Document 6534280

Transcription

Document 6534280

PARTNERSHIP PROGRAM FOR RUSSIA
USAID Cooperative Agreement #: EE-A-00-98-00009-00
FY 2003 ANNUAL REPORT
Prepared October 2003
American International Health Alliance, Inc.
1212 New York Ave., NW, Suite 750, Washington, DC 20005 Tel: (202) 789-1136
Fax: (202) 789-1277
www.aiha.com
Table of Contents
List of Acronyms and Abbreviations.............................................................................................. ii
I.
Introduction..........................................................................................................................1
II.
Partnership Travel and In-Kind Data...................................................................................1
III.
Highlights of Program Accomplishments............................................................................3
Key Terms, Definitions and Assumptions ...................................................................3
Primary Health Care ....................................................................................................3
Women’s Health ..........................................................................................................9
Neonatal Resuscitation...............................................................................................12
Health Care Knowledge Resources (LRCs) ..............................................................13
Infection Control........................................................................................................15
Nursing (Region-wide funding).................................................................................17
Emergency and Disaster Medicine (Region-wide funding).......................................18
IV.
Success Stories...................................................................................................................19
V.
Attachments:
Attachment I: Russia Strategic Objective/AIHA Indicator Chart.........................21
Attachment II: Data Tables.....................................................................................22
Attachment III: New Health Practices .....................................................................30
FY 2003 AIHA Annual Report/Russia
i
List of Acronyms and Abbreviations
AIHA ............................................................................................... American International Health Alliance
CAR ................................................................................................................................Central Asia Region
CEE..................................................................................................................... Central and Eastern Europe
CPG.................................................................................................................... Clinical Practice Guidelines
EBP ........................................................................................................................ Evidenced-based Practice
EDM......................................................................................................... Emergency and Disaster Medicine
HCM ...................................................................................................................... Health Care Management
HME...............................................................................................................Health Management Education
IC .........................................................................................................................................Infection Control
ICTC ......................................................................................................... Infection Control Training Center
LRC....................................................................................................................... Learning Resource Center
MTCT ................................................................................................ Mother-to-Child Transmission of HIV
M&E .................................................................................................................... Monitoring and Evaluation
NIS ........................................................................................................................... New Independent States
NRC .......................................................................................................................Nursing Resource Center
NRP .............................................................................................................Neonatal Resuscitation Program
NRTC............................................................................................... Neonatal Resuscitation Training Center
PHC ............................................................................................................................... Primary Health Care
USAID ........................................................................ United States Agency for International Development
WH....................................................................................................................................... Women’s Health
WWC ................................................................................................................... Women’s Wellness Center
ii
I. Introduction
This document represents AIHA’s second annual report to USAID within the framework of AIHA’s monitoring and
evaluation (M&E) strategy as described in the May 2002 strategy document approved by USAID/Russia. It covers
the period from October 1, 2002 through September 30, 2003 (fiscal year 2003). The annual report, unlike quarterly
progress reports which focus on individual partnership activities and results, presents aggregated information about
accomplishments across program areas such as primary health care and women’s health, reporting by objective on
key output and outcome indicators, based on AIHA’s program results frameworks.
Taking into account USAID missions’ strategic objectives and intermediate results, the results frameworks were
designed to capture AIHA’s program results on a country/sub-regional level as well as NIS region-wide basis.
Region-specific indicators requested by individual USAID missions have also been incorporated into AIHA’s M&E
strategy and this report. Much of the data collected come from the NIS partners themselves, while some are from
AIHA’s own sources, either routine program monitoring or targeted assessments/evaluations. While every effort
has been made to provide partners with standardized forms and guidelines for collecting and reporting data, and to
review the data received from partners, experience has shown that it is extremely difficult to ensure data accuracy
and consistency. Data collection and quality issues are exacerbated by the fact that AIHA has been providing little
direct support to partners in certain program areas where outcomes are still reported. Nevertheless, we have
attempted to assemble and analyze as much of the available data as possible, explaining limitations where
applicable. In some cases, outcome data are not yet available as assessments and evaluations are either still
underway or results are undergoing analysis. AIHA expects to be issuing full reports of several evaluations during
the first part of FY04.
The annual report is organized into three main sections: partnership data, narrative summaries of program
accomplishments, and data tables. As exchanges constitute a central element of partnership activity, part two of this
report presents statistics about partnerships in Russia, in the form of person trips and number of individuals
benefiting from exchanges to the US. Another key element of AIHA’s partnership model is in-kind contributions by
US partners, which are also reported in this section. Part three of this report provides a narrative overview of key
FY03 program accomplishments and selected data presentations, organized by program areas relevant to AIHA’s
program in Russia. These descriptions are followed by sample “success stories” providing anecdotal evidence of the
impact of AIHA programs.
The data tables in the appendices are preceded by a chart illustrating how AIHA indicators contribute to USAID
intermediate results. The data tables themselves are organized by program area and show selected output and
outcome performance data for FY03.
II.
Partnership Travel and In-Kind Data
Two of the following data tables provide an overview of the level of partnership activity, as measured by the number
of person trips in each direction (to the US and to Russia). The third table provides the unduplicated number of
individual Russian “beneficiaries” of partnership exchanges, as person trips may include multiple trips made by the
same person; this table provides a more accurate picture of the number of individuals benefiting from the training
and other activities that occur during exchanges. Due to different start dates and funding levels of partnerships, each
partnership’s level of activity as measured by the number of person trips should be analyzed independently.
Four primary health care partnerships were established in Russia in 1999 (Sarov/Los Alamos, Samara-Stavropol/
Iowa, Khabarvosk/Lexington, and Kurgan-Shchuche/Appleton) and one infection control partnership was continued
from the previous Cooperative Agreement (St. Petersburg/Boston). Three additional primary health care
partnerships were established in 2000 (Snezhinsk/Livermore and Sakhalin/Houston began in January 2000; Tomsk/
Bemidji in October 2000), and the Volgograd/Little Rock partnership was funded in March 2001. The
Snezhinsk/Livermore partnership graduated in December 2002.
1
PARTNERSHIP EXCHANGES (# OF PERSON TRIPS) TO THE USA
FY03
Partnership
Khabarovsk/Lexington
Kurgan-Shchuche/Appleton
Sakhalin/Houston
Samara-Stavropol/Iowa
Sarov/Los Alamos
Snezhinsk/Livermore
St. Petersburg/Boston
Tomsk/Bemidji
Volgograd/Little Rock
TOTAL
0
3
2
0
0
n/a
0
4
5
14
FY99FY02
17
31
29
58
46
25
11
37
7
261
INDIVIDUAL NIS PARTNER BENEFICIARIES
TOTAL
# of Individuals
Traveled in FY03
17
34
31
58
46
25
11
41
12
275
0
1
1
0
0
n/a
0
4
4
9
# of Individuals Traveled
in FY99 – FY02
17
25
33
56
43
22
8
30
8
242
PARTNERSHIP EXCHANGES (# OF PERSON TRIPS) TO THE NIS
Partnership
Sakhalin/Houston
Sarov/Los Alamos
Snezhinsk/Livermore
Tomsk/Bemidji
TOTAL
FY03
FY99-FY02
TOTAL
0
0
4
2
2
n/a
2
9
7
26
42
42
34
31
59
51
22
25
47
31
342
34
27
57
49
22
23
38
24
316
In-kind contributions by US partners is one of the hallmarks of the AIHA partnership program. The following table
provides the contributions (in the form of professional time, goods, materials and services) by partnership. The total
figure for Russia below does not include in-kind contributions generated for AIHA cross-partnership programs,
trainings, and conferences in Russia, so this total is somewhat lower than the numbers reported in AIHA’s quarterly
reports. Since the inception of AIHA’s new cooperative agreement, the total in-kind contribution made by US
partners and their sponsors working in AIHA’s Russia program is estimated at nearly sixteen million dollars.
