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Post-Conflict Transition and Sustainability in Kosovo: Establishing Primary Healthcare-Based Antenatal Care

Published online by Cambridge University Press:  28 June 2012

Fay F. Homan ,
Cristina S. Hammond ,
Ellen F. Thompson ,
Donald O. Kollisch  and
James C. Strickler
Fay F. Homan*
Affiliation:
Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire, USA
Cristina S. Hammond
Affiliation:
Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire, USA
Ellen F. Thompson
Affiliation:
Office of Care Management, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
Donald O. Kollisch
Affiliation:
Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education at The City College of New York, New York, New York, USA
James C. Strickler
Affiliation:
Departments of Medicine and Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire, USA
*
Little Rivers Healthcare65 Main StreetWells River, Vermont 05081USA E-mail: fay.f.homan@dartmouth.edu
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Abstract

Introduction:

Kosovo is a post-conflict nation with an extensively damaged infrastructure, a weak primary care base, and poor maternal-child health outcomes. The Kosovo-Dartmouth Alliance for Healthy Newborns (the Alliance) sought to improve maternal and neonatal health in Kosovo by providing family medicine-based antenatal care (ANC).

Methods:

The ANC Program used a modification of the World Health Organization's four-visit, prenatal care model. The program is based in family medicine and requires minimal medical equipment, such as a blood pressure cuff, fetal doppler, measuring tape, urine dipstick, and charting materials. Patient education and counseling are stressed. Women are taught about danger signs in pregnancy and establishing an emergency plan, so that they can respond promptly if complications occur. Antenatal care doctors and nurses are trained to refer women to obstetricians for deviations from normal pregnancy. The providers are taught using a “Training of Trainers” approach, building on an existing system of family medicine trainers. In order to address challenges in implementation and sustainability, microsystems methodology is used to focus on implementing change and assuring quality improvement through shared decision-making and the study of outcomes.

Results:

Based on chart reviews and direct observation, ANC providers showed mastery of the components of ANC, including physical examination, recognition and referral of high-risk pregnancies, and patient education. After an initial pilot project, Kosovo's Ministry of Health recommended this program for dissemination throughout the country. During the next year, ANC was implemented at 27 Family Medicine Centers in nine municipalities; 1,671 women were seen for a total of 3,399 visits. Currently, the Alliance's model of ANC is offered in 30% of Kosovo's municipalities.

Discussion:

International aid projects often lack attention to long-term sustainability. Microsystems training gives participants the tools and framework to implement and sustain change, even after international support is withdrawn.

Conclusions:

The Alliance's model of family medicine-based ANC is simple to teach and emphasizes sustainability. It may be modified for use in different cultures and healthcare systems and offers the opportunity to improve maternal and infant health by providing low cost antenatal care, available in a woman's own community.

Keywords

antenatal carefamily medicineimplementationinternational healthKosovomicrosystemspost-conflictprimary healthcaretransition
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 1 , February 2010 , pp. 28 - 33
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

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