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AIHA Women’s Health Initiative

“The value of AIHA’s Women’s Wellness Centers is that, besides delivering qualify midwifery services, the staff can counsel patients on a wide range of issues, including family planning and the prevention of sexually transmitted infections, as well as offer assistance in solving problems related to family violence. Just a couple of years ago, all of this would have been extraordinary for Moldova.”

Ion Ababii, rector of the Nicolae Testemitanu State University of Medicine and Pharmacy in Chisinau, Moldova (Chisinau/Minneapolis and Chisinau/Norfolk partnerships)

In the years following the collapse of the former Soviet Union, the already incomplete and fragmented healthcare services that previously existed for women eroded further, leaving huge gaps in coverage for many of the nearly 180 million women living in Central and Eastern Europe and Central Asia.

The transition to a market economy and breakdown of state-supported social and health systems resulted in a decrease in economic self-sufficiency for millions of women, according to studies conducted by UNICEF. This financial instability—coupled with increased rates of tobacco use, alcohol and drug abuse, unsafe sexual practices, intimate partner violence, and a host of other medical and behavioral concerns—has led to reduced life expectancy for women in more than half of the countries in the region.

Since 1997, AIHA and our partners have sought to fundamentally change both the way women’s health is viewed and how clients are treated in Central and Eastern Europe and Central Asia. Drawing on the strength of existing hospital-based partnerships, AIHA brought together key medical professionals, educators, and policymakers to form the Women’s Health Task Force.

Members of the Task Force participated in a series of workshops and meetings to build consensus on priorities and approaches for attaining universal goals such as reducing the number of unintended pregnancies, screening for diseases ranging from diabetes to breast cancer, and educating patients on healthy lifestyles. The Task Force also worked to formulate a women’s wellness program and create a model for centers that provide access to a wide range of clinical services and educational outreach programs.

Projects

AIHA’s efforts to improve the scope and availability of high-quality women’s health services are carried out through specific programmatic activities, including:

Partnership to Improve the Health of Women and Children in Kosovo

Launched in early 2009, this three-year USAID-supported partnership project is designed to improve the health of women and children in Kosovo by strengthening maternal and child healthcare capacity at the primary, secondary, and tertiary levels.

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More than two decades of political unrest culminating in war in 1998-1999 has left Kosovo’s healthcare infrastructure in severe crisis. The continuing poor health status of women and children represents a critical barrier to socio-economic development. Kosovo is home to around 2 million people, half of whom are under the age of 25, with some 350,000 women in their reproductive years.

Currently, Kosovo’s infant and maternal mortality rates are among the highest in Europe and the healthcare system is characterized by a lack of coordination among care providers, whether public or private, at all levels of care. Other key challenges include the inability to collect accurate maternal and child health data, quantify problems, and affect systematic solutions; lack of necessary equipment and supplies; significant clinical training and education gaps in pediatrics and women’s health; lack of regularly implemented hospital-based continuous education programs in neonatal resuscitation, pediatric emergency medicine, and other child health issues; and lack of community-based outreach programs focused on health promotion and disease prevention.

With support from the American people through USAID/Kosovo, AIHA launched a three-year partnership project to improve the health of women and children in Kosovo in March 2009. This partnership links US health and civic organizations with counterpart institutions throughout Kosovo to strengthen maternal and child healthcare capacity at the primary, secondary, and tertiary levels.

Together with key national and local stakeholders in Kosovo, AIHA and its partners are working to build the prerequisite institutional and human resource capacity needed to:

  • improve quality, scope, and frequency of prenatal care;
  • improve quality of primary level care for infants and children;
  • improve perinatal and post-partum care for women and newborns;
  • improve quality of care for high-risk mothers and infants, as well as emergency cases; and
  • raise awareness of the importance of prenatal care through targeted patient education and community outreach.

Additional project objectives include strengthening and expanding women’s gynecological services to include screening and early detection for breast and cervical cancer and premalignant disease; strengthening maternal and child health data collection, information, and reporting systems to better inform related policies and programs; and improving health professions education opportunities and tele-consultation services.

US partners contributing their knowledge and expertise include the Providence-based Women and Infants Hospital of Rhode Island and National Perinatal Information Center, California-based ValleyCare Health Systems and Livermore Rotary Club, and the American Medical Resources Foundation and Assist International.

To date, working closely with the Ministry of Health and local administrations, AIHA and its partners have completed a comprehensive assessment of tertiary, main secondary, and selected primary maternal and child health institutions spanning Kosovo. They have also conducted a maternal and child health roundtable and case management discussion with key local and international stakeholders, supported in-country activities related to the International Day of the Midwife, participated in the US Embassy’s Balkan Breast Cancer Initiative activities, initiated colposcopy services at the University Clinical Center of Kosovo in Pristina, and secured the donation of two ambulances, which will soon be equipped for neonatal transport and given to the Center. Other activities include participation in the National Maternal and Child Health Conference held in Pristina in May 2009, conducting a consensus meeting on the regionalization of perinatal care, and conducting trainings on neonatal resuscitation and obstetric emergency care at four regional hospitals.

