Utilization of Specialists with New Levels of Training in Applied Public Health

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by Maya Ababkova

Almaty public health institutions have employed 1996 Almaty City Medical College graduates from all four levels of training; graduates were assigned according to the demand for nurses within these institutions.

In the Perinatology Center and the Nursing Hospital, improvements have been implemented by a team of young specialists. In the Perinatal Center, indicators of high productivity include: pregnancy or treatment outcomes, epidemiology and patient satisfaction surveys.

Currently it is impossible to accurately estimate efficiency, due to the limited survey time (August through November). But one cannot help but admit the advantages of a rigid hierarchical nursing structure---a unified approach to duties, a division of functions, a high level of basic training and collective responsibility.

Our partnership has had concrete results, such as introduction of a infection control system supervised by nurses. As a result, in maternity hospitals the frequency of septic illness in newborns declined from 16.4 to 14.7 per 1,000 newborn infants, and the proportion of septic complications in surgical hospitals fell from 1.6% to 1.2%. These are true indicators of infection control efficiency.

Our work to perfect the infection control system continues. Continuous training of nurses in all city health institutions on issues of internal hospital infection control was established in the City Central Clinic. Several programs on infection control were developed:

We use specialists with level 4 secondary medical education training (nurse-managers) in all city high schools, where they organize complete medical aid, prophylactic work, sanitary situation control and health education. There are attempts to start research. A large part of their activities is devoted to teaching, and for this purpose new qualifications and a job description for nurse-organizers in school medical rooms were drawn up and approved.

In the hospital, nurses observe patients, correct prescriptions, help with rehabilitation and work in a team setting. They continue to expand their professional role. Standards on emergency care for syndromes are being drawn up. Seminars on therapy for geriatric syndromes, training ethics, medical ethics and communication are held, and reforms continue to be carried out. Since 1996, the director of this institution has been a nurse of the highest qualification, Manshuk Kozhabekova, who earlier worked as head nurse. Appointing her was a rather bold step on the part of the Health Department because health officials had no experience in such matters.

In the Nursing Hospital, similar progress has been made. Reforms that began five years ago now go deeper. Nurses review hospital charts of patients, make decisions based on doctors' advice, take part in discussions on a patient's condition, and have their own point of view on the care of their patients. Work on drawing up nursing standards continues. Patients with endocrine, heart and vascular illnesses receive education. The hospital is a training base for Almaty Medical College students, and graduates replenish the hospital staff. Set up by volunteers, the Mercy Group also strives to perfect issues on care of patients. Our hospital experience can be valuable for international partners as well as for the World Health Organization. Specialists in similar, newly established institutions---the number of which will evidently be increasing---can learn from this experience, since the hospital's services are substantially cheaper than those of a polyclinic.

Maya Ababkova is Chief Specialist on Nursing with Almaty City Health Administration, Almaty, Kazakstan.

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