US PARTNER IN-KIND CONTRIBUTIONS ($)
FY03
Partnership
Sakhalin/Houston
Sarov/Los Alamos
Snezhinsk/Livermore
Tomsk/Bemidji
TOTAL
0
254,304
104,828
193,001
192,397
33,788
25,597
269,831
239,489
1,313,235
FY99-FY02
TOTAL
1,370,860
1,514,160
1,044,343
2,159,844
2,605,307
1,442,962
613,743
1,271,419
1,022,548
$13,045,186
1,370,860
1,768,464
1,149,171
2,352,845
2,797,704
1,476,750
639,340
1,541,250
1,262,037
14,358,421
2
III. Highlights of Program Accomplishments
KEY TERMS, DEFINITIONS, AND ASSUMPTIONS
The following are terms and definitions specific to the Strategic Objective framework and indicators agreed upon by
USAID/Moscow and AIHA.
Health councils: any multi-sectoral community-based organization that comprises representatives of public and
private sector entities (e.g., mayor’s office, public health, education, social affairs, non-government organizations,
media, business, etc.) and promotes and advocates for health in the community. “Active” health councils conduct
meetings on a regular basis. (Performance Indicator 3.2.3)
Health promotion: efforts to change people’s behaviors in order to promote healthy lives and to help prevent
illnesses and accidents. By World Health Organization (WHO) definition, health promotion is “the process of
enabling individuals and communities to increase control over the determinants of health and thereby improve their
health. This is an evolving concept that encompasses fostering lifestyles and other social, economic, environmental
and personal factors conducive to health.” (Performance Indicator 3.1.1)
Evidence-based: one of the following practices based on current international healthcare standards: (1)
comprehensive outpatient women wellness services provided to women of all ages, including prenatal care; (2)
family planning counseling; (3) exclusive breastfeeding practices; (4) essential infant care practices including
neonatal resuscitation; and (5) infection control practices pertinent to MCH facilities. (Performance Indicator 1.1.1)
Preventive health programs: actions directed toward decreasing the probability of occurrence of diseases or
accidents, or the consequences associated with such occurrences. Preventive health programs include: primary
prevention—decreasing the probability of an individual developing a disease or having an accident (e.g., smoking
prevention); secondary prevention—actions designed to detect disease at a sufficiently early stage so that the
likelihood of optimal outcomes is increased (e.g., screening for cancer, high blood pressure); tertiary prevention—
actions designed to reduce the consequences of chronic disease (e.g., management of diabetes). “New” preventive
health programs include those that have been launched and implemented as a result of AIHA partnership activities.
(Performance Indicator 3.2.1)
Primary health care (PHC) institutions: both pre-existing healthcare facilities (e.g., polyclinics, women’s
consultations, etc.) and newly opened PHC and Women’s Wellness Centers. (Performance Indicator 1.1)
New: services that have been introduced or modified by a PHC institution as a result of AIHA partnership activities.
(Performance Indicator 1.1)
Improved: services that comply with internationally recognized approaches and recommendations and have been
introduced or modified by a PHC institution as a result of AIHA partnership activities. (Overall Indicator)
Primary health care (PHC) providers: physicians (i.e., family practitioners, general practitioners, internists,
pediatricians, and some specialists), nurses, and feldshers. (Performance Indicator 1.3)
Providers involved in deliveries: OB/GYNs, neonatologists, pediatricians, anesthesiologists, midwives, and neonatal
nurses. (Performance Indicator 1.1.2)
PRIMARY HEALTH CARE
AIHA established the following goal and objectives for all of its primary healthcare work throughout Eurasia and
provides annual reports to USAID/DC and regional missions on indicators identified for these objectives.
Overall Goal:
To improve the quality of primary health care services, improve health outcomes and promote healthy lifestyles in
the NIS and CEE, contributing to the reorientation towards primary care in these countries.
Objectives:
1. Increased capacity to deliver quality primary care services in targeted communities.
3
2.
3.
4.
Increased patient satisfaction with PHC services.
Increased acceptance and availability of PHC evidence-based practices and clinical practice guidelines.
Increased community participation in improving the health of the community
While AIHA’s Russia program contributes to achievement of these objectives, in 2002 USAID/Moscow and AIHA
reached agreement on Russia-specific indicators that would be reported (quarterly or annually) in place of reporting
on the AIHA-wide indicators contained in the attached statistical tables. Therefore, the section on primary health
care that follows, as well as portions of other program areas such as women’s health and neonatal resuscitation,
present results against those agreed-upon indicators.
Russia-Specific Indicators
AIHA’s activities under the current cooperative agreement with USAID/Moscow address Strategic Objective 3.2:
Increased use of improved health and child welfare practices. Outcomes and outputs of the partnership program
contribute to achieving two intermediate results: 1) access to more effective primary health care services increased;
and 2) demand for preventive health by individuals, communities, and decision-makers increased.
¾
Overall Indicator: Percentage of population in selected regions with access to improved primary health
care practices (reported annually)
Although this indicator was omitted from the USAID/Russia SO 3.2. framework, USAID/Moscow agrees that
AIHA will report on the indicator to reflect overall partnership progress in increasing access to improved
primary healthcare practices. As indicated in AIHA’s quarterly reports, no significant changes in this indicator
were anticipated, nor occurred, due to decreased partnership activities during FY03 (the anticipated decreased
activity was due to the reduced funding provided in the final partnership year and the significant delay in
funding to AIHA from USAID/Moscow which delayed partnership exchanges and planned replication/
dissemination activities).
The table below provides the percentage of the total population (men and women) served by the respective
partnership institutions providing primary care (polyclinics and new PHC centers) and the percentage of the
total female population served by Women’s Wellness Centers. As best as AIHA can determine, there has been
no increase in the percentage of the population served by the partnership PHC institutions; the catchment area
served by the centers is not determined by the Russian partners (government establishes the area) and fee for
service from patients outside the catchment area has not been instituted. Only the Volgograd RussAM clinic is
a private fee-for-service clinic and does not have a government defined catchment area.
