Meeting on IMCHS Project Monitoring Results: Recognizing Achievements and Lessons Learned

By Maxim Fazlitdinov

Health care system representatives from all 14 provinces of Uzbekistan, UN agencies, the Asian Development Bank and other partners of the Improving Mother and Child Health Services (IMCHS) project gathered in Tashkent on 16 June 2011 to review the project’s integrated monitoring results.

Launched in 2008, the project is being implemented by the Ministry of Health in partnership with UNICEF and the European Commission in eight regions across the country. It aims to improve the quality of maternal and child healthcare. A nationwide scale up of the project is planned for the period of 2011 – 2014.

During the meeting, national monitoring experts shared findings of the project integrated monitoring in the areas of Newborn Care, Effective Perinatal Care, Breastfeeding, Child Growth and Development Monitoring, Integrated Management of Childhood Illnesses (IMCI) and training of patronage nurses in Inter-personal Communication (IPC).

The meeting became instrumental in summing-up the achievements and lessons learned from the project and allowed participants from different provinces to share experiences and address some of the key challenges in taking the achievements through development of recommendations and action points in small working groups.

Mr. Jean-Michel Delmotte, UNICEF Representative in Uzbekistan underlined the value of lessons learned during the monitoring process and called upon the project partners to build on these lessons to make the scale up effort a success.

Dr. Dilorom Ahmedova, Head of the Mother and Child Health Department of the Ministry of Health (in the centre) chairs the meeting on the IMCHS project’s integrated monitoring results

 © UNICEF Uzbekistan/2011

“Proper documentation and communication of lessons learned will help avoid similar obstacles and will ensure the same mistakes are not repeated at the cost of delaying the project, budget overruns and beneficiary dissatisfaction.” – commented Mr. Delmotte.

The meeting participants highlighted improved quality of health care services provided by health professionals in eight pilot provinces as one of the major achievements of the project.

The project allowed for 20-25% savings in the health care system achieved through reducing hospitalization and applying less invasive procedures.

Significant decrease in use of unnecessary medicines promoted by the project helped reducing out of pocket expense of the patients many of whom represent vulnerable population groups.

Meeting participants develop recommendations and action plans on addressing the challenges in the IMCHS project implementation. These recommendations and lessons learned will be taken into account during the nationwide project scale up activities in 2011 – 2014.

 © UNICEF Uzbekistan/2011

“It is important to monitor and evaluate any health intervention to determine its contribution and impact on the population it was designed to help, in addition to its sustainability.” – said Dr. Dilorom Ahmedova, Head of Mother and Child Health Department of the Ministry of Health who chaired the meeting. “We made a good effort to ensure that the monitoring processes were established during the inception of the project to identify a baseline, and methods of gathering data. Our team of monitoring experts developed a low-cost, comprehensive and easy to apply integrated monitoring tool which was used to gather information we are discussing today.”

Dr. Ahmedova also mentioned that improving health services for children and mothers is vital if Uzbekistan is to achieve its Millennium Development Goal targets by 2015 on reducing child mortality and improving maternal health. In this regard, the IMCHS project is one of the top priority interventions for the Government of Uzbekistan in the area of mother and child health.

“For better tracking the progress, monitoring processes will be further enhanced and incorporated more deeply in the mother and child health interventions at all levels.” – concluded Dr. Ahmedova.

EU Development Commissioner Gets End-user Feedback from MCH Project in Uzbekistan

By Savita Varde-Naqvi

TASHKENT, Uzbekistan, 24 November 2010.

“We know now that more injections and more medicines do not necessarily mean better treatment for patients,” Dr Abdumalik Rahmanov, Chief Doctor of the Namangan Regional Children’s Hospital in Eastern Uzbekistan told Mr Andris Piebalgs, European Union (EU) Commissioner for Development in the Uzbek capital of Tashkent recently.

During their visit to Uzbekistan on 15 and 16 November 2010, a five-member EU delegation led by Mr Piebalgs got a local flavour of the Mother and Child Improvement Project supported by the EU and UNICEF from the health professionals who had come to meet him from different areas where the project is being implemented.

Mr. Jean-Michel Delmotte, UNICEF representative and Prof Adham Ikramov, Minister of Health receive EU Commissioner for Development Andris Piebalgs outside the Ministry of Health in Tashkent Uzbekistan.

 © UNICEF Uzbekistan/2010

“With the training we received in child survival and newborn care, we made sure to vaccinate and take care of 35,000 children who came into the Ferghana Valley with the refugee influx from Kyrgyzstan in June this year Dr Rahmanov added with the confidence of an empowered public health practitioner.

