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Mother and Infant Health Project Description

JSI, with the MIHP Project (2006-2010), will roll-out MIHP services and key interventions of evidence-based medicine (EBM). With funding from USAID, possible private sector funding and the support (financial, logistical, legal, and technical) of the MOH and participating facilities, JSI will achieve nearly complete roll-out by the end of year four of the project. This will be accomplished by establishing three regional offices to support the roll out process in six new clusters of 3 - 4 oblasts. By the end of the new four year project, JSI should be able to directly cover at least 30% of all births in Ukraine and indirectly cover 50% of all births through the dissemination efforts of selected MIHP facilities - thereby increasing the use of evidence-based maternal and newborn health care practices, services and resources in order to improve maternal and newborn health and reduce maternal and neonatal mortality.

Through MIHP, JSI will improve women's reproductive and newborn health and increase public awareness of healthy behaviors. In new facilities, JSI will achieve the same profile of results observed under the current MIHP - the development of family-friendly delivery rooms, the reduction of practices such as amniotomies and episiotomies, and an increase in free position during delivery, immediate skin-to-skin contact, early breastfeeding and the rooming-in of mothers and newborns.

MIHP will conduct the following strategic activities:

• Assisting the MOH with review and revision of existing protocols; development of new EBM standards for mother and newborn health care, with a stronger focus on integration of these standards into a package of EBM perinatal practices in Ukraine

• Collaborating with oblast health authorities to improve linkages between women’s clinics, maternities and pediatric polyclinics and/or family doctors

• Revising current curricula for pre- and post-service medical institutions (medical universities and colleges) in order to increase the evidence base of educational programs for medical students and health care providers including OB-GYNs, midwives, and nurses

• Improving health care providers’ interactions with patients and counseling, promoting client-oriented services to increase client satisfaction, and ensuring continuity and consistency in client-provider communication across service levels

• Developing centers of excellence to serve as models for training/education for other clinical institutions. When appropriate, these centers of excellence will be developed in collaboration with the new USAID-funded, Improving Family Planning/Reproductive Health (IFP/RH) Project

• Facilitating a “learning by doing” process through competency-based clinical training of client-centered and evidence-based approaches. Each training course will include the PMTCT based on a comprehensive approach including primary prevention of HIV infection in reproductive age women; family planning (FP) and contraception in HIV positive women; prevention of HIV transmission in perinatal period, and continuum of care for mothers, infants and other family members. Early integration of all components into primary maternal and newborn/infant/child care services as well as creating linkages with non-governmental organizations (NGO) working in HIV/AIDS area will be considered a priority

• Raising the general population’s awareness of effective birthing and childcare practices with a special focus on “warm chain” techniques,  breastfeeding, complementary feeding, and Sudden Infant Death Syndrome (SIDS)

• Establishing a sound monitoring and evaluation (M&E) system and introducing the concept of quality improvement within the MOH and local health departments to measure effectiveness of implementation of EBM

• Procuring basic equipment for MIHP centers of excellence for the effective implementation of perinatal practices

MIHP-II has received requests from all the Ukrainian oblasts to join the Project. All the requests have undergone selection criteria and some oblasts were selected for the MIHP Year I activities. MIHP plans to involve all the oblasts which met the criteria of selection.  One facility from each selected oblast will be developed into a center of excellence that will serve as an example and training site for neighboring facilities and oblasts its cluster. As the facilities “graduate” as centers of excellence, MIHP will expand out to other facilities and oblasts in the region.

The project interventions will be built on the already achieved success of MIHP and other donor-funded programs in Ukraine. It will consist of clinical and counseling training for health providers at different levels, facility and community-based information and education for both families and providers along with creating a supportive environment through advocacy, policy interventions, and media campaigns.

To ensure sustainability, the final phase will be conducted. During this phase, supportive supervision will continue and follow-up tutorial trainings will be conducted by local trainers. JSI will work with oblasts and facilities to explore possibilities for leveraging financial and in-kind contributions throughout implementation, but particularly during this phase to insure continuation and further expansion of MIHP activities.

JSI will also enlist the support and assistance of health insurance organizations and the private sector to promote sustainability.