Project activities have also focused on practitioner education, training, and networking; implementing a system of regionalization of neonatal care using the ambulances to transfer the most at-risk newborns to the tertiary care hospital; public education and outreach campaigns and targeted media messaging; and assessment, revision, and/or development of obstetric and neonatal protocols..

In addition, on September 16, 2009, AIHA and its partners helped conduct a health symposium titled “A Healthy Start in Life” at Camp Bondsteel, the US army base in eastern Kosovo. The event brought together nearly 200 Kosovar and Serbian physicians, midwives, and allied professionals working in healthcare facilities throughout the country.

To read more about this public-private partnership in the project closeout report, please click here.

Women’s Wellness Centers

Since 1997, AIHA partners have established Women’s Wellness Centers in some 30 communities throughout Central and Eastern Europe and Central Asia. These innovative centers represent a new, integrated model of women’s health service delivery in the region. Women’s Wellness Centers feature a client-centered approach and provide a full range of reproductive health, primary care, and selected specialty care services, including breast cancer education, prevention, early detection, and treatment or referral to an appropriate tertiary care facility.

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AIHA partnership Women’s Wellness Centers fill a void by providing not only diagnostic screening and clinical services for both acute and chronic conditions, but also much-needed patient and community health education and support programs. For the first time, women in Central and Eastern Europe and Central Asia can come to a single place to seek treatment and advice on health-related matters ranging from cancer, cardiovascular disease, and diabetes to family planning, maternal care, behavioral health, and menopause.

Women are empowered through programs that teach the value of good health and the importance of taking charge of their own wellbeing by adopting healthier lifestyles, performing monthly breast self-examinations, and avoiding situations that put them at greater risk.

These centers provide a comprehensive range of primary care services within the setting of an ambulatory care facility. They also offer a wide variety of health promotion programs such as classes, public education campaigns, telephone hotlines, and support groups addressing topics from domestic violence and substance abuse to coping with cancer.

The objective of each Women’s Wellness Center is to improve the quality of life—not just of the patients they treat, but their families and communities as well—by empowering women to play an active role in their own healthcare. Clinic staff accomplish this through on-going dialogue with patients, who are encouraged to participate actively in the decision-making process.

Primary Healthcare Partnerships

Through its expansive network of healthcare partnerships in Eastern Europe and Central Asia, AIHA has helped establish some 70 primary care, family medicine, and women’s wellness centers that provide comprehensive, high-quality clinical care to thousands of women each year.

Practitioners working at AIHA’s primary care or family medicine centers are trained to provide a wide range of women’s healthcare services, including breast and cervical cancer screening, reproductive health counseling and care, and education about healthy lifestyle choices. These clinics and the dedicated health and allied professionals who staff them are committed to ensuring the health of women and their families.

Breast Health Program

A key component of AIHA’s women’s health model is educating patients so they are better able to take an active part in their own wellbeing. This is evident in AIHA’s Breast Health Program, which not only provides clinical exams, but also focuses on teaching the basics of self-examination and encouraging healthy lifestyle choices. Additionally, as part of the Breast Health Program, some Women’s Wellness Centers have been equipped with state-of-the-art diagnostic tools and offer both ultrasound and mammography screening to patients who are self- or physician-referred.

Reported cases of breast cancer in Ukraine have risen some 70 percent over the past two decades and, with little education about early detection or access to reliable mammography equipment, diagnosis often comes too late. In response, AIHA Women’s Wellness Centers in Kiev, L’viv, and Odessa have placed special focus on breast cancer screening and care, offering both clinical services and psycho-social support.

Prevention of Mother-to-Child Transmission of HIV

Mother-to-child transmission is the primary route of HIV infection among children around the globe. Without intervention, an HIV-infected mother has a more than 30 percent chance of passing the virus on to her baby during her pregnancy or birth, or via breast milk after the child is born. Since 2000, AIHA has been training practitioners to prevent vertical transmission and helping raise public awareness—especially among vulnerable or high-risk populations—about treatment options.

More and more, the HIV/AIDS epidemic in Eastern Europe and Central Asia is breaking away from the high-risk populations of injecting drug users (IDUs) and commercial sex workers who first fueled its rapid spread. Statistics indicate that heterosexual transmission now accounts for nearly half of all new HIV infections. Women—particularly those in their reproductive years—are increasingly bearing the brunt of the epidemic, which makes effective prevention of mother-to-child transmission (PMTCT) even more critical.

AIHA’s PMTCT projects include:

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