Dr Kochkor Eshmuradov from a health post in Jizzak region said he was speaking on behalf of many rural doctors and health providers who could not meet Commissioner Piebalgs in person that day. “In the beginning, a lot of us were sceptical; but after seeing positive outcomes of an integrated management approach to childhood illnesses, it became evident that we badly needed a surge of new knowledge and techniques. I graduated some 35 years ago and can tell you that a lot has changed in medical science since then,” he said jokingly.

Kochkor Eshmuradov, doctor from Zomin district of Jizzakh region, Talks about empowerment of service providers at its positive knock-on effect on community level health facilities.

 © UNICEF Uzbekistan/2010

Improving Mother and Child Health (MCH) services is a key priority of the Government of Uzbekistan. According to the Multiple Indicator cluster survey (MICS) jointly conducted in 2006 by the Government of Uzbekistan and UNICEF, 57 out of a 1000 Uzbek children die before their fifth birthday. Among 57 child deaths, 26 occur during the first 30 days of life. Clearly, survival of newborns and their mothers is crucial for Uzbekistan to achieve Millennium Development Goals 4 and 5 of reducing child and maternal mortality.

Making effective and inexpensive social services accessible to all children and mothers who need them is high on EU’s development agenda too, particularly after it adopted the Lisbon Treaty earlier this year. “Maternal and child health is not a one-time intervention. It requires an ongoing development of the health system. We can use this example in other countries, especially in the rural areas to create a win-win situation for all,” affirmed Mr Piebalgs.

Based on an innovative package of newborn and child survival interventions piloted by the Ministry of Health and UNICEF in the eastern region of Ferghana, this collaborative project in its current form is being implemented in eight regions of the country, namely Jizzak, Sardariya, Kashkadarya, Surkhandarya, Namangan, Andijan, Samarkand and Novai.

It has trained more than 13,000 health professionals (doctors, nurses, midwives and health managers) and promoted safe motherhood, newborn and child care among 14.5 million people in the pilot regions, constituting more than half the population of the country. A central feature of the project is the training and mentoring of health providers in low cost, high impact, newborn and child survival techniques that are rooted in evidence. Improved quality of care has contributed to the overall wellbeing of young children and their mothers.

Mr Jean-Michel Delmotte, UNICEF Representative in Uzbekistan highlighted partnership and equity as the two main axes along which the Mother and Child Health Improvement project is built. “This joint project pulls in partners like WHO, USAID, GTZ insuring coherence, complementarity and contribution to the overall health sector reform. It also enables us to implement a strategy that concentrates on the hard to reach and the poorest communities, making it in fact more cost effective than focusing on the most accessible,” explained Mr Delmotte.

Some of the achievements of the project underscored by Deputy Minister of Health in charge of maternal and child health, Prof. A Kamilov were institutional strengthening of the health sector and its contribution to the ongoing health reform.

Dr Habibo Aipova, Chief Doctor at the Baby Friendly Hospital in Jizzakh talks to UNICEF about the benefits of the project in terms of exclusive breastfeeding, hand-washing, diarrhea control and overall infection management.

 © UNICEF Uzbekistan/2010

Dr Habibo Ibragimova, in charge of the multi-profile paediatric centre in Jizzak summed up the difference the training and mentoring was making to her and many like her, “With the capacity to provide newborn resuscitation, deaths due to asphyxia have gone down; overall infection control has considerably improved; with children being treated more efficiently and according to international standards, the number of days they need to stay in the hospital have been reduced, making a considerable saving for families as well as hospitals. With mothers allowed to be with their children during treatment, it is less stressful for everyone.”

But what happens if a mother-in-law forces her young daughter-in-law to give water the baby she wants to exclusively breastfeed? “Oh, we take care of that and prepare the mother-in-law to be an ally well in advance. We have breast feeding support groups that engage with not only mothers in law, but also with husbands and help them to play a facilitating role,” Dr Ibragimova said with impressive self-assurance.

Little wonder then that the EU has already agreed to Phase II of this project which will have a tighter focus on equity and participatory community learning, promoting positive household practices in child care, nutrition, health and hygiene as well as enable families to recognise ‘danger signs’ in children that should tell them to run for help to the nearest health facility immediately.

