Home visiting in Serbia
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- Verity Patterson
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1 Home visiting in Serbia Dr Svetlana Mladenović Janković Institute of Public Health of Belgrade
2 Health care system in Serbia Integrated model of state owned facilities 3 levels of health care MoH, Local Self-Government Universal access and availability of services Reform process
3 PHC Dom zdravlja Service for Adult Health Preventive Center Service for Women Health Polyvalent Patronage Nurse Service Service for Pre-school Children Health Counseling Unit for ECD Service for Schoolchild Health Counseling Unit for Youth Health Service for dental health Service for Diagnostics, RO, Lab Service for Home Treatment and Care Consulting Service Unit for Ophtalmology Unit for Physical Therapy Unit for Mental Health Department for HR Unit for Internal Medicine Unit for ORL Department for finance Department for Maitaining
4 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 National Program for Women, Children and Youth Health
5 Service delivery Home visiting pregnant women women after delivery newborns infants children in 2 nd, 4 th year the elderly people with some health conditions Health education. work in PHC and community school for parenting counseling unit for youth health preventive unit primary schools public places clubs for elderly expecting parents youth adults schoolchildren general population elderly people
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14 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 Referrals
15 Patronage nurse as linking factor NGOs Local authorities Chosen pediatrician/ ECD Unit Kindergarten /School PPN&Family GP Child protection Social welfare center Gynecologist
16 HV in Belgrade: Coverage of target groups and number of visits per person Realized number Expected number Coverage Pregnant woman Newborn Infant 2 years 4 years 0
17 Daily workload and number of nurses in patronage service in Belgrade No visits/nurse/day No employed nurses/no nurses according standard No visits/nurse/day Workload norm No employed nurses/no nurse according standard PHC
18 Human resources 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 Roma mediators
19 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
20 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 HOME VISITS Home care during illness Breast feeding
21 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 /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 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% HALO BABY as a NATIONAL BRAND
22 Manual for Parents DVD Booklet Cell phone softwer
23 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 Insufficient data flow among services and sectors
24 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 , 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
25 VIDEO: HV in Serbia Cooperation between UNICEF Regional & Country Office and IPH Belgrade
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