Access to Improved Primary Care Practices
Geographic Location of
PHC Site
Total Population
(Only the Female
Population for
WWC)
Catchment
Population
Proportion of
Population Who
Have Access
Comments
Khabarovsk Krai
1,433,100
52,300
4%
Catchment population for
Pereyaslavka CRH and Khor
Rayon Hospital ( Lazo district)
Kurgan Oblast
1,050,000
99,000
9%
Catchment population for Kurgan
Maternity #1 and Shchuche CRH
640,000
47,900
7%
Korsakov CRH
3,200,000
153,000
5%
Polyclinics #9 and #15
n/a
n/a
100%
Catchment population for MSU
#50*
49,270
49,270
100%
Catchment population for MSU
#15
Tomsk Oblast
1,000,080
53,500
5%
Timiryazevo CRH, Svetly
Polyclinic, and Kislovka FPC
Volgograd
1,006,100
n/a
n/a
RussAm clinic
Sakhalin Oblast
Samara Oblast
Sarov, City of
Snezhinsk, City of
4
There has not been an increase in the percentage of the population served by Dubna, Essentuki, and Snezhinsk
WWCs between FY02 and FY03. The Moscow WWC does not serve a specific catchment population, but
serves women from the Eastern District of Moscow as well as women from other districts of Moscow or other
cities based on fee-for-service. The St. Petersburg WWC is similar in that it does not serve a specific catchment
population and also serves women from other cities and the Leningradskya Oblast. Due to security restrictions,
the Sarov partners were unable to provide the numbers for their catchment population, but reported that 100%
of the population has access to improved care.
Geographic Location of
WWC
Total Population
(Only the Female
Population for
WWC)
Catchment
Population
Proportion of
Population Who
Have Access
Comments
Catchment population for Dubna
WWC
Dubna, City of
25,810
25,810
100%
Essentuki, City of
48,803
48,803
100%
Khabarovsk Krai
760,830
28,492
4%
Moscow, Eastern okrug
350,000
n/a
n/a
1,850,000
85,879
5%
n/a
n/a
100%
Catchment population for Sarov
WWC
26,019
26,019
100%
Snezhinsk WWC
4,600,000
n/a
n/a
Samara Oblast
Sarov, City of
Snezhinsk, City of
St. Petersburg, City of
Essentuki WWC
Pereyaslavka WWC (Lazo
district)
Catchment population for Moscow
WWC
Catchment population for WWCs
at Polyclinics #9 and #15
Catchment population for St. Pete
WWC
Intermediate Result 1: Access to more effective primary health care services increased
¾
Indicator 1.1: Number of PHC institutions adopting new health practices (reported annually)
The number of PHC institutions adopting new health practices did not change in FY03 and remains at 20. As
identified in the FY02 annual report, seven additional institutions in Kurgan had been expected to adopt new
PHC health practices, replicating those established at the Shchuche CRH, but lack of funding in FY03
prevented the rollout. While the Kurgan Oblast Health Administration still expects to replicate the PHC model,
the inability to grant family medicine licensure remains a barrier, and the two physicians re-trained in family
medicine by the partnership have left the Oblast and are not available to conduct training.
However, AIHA verified a number of practices that were identified in the FY02 Annual Report, attachment IV,
as “To be Verified.” Please see Attachment III, New Health Practices, for the updated number of new health
practices at the 20 institutions.
¾
AIHA developed a series of questions within the standardized self-assessment forms administered to all
partnerships in order to determine whether partnership PHC institutions are meeting the standards of AIHA’s
PHC model. Preliminary analysis indicates that Sarov, Samara, Sakhalin, Shchuche and Tomsk have integrated
most if not all elements of AIHA’s PHC model, focused on prevention-oriented, family-based primary care, and
has gone further by integrating delivery of social services into health care. According to AIHA’s definition of
a model clinic, a primary healthcare institution has to meet at least eight of 10 criteria related to: counseling,
implementation of evidence-based practices, screening services, involvement of nurses in direct patient care and
patient/community education, availability of patient education materials developed through partnership,
availability of group health education/promotion classes for patients, continuous quality improvement activities,
implementation of occupational health and infection control protocol and practices, and finally, community
outreach activities.
¾
Indicator 1.2: Number of new PHC and WWC centers opened (reported annually)
No new centers were opened by AIHA in FY03. The Volgograd partners expected to open a second clinic, but
renovation delays set the opening back to FY04. Although the Snezhinsk center officially opened in October
2003, the center became operational and began reporting data in FY02.
5
Intermediate Result 1.1: Use of evidenced-based practices in women/infant’s health and non-communicable
chronic diseases increased
¾
Indicator 1.1.1: Number of health institutions implementing evidence-based maternal and child health
care practices (reported annually)
Twenty-five (25) healthcare institutions* are implementing evidence-based maternal and child health care
practices; seven (7) facilities began these practices in FY03. Four health facilities in the Tomsk rayon
(Loskutovo, Svetly, Turuntayevo and Oktyabrsky) are implementing evidence-based breastfeeding counseling
practices and three health facilities in the Samara region (Samara Oblast Kalinin hospital, Togliatty City
Polyclinic # 2, and Togliatty City Hospital #2) are implementing/replicating the AIHA Odessa MTCT Training
Center protocols on the prevention of mother-to-child transmission of HIV.
*Institutions that can be counted to meet this indicator include women’s wellness centers from graduated and
current partnerships and PHC partnership institutions.
Intermediate Result 1.2: Quality improvement methodologies applied to primary health care
¾
Indicator 1.2.1: Number of clinical practices changed toward evidence-based performance as a result of
AIHA activities, by type and site (reported annually)
One new clinical practice – smoking cessation patient counseling – was adopted in FY03 by the all the Russia
partners (except Tomsk) after attending the AIHA/Sarov Tobacco Control and Smoking Cessation conference
in September 2002. A total of fifteen practices have changed in partnership institutions in FY02 and FY03:
(1) general practice services provided through a new PHC center; (2) comprehensive outpatient women’s
wellness services provided to women of all ages; (3) outreach educational programs for the community; (4)
evidence-based management of bronchial asthma, arterial hypertension, and diabetes through adaptation and
implementation of clinical practice guidelines and patient schools; (5) screening, diagnosis, referral, and
management of depression in the out-patient settings; (6) evidence-based infection control and occupational
health practices; (7) patient counseling on STI and HIV/AIDS prevention; (8) expanded primary healthcare
services provided by nurses; (9) evidence-based breast health practices, including clinical breast examination
and self-examination; (10) patient counseling, prevention and treatment of substance abuse; (11) screening,
referral, and support for victims of domestic violence; (12) evidence-based prevention and treatment of TB in
PHC setting; (13) patient counseling on smoking cessation; (14) publishing and distributing printed health
promotion materials; and (15) evidence-based neonatal care.
While no additional clinical practice guidelines were implemented by the PHC partnerships in FY03, partners
from Polyclinic #15 in Samara formed task force groups and began developing guidelines on the following:
hypertension, heart failure, chronic hepatitis, kidney disease, chronic obstructive pulmonary disease, ischemic
heart disease, acute cerebral ischemia, and arthrosis.