EU Parliamentarians Applaud MCH Project in Uzbekistan

By Savita Varde-Naqvi


TASHKENT, Uzbekistan, 28 October 2010. - Members of Parliament of the European Union (EU) visiting Tashkent, Uzbekistan were delighted to see the impact of the Mother and child Health (MCH) project being implemented by the Ministry of Health in partnership with UNICEF and the European Union in eight regions of Uzbekistan. The delegation was briefed by the Ministry of Health of Uzbekistan and UNICEF about the ongoing Phase I of the project (2008-2011) and the positive results it has produced in terms of safe motherhood and improved survival of newborns and children below five years through.

The parliamentary delegation visited the MCH Training Centre at the Republican Scientific Research Institute of Paediatrics in Tashkent and was addressed by Prof A. I. Kamilov, Deputy Minister of Health and Mr Jean-Michel Delmotte, UNICEF Representative in Uzbekistan. Prof. Kamilov highlighted the importance of the project to the Health Sector Reform by reducing health service costs related to maternal and newborn care. “Presidential Decree 1096 on MCH which came into force in 2009 has put mother and child health at the heart of the Health Sector Reform,” Deputy Minister Kamilov said. “Our President, Islom Karimov was recently at the UN General Assembly Special Session on the review of the Millennium Development Goals and reiterated Uzbekistan’s commitment to achieving these global targets. The MCH project supported by EU and UNICEF helps us considerably to move forward on MDG 4 and 5,” he emphasized.

“After the adoption of the Lisbon Treaty, Children’s right to education, nutrition and better health care has become one of the core agenda items of the European Union. Your presence here shows the commitment of European Union to ensure that all children have access to and enjoy better health care,” Mr Delmotte told the Parliamentarians. Working through 85 maternity hospitals, regional and district level children’s hospitals and more than 2,000 primary health care units (PHC), the project has covered 14.5 million people, which is half the population of Uzbekistan. It has brought within the reach of ordinary people high impact and low cost interventions that correspond to international quality protocols like the
Integrated Management of Childhood Illnesses (IMCI).

The EU Parliament's members and delegation are briefed on the project's achievements.

 © UNICEF Uzbekistan/2010

Contribution to Millennium Development Goals

The project has so far focused on improving the technical skills of service providers and medical staff through a series of quality trainings and introduction of new evidence-based practices. Funding for Phase II of the project, envisaged for the period 2011 to 2014, has already been sanctioned by the EU to consolidate the gains of Phase I and expand them in the form of good governance across the health sector. “Phase II of the project will introduce new participatory strategies of working with families and communities to involve them in the management of their own health and that of their children,” explained Mr Delmotte.

Dr Hari Krishna Banskota, Project Manager, presented the progress made by the project in less than three years. One of the key achievements of the project he said was the reduction of cost to families in terms hospitalisation and overuse of medicines which was the case before the project was introduced. Citing evidence provided by the Children’s Hospital in the eastern province of Namangan, he said the treatment of a case of bronchial asthma had gone down from 50,000 Sums (approximately USD 31) to 6,000 Sums (approximately USD 4) with the introduction of IMCI interventions. The number of hospital days was reduced from 12-14 to 3-5 and patients were being treated with just one drug (Salbutamol) with oxygen therapy rather than with nine drugs including antibiotics, which was the case earlier.

The project has created a pool of 665 national and regional trainers who have already trained 13,000 doctors and other health providers reaching the positive impact of the project to Primary health Centres and households. The project has demonstrated that considerable progress in reaching the Millennium Development Goals can be made through an equity-focused approach taking life saving interventions to communities that have least access to quality health services.

The EU delegation with Deputy Minister of Health Professor Asomiddin Kamilov, Vice-Chairman of the delegation Alfreds Rubiks and UNICEF Representative Jean-Michel Delmotte (first row, from left to right)

 © UNICEF Uzbekistan/2010

Policy change and quality improvement

Using the framework of the Presidential decrees 1096 and 1144 on MCH reform, the MCH project is providing evidence for shaping national health policy through a package of high impact interventions at a considerably reduced cost. Dr Banskota highlighted the sense of empowerment of health workers who were now able to conduct self evaluation of their work using quality assurance tools developed by WHO and widely introduced through the project. Parliamentarians were able to see the strategy for sustaining quality health services through a systematic approach to skill enhancement and use of indigenously developed training materials with the inputs and participation of doctors and health workers.

