Interesting country example: SERBIA
The continuum of care through the health
sector to reduce disabilities and
vulnerabili...
Mother/Child health care system
in Serbia
• Integrated model of publicly owned facilities
• 3 levels of health care
• MoH,...
Health status of women/children in
Serbia
Indicator 2005 2010 MDG 2015
General
population
Roma
population in
settlements
G...
Enabling policies
• Comprehensive multisectoral policy towards children
as an important component of Serbia’s development
...
National program on health care of
women, children and youth
• Goals
• Objectives
• Principles:
– Continuity
– Equity
– Ac...
Hospital – maternity,
neonatology
Counseling
unit for
parenting
ECD
Counseling
unit
Service for women
health care
Service ...
Antenatal health care in primary level (1)
• Guidelines for PHC professionals
– Standards and procedures
– Health status c...
Antenatal health care in primary level (2)
• Counseling unit for parenting:
– Group health education
– Gynecologist, midwi...
Perinatal care
• Guidelines for professionals:
– Physiological delivery
– General principles of care and treatment in
mate...
Health care of newborn –
maternity hospital
• Guidelines for newborn care
– Clinical care
– Screening for metabolic disord...
Guidelines for communication
with parents of newborns at risk (1)
• Training of professionals in maternity hospitals
• Soc...
• Objectives:
– provide adequate information to parents
– provide support
– link family with available services in their c...
Health care of newborn – PHC
– All children:
- Polyvalent patronage nursing services
- Child health care services
– Childr...
Patronage nursing services
• College-educated nurses
• Preventive home visits
• Health education in PHC or
community
• Uni...
Home visiting objectives
• Promote family health
• Assess family health, its functionality , the family’s living condition...
• Family Data Set
– Risk assessment (health, social, environmental)
– Checklist of risks
– Interview, observation, medical...
Home visiting of high-risk families
• Family monitoring
• Evaluation of strengths
• Priorities:
– Health control Early dia...
Phone Counseling for a Healthy Baby
‘Halo Beba’• Aims:
– to improve availability of information on child health and care t...
Child Health Care Services
• Team: Pediatrician and pediatric nurse
– Preventive checkups
– Control checkups
– Health educ...
ECD Counseling unit
• Organizational unit (areas with more than 8500 children 0-6)
• Team members:
– Pediatrician
– Nurse
...
Achievements of Serbia’s MCH
services for young children
• Improvement of mother/child health status
• Strong leadership
•...
Remaining challenges
– Increase the number and coverage of counseling units for
parenting in PHC, primarily for vulnerable...
Thank you
• Contact:
Svetlana Mladenovic Jankovic
Email: jankovic.svetlana@gmail.com
Upcoming SlideShare
Loading in...5
×

Presentation by Ms. Svetlana Mladenovic Jankovic, Head of the Health Education Unit, Health Promotion Center, Institute of Public Health of Belgrade, Serbia

319

Published on

The continuum of care through the health sector to reduce disabilities and vulnerabilities – from the maternity to home visiting at the household level.
From 4th Child Protection Forum in Tajikistan, 2013.

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
319
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
6
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • ,
  • Transcript of "Presentation by Ms. Svetlana Mladenovic Jankovic, Head of the Health Education Unit, Health Promotion Center, Institute of Public Health of Belgrade, Serbia "