The graphs below provide data from the three partnerships (in Korsakov, Sarov and Tomsk) that implemented
specific guidelines prior to FY03; the data indicate that for those patients who are taught to monitor their
disease (hypertension, asthma), they are successful in controlling their disease. The Tomsk/Bemidji partners
completed a hypertension audit in Timiryazievo region, but the analyzed results have not yet been provided to
AIHA.
Proportion of Hypertension Patients (%)
Controlling Their Blood Pressure, FY03
Number of Hypertension Patients
Monitoring Their Blood Pressure, FY03
100
160
90
80
120
70
100
60
Korsakov
50
Tomsk
Sarov
80
Korsakov
Tomsk
60
Percent
Number of Patients
140
Sarov
40
30
40
20
20
10
0
Oc
t.
02
De
c.0
2
Fe
b
.0
Ap
3
r.0
3
Ju
n.
03
Au
0
g.
0
3
Oc
t.
02
No
v.
0
De
2
J
F
Ma
Ap
Au
Ma
Se
Ju
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n
ly
c.0 an. 0 eb.
r
g
p
03 r. 03 .03 y.03 . 03 . 03 . 03 t.03
2
3
6
Proportion of Asthma Patients (%) Controlling
Their Peak Expiration Volum e, FY03
100
250
80
200
150
Sarov
100
Korsakov
Percent
Number of Patients
Number of Asthma Patients
Monitoring Their Peak Expiration Volume,
FY03
60
Sarov
40
Korsakov
20
50
0
0
Oc
t.
02
De
c.0
2
Fe
b.
03
Ap
r.
03
Ju
n.
03
Au
g.
03
Oc
t.
02
De
c.0
2
Fe
b
.0
Ap
3
r.0
3
Ju
n.
03
Au
g.
0
3
In addition, AIHA verified a number of clinical practices that were identified as “To be Verified” in the FY02
Annual Report, Attachment IV. Please see Attachment III for the updated number of PHC Institutions adopting
new health practices. Please also see the Health Care Knowledge Resources section below for additional
information on activities related to promotion of evidence-based practices.
¾
Patient satisfaction is one indicator of quality services and satisfaction surveys are often used as a quality
improvement tool. Four primary health care centers in Russia – Kislovka, Svetly, Samara and Sakhalin – each
conducted a patient satisfaction survey in spring 2003 using a survey instrument developed by AIHA. Partners
were also provided with specially-designed data entry software and AIHA compiled summary results based on
the raw data submitted by partners. Survey respondents indicated their level of satisfaction for 22 variables
associated with center characteristics (e.g., comfort and cleanliness), staff (e.g., friendliness and courtesy), and
service (e.g., scope of services). AIHA’s PHC results framework established an ambitious satisfaction target of
at least 5.8 on a 7-point scale for the average of the mean rating for each of these variables (with 7 being “very
satisfied”). While the results for the first round of the patient satisfaction survey resulted in overall average
scores at the centers ranging from 4.4 to 5.6, repeated periodic administration of the survey will enable the
centers to focus on variables where the need for improvement is indicated and provide guidance to the center’s
efforts to continuously improve quality.
¾
Indicator 1.3: Percentage of PHC providers from partnership institutions trained at cross-partnership
seminars (reported annually)
No cross-partnership trainings were conducted in FY03 due to significantly decreased funding as expected for
the partnership program’s final year and the focus on partners completing their specific partnership activities.
However, the Russia partnerships themselves conducted 66 training events (Korsakov and Sarov accounted for
52 of these) for a total of 853 physicians, nurses and other health professionals. Through the partnership
program, the Russian partners have learned the importance of interdisciplinary work and training as well as the
importance of increasing the skills of the nurses. 65% of the professional training courses in FY03 offered by
partners were for nurses; only 37% of the trainings were for nurses in FY02.
Professional Mix of the Audience at the
Partnership Professional Training
Activities, FY03, Russia
134
16%
160
19%
MD's
RN's
Others
559
65%
7
Intermediate Result 3: Demand for preventive health by individuals, communities, and decision-makers
increased
Intermediate Result 3.1: Awareness of preventive health care benefits increased
¾
Indicator 3.1.1: Number of health promotion activities, by subject and site (reported quarterly)
The community-based PHC partnerships devote significant time and effort to community health promotion and
education. The most active partnerships in FY03 include Samara and Sakhalin partners with a total of 423 and
456 health promotion activities respectively.
Site
Total PHC:
FY02
III-IV
FY03
I
FY03
II
FY03
III
302
367
269
378
FY03
IV
FY03
257
1271
Comments
In PHC, health promotion activities are counted as complete courses, which may consist of one or several classes or
sessions.
Khabarovsk
Pereyaslavka Youth
5
4
4
N/A
N/A
8
Krai
Education Center
Kurgan Maternity Hospital
Kurgan
3
18
26
69
45
158
#1 and Shchuche Central
Oblast
Rayon Hospital
Sakhalin
Korsakov Central Rayon
77
116
103
152
85
456
Oblast
Hospital
Samara
145
171
69
92
91
423
Polyclinics #9 and 15
Oblast
Sarov
43
33
27
31
33
124
Medical Sanitary Unit #50
City
Dental health education for
Snezhinsk
9
N/A
14
6
N/A
20
school children and their
City
parents
Tomsk
Svetly Public Health
20
25
26
28
3
82
Oblast
Center
¾ The chart below shows the number of participants in community education events conducted by the partners.
The community education events by topic and number provided in FY03 were similar to those provided in
FY02.
Participants in Partnership Community Education
Events (# and % by topic) FY03: Russia
1,119
5% 1,645
7%
7,385
34%
Healthy Lifestyle 5%
Substance Abuse 7%
3,640
16%
Sex Education 16%
Maternal and Child Health 18%
Dental Health 20%
4,500
20%
3,945
18%
Other, incl. chronic disease
management schools and health fairs
34%
8
WOMEN’S HEALTH
Overall Goal: To provide a client-centered approach to women’s health care through services that address women’s
health needs throughout their life continuum.
Objectives:
1. Increased capacity to deliver comprehensive, outpatient health services to women of all ages
2. Increased utilization of health promotion and prevention services within the WWC
3. Maintenance of a high level of patient satisfaction with the WWC and its services
4. Increased implementation of women’s health clinical practice guidelines
5. Increased use of contraceptive methods among women of reproductive age who wish to avoid pregnancy
(excludes women who have had hysterectomies)
6. Improved sustainability of the WWCs
FY03 Key Activities/Outputs/Outcomes:
Capacity for Comprehensive Care
¾ In October 2002, the Women’s Wellness Center in Snezhinsk was officially opened; however data for this
center was collected and reported in FY02. The total number of WWCs operational in Russia is nine: four
(Dubna, Essentuki, St. Petersburg and Moscow) were established in FY98 and another four (Sarov,
Pereyaslavka, two in Samara) were opened in FY02.
¾ AIHA distributed self-assessment surveys to WWCs towards the end of FY03. Among other things, the survey
seeks to determine the extent to which the Centers provide core services consistent with the WWC model.