The project briefing to the EU Members of Parliament at Tashkent’s premier Republican Scientific Research Institute of Paediatrics provided them with crucial insights into the significance of EU’s partnership with the Government of Uzbekistan and UNICEF for improving the survival and wellbeing of children and their mothers. “Safe motherhood is high on the list of priorities of EU’s development agenda,” Mr Alfreds Rubiks, Vice Chairman of the delegation said. “Thanks to this partnership, we were able to see the best use of EU’s development assistance in this part of the world.” 

 Key Achievements of the project

•     Presidential Decree 1096 on MCH (2009 – 2013) has included project interventions as key priorities of MCH sector reform. 
•     International Live Birth Definition has become the national level perinatal outcome reporting system. 
•     Revised MCH curriculum introduced in Medical Institutions.
•     WHO QoMNHC tool introduced for CQI System.
•     Pool of National and Oblast Trainers (665) established
•     13,000 health workers and managers trained and supervised
 

Ensuring Quality Care

Training of health professionals on new techniques is part of the strategy to improve the quality of mother and child care. In turn, several hundred trainers oversee future training to guarantee continuity of the new techniques introduced.

Perinatal services at the Namangan Children’s Multi-Profile Medical Centre, as with hospitals throughout the country, have benefited from the programme of improvements introduced by the Uzbek Ministry of Health, the European Commission and UNICEF.

The need for change was obvious. Although practically all births in Uzbekistan were being attended by medical professionals, 50 percent of infant mortality was occurring during the neonatal period. Thanks to the training of thousands of medical professionals in new techniques, lives are being saved.

What is more, they are changes which are sustainable, with the recruitment of several hundred trainers, who oversee future training to guarantee continuity of the new techniques introduced.

And the improvements are being guaranteed, thanks to a quality assurance system, with specialists trained in monitoring performance of medical institutions around the country.

Azimova Dilbar is a senior Neonatologist and Quality Assessor who’s job it is to help monitor peformance.

“Our assessments are based on WHO standards of quality assurance,” she said, “Which are then analyzed and presented to the health facilities with plans for improvements to very specific deadlines.”

Perhaps the biggest guarantee of this programme having a long-term impact, is its adoption by the Uzbek Government at a national policy level. Diloram Akhmedova, the Chief of the Department on Mother and Child Health, explained her Government’s position. “The goals of this project have now been embraced by a Government policy aimed at strengthening human capacity to improve health care to mothers and children throughout Uzbekistan.”

Now two years into the project, it is an extremely satisfying position for the UNICEF team involved in its implementation. “You can see there has been impressive results in the skills of the health professionals,” explained Hari Krishna Banskota, UNICEF Maternal and Child Health Specialist. He went on, “And it is quite equitable, because this has been expanded to the most rural areas of Uzbekistan.”

In the delivery room back at the hospital in Namangan, a few minutes after giving birth, the beaming smile on Margubu’s face was proof of the changes that have taken place.

Looking tired, but clearly elated she said, “I’m very lucky to have such a great midwife, and having my husband here with me.”

Snuggled against her body, was their tiny baby, Yusuf; Uzbekistan’s newest citizen, enjoying a better start in life, thanks to changes in mother and child medicine, that will benefit his children a generation from now.

 

Supporting Action for Child Survival

NAMANGAN, Uzbekistan, 19 September 2010. - Early morning at the Namangan Children’s Multi-Profile Medical Centre in eastern Uzbekistan, is the busiest time in the admissions department. Parents with their children, some of them having traveled overnight many kilometres to get here, wait in turn to be seen. Amid the cries of babies and the press of anxious parents, the staff work efficiently and calmly, prioritizing the cases.

Namangan Children’s Multi-Profile Hospital is using red, yellow and green ribbons to prioritize cases and make sure that children with serious illnesses are admitted first.

In doing so, they are helped by a colour ribbon system which ensures the most urgent cases are seen first. During a lull in the clinic, nurse Yumrzakova Iroda explains the coding of green, yellow and red ribbons which are tied around the babies arms, with the red ribbon cases going to the front of the queue. These are babies considered critical with demanding urgent attention.

It is all part of the improvements under the country-wide IMCI programme (Integrated Management of Childhood Illnesses) being carried out by the Uzbekistan Ministry of Health, the European Commission and UNIEF, which is producing a dramatic transformation in hospitals such as this one, and producing a real impact on child survival.

Upstairs in the hospital’s Resuscitation Unit, we witnessed further evidence of the changes.

Three month old baby, Abdugaffarova Mavluda, had just been admitted with breathing problems caused by a lung infection, but was now out of danger thanks to prompt intervention. Overseen by the Chief of the Resuscitation Department, Dr. Aripov Alisher and his team, the baby was being given oxygen and being closely monitored.

