Better hospital care for children
In Kyrgyzstan and Tajikistan, children are receiving better care and hospitals are enjoying increased capacity following a WHO project on improving the quality of paediatric care in hospitals. The 3-year pilot concluded in December 2014, and has already delivered dramatic and visible results.
WHO/Europe supported the project's activities in 10 pilot hospitals in each country, with funding from and in partnership with the Russian Federation. Each hospital has reported significant improvements within the full spectrum of their paediatric patient care and in how their facilities operate. Improvements include reductions of unnecessary hospitalizations, and of unjustified and painful paediatric procedures such as injections and intravenous infusions, shortened hospital stays, more rational use of medicines and significant hospital resource savings.
Significant improvements in paediatric care in Kyrgyzstan's pilot hospitals
Systematic evaluation of the project's impact in Kyrgyzstan has shown that correct treatment in pilot hospitals after programme implementation was substantially higher than in control hospitals. Similarly, unnecessary hospitalization of children has fallen dramatically to 13% in pilot hospitals, compared to 62 % in the control group. One hospital reportedly measured savings of 68% over a 1-year period in 2 departments (paediatric care and infectious diseases). Iatrogenic risk (from inappropriate medical treatment or advice) in 10 hospitals was reduced from 95% to 14.5% within a year.
Improving medical staff skills
Health staff in the intervention hospitals reported considerable improvement in their ability to provide appropriate services. One nurse stated, "I have been trained in this hospital for 40 years, and now we are child friendly. This project helped us a lot, we have new equipment, we have new nice interiors, and when I go to work it is like a fairy tale. Now children are not afraid of us anymore."
"This project has reduced costs. This is one of the major achievements of the project," a hospital manager commented. The success has been recognized by both staff and patients, with those taking part expressing common sentiments that the project reduced workload, built trust in the population and dramatically reduced complaints in cases involving children.
All levels of WHO, in close collaboration with paediatricians from the Russian Federation and health sector representatives within Kyrgyzstan and Tajikistan, were involved to support the development, implementation and continual supervision of the pilot hospitals and their staff.
Specific project activities
The team conducting the project began with a thorough assessment of the quality of care, identifying gaps and areas for improvement in each pilot hospital and developing action plans. Recommendations followed an integrated approach to address the hospitals' common and specific needs.
- Adapt the WHO "Pocket book of hospital care for children" to national needs, providing easily accessible WHO guidelines.
- Train medical doctors and nurses on the use of evidence-based guidelines and foster a teamwork approach.
- Undertake self- assessments, including a child rights survey, and involve the hospital administration, health staff, parents and children up to 18 years old.
- Renovate hospitals and improve life-saving equipment.
- Train hospital directors and encourage a supportive professional culture through regular supervisory visits.
- Revise the medical institutes' curricula for post-graduate and continuous training, and improve the teaching of undergraduate medical students and colleagues on principles and guidelines of quality hospital care for children.
- Train and support national paediatric institutes and centres to strengthen sustainability and long-term capacity, and encourage their growth into centres of clinical excellence for their countries.
Sharing results and best practices
The project culminated with a roundtable of key stakeholders in Kyrgyzstan and Tajikistan who shared the final results of the project, and agreed on actions to encourage extending the best practices to the remaining hospitals in both countries. The project catalysed partnerships to improve the quality of child care in first-level hospitals in both countries, stimulated the development of policy and financial mechanisms to support the work.
Rolling out the WHO European child and adolescent health strategy 2015–2020 at national level
The project to improve paediatric quality of care sets an example for other Member States in the European Region and globally, to implement similar programmes that systematically improve child hospital care and health-care worker training processes. WHO/Europe will help to ensure that the success of this initial programme will be expanded in both countries, as well as extended to other countries within the European Region.
The project is one example of how the WHO European child and adolescent health strategy 2015–2020 can be implemented at country level. The strategy supports countries that are not yet on course to achieve the Millennium Development Goal (MDG) targets on infant and childhood mortality and reduce the burden of avoidable disease and mortality.