Preliminary analysis of responses from the WWCs indicates that Samara #15 and St. Petersburg are providing
services in 10 core areas consistent with AIHA’s WWC model. The rest of the centers offer between seven and
nine of the key services related to: family planning and reproductive health, prenatal and perinatal care, sexually
transmitted infections, cancer screening/diagnosis, substance abuse, mental health, chronic disease, services to
older women, healthy lifestyle programs, and community-oriented programs. AIHA will prepare a report of
survey results once all completed surveys are translated and submitted to AIHA by its regional offices.
¾ AIHA implemented a uniform data reporting form for WWCs in FY02 and the graph below shows the total
number of patient visits reported by the WWCs in FY03. As noted in the FY02 annual report, Sarov reported 5
months of data in FY02, Pereyaslavka reported 3 months of data, and the other centers reported 6 months of
data; thus comparison and analysis is less than optimal. The FY03 total number of patient visits for 12 months
(260,435) compared to the total number of patient visits in FY02 for 6 months or less (152,063) suggest there
was a decrease in patient visits. Snezhinsk is the only exception which had an 8% increase in the number of
patient visits in FY03 (adjusting for the difference in the number of months data was collected). Although the
WWCs could not provide an explanation for this decline, possible reasons could include: 1) more women’s
consultation centers available in the community to serve the population or 2) inaccurate reporting of the number
of patient visits. Further investigation/consideration is desirable, but would require additional resources.
FY03 Total Patient Visits: Russia WWCs
70,129
55,488
38,190
30,555
21,339
10,098 6,895
10,039
Sa
St
ro
.P
v
et
er
sb
ur
g
Sn
ez
hi
ns
k
17,702
Du
bn
a
Es
se
nt
uk
i
M
os
co
Pe
w
re
ya
sl
av
ka
Sa
m
ar
a
#9
Sa
m
ar
a
#1
5
80,000
70,000
60,000
50,000
40,000
30,000
20,000
10,000
0
9
¾
The FY02 annual report included data on the number of four types of diagnostic tests performed. Although
AIHA believes that these tests indicate that the centers are involved in preventive and screening activities as
opposed to only treatment, the data is not provided this year because USAID/Moscow believes these
services/tests are provided by all women’s consultation centers and cannot be attributed to partnership activity.
However, it is important to recognize that at the Snezhinsk WWC, mammography services became available in
February 2003 and partners reported conducting 2,105 mammograms between February and September and
detecting pathology in 228 women.
Health Promotion
¾ The WWCs continued to emphasize health promotion and disease prevention in their activities. The centers
reported that during FY03, their health education activities were attended by over 16,000 participants (this
number may include double-counting as some individuals may have attended multiple programs). The number
of participants is comparable to those in FY02 (8,000 participants/6 months). Comparing the data to the sixmonth data in FY02, the following centers increased the number of participants fairly significantly: Samara #15
(291/647), Pereyaslavka (9/251), Sarov (645/1,491) and Essentuki WWCs (2,124/7,750). Such an increase may
demonstrate that the Centers are expending more effort to promote their activities and/or that citizens are
becoming more interested in learning about their health. The only center with a decrease in participants was the
St. Petersburg WWC; possible explanations include the absence of courses during the summer and/or a more
fee-for-service orientation at the center.
Participants in Health Promotion & Patient Education Courses and Programs (by sites)
FY03: Russia WWCs
254 756
397
1491
Dub na, 397
Essentuki, 7750
647
Moscow, 2148
Pereyaslavka, 251
Samara
7750
#9, 3203
Samara #15, 647
3203
Sarov, 1491
St.Petersb urg, 254
Snezhinsk, 756
251
2148
¾
The graph below indicates distribution of participants in WWC patient education activities by topic. The
majority of courses provided by the centers are related to family planning (39%) and prenatal care (31%)
because adolescents and young people as well as expectant mothers are the targeted population served by the
WWCs. The relatively low number of breastfeeding courses can be explained by the fact that most of the
WWCs include education on breastfeeding promotion in the birth preparation courses and do not report on these
classes separately.
Participants in WWC Health Promotion & Patient Education Courses and Programs
(% by topic)
FY03: Russia WWCs
12%
8%
Healthy lif esty le, 8%
4%
4%
Peri or post-menopausal sy mptoms
and management, 4%
2%
Sex education, 39 %
Partners in birth, other pregnancy
related, 31 %
39%
Others including newborn massage,
open house ev ents, 2%
Breast cancer prev ention, 4%
31%
Breast f eeding, 12%
10
Intermediate Result 3:
increased
Demand for preventive health by individuals, communities, and decision-makers
Intermediate Result 3.1: Awareness of preventive health care benefits increased
¾
Indicator 3.1.1: Number of health promotion activities, by subject and site (reported quarterly)
WWCs began reporting on the number of health promotion activities in January 2003, thus the data for this
indicator are available only for a nine-month period. In the WWCs, health promotion activities are counted as
single classes or sessions conducted. These sessions may or may not be part of longer courses. The most active
WWCs include both Samara WWCs (1,091 total health promotion activities), Moscow (591 activities), and
Sarov (336 activities).
FY02
III-IV
FY03
I
FY03
II
FY03
III
FY03
IV
FY03
Site
WWC:
N/A
N/A
1066
900
531
2497
Dubna
City
Essentuki
City
Khabarovsk
Krai
Moscow
City
Samara
Oblast
Sarov
City
Snezhinsk
City
St.Petersburg City
Comments
14
13
12
39
85
100
104
289
0
7
0
7
219
239
133
591
Dubna WWC
Essentuki WWC
Pereyaslavka WWC
Moscow WWC
WWCs at Polyclinics #9
and 15
575
358
158
1,091
110
114
112
336
18
16
12
46
Snezhinsk WWC
45
53
0
98
St. Petersburg WWC
Sarov WWC
Patient Satisfaction
¾ AIHA developed and distributed a patient satisfaction survey form to all WWCs as a tool they could use for
quality improvement purposes. Three WWCs in Russia (Samara #9 and #15 and St. Petersburg) conducted the
survey during the second half of FY03 and submitted results to AIHA using specially-designed data entry
software provided by AIHA. As part of its results framework, AIHA established a score of 5.8 (on a scale of 17) as the desired threshold for satisfaction the WWCs should seek to achieve. Of the three WWCs, one Center
achieved an overall average score of 6.0, thus exceeding the threshold score, and the other two scored just
below the threshold at 5.7 and 5.6. All WWCs are strongly encouraged to conduct the surveys at least twice a
year to enable them to monitor the level of satisfaction with their services and to implement changes for further
improvement of quality of care.