Thanks to prompt intervention, a three month old Mavluda, who was admitted to the hospital’s resuscitation department with a lung infection, is now out of danger.

“Before we would have used intravenous injections,” explained Dr. Aripov. “But now we have been trained to give oral medicines, which are more effective, and less stressful.”

Less invasive treatments and fewer prescribed drugs has also resulted in significant cost savings at hospitals such as this one, with reductions of up to 25%.

What has also helped relief stress for mothers and babies alike, is allowing them to remain together during treatment, when in the past the parents would have been excluded.

Cuddling her five month baby, Begim, mother Akhmedova Muyassar, told us she was allowed to stay with her baby throughout her treatment for fever which was now passing. “I knew she was recovering,” she said, “when her smile returned.”

Muyassar Akhmedova has been allowed to stay with her five month baby throughout her treatment for fever which was now passing.

Many more babies and their parents are are grateful for the changes taking place in provinces throughout Uzbekistan thanks to the IMCI programme. It is helping to promote infant and young child feeding, newborn care at community level and growth monitoring. IMCI training has also been extended to doctors in hospitals, at primary care level and also in rural communities.

Chief Doctor at the Multi-Profile Medical Centre, Rakhmanov Abdumalik, explained the impact the system was having even in the remotest rural areas in the surrounding countryside. “During home visits, nurses give advice on things like exclusive breast feeding, nutrition and hygiene.”

The result is a reported drop in the number of diarrhea cases coming for treatment.

At the nearby Infectious Disease Hospital, the number of children being admitted for diarrhea fell from around 9,000 in 1998, to less than 3,000 today.

Further proof of changes, which are contributing to greatly improved child survival for the under-fives.
 

Improved Care for Newborns

FERGANA VALLEY, Uzbekistan, 31 August 2010. - Watching her new born baby sleep, in the special care unit at the Namangan Centre of Obstetrics and Gynecology, young mother Bobokhanova Madina wears the kind of loving smile that can only come from someone who knows how lucky she is to be a mother.

Regional training centres established under the joint Ministry of Health, EU and UNICEF project help ensure that trained professionals share with their teams newly gained knowledge and skills on newborn and child care.

 © UNICEF/NYHQ 2010/Estey

But that was six years ago, and well before a joint initiative by the Ministry of Health of Uzbekistan, the European Commission and UNICEF, to improve mother and child health services across the country.

Weighing less than two kilogrammes, Madina’s new baby is clearly well and thriving, and is allowed to be with her all the time. “The doctors include me in all aspects of the baby’s treatment,” she said.

Now at the end of the second year of implementation of the Ministry of Health, EC and UNICEF project, 11,000 health professionals have been trained in maternal and child care in the eight regions, including Namangan. Out of these, 3,000 have received additional training in new-born care, which is having a direct impact on reducing child mortality in the region. The project also monitors health professionals for improvement in the quality of medical care they are able to provide following the training.

 

Marguba Tukhtabaeva with her new born son Mukhammad Yusuf at the Namangan Perinatal Centre.

 © UNICEF/NYHQ 2010/Estey

“Mothers are able to choose the position to give birth and can have husbands and relatives present,” said Dr. Abdukhalieva. Fellow Neonatologist, Kodirova Manzura, pointed out other benefits. “We’ve also been taught the importance of breast milk and exclusive breast feeding,” she said. “And have introduced immediate contact between new born babies and their mothers, which helps good breast feeding.”

Having just arrived in labour, Marguba Tukhtabaeva and her husband Akmal Muminov are awaiting the birth of their baby. The midwife Sohiba Sadriddinova helps them prepare with exercises.

 © UNICEF/NYHQ 2010/Estey

They were talking in one of the newly completed training rooms attached to the project. In another room, general practitioners and paediatricians from the Andijan region were being trained in IMCI techniques (Integrated Management of Childhood Illnesses), through a stimulating role playing session with each taking it in turn to be doctors and patients to hone their skills in correctly diagnosed early intervention.

 

Pediatrician Uktamkhon Toirova from Andijan attends training on new born and child care techniques under the joint project of the Ministry of Health of Uzbekistan, the European Commission and UNICEF.

 © UNICEF/NYHQ 2010/Estey

“This exercise is very useful,” explained Paediatrician, Toirova Uktamkhon, during a break in the training. “Sometimes we have to find solutions quickly, so this helps to improve our skills.”

