Health status of women/children in GeorgiaIndicator Statistical data

2009 2011

Maternal mortality rate 52,1 27,6

Antenatal visits 99,2 99,8

Skilled attendant at delivery 97,4 98,4

Under 5 mortality rate 16 13,8

Infant mortality rate 14,9 12,1

Underweight 1,7

Stunting 11,1

Sub-optimal breastfeeding 45

Children with disabilities or developmental Children with disabilities or developmental difficultiesdifficultiesLegislative basement

Approximately 8000 children with special need Community Based Services

Funded by the State

Early intervention services ( 0-7 years)

Day care centers ( 6-18 years)

Inclusive Schools

Inclusive kindergartens (limited)

Project based

• Home care services

Residential and Alternative Services

Specialized foster care for children with special needs (0-18 years)

Boarding schools

Two Residential Institutions (6-18 years)

One Infant Home (0-6 years) with increasing rate of children with disabilities (about 70%)

Residential Institutions of child care (unit)

Maternal and Child Health Care Services in Maternal and Child Health Care Services in

GeorgiaGeorgia

Women’s consultation

Family center Doctor

Maternity houses

Referral (transportation)

services

Outpatient clinics

ambulance

Diagnostic Centers

Clinics/ Hospitals

Child developmentcenters

Rehabilitation/ interventionprograms

Health care services

Preschool

Counseling parent education

Early identification, intervention in case of problems

Feasible: ~30 Contacts with Health System during pregnancy and first 2 years

3

2

Conceptual Overview:

MCH Contacts during 1000 day Period

Developmental Evaluation

Developmental surveillance

Developmental screening

Developmental assessment and

intervention

Primary health care

ECD Center

Mental Health Center

• EARLY IDENTIFICATION• ADEQUATE

MANAGEMENT / REFERRAL

Primary

health care

State Program on Child Health and Developmental Surveillance for

Primary Health Care Facilities

• Antenatal care - 4 visits of pregnant women in Women

Consultation/Maternity Units (prevention, assessment, identification of

high risk, diagnostics, counseling, referral)

• Delivery – based on risk, in different level maternity units (I,II,III), and

established referral system for transportation

• Healthy child visits – in outpatient clinic ( patronage visits)

• Ambulance services

Primary health care

Development of national guidelines and protocols for primary health care services (simple, easy to use, based on milestones and red flags of development)

Development of referral criteria for referral from Primary Health Care level to the National ECD Center

Development and implementation of mother–baby book (includes doctor’s record; mother notes; and main recommendations on breastfeeding, complementary feeding, child developmental milestones, and stimulation)

Development and revision (by international experts) of training modules on child development

Development of guidelines on child abuse and neglectTraining of primary health care staff on child development

Activities conducted by ECD center staff

ECD Center

Clinical direction

Educational Direction Research

Direction

ECD Center

Clinical direction

• CHILD DEVELOPMENT IS HOLISTIC.• Assessed by multidisciplinary team (pediatrician, neurologist, psychologist,

ophthalmologist…): Child physical growth, BMI based on WHO growth standards Risk factors of child development Child development using parent questionnaires and screening tools

(ASQ, PEDS, PEDS DM, Pediatric symptom check list, DENVER, MCHAT, RAVEN, KAUFMAN, WECHSLER, PIK 17 …)

Assessment of mother child interaction (BRIGANCE) Assessment of child behavior by psychologist Neurological assessment Visual screening Hearing screening Assessment of school readiness

• Counseling of parents

State Program on Child Development Screening at the ECD Center

ECD Center

Clinical direction

Some indices of developmental and behavioral problems

Over one year, 5’875 patients (0-6 years)

Case A Preterm girl born at 32 weeks of gestation, with very low birth

weight 1240, length 40 cm, small for gestational age, RDS

2 years old practically healthy child, she catches up in growth and her development is appropriate for her biological age

Maternity unit Children’s Hospital (NICU)

ECD

• retinopathy

• nutritional problems

•motor developmental problems

Specialized

ophthalmological

services Physical

therapy

Case B Boy 3 years and 6 month, with probable language development

delay

Now he is 5 years boy, with mild communication problems,

speech is understandable

Outpatient clinic

ECD

• autistic spectrum disorder

• deprivation

ABA therapy Home

visiting

program

Inclusive

Kindergarten

Case C Girl 3 year-old, with probable language developmental

delay

Now she is 4 years, starting to speak

Outpatient clinic

ECD

• hearing screening – hearing impairment

Full audio logic

assessment

Speech

therapist

Special Cochlear

Implants

ECD Center

Educational Direction

Development of

•Syllabus and Curriculum for 4th grade medical students on

CHILD DEVELOPMENT (materials for teachers and students,

lecture slides, case studies, tests)

•Materials on identification of child abuse and neglect for

students and teachers

•Two-month training program on CHILD DEVELOPMENT and

BEHAVIOR for residents

•Participation in Development and Validation of ELDS Standards

Development of training curriculum for medical staff

•Training activities

ECD Center

Research Direction

Nutrition problems and child development

Biological and social risk factors

Heavy metals and child development

Future PlansFuture Plans

CLINICAL DIRECTIONCLINICAL DIRECTION

Implementation of high sensitive and specific developmental

assessment and screening tools and upgrading the skills of

specialists (speech therapist, occupational therapist, behavioral

therapist)

Strengthening the referral system from the Primary Health

Care facility to National ECD center

Establishment of regional ECD centers

Future PlansFuture Plans EDUCATIONAL DIRECTIONEDUCATIONAL DIRECTION

Development of practical textbook on child development and

behavior

Training of medical staff from the primary level to regional centers

Society awareness campaign on importance of early years,

supporting child development and the benefit of early intervention

ALL DIRECTIONSALL DIRECTIONS

Establishing partnership between Georgian National ECD Center

with well functioning ECD centers in developed countries for

ongoing collaboration and consultations regarding patients,

assessment tools, teaching tools, research and etc.

ConclusionsConclusionsVulnerable children have a right to health and wellbeing

services to achieve their potential

The window of opportunity for early identification and intervention is short, but

The health sector in CEE/CIS Is in frequent contact with pregnant women, infants, and young

children Has the opportunity to prevent disabilities and delays and support

good parenting Can identify risk and intervene early to improve outcomes for children

There are many effective and efficient opportunities to improve the Continuum of Health Care and improve collaboration with other sectors

“We are guilty of many errors and many

faults, but our worst crime is abandoning

the children, neglecting the fountain of life.

Many of the things we need can wait. The

child cannot. Right now is the time his

bones are being formed, his blood is

being made, and his senses are being

developed. To him we cannot answer

‘Tomorrow’, his name is today.”

- Gabriela Mistral

Thank you for your attention