Clinical Practice Guidelines
¾ In order to further promote the implementation of women’s health CPGs and raise WWC expertise in the
area of HIV/AIDS prevention and treatment, AIHA sponsored a region–wide workshop, Women’s Health
CPG Associated with HIV/AIDS, in Odessa, Ukraine. Directors from all nine Russian WWCs attended the
workshop. The process for developing, adapting and revising guidelines was presented to the participants as
well as the process for using clinical practice guidelines to evaluate and improve the quality of care. Because
HIV/AIDS is a problem of growing proportion in most of the regions served by AIHA including Russia, every
WWC is expected to play a significant role in preventing HIV/AIDS. During the workshop the participants
became familiar with the AIHA program, Preventing Maternal to Child Transmission of HIV, which operates in
Odessa as well as a range of clinical practice guidelines being developed and implemented to prevent
transmission of HIV/AIDS and to foster quality treatment and supportive services.
¾ Preliminary analysis of the WWC self-assessments mentioned above show that eight Russia WWCs have
implemented continuous quality improvement processes which enable the centers to monitor consistency with
one or more clinical practice guidelines.
Family Planning
¾ During FY03, AIHA collected information from WWCs on visits by category. Although family planning was
one of the visit types defined for use, many WWCs indicated a problem providing data consistent with AIHA’s
11
¾
instructions due to national or local requirements and reimbursement issues. Data was also requested from
WWCs on type of contraception selected as a result of a family planning visit. However, reporting on
contraceptives was also found to be inconsistent with the reporting directions supplied by AIHA.
Lack of uniformity in family planning data made it impractical for AIHA to display data in quarterly reports for
multiple centers. To the extent that individual WWCs are collecting data in a uniform manner for each reporting
period (generally monthly), the data enables monitoring of trends and assessment of progress at the center level.
Sustainability
¾ As part of the WWC self-assessment, AIHA asked questions related to center sustainability. Three Russian
WWCs were confident that they would meet the standards of a WWC and be operational 10 years from now
and five WWCs reported they were confident that they would be operational for the next 5 years. Among the
factors identified as contributing to their belief in the WWCs’ long-term sustainability include: funding from
municipal sources, agreements with insurance companies, implementation of fee-for-services, and collaborative
relationships with pharmaceutical companies. A full report of findings will be prepared in FY04.
NEONATAL RESUSCITATION
Overall Goal: To decrease infant mortality and morbidity rates in the immediate newborn period through the
implementation of appropriate neonatal resuscitation skills in the delivery rooms.
Objectives:
1. Increased capacity to provide training in evidence-based neonatal resuscitation care as the standard of
clinical practice
2. Improved sustainability of the neonatal resuscitation program (NRP).
In Russia, six NRTCs were established prior to FY03 with financial assistance from AIHA to purchase equipment,
conduct training courses, and to establish Internet connectivity. Three NRTCs, located in Chelyabinsk, Moscow, and
Ulan-Ude were established by AIHA partnerships. Samara, Tver, and Saratov NRTCs were established at the
request of their local health administrations as replication models. During FY03, AIHA’s financial support to the
NRTCs in Russia was limited to Internet connectivity.
Training Capacity
¾ Over 7,000 providers have been trained in NRP in selected regions of Russia (Buriat Republic, Moscow,
Chelyabinsk, Tver, Samara, and Saratov Oblasts) since the beginning of the Neonatal Resuscitation Program
through September 30, 2003; The total number of health professionals who received training in NRP (including
interns trained by Tver, Ulan Ude and Chelyabinsk NRTCs and additional providers) in FY03 is 769. The Tver
NRTC has already trained almost 100% of the providers who attend deliveries in the Tver region, thus they
focused their activities on recertification and maintenance of quality assurance in their training.
¾ In FY03, the Moscow NRTC provided an advanced training-of-trainers course to a representative from the
Ivanovo Institute of Maternal and Child Health (MCH). With support from the Ivanovo Oblast Health
Administration and continuing methodological assistance from the Moscow NRTC, the Ivanovo MCH Institute
plans to establish a NRTC in FY04.
¾ The Chelyabinsk NRTC established collaborative relations with John Snow International Women’s and Infant’s
Health (JSI/WIN) project. In April 2003, by invitation of JSI/WIN, the Chelyabinsk NRTC conducted an
outreach course for delivery room personnel from the maternity houses in Perm. The cooperation will continue
in FY04 to further disseminate the evidence–based practices of neonatal resuscitation.
Intermediate Result 1.1: Use of evidenced-based practices in women/infant’s health and non-communicable
chronic diseases increased
¾
Indicator 1.1.2 Proportion of providers attending birth deliveries in selected regions who are trained in
neonatal resuscitation
The proportion of providers trained in neonatal resuscitation varies from 13% to 99% in the six regions where
Neonatal Resuscitation Training Centers (NRTC) have been established. Results of 10,000 Births Study
published in AIHA’s 2002 Annual Report indicate that the optimal proportion of personnel trained in neonatal
resuscitation is 25%. Centers in Tver, Samara, Ulan –Ude and Saratov (only opened in May 2002) have already
achieved this benchmark and Tver and Samara are actively re-certifying providers previously trained. The
Chelyabinsk Center has not yet achieved this benchmark, but has begun a recertification process. The Moscow
12
NRTC is not targeting any particular region or city, and is not subject to benchmarking. The graph below
presents the proportion of providers trained in the respective regions since each NRTC was opened.
Proportion of Providers Attending Deliveries Trained in NRP
in Selected Regions of Russia, by the end of FY03
120%
99%
100%
80%
60%
50%
48%
40%
25%
20%
13%
0%
Bu
C
Sa
Sa
Tv
he
er
ry
ra
m
ly
at
t
a
O
o
ab
ra
v
R
bl
in
O
O
ep
as
sk
bl
bl
ub
t
a
a
O
st
st
lic
bl
as
Sustainability
¾ Acknowledging the success of the AIHA neonatal resuscitation training program and the great need for
additional training in the Russian regions, the Ministry of Health of Russia asked USAID for continuing support
for the existing Centers and assistance to establish additional NRTCs throughout the country.
Impact
¾ The 10,000 Births Study conducted in FY02 was repeated in FY03 to collect comparative data. Data was
submitted by six Russia NRTCs that worked with 32 hospitals to train NRP personnel. Designed to assess the
impact of the NRP program on infant outcomes, the results of the FY03 study is expected to provide additional
evidence that hospitals with at least 25% of delivery personnel trained have improved outcomes compared to
facilities with less than 25% of such personnel trained. The study report is expected to be issued the second
quarter of FY04.
¾ The Ulan Ude NRTC issued a report on the impact of the NRP program on decreasing perinatal and early
neonatal mortality rates during the last five years. In 1997 the perinatal mortality rate decreased from 14.4 in
1997 before the program inception in Buriatia Republic to 10.8 in 2002; the early neonatal mortality rate
decreased from 7.7 in 1997 to 5.6 in 2002.
HEALTH CARE KNOWLEDGE RESOURCES
Overall Goal: To promote improved health care practices through increased access to, use of, and understanding of
available knowledge resources.
Objectives:
1. Increased access to up-to-date health care knowledge resources.
2. Increased promotion of evidence-based practice.
3. Demonstrated ability to sustain access to knowledge resources independent of AIHA funding.
4. Increased development and use of information and communication technology tools and applications.
Through the healthcare partnership program, AIHA has supported the establishment of a total of 139 Learning
Resource Centers (LRCs) in the NIS and CEE. Currently, 17 LRCs are active in Russia.
