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Кыргызско – Швейцарский проект

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Access and Quality of Primary
Health Care with focus on
Mother and Child Care
Tolkun Jamangulova
Kyrgyzstan
CARC MCH Forum
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 supplementation
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
Duration of breastfeeding
Months of breastfeeding of last
child
0 – 5 months
No. mothers (n=145)
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%)
Maternity departments
• Complains for bad service and
conditions В«everything is
missingВ»
• 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 Sometimes
time
Condoms
IUD
Contraceptive
pills
FGP
FAP
FGP
15
13
13
2
3
3
4
3
Never
FAP FGP FAP
5
1
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 equipment
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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