Kyrgyzstan CARC MCH Forum

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KyrgyzstanCARC MCH Forum
Access and Quality of Primary Health Care with
focus on Mother and Child Care
Tolkun Jamangulova

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• Rapid Appraisal Study in Chui and
• Issyk-Kul oblasts, Kyrgyzstan
• Prepared by
• Kyrgyz-Swiss Health Reform Support Project

on behalf of UNICEF, Kyrgyzstan
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• 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

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• Family planning
• Not enough information on family planning
• 71 of women have IUD (100-150 som for placing)
• 48 of women use contraceptives

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• 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)

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• 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 lt 3 years old
• only 8 (4) had ever been given iron supplement

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• Duration of breastfeeding

Months of breastfeeding of last child
No. mothers (n145)
15 (10)
0 5 months
15 (10)
6 12 months
115 (79)
gt 12 months
Time of beginning supplementary food
No. mothers who have started (n196)
supplementary food for their last child
Time
63 (29)
0 months
83 (39)
5 7 months
29 (14)
8 2 months
23 (11)
gt 12 months
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• Maternity departments
• Complains for bad service and conditions
  everything is missing
• Informal payments in between 225-425 som

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• 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

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• 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.
  

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• 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.

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• 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).
  

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• 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.

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• 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

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• Availability of family planning material
• FAP 7, FGP 14, FMC 3. Total - 24

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• 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)

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• 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

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• 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).