and UNICEF support

Child deaths in Samarkand hospitals drop rapidly through joint EC and UNICEF support

By Matthew Taylor

Samarkand, Uzbekistan, August 6, 2009 - A baby boy was recently rushed into Samarkand’s Paediatric Hospital Number 1. He was in shock, dehydrated and his arms and legs were cold.

Better diagnoses and improved emergency care is saving young lives in Samarkand.

Dr. Turaev ran rapid all round checks in the entrance hall, provided oxygen, intravenous rehydration and sent him on to the intensive care unit (ICU). ‘Before we would have sent him straight down to the ICU,’ he says, ‘now I’m able to start life saving care faster.’

In an emergency, seconds can mean the difference between life and death.

Joint Ministry of Health, UNICEF and European Commission training is making these seconds count. Medical professionals from Samarkand and 7 other Uzbek’ regions are being trained in the Integrated Management of Childhood Illnesses (IMCI). These are low cost, high impact World Health Organisation care techniques.

IMCI training and guidelines help medical professionals swiftly spot and treat dangerous childhood conditions. By following clear, simple procedures, doctors can save more lives and avoid prescribing unnecessary drugs.

In the Samarkand hospital IMCI techniques have helped cut infant mortality. ‘In the first quarter of 2008,’ says Chief Doctor Azizov, ’28 of 370 children that came in died. In quarter one of 2009, after the introduction of IMCI, we lost only 12 out of 378.’

IMCI is just one element in a huge maternal and child health care reform project that will see over 12,000 health professionals trained by late 2010. Seventeen new training centres are also being refurbished and equipped. The project kicked off in July 2008 and the European Commission is providing 3.5 million Euro of a total budget of 3.8 million.

Saving time, saving lives

Respiratory diseases like pneumonia are major child killers in Samarkand. Doctor Azizov says that doctors now diagnose these faster and more accurately. ‘They now diagnose pneumonia through monitoring the child’s breathing; how regular breaths are and the way they breathe. ’ he says. ‘This means we get the kids to the best place for targeted treatment much quicker.’

With doctors better able to diagnose and treat, new triage systems have been put in place. On entering the hospital, children are checked and given red, yellow or green ribbons. Reds are priorities and are swiftly whisked off to specialists.

And mothers are now encouraged to help cure their own children. They’re also kept together while complications are being treated; as a calm child is a far easier child to care for.

The new practices are now included into budding doctors university curricula, so when the training stops, the knowledge keeps saving lives.

Huge health improvement project sees four thousand medical professionals trained in life saving skills

TASHKENT 7 July 2009, officials from UNICEF, the EU and Uzbekistan’s Ministry of Health met today to mark a year’s progress for mothers and children. By December 2010, 14,000 health workers will be trained in improved maternal and child care. One year in, four thousand of these are already sharing their skills throughout the country.

“I’ve seen it with my own eyes. This project is doing good helping mothers and families,” said William Hanna, Head of Unit for Centralised Operations for Asia and Central Asia in the European Commissions Directorate General for Humanitarian Aid, “It’s an excellent example of what we can do together and it’s a great example of how the EU is helping people and development. I want people at home to fully understand the good work we’re doing here - and I’ll be taking the message back to Brussels with me.” he said.

EC and UNICEF officials open a new maternal and child health training centre in Samarkand

The Improvement of Mother and Child Health Services (IMCHS) project in Uzbekistan was launched in July 2008 with a total budget of almost $6 million, of which the EU provided $5.5 million and UNICEF $450,000.

Today’s meeting, chaired by Mr A. Kamilov, Deputy Minister of health, evaluated progress to date and charted a course for the future.

Beating expectations

The 4,000 medical workers trained to date are now fully capable of sharing the latest practices in emergency newborn care and childcare in maternity wards, polyclinics and primary healthcare facilities. 12 of the 17 planned training centres are already decked out with new kit to ensure quality care.

Dr. Hari Krishna Banskota, UNICEF’s project manager, noted the project’s key achievements and challenges so far. ‘The offer of training and materials was met with overwhelming demand” he said. “So we’re now upping the projected numbers for training from 14,000 to 19,000 by the end of 2010.”

On the home stretch

Partners reaffirmed their determination to see the project through. “The project already spans half the country, yet much more needs to be done. I hope the project will also bring systemic changes into effect” he said

Bringing modern standards into university medical curricula and creating a national certification system for medical institutes and practitioners are some of remaining challenges to meet and beat.

Mr Kamilov, Deputy Minister of Health, called for further cooperation, “we shouldn’t stop at 2010 – if projects such as this continue it will bring Uzbekistan closer to meeting the millennium development goals.”

New training centre opened

To coincide with the one year review Mr William Hanna, from the European Commissions EuropeAid office, inaugurated a new training centre in Samarkand.

Mr Hanna was pleased to note the competent project leadership by the Ministry of Health and met with doctors and project leaders on the ground. They explained how training in the integrated management of childhood illness Protocol (IMCI) has helped to better triage sick children and to make less and better use of drugs for diseases like pneumonia among other successes.
 

Quality maternal and child healthcare to reach remote Uzbek communities

TASHKENT, Uzbekistan – 12 May 2009.

In a sweeping set of nationwide healthcare reforms, Uzbek maternal and child health workers in 9 regions are receiving training in international standards to save more mothers and babies lives. The joint Ministry of Health, European Commission and UNICEF project will see nearly 12,000 health workers trained in new techniques by the end of 2010. The emphasis is on ensuring child survival, safe motherhood and improving essential newborn care.

The project kicked off in July 2008, yet the huge training programme is now rolling out to the regions.

In the Eastern region of Andijian staff are being trained in newborn resuscitation, essential newborn care, the promotion of exclusive breastfeeding and effective growth development monitoring to better keep track of babies health and development. In the Central Samarkand region, training is underway in the integrated management of child illnesses for both doctors and nurses and the full introduction of the international live birth definition (ILBD). The ILBD provides better data on infant mortality to better address issues in care at the policy level. It is being rolled out nationwide in 2009.

Programmes are also underway in Tashkent city, Samarkand region, Namangan, Syrdarya, Khaskhadarya, Surkandarya, Navoi and Djizzak, thats 9 of Uzbekistan 14 regions.
Seveenteen training centre’s across the country are also being built up from scratch and the new techniques are being included into university medical curricula so future doctors and nurses keep up the good work.

According to UNICEF’s State of the World’s Children 2009, every day around 1,500 women die from complications related to pregnancy and childbirth globally. Since 1990, the estimated annual number of maternal deaths worldwide has exceeded 500,000. That’s nearly 10 million maternal deaths during the past 19 years.

In Uzbekistan, 99% of births are attended by a health professional and 97% take place in health facilities. There are almost as many maternal and child health workers as in Western Europe. Yet mortality rates are far higher, so it’s all about training professionals to give better care.

For more info, please contact:

Matthew Taylor @ UNICEF mataylor@unicef.org
Tel +998-71-233.9512
Cell +998-93-399.0558