Better child and maternal health in Kazakhstan

WHO/Alberta Bacci

Every year, thousands of newborn babies and children younger than five years die in Kazakhstan. Many of these deaths could be avoided by using simple tools and techniques. An ongoing project on support for maternal and child health in Kazakhstan, supported by WHO and the European Union (EU), has successfully improved both maternal and child health in three regions (South Kazakhstan, Karaganda and Aktobe). On 25 August 2011, the project partners will present the achievements so far. Plans are also ongoing to extend the project to other regions and to use the experiences gained in the pilot regions as examples of good practice.

Tackling high maternal and neonatal mortality rates

The maternal and neonatal mortality rates in Kazakhstan are several times higher than those in the EU. More than 5000 children younger than five years (about half of which are newborn) die in the country each year, mainly from perinatal complications, infections, trauma and anomalies of development. WHO estimates that using simple tools and techniques could save the lives of about one third of these children.

In addition, more than 100 women die each year because of bleeding resulting from aggressive labour management during childbirth and complications of abortions. Many of these deaths can be avoided by introducing and replacing the aggressive clinical management with simple, scientifically proven, evidence-informed, cost-effective and efficient tools.

Reorganized referral system

The project in Kazakhstan has reorganized existing resources, first by establishing an effective referral system and strengthening community involvement. Existing health care services are rationalized to ensure that each pregnant woman and each newborn baby is cared for in an appropriate facility.

There are three levels of care: the first provides for normal pregnancies and healthy newborn babies; the second for pregnancies at moderate risk; and the third is a regional referral centre with a neonatal intensive care unit. Bringing all the high-risk infants together at the third level enables the necessary expertise to develop, so that each baby can have the best chance of survival. This also creates a referral system, with clear criteria indicating where women in each risk category should give birth, and includes instructions for moving from one level to another.

Following WHO guidance, the project works with individuals, families and communities to develop a commonly agreed multisectoral district plan of action for district authorities, nongovernmental organizations and communities themselves. This approach builds capacity for care in the home, making health decisions and responding to obstetric, neonatal and child emergencies, and strengthens social support mechanisms.

Questioning normal routines

As part of the project, an eight-day WHO training course on effective perinatal care teaches midwives, doctors and nurses to question the normal routines and discard practices they have previously thought to be appropriate, enabling participants to understand that they themselves can make a change. The course advocates that all care should be family-centred and evidence informed and that only low-cost interventions should be carried out. Experience in the country shows that pregnant women are often hospitalized unnecessarily and given excessive medication.

During the course, the role of the midwife is upgraded so that midwives manage all normal cases of labour and delivery. The obstetrician in charge only takes over when there is a deviation from the normal process. Obstetric complications often occur as a result of outdated knowledge, poor skills and the absence of evidence-informed clinical protocols. The project focuses on improving the skills of health care staff and improving the health practices carried out by families and communities.

Women and babies in Kazakhstan are receiving the most appropriate treatment, and a better start through placing more control in the hands of midwives and communities and training health personnel in evidence-informed techniques.