Development of Primary Pediatric Care in Ukraine

1. Development of Primary Pediatric Care in Ukraine Prof. M.Aryayev Odessa State Medical University Odessa Ukraine

2.  Established in 1900; IAU, CRE, Medine, MCU member; 4000 students, including 1500 foreign students from 37 states; 800 teachers.

3. OSMU PHC projects

4. OSMU International Projects supported nation–wide PHC restructuring, officially prioritized by the Government; contributed to accreditation the GP and nurse professions; contributed to creation GP and nurse re-training curriculum; supported foundation and development of the National GP Association.

5. Live birth rate – 10,2 ‰ General mortality rate – 16,4 ‰ Perinatal mortality rate – 10,8 ‰ Neonatal mortality rate - 5,7 ‰ Infant mortality rate - 9,8‰ Life expectancy for male - 62 years for female - 73 years

6. Ukraine UA is number 78 on the Human Development Index GNP – 118,5 billions $ USA GDP – 5,5 $ USA per capita (29,4 $ in NL) Expenses for health care: UA – 210 $ USA per capita a year RUS – 535 $ USA per capita a year NL – 2564 $ USA per capita a year

7. Ukraine 603 700 sq. km in size 46 mln inhabitants urban population 68% population density 76 per sq. km literacy rate – about 100%

8. Realization of nation-wide FM restructuring in Ukraine needs following context Declining number of hospital beds Expanding and improving the PHC system Multi-channel finance system Urgent health promotion campaigns Partly replacing cure for care and prevention

9. Development of Primary Pediatric Care in FM restructuring Creation of adequate FM team model efficient in primary pediatric care. Improving of primary pediatric teaching for members of FM team. European integration of higher medical education system and pediatric teaching in Bologna process.

10. Improving the health of children and adolescents by implementation of multi- and inter- professional approaches to FM pilot polyclinics practice in Odessa with stress on the role of primary pediatric care

11. There are 2 courses of primary pediatric care in the history of medicine 1) Children received their primary care from GP’s and pediatricians are consultants (Western Europe) 2) Pediatrics established as primary care specialty by providing well-child visits with health screening and immunization (USSR, NIS). There are 2 options for FM and pediatrics future: 1) FM could partially or wholly withdraw from the care of children or they could complete directly with pediatrics for the primary pediatric care 2) FM and pediatrics could collaborate in providing primary pediatric care for all children and their families (an example is pediatrician in FM team)

12. Items of discussion Responsibility for coordination of primary pediatric services: general practitioner vs. pediatrician in FM team. Retraining of “basic specialists” (therapeutist, gynecologist, pediatrician) in existing specialized therapeutic, gynecologic, pediatric polyclinics towards a general practitioners and postgraduate training new GP’s. Cost and value of developed primary pediatric care as specialism in FM in Ukraine.

13. FM team models in pilot polyclinics

14. Advantages of pediatrician as FM team member Improving therapeutic and rehabilitation medical services for children and producing better health outcomes. Improving child supervision, risk factors assessment, child physical evaluation (by pediatric growth charts), child neuropsychological evaluation ( by Vineland scale). Improving care of children with long-term effects of chronic illness or catastrophe. Home visiting, pediatric nutritional counseling, education, preventive and health promotion campaigns AIDS, child abuse, youth and family support).

15. Advantage of psychologist as FM team member Psychological support and treatment for children with psychosomatic disorders, chronic conditions, disabled children, victims of child abuse and hyperactive children. Assessment of child’s mental development, emotional, social, cognitive function and planning of appropriate activities to help children realize their potential in this area.

16. Conclusions Development of primary pediatric care in the field of FM, multi- and inter- professional cooperation in FM team produces better health outcomes. Participation of pediatrician in FM team improves therapeutic and rehabilitation medical services for children, child supervision, risk factors assessment, child physical and neuropsychological evaluation, chronic care services, home visiting, pediatric nutritional counseling, health promotion campaigns. FM and pediatrics collaboration in providing primary care for children and adolescents is an important option for the future.