Home / Setting the scene

“Mother and child care is a priority in the Health system of our country. This regulation is enshrined within fundamental state documents and State programs on specification of the Health department system. In 1992 the Republic of Uzbekistan ratified the Convention on Child Rights and in 2000 our county took responsibility for achieving the MDG’s.”

 H.E. Mr Feruz Nazirov. Minister of Health of the Republic of Uzbekistan

In a large number of low and middle income countries, maternal and child mortality through preventable causes remains high. We have the technology and knowledge to stop over 60% of current child deaths globally. Yet having this knowledge is not enough; the challenge lies in its sustainable application.

Uzbekistan ranks 62 globally in under five (U5) mortality figures (UNICEF SOWC 2008). An independent assessment puts U5MR at 57 per 1000. The Infant Mortality Rate (IMR) is 48 per 1000 and the maternal mortality rate (MMR) is 28 per 100,000 (MICS, 2006). 99% of births are attended by a health professional and 97% of births take place in health facilities. Uzbekistan has almost as many health workers working in maternal and child care as the developed world, yet the mortality rates are far higher. The challenge lies in improving standards of care and ensuring they are sustained in the long term.

Service delivery for personal health services is characterized by excess infrastructure, mostly inherited from the Soviet era, with an emphasis on hospital facilities. There are 4310 outpatient facilities serving the population of nearly 27 million. The ratio of hospital beds per 10,000 population is 48.3 compared to a European average of 32. The ratio of physicians per population (26.5 per 10,000 population) is lower than the European average (33 per 10,000) and their geographical distribution is skewed towards urban areas, - creating physical access problems in rural and mountainous regions.

The Ministry of Health (MoH) is the main government body responsible for health policy, including Maternal and Child Health (MCH), which is now becoming a majority reform priority. A Deputy Minister for MCH coordinates the national reform programme and chairs the coordinates cooperation with both national and international bodies that are involved in supporting MCH activities

The Ministry of Health provides guidance to the Health Minister the Autonomous Republic of Karakalpakstan and acts as the supervisory authority for all 13 regions and 202 City and neighbourhood health departments. Each regional Health Department has one Deputy and 2-3 specialist staff devoted to MCH.

Mother and child healthcare is a national priority, numerous high level governmental policy documents have been adopted on MCH since 2002. These include national action programmes, Presidential executive orders and others.

A baby sleeps at the Ferghana regional maternity centre

Mother and child health reforms to date have led to positive results. MCH indicators, such as maternal and infant mortality rates, have improved in some areas To meet these trends should now be enhanced, expanded and improved.

THE FERGHANA PILOT

A child’s check up at a Ferghana regional maternity centre

UNICEF and partners have supported the Governments health sector reform efforts in maternal and child healthcare in the Ferghana region since 1999.

The EU supported roll out across the country is evidence based. It builds on the Ferghana experience, consolidates the Ferghana intervention projects into a cohesive package and adds new elements.

‘LOW COST & HIGH IMPACT’ - The Lancet – March 2006

The core element was the Newborn Survival Package. This included:

•  Emergency obstetric care
•  Introduction of WHO Live Birth Definition
•  Neo-natal resuscitation
•  Essential newborn care
•  Promotion of exclusive breast feeding

In 2007 an independent study compared Samarqand, a non-intervention area, with Ferghana. Between 2003 and 2006 the results showed consistent mortality rates in Samarqand and a consistent reduction in mortality rates in Ferghana. Birth asphyxia, a major cause of death, also consistently fell between in Ferghana during this period.

The project facilitated policy level, health system and community level changes. New techniques led to a 25% increase in previously uncounted infant deaths, alongside an increased accuracy and quality in the recording of newborn & prenatal deaths. With more information, problems in the health system are now more easily identified.

“I think it (the training) made me realize just how painless birth could be for all involved; for the mothers, for the child and for us. Allowing partners into the delivery process makes mothers feel at ease, taking a very consultative approach and just being more friendly and relaxed in general makes the whole process less stressful, more pleasurable and ultimately safer.”

Ishimova Flora is Chief Doctor at the Ferghana regional maternity centre


SCALING UP AND ROLLING OUT

 

Ferghana training session for maternal and child health workers

The project being scaled up across across eight regions; Khashkadyria, Surkhandarya, Samarkand, Jizzak, Sirdarya, Namanagan, Andijon and Navoi.

The Ministry of Health is leading on implementation, with technical support being provided by UNICEF.

As well as scaling up, the project consolidates the different intervention packages piloted In Ferghana into one cohesive package. This is fully in line with the Governments wider healthcare reform efforts and to meet Millennium Development Goals 4 and 5.

The Project includes strengthening MCH services by upgrading both perinatal and postnatal services, in close collaboration with international development partners active in the Mother and Child Health sphere in Uzbekistan.

Read more

back to top