KyrgyzstanKyrgyzstanCARC MCH ForumCARC MCH Forum

Access and Quality of Primary Access and Quality of Primary Health Care with focus on Health Care with focus on Mother and Child CareMother and Child Care

Tolkun JamangulovaTolkun Jamangulova

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 supplementationOut 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

115 (79) > 12 months

15 (10%) 6 – 12 months

15 (10%) 0 – 5 months

No. mothers (n=145)Months of breastfeeding of last child

Duration of breastfeeding

23 (11%)> 12 months

29 (14%)8 – 2 months

83 (39%)5 – 7 months

63 (29%)0 – months

No. mothers who have started (n=196) supplementary food for their last child

Time

Time of beginning supplementary food

Maternity departments

• Complains for bad service and conditions «everything is missing»

• 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 time

Sometimes Never

FGP FAP FGP FAP FGP FAP

Condoms 15 2 - 5 - -IUD 13 3 4 1 - 3Contraceptive pills

13 3 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 equipmentFAP:

– 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).