    1. 1. Interesting country example: SERBIA The continuum of care through the health sector to reduce disabilities and vulnerabilities – from the maternity to home visiting at the household level Dushanbe, August 1, 2013 Svetlana Mladenovic Jankovic Institute of Public Health of Belgrade, Serbia
    2. 2. Mother/Child health care system in Serbia • Integrated model of publicly owned facilities • 3 levels of health care • MoH, Local Self-Government • Financing: Health Insurance Fund • Access to services –Strengthening the role of paediatricians and gynaecologists in PHC: “dom zdravlja” (DZ) – Moving from curative towards a preventive approach – Developing and strengthenning home visiting services
    3. 3. Health status of women/children in Serbia Indicator 2005 2010 MDG 2015 General population Roma population in settlements General population Roma population in settlements General population Roma population in settlements Infant mortality rate 8.0 25.0 6.7 14.0 4.5 12.0 Under 5 mortality rate 9.3 28.0 7.1 15.0 5.0 14.0 Exclusive breastfeeding under 6 months 14.9 18.0 13.7 9.1 30.0 Antenatal care, at least once 99.3 88.9 99.0 94.5 / Skilled attendant at delivery 99.2 92.9 99.7 99.5 99.9 Early child development index / / 94.3 88.3 / MICS 2005, 2010, UNICEF World Bank Report, 2012 National MDG Report, Government of the Republic of Serbia, 2006
    4. 4. Enabling policies • Comprehensive multisectoral policy towards children as an important component of Serbia’s development policy • Instruments to mobilize all social partners to create conditions that are as favorable as possible for children’s development and social integration • Instruments to identify and reach children from the most vulnerable populations, such as children with developmental difficulties and children from socially and culturally excluded populations • Mechanisms to monitor the state of child rights and child welfare during this period of economic, social and political transition in Serbia
    5. 5. National program on health care of women, children and youth • Goals • Objectives • Principles: – Continuity – Equity – Accessibility – Human rights protection – Caring for vulnerable groups – Participatory approach – Inter-sectoral cooperation – Quality of health care services • Implementation policies and guidelines – Activities – Content – Technologies – Team members – Data management
    6. 6. Hospital – maternity, neonatology Counseling unit for parenting ECD Counseling unit Service for women health care Service for child health care Patronage nurse service Community services Primary Health Care Continuum care: Organizational structure Institute of Public Health “Halo Beba” Phone Counseling Institutes for diagnostic and treatment
    7. 7. Antenatal health care in primary level (1) • Guidelines for PHC professionals – Standards and procedures – Health status control – Risk assessment – Criteria for referrals • Team: Gynecologist, midwife, patronage nurse – Clinical and ultrasound checkups – Laboratory examinations – Health education
    8. 8. Antenatal health care in primary level (2) • Counseling unit for parenting: – Group health education – Gynecologist, midwife, pediatrician, dentist, patronage nurse, nutritionist – 7th – 9th months of pregnancy • Preparation exercises for delivery • Home visiting – Patronage nurse – Health education, risk assessment, reporting to gynecologist
    9. 9. Perinatal care • Guidelines for professionals: – Physiological delivery – General principles of care and treatment in maternity wards • Team: Gynecologist, neonatologist, midwife • Baby-friendly (BF) and BF+ programs not fully implemented
    10. 10. Health care of newborn – maternity hospital • Guidelines for newborn care – Clinical care – Screening for metabolic disorders – Screening for visual or hearing disorders • Discharge criteria/Early diagnosis/ Criteria for referral
    11. 11. Guidelines for communication with parents of newborns at risk (1) • Training of professionals in maternity hospitals • Social model of counseling – partnership approach with long-term impact on: – decision-making with regards to the needs of the child – the quality of cooperation between the parents and the professionals – reduced risk of mother-child separation and institutional placement – influencing the positive experience of raising one’s child (relationship, nurturing, discipline practices) – expectations from the child.
    12. 12. • Objectives: – provide adequate information to parents – provide support – link family with available services in their community • Team for counseling: pediatrician/neonatologist, head nurse, gynecologist, psychologist, social care associate, psychiatrist • Phases: first counseling and support in maternity ward followed by counseling before discharge • Notification of PHC services Guideline for communication with parents of infants at risk (2)
    13. 13. Health care of newborn – PHC – All children: - Polyvalent patronage nursing services - Child health care services – Children with developmental risks: - ECD Counseling unit
