www.zdravlje.org.rs
Home visiting
in Serbia
Dr Svetlana Mladenović Janković
jankovic.svetlana@gmail.com
in Serbia
•
Integrated model of state owned facilities
•
3 levels of health care
•
MoH, Local Self-Government
•
Universal access and availability of services
www.zdravlje.org.rs
PHC ‘Dom zdravlja’
Service for Adult Health
Service for Home Treatment and Care Preventive Center Service for Pre-school Children Health Service for Schoolchild Health Polyvalent Patronage Nurse Service Service for Women Health Service for Diagnostics , RO, Lab
Consulting Service
Unit for Mental Health
Unit for Internal Medicine Unit for ORL
Unit for Ophtalmology Unit for Physical Therapy Counseling
Unit for Youth Health
Counseling Unit for ECD
Department for HR
Department for Maitaining Service for dental health
Polyvalent Patronage Nurse Service
•
Long tradition
•
Monovalent
polyvalent approach
•
Exclusively preventive service
•
Legal framework
– Health Care Law
– Health Insurance Law
•
Policy framework
– National Children’s Action Plan
– National MDGs
www.zdravlje.org.rs
Service delivery
Home visiting
•pregnant women•women after delivery
•newborns
•infants
•children in 2nd, 4thyear
•the elderly
•people with some health conditions
.
Health education
work in PHC and
community
•school for parenting expecting parents
•counseling unit for youth health
youth
•preventive unit adults
•primary schools schoolchildren
•public places general population
Home visiting
• Universal progressive model:
– essential package + additional visits
• Guideline
– Risk assessment (health, social, environmental)
• Interview, observation, medical record data, health status control
• Family records – Method • Flexibility • Family needs • Family participation • Strength based – Activities
• Information and counseling
• Health status control
• Skills demonstration
www.zdravlje.org.rs
Patronage nurse as linking factor
NGOs Kindergarten /School Child protection Social welfare center Gynecologist GP Chosen pediatrician/ ECD Unit Local authorities PPN&Family
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5
Pregnant woman Newborn Infant 2 years 4 years
0 10 20 30 40 50 60 70 80 90 100 Realized number Expected number Coverage HV in Belgrade: Coverage of target groups and number of visits per person
www.zdravlje.org.rs 0 1 2 3 4 5 6 7 8 9 PHC N o v is it s/ n u rs e / d a y 0.0 0.2 0.4 0.6 0.8 1.0 1.2 N o e m p lo y e d n u rs e s/ N o n u rs e s a cc o rd in g s ta n d a rd No visits/nurse/day Workload norm
No employed nurses/No nurse according standard
• 3 year nurse college (180 ECTS)
• Post graduate studies
• Licensed nurse (7 years)
• Chamber of Nurses
• Continuous medical education/ in service training (24 credits/year)
• Health Council Body of Serbia
• Job description: home visits, health education, reporting
www.zdravlje.org.rs
Financing
• Revenue collection: mandated social health insurance
• HIF Budget, MoH Budget, Local government budget
• Purchasing: Contract between PHC facility and HIF
• Global budget, capacities based
• Pre-set salary scale: education level, type of activities, working conditions, level of management responsibility
• Capitation formula Oct 2012
• Home visiting services guaranteed as part of the basic package of universal primary care services, covered 100% from the HIF budget
Research on home visiting
• Few…
• KAP study, mothers of 2y old
children in Belgrade, 2008
• Questionnaires on child health
and parental practice + SF HOME
• Home visits predict mother’s
behavior Early stimulation Breast feeding Home care during illness HOME VISITS
www.zdravlje.org.rs
Phone Counseling ‘Halo Beba’
• Aims:
– to improve availability of information on child health and care to
parents
– to improve coordination of MCH services and continuity of care
•
Since 2001• 24/7 concept
• 36 patronage nurses
• Over 1.000,000 received calls
• 170,000 calls to families
• Encompassed 170,000 mothers after delivery
• 200,000 visits to www.halobeba.rswww.halobeba.rs
• On line counseling
• Outcomes:
– visits to outpatient paediatric clinics and dom zdravlja has decreased
by 10%
– coverage of the newborns and mothers by home visits has increased
from 62%- 97%
Booklet
DVD
www.zdravlje.org.rs
Characteristics of
Home visiting in Serbia
• Strong governance
• Minimized financial barriers
• Individual / Family-centered
• Needs based
• Participatory approach
• Diverse activities and contents
• Continuum of care
• Staff deficit
• Decreasing motivation
• Inadequate (excessive) workload norm
Further improvement
• Project “Support to Early Childhood Development and Social Inclusion of Children by Building the Capacities of Polyvalent Visiting Nurse Service and by Ensuring the Continuity of Family Healthcare” , UNICEF, IPH Belgrade
• 2014-2016, 10 PHC
– Improving the knowledge, skills and practice of patronage nurses
related to early childhood development
– Improving the knowledge, skills and practice of Roma health
mediators related to early childhood development
– Improving the cooperation of polyvalent visiting nurses and Roma
mediators with other services
– Improving the standards of work of polyvalent visiting nurse
service
– Advocating for the importance of the role of polyvalent visiting
nurses and Roma health mediators in maintaining and improving family health and early childhood development
www.zdravlje.org.rs
VIDEO: HV in Serbia
Cooperation between UNICEF Regional & Country Office and IPH Belgrade