By focusing on new-born care, the joint project of the Ministry of Health, EC and UNICEF is already making positive contribution to the overall health sector reform and quality of care. 

Breastfeeding: Health workers help get things right

By Nigina Baykabulova  

GULISTAN, Uzbekistan, 5 August 2010. - A two-month old Abdulaziz is sleeping quietly in the arms of his mother. He looks very healthy like the big cute baby doll counselors use in maternity hospitals across the country to teach new mothers the basics of breastfeeding.

Dildora Rakhmankulova, 24, is not a first-time mother. Her elder daughter Diyora was born in the same maternity hospital as Abdulaziz and is already three years old. What is striking for the young mother is the difference in the way she is feeding her newborn now than what she did with three years ago with his sister.
 

Dildora Rakhmankulova, 24, feeds her two-month old son Abdulaziz only with breast milk.

“I’m giving my son only breast milk, no other food, and no water. I see that he is doing really well, especially in comparison to my daughter. He didn’t have a cold or any other illness so far,” says Dildora. She thinks it’s all because of the benefits of exclusive breastfeeding: “I am convinced that my breast milk is the best and the most natural food for my child. It makes him stronger and also helps prevent various childhood illnesses”.  

On the contrary, looking after her daughter during the first few months after she was born was a real challenge. Dildora didn’t know how to breastfeed and who to refer to for a piece of advice. Her daughter often fell sick and she sometimes gave her breast milk, at other times milk formula and medicines ever so often.

Clearly, it was not her intention to treat the older child that way. “I simply did what the doctors had prescribed and told me to do,” she adds.

Supporting mothers

Health providers are essential in getting mothers to breastfeed their newborns and infants. They watch women closely during their pregnancy, as well as during and after delivery, and are called on for expert advice. But far too often, health workers themselves lack up-to-date knowledge and skills and fail to guide the would-be mothers correctly.

“For years, we have been taught to keep mothers and newborns separately, feed infants not on demand, but according to the clock. Similarly common was the practice of giving breast milk substitutes. In fact it was considered a progressive thing to do,” explains Maryam Hojimatova, chief doctor of the maternity unit of Gulistan’s health department in Syrdarya region.

Her maternity unit was not actively promoting breastfeeding till three years ago. But now it is taking big strides to change the situation in the region. Maryam-opa’s team has achieved this by making a big push to create a fully supportive environment for mothers, expectant and nursing alike. Promotion of exclusive breastfeeding is a major component of this effort.

“We seem to have long underestimated the role of exclusive breastfeeding for both children and their mothers. We now understand that it lays the foundation for the future well-being of a child,” says Maryam-opa.

After taking part in a series of very useful trainings, her team became a passionate advocate for breastfeeding among women and their families. Immediate relatives of the health workers were to benefit first. “It’s not easy to say “no” to old practices if you are not convinced yourself,” admits the senior nurse Dildora Mavlyanova.

This August, the Gulistan maternity unit was listed among other 35 health facilities of Uzbekistan, which successfully joined the “Baby-Friendly Hospital Initiative” supported by UNICEF. This means they follows the 10 steps to successful breastfeeding and encourage all new mothers to come along.
 

Nargiza Rozikova, 30, (left) delivered her third child at Gulistan’s maternity unit just two days ago. After counseling by health workers, she is determined to spread the word about the importance of exclusive breastfeeding in her home village Bogoriston of Syrdarya region.

Making impact last longer

As elsewhere, in Uzbekistan women do not stay long in maternities. Few days of counseling are not enough to keep new mothers fully committed and continue breastfeeding. They soon go out and enter a different world, full of contradicting messages and misinformation. It is not surprising then that the national rate of exclusive breastfeeding stands at 26%, which is below the global average of 37% which is already low.

That is why the Gulistan maternity unit extended its chain of influence by involving four family clinics and five rural health points in their area. “We all receive the same patients, at one point or another. So we thought, why not work together to improve our women and children’s health,” says Maryam-opa.

Mothers’ support groups are also part of this chain. Led by nursing mothers, sometimes the groups enjoy greater trust in the families and communities. “A doctor’s advice may not always come through strongly. Healthy babies of healthy mothers are a better proof of the value of breastfeeding,” acknowledges Maryam-opa.

The collective effort is yielding some positive results. This year the ‘connected’ rural health points are reporting fewer or no cases of diarrhea and other routine illnesses among the babies, while the Gulistan maternity unit confirms that all deliveries have been safe.