    14. 14. Patronage nursing services • College-educated nurses • Preventive home visits • Health education in PHC or community • Universal/enhanced approach • Promotive care, prevention, early intervention • Since 2008: Roma health mediators Target groups and number of visits •pregnant women 1 or more )* •women after delivery 5 or more )* •newborns 5 or more )* •infants 2 or more )* •children in 2nd , 4th year 1or more )* •the elderly 1or more )* )* RISK OBSERVED
    15. 15. Home visiting objectives • Promote family health • Assess family health, its functionality , the family’s living conditions, and identify health and wellbeing-related risks of its members • Identify vulnerable populations and assess risk for neglect and abuse • Promote health of the children and stimulate early child development • Promote responsible parenthood and positive relations between parents and children • Connect the family with social and welfare services and other services, according to family needs
    16. 16. • Family Data Set – Risk assessment (health, social, environmental) – Checklist of risks – Interview, observation, medical record data, health status control • Method – Flexibility – Family needs – Family participation • Activities – Health education – Health status monitoring – Skills training – Link family and local community services (MoH, IPH Bgd,UNICEF, CPHA) Guidelines for Home Visiting
    17. 17. Home visiting of high-risk families • Family monitoring • Evaluation of strengths • Priorities: – Health control Early diagnosis of developmental difficulties and surveillance – Skills training Early stimulation to promote development – Linking family with services in local community PHC: pediatrician Social welfare service ECD counseling unit Kindergarten NGOs SOCIAL INCLUSIONSOCIAL INCLUSION • Project ‘Family as a center of child development’ (UNICEF, IPH Belgrade) – Patronage nurses, social welfare, local government, NGOs – Trainings, round tables, manual
    18. 18. Phone Counseling for a Healthy Baby ‘Halo Beba’• Aims: – to improve availability of information on child health and care to parents and family members – to improve coordination of MCH services and continuity of care • Since 2001 • 24/7 concept • 46 patronage nurses + IPH • 900,000 received calls • 170,000 calls to families • Encompassed 170,000 mothers after delivery • 15,000 calls to pregnant women • 200,000 visits to www.halobeba.rswww.halobeba.rs • 2,000 answers by email • Outcomes: – visits to outpatient paediatric clinics and dom zdravlja have decreased by 10% – coverage of newborns and mothers with home visits has increased from 62% - 97% • ‘HALO BABY ‘ as a NATIONAL BRAND
    19. 19. Child Health Care Services • Team: Pediatrician and pediatric nurse – Preventive checkups – Control checkups – Health education – Home visit • Referral to ECD Unit – Risk factors (biological, psychological, family, social) • Referral to secondary and tertiary health care institutions – According to records from ECD Unit • Monitoring of child health status and provision of health services • Risk assessment • Increase parental capacities for responsive parenting
    20. 20. ECD Counseling unit • Organizational unit (areas with more than 8500 children 0-6) • Team members: – Pediatrician – Nurse – Psychologist – Speech therapist – Pedagogue educator – Social worker • Early detection of disabilities/vulnerabilities • Needs and capacities assessment • Family support • Individual plan of intervention • Early stimulation • Referral to other health services and institutions for treatment • Referral to community services for family support • Pediatrician as a member of Committee on needs assessment for educational, health and welfare support
    21. 21. Achievements of Serbia’s MCH services for young children • Improvement of mother/child health status • Strong leadership • Decentralization in PHC • Accessibility of services • Improvement of professional capacities • Early detection • Referral system • Strong home visiting program • Strengthening of family capacities • Involvement of trained lay persons • Inter-sectoral cooperation • Social inclusion
    22. 22. Remaining challenges – Increase the number and coverage of counseling units for parenting in PHC, primarily for vulnerable parents – PHC ECD unit: Organizational unit Functional team – Provide additional education of pediatricians in PHC on early detection and intervention – Develop and implement the use of screening and assessment tools for ECD – Fully institutionalize the BF+ standards – Update legislation on data management and reporting in health care system – Improve data flow between services (particularly from PN to other professionals within and outside health system) – Develop a data base of children with developmental difficulties – Strengthen partnership for health (local community involvement, intersectoral coordination; civil society organizations involvement)
    23. 23. Thank you • Contact: Svetlana Mladenovic Jankovic Email: jankovic.svetlana@gmail.com
    1. A particular slide catching your eye?

      Clipping is a handy way to collect important slides you want to go back to later.

    ×