Increased Access
¾ In FY03, 75% of health professionals at partner institutions in Russia are directly or indirectly accessing up-todate health care research and information using the Internet and other computer-based technologies. This
represents approximately the same percentage (76%) observed in FY02 and an increase from less than 10%
13
before the partnership program began. Russia partnership health professionals surveyed by AIHA now receive
32% of their information from computer-based sources, including the Internet, again up from a negligible
percentage prior to the partnership program.
Access to Knowledge Resources - Russia
80%
70%
60%
50%
40%
30%
20%
% Using LRC/Internet
% of Information Received from
LRC/Internet
2002
2003
Promotion of Evidence-based Practice
¾ Through the LRC program, AIHA has consistently strived to promote the ideas and principles of evidencebased practice (EBP) at both the individual practitioner and the broader institutional level. Because of the broad
range of institutions involved in the partnership program and variations in practice among regional and national
health administrations, these promotion efforts have largely been non-prescriptive, i.e., rather than advocating
particular institutional quality assurance processes, AIHA has tried to instill the EBP philosophy into existing
processes and practices. AIHA measures the success of these efforts by determining whether staff at partner
institutions are able to demonstrate their understanding of EBP methodologies and whether quality review
processes that embody these principles exist or are being developed within the institutions.
¾ Thirteen of the 25 Russian partnership institutions with functioning LRCs are successfully demonstrating the
use of evidence-based methodologies in reviewing standards of clinical and educational practice at their
institutions. As part of the partnership program, staff from each LRC work with other health professionals at
the partnership institution to review two specific clinical or educational practices per year. Upon receiving
these written reviews, AIHA staff work with partners to help them evaluate the search strategy and their critical
appraisal of the existing research. Through this process, partners gain a fuller understanding of the principles of
evidence-based practice and how to apply its principles in practice. (Note: at the time of this writing, many of
these reviews are still in the process of being submitted and therefore are not included in the statistical
summary.)
¾ In FY03, AIHA conducted its first Evidence-based Practice Survey, asking partners to describe their internal
processes for reviewing and evaluating current practice standards. The survey results show that 20% of Russia
partner institutions currently have established regular and ongoing processes for widely and routinely evaluating
standards using the latest available evidence. This compares to 17% of all partner institutions in the NIS and
CEE. While a much larger percentage of partners have established review processes of various kinds, many of
these were not considered to be sufficiently routine or did not adequately utilize the latest available research
evidence. Based on further feedback and an EBP distance education program to be provided in FY04, AIHA
expects this indicator to increase gradually over time.
Sustainability
¾ AIHA partners have continued to make progress in their efforts to establish sustainable Internet access for staff
at their institutions. In FY03, 40% of Russian partner institutions were maintaining Internet connectivity
without AIHA support, up from 32% in FY02. In addition, 24% have at some point during the course of the
project received grants supporting Internet connectivity or other resources and infrastructure that enhance the
capabilities of the LRC, up from 12% in FY02. Finally, 24% of the Russia LRCs (up from 12% in FY02) are
partially recovering some maintenance costs by, for example, renting equipment and facilities and charging
external clients for information/clerical services. It is the underlying philosophy of the LRC project that AIHA
partners will come to recognize and value the benefits of providing information access to staff and will begin to
cover these costs on their own as soon as the economic environment allows. In the meantime, grant funding
and modest cost recovery help to instill the principles of self-sustainability.
14
LRC Sustainability - Russia
50%
40%
30%
20%
10%
0%
Covering Internet Costs
Received Grants
2002
Cost-recovery
2003
ICT Tools and Applications
¾ LRCs have planted a variety of “seeds” within partner institutions, helping to foster the growth of IT
infrastructure, improved management information systems, and telemedicine capabilities. In FY03, the number
of Russian partner institutions that have developed databases (including electronic medical records,
financial/accounting systems, and/or bibliographic/research databases) remained constant at 68%. Those that
have installed local area networks rose from 64% to 72%. 96% of all partner institutions have developed their
own Web sites and 76 % actively engage in Internet-based tele-consultations to enhance patient care.
ICT Tools and Applications - Russia
100%
80%
60%
40%
20%
0%
Database
Applications
Local Area
Networks
2002
Web Site
Development
Telemedicine
2003
INFECTION CONTROL
Overall Goal: To improve quality of healthcare services through regional and institutional infection control
programs aimed at reduction in hospital-acquired infection rates and effective control over antibiotic resistance in
microorganisms.
Objectives:
1. Improved surveillance and assessment capacity in the areas of nosocomial infections and a/b resistant
microorganisms
2. Strengthened training capacity in infection control, clinical epidemiology and evidence-based medicine
3. Improved infection control practices based on evidence-based clinical and management practice protocols
4. Enhanced sustainability of Infection Control program
Surveillance and Assessment Capacity
¾ Active surveillance of antibiotic resistance has been instituted in healthcare institutions throughout the city of
St. Petersburg and in major cities of the Russian North-Western Region. Partners were involved in ongoing
training of epidemiologists on establishing systems of surveillance and the use of the WHONET database. All
data collected locally was forwarded to the Mechnikov Academy for further analysis.
¾ During the last quarter of FY03 AIHA designed a survey to assess hospital-based infection control capacity and
surveillance within the NIS. The purpose of the study was to determine if there had been improvement in
surveillance and assessment capacity in the areas of nosocomial infections and antibiotic resistant microorganisms; infection control practices centered on evidence-based clinical and management practice protocols;
15
¾
¾
and infection control practices of clinical staff. Respondents were randomly selected from a sample of
institutions which had sent participants to the AIHA Infection Control Training Center courses and represented
institutions in northwest Russia. Survey results were collected from 13 Russian hospitals and the data are
being analyzed; the results will be published on the AHIA Web site and provided to USAID.
AIHA conducted a two-part telephone survey of WHONET laboratories in the NIS to determine whether they
are performing the functions – collecting and processing data on antimicrobial resistance – for which they were
established. Of the 18 labs established by AIHA since 1997, 13 (including three of six in Russia) were
identified as currently functioning and using the WHONET database for data collection, storage, and analysis.
The currently functioning WHONET labs in Russia are in Samara, St. Petersburg Mechnikov Academy and
Vladivostok. Although one of the labs in Russia was not reachable via telephone, the St. Petersburg partners
were able to answer the survey questions because of the relationship with the lab and its functions. WHONET
labs in Russia reported routinely conducting surveillance of antibiotic resistance and using the WHONET
software to identify both new patterns of antibiotic resistance and antibiotic use. Complete results of the survey
will be published on the AIHA Web site.
Data collection for the AIHA-funded international study of antibiotic resistance of E. coli and urinary tract
infections (UTI) officially stopped during the 2nd quarter of FY03. Although more than 900 specimens were
collected from five study sites it was difficult to ascertain the number of specimens testing positive for E. coli
infection. The study was limited by difficulties acquiring and shipping supplies and unreliable quality control
mechanisms at study sites. The expert consultant who worked with AIHA to design the study has been
unavailable to analyze the data or provide a summary report.
