Model of successful implementation of effective perinatal practices in Ukraine

USAID's Maternal and Infant Health Project (2002- September 29, 2009) has achieved major success by promoting evidence-based international best practices. It provides a full cycle of effective evidence-based mother and infant health care practices in 13 region of Ukraine and will further roll-out nationwide. Through close cooperation with Ukraine's Ministry of Health, the project has developed more than 40 standards of care and clinical guidelines/protocols for maternal and infant health services and practices. The project initiate the revision with the leading universities of maternal and infant health curricula for graduate and post-graduate students of the medical educational establishments; reinforcing evidence-based practices of family medicine practitioners to become first-line contacts for timely diagnosis and referral of complicated pregnancies. MIHP integrated the prevention of HIV mother to child transmission in every project activity to prevent the reinforcement of the verticalisation of stigmatization.

In cooperation with the WHO European Division, the project developed an effective evidence-based training package on antenatal, perinatal, and pediatric care. Counseling and information for women and family members on birthing practices, contraception, baby care, nutrition, and feeding practices were an integral part of all perinatal trainings.

Major project achievements at pilot sites include a substantial decrease in incidences of hypothermia in newborns from 76% to 1%; an increase in the presence of companions in the delivery room from 3% to 72%; an increase of normal deliveries from 26% to 70%; a decrease of Caesarean sections from 31% to 17%; decreases in episiotomies from 25% to 4%; a decrease in infant mortality by approximately 30%;

A cost study survey conducted by MIHP in three maternity wards last year showed that reductions in unnecessary (sometimes harmful) non-evidence-based medical interventions in birthing practices yielded significant savings. Donetsk Maternity N.3 reported $45,000 in savings, Lutsk Maternity saved $60,000 and Kovel Rayon Maternity conserved $10,000.

To ensure the sustainability of results, MIHP /USAID initiated the integration of evidence-based practices into training curricula for medical students, midwives, and pediatric nurses. Finally, the project has been so successful that the Government of Ukraine has specifically requested that MIHP pilot site success be rolled-out nationally, as this is a top health priority of the Ukraine President's agenda.