Development of Primary Pediatric Care in Ukraine

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Development of Primary Pediatric Care in Ukraine

• Prof. M.Aryayev
• Odessa State Medical University
• Odessa
• Ukraine

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Odessa State Medical University

• Established in 1900
• IAU, CRE, Medine, MCU member
• 4000 students, including 1500 foreign students
  from 37 states
• 800 teachers.

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OSMU PHC projects
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OSMU International Projects

• supported nationwide PHC restructuring,
  officially prioritized by the Government
• contributed to accreditation the GP and nurse
  professions
• contributed to creation GP and nurse re-training
  curriculum
• supported foundation and development of the
  National GP Association.

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• Ukraine

• Live birth rate 10,2
• General
• mortality rate 16,4
• Perinatal
• mortality rate 10,8
• Neonatal
• mortality rate - 5,7
• Infant mortality rate - 9,8
• Life expectancy
• for male - 62 years
  for female - 73 years

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• Ukraine

• UA is number 78 on the Human Development
  Index
• GNP 118,5 billions USA
• GDP 5,5 USA per capita
• (29,4 in NL)
• Expenses for health care
• UA 210 USA per capita a year
• RUS 535 USA per capita a year
• NL 2564 USA per capita a year

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Ukraine

• 603 700 sq. km in size
• 46 mln inhabitants
• urban population 68
• population density 76 per sq. km
• literacy rate about 100

• 43 doctors (2 pediatricians) per 10 000
  population
• 88 hospital beds (20 for children) per 10 000
  population

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Realization of nation-wide FM restructuring in
Ukraine needs following context

• Declining number of hospital beds
• Expanding and improving the PHC system
• Multi-channel finance system
• Urgent health promotion campaigns
• Partly replacing cure for care and prevention

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Development of Primary Pediatric Care in FM
restructuring

• Creation of adequate FM team model efficient in
  primary pediatric care.
• Improving of primary pediatric teaching for
  members of FM team.
• European integration of higher medical education
  system and pediatric teaching in Bologna process.

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Improving the health of children and adolescents
by implementation of multi- and inter-
professional approaches to FM pilot polyclinics
practice in Odessa with stress on the role of
primary pediatric care
Purpose of Child Care Development in Odessa
polyclinics as Pilot Objects
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• There are 2 courses of primary pediatric care
  in the history of medicine
• 1) Children received their primary care from GPs
  and pediatricians are consultants (Western
  Europe)
• 2) Pediatrics established as primary care
  specialty by providing well-child visits with
  health screening and immunization (USSR, NIS).
• There are 2 options for FM and pediatrics
  future
• 1) FM could partially or wholly withdraw from the
  care of children or they could complete directly
  with pediatrics for the primary pediatric care
• 2) FM and pediatrics could collaborate in
  providing primary pediatric care for all children
  and their families (an example is pediatrician in
  FM team)

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Items of discussion

• Responsibility for coordination of primary
  pediatric services general practitioner vs.
  pediatrician in FM team.
• Retraining of basic specialists (therapeutist,
  gynecologist, pediatrician) in existing
  specialized therapeutic, gynecologic, pediatric
  polyclinics towards a general practitioners and
  postgraduate training new GPs.
• Cost and value of developed primary pediatric
  care as specialism in FM in Ukraine.

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FM team models in pilot polyclinics
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Advantages of pediatrician as FM team member

• Improving therapeutic and rehabilitation medical
  services for children and producing better health
  outcomes.
• Improving child supervision, risk factors
  assessment, child physical evaluation (by
  pediatric growth charts), child
  neuropsychological evaluation ( by Vineland
  scale).
• Improving care of children with long-term effects
  of chronic illness or catastrophe.
• Home visiting, pediatric nutritional counseling,
  education, preventive and health promotion
  campaigns AIDS, child abuse, youth and family
  support).

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Advantage of psychologist as FM team member

• Psychological support and treatment for children
  with psychosomatic disorders, chronic conditions,
  disabled children, victims of child abuse and
  hyperactive children.
• Assessment of childs mental development,
  emotional, social, cognitive function and
  planning of appropriate activities to help
  children realize their potential in this area.

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Conclusions

• Development of primary pediatric care in the
  field of FM, multi- and inter- professional
  cooperation in FM team produces better health
  outcomes.
• Participation of pediatrician in FM team improves
  therapeutic and rehabilitation medical services
  for children, child supervision, risk factors
  assessment, child physical and neuropsychological
  evaluation, chronic care services, home visiting,
  pediatric nutritional counseling, health
  promotion campaigns.
• FM and pediatrics collaboration in providing
  primary care for children and adolescents is an
  important option for the future.

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ODESSA
Thank you for attention!