A new model of primary maternal and newborn care in Kazakhstan
Kazakhstan is on the way to reforming primary health care. In the context of the Global Conference on Primary Health Care, held in Astana in 2018, the country is building integrated and socially oriented health services at the primary care level. This is also one of key priority areas of the state health development programme “Densaulyk”.
Primary health care can help to reduce maternal and infant mortality. However, gaps in the knowledge and clinical skills of health professionals may affect the quality of primary care. To address this, primary care services must be oriented so that the patient is at the centre.
A new model of maternal, antenatal and postnatal care is being implemented in 17 primary health-care centres of excellence around the country, which were launched in 2018 and 2019. One of these centres of excellence is located in the town of Esik, in the Enbekshikazakh Region near Almaty.
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A network of primary health-care centres in the Enbekshikazakh Region is an early adopter of a person-centred approach in Kazakhstan.
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Community nurses play an important role in the health and well-being of new parents and babies. They educate and help parents to take care of their babies.
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Here in Esik, a multidisciplinary team provides care to mothers and children at the primary health-care facility.
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Multidisciplinary teams make the best use of the skill mix of the health workforce. They include family doctors, paediatricians, dentists, primary care nurses, nurse aids, social workers and health administrative staff. Health workers interact closely with patients and families, draw up patient-specific treatment plans and share responsibility for decisions on patients’ health.
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The network managers in Esik redistributed and optimized the roles of health workers and increased the number of social workers. Paediatricians and therapists went through reorientation training to become family doctors.
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The role of nurses was also expanded. Nurses now provide autonomous counselling separately from family doctors. In 2018 and 2019, nurses participated in trainings to learn how to work in a multidisciplinary team, including how to communicate within the team and with patients. They also learned how to assess a family’s situation in a holistic way, taking into consideration their history, living conditions, income, and other social and psychological factors.
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The new approach to delivering health care in the community is based on the universal progressive model of home visiting services – an effective and evidence-based methodology that puts the child at the centre of care.
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“I advise mothers on following a healthy diet, explain breastfeeding, tell them when it’s time for vaccinations. We, community nurses, follow pregnant women, newborns and children until the age of 5,” says Akmaral, a nurse working in Esik.
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During her visits to families, Akmaral is often accompanied by one of the social workers who assesses the “climate” within the family. The social worker must ensure that there is no harm to the physical, emotional or psychological development of the children. If the social worker ranks a family as being at risk, the family is flagged to one of the relevant governmental organizations or local nongovernmental organizations.
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Social workers also provide advice to families at the primary health-care facility. Here the social worker is talking to a family about the allowances they can receive from the government as parents with many children.
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The introduction of community nurses helped to reduce child mortality in the area and eliminated inequality in access – every family with small children has the right to regular visits and check-ups.