Training Capacity
¾ Partners conducted a variety of training courses in St. Petersburg, Izhevsk (Republic of Udmurtia), Cherepovets,
Kaliningrad, Murmansk, Perm, Pskov, and Vologda. In FY03, 394 physicians, epidemiologists and nurses were
trained in evidence-based medicine basics, epidemiology, nosocomial infection control and prevention,
infection control and microbiology, tuberculosis and monitoring of antimicrobial resistance; in total 1,363
health professionals have been trained since opening of the ICTC.
¾ The Third International Russian Applied Research Conference was held in St. Petersburg, September
2003. Nearly 400 Russian infection control specialists and policy makers attended the conference which was
designed to explore challenges in the area of epidemiology and prevention of nosocomial infections in Russia.
It also aimed to direct attention to the growing HIV/AIDS epidemic in the region and its impact on the general
population as well as health care providers. The conference was sponsored by the St. Petersburg/Boston
Partnership in cooperation with the Mechnikov Medical Academy, the Russian Ministry of Health and the
Goldsmith Foundation of New York. Four US HIV/AIDS experts made presentations on the treatment of
HIV/AIDS, mother-to-child-transmission of HIV/AIDS, and addressing HIV/AIDS infection in community
practice.
Evidence-Based Practices
¾ The preliminary version of an evidence-based guideline on hand hygiene was developed. Work was started on
evidence-based guidelines on infection control in dialysis and neonatology. These guidelines are expected to be
approved by the MOH as one “package” upon their completion.
¾ ICTC specialists from St. Petersburg provided technical expertise to several maternity hospitals in Perm who
are partners in a USAID-sponsored JSI-WIN project. The effort was to create a comprehensive, evidence-based
infection control system. This joint work culminated in an infection control conference for maternity facilities in
Perm. A similar project was started with another USAID/Russia contractor, Quality Assurance Project.
¾ Production of the 2nd edition Infection Control Manual was completed during FY03. The manual, which was
produced in both English and Russian, contains chapters and relevant articles on topics such as organization of
infection control programs, surveillance, common microorganisms and antibiotic resistance. A hard copy
manual and a CD-ROM containing all chapters and appendices are available. Approximately 500 copies of the
Russian edition were distributed to participants at the Third International Russian Applied Research Conference
(St. Petersburg, September 2003). Copies of the manual will also be distributed to USAID/Moscow, Minister of
Health, AIHA partners, Regional Health Authorities, the ICTC in St. Petersburg, Sanitary Epidemiology Station
(SES) offices and contributors to the manual.
Policy
¾ A meeting of the temporary working group on nosocomial infections was held at the Russian State Epidemical
Surveillance office to assess progress and discuss next steps for the development of evidence-based guidelines
and sanitary rules on the prevention of nosocomial infections; the working group convened in FY02 at the
request of the Russian Ministry of Health. Participants included Russian Ministry of Health officials,
representatives from the ICTCs in Kazakhstan and Georgia and partners from St. Petersburg. The partners
16
¾
proposed detailed evidence-based recommendations for drafting new regulations on nosocomial infections and
presented drafts of several revised regulations, including one on surgical site infections. Despite a difference of
opinions on the use of evidence-based approaches, the results of the temporary working group were approved
and a revised regulation submitted to the MOH.
The St. Petersburg partnership coordinator participated in a public health policy seminar in Moscow on
epidemiology and control of infectious diseases, sponsored by the World Bank. The purpose of the seminar
was to: increase awareness of the magnitude and impact of infectious diseases on the health status and on the
healthcare system in the Russian Federation; identify strategies and technologies that are evidence-based and
that have been demonstrated to be cost-effective and feasible, but are not in common use in the Russian
Federation to prevent and control infectious diseases; identify strategies and technologies that are commonly
used in the Russian Federation that are not evidence-based, but that have not been demonstrated to be costeffective to prevent and control infectious diseases; identify challenges, needs, and opportunities to prevent and
control non-communicable diseases in the Russian Federation; define strategies and programs for prevention
and control of infectious diseases in the Russian Federation; raise the visibility of effective infectious disease
prevention and control activities (federal and regional) in the Russian Federation; and promote the need for
advancement and enhancement of prevention and control of infectious diseases in the Russian Federation with
policy-makers and a non-technical audience. The coordinator’s participation in this seminar was recommended
to the World Bank by USAID.
Sustainability
¾ The on-line availability of the 2nd Edition Infection Control Manual (mentioned above) significantly contributes
to the sustainability of the ICTC and the progress made in infection prevention and control thus far in Russia.
The on-line availability also further disseminates the evidence-based information contained in the manual.
¾ The Ministry of Health continues to view the St. Petersburg partners as leading experts in infection control and
seek their assistance regularly.
NURSING
Overall Goal: To improve patient care through effective, quality nursing practice and through strengthening the
profession’s contribution to systemic health care reform within the NIS/CEE.
Objectives:
1. Enhanced capacity for professional nursing education that meets international standards.
2. Increased status of nursing as a profession.
3. Improved nursing practice through nurse training and introduction of new models of nursing care and
nursing roles.
4. Increased access of nurses to information resources and networking opportunities through sustainable
Nursing Resource Centers.
Many of AIHA partnerships in Russia have integrated activities related to nursing and therefore contribute to the
above objectives. However, AIHA resources dedicated specifically to nursing objectives have been relatively
limited and largely funded through the NIS Region-wide cooperative agreement. During FY03, AIHA continued
financial support for Internet Connectivity to the four Nursing Resource Centers (NRCs) previously established in
Russia.
FY03 Key Activities/Outputs/Outcomes
Capacity-building for Nursing Education
¾ Although no activities were funded by AIHA related to this objective, two former partners reported that in
FY03 they developed four new nursing curricula along with state nursing education standards. Sokolov Center
of Post-graduate Education reported a new pilot distance learning program for nurse managers, pilot program on
geriatrics in nursing, and course on development of nursing in EU countries. The Pavlov Nursing College
developed an updated nursing curriculum on infection control for nurses.
Professional Development
¾ Two Russian graduates of the INLI program received small grants from AIHA to complete proposed projects in
association building, clinical practice, leadership and curriculum development. The projects will benefit the
nurse’s partnerships or local communities. The first round of proposed projects is complete and a second round
grants was issued at the end of this year. The nurses are reporting their results upon project completion.
17
¾
AIHA conducted a survey of the 56 nurses who graduated from its International Nursing Leadership Institute
(INLI) program, including eight nurses from Russia. The purpose was to determine outcomes of the INLI
program, which ended in 2002. Among the 48 nurses who responded to the survey (including all eight from
Russia), 31% said that they had received a promotion as a result of the INLI program; 90% said that INLI
helped them gain respect from their physician colleagues; and 67% are involved in nursing associations. Of the
Russian INLI graduates, one said she had received a promotion as a result of the INLI program; six said INLI
helped them gain respect from their physician colleagues; and five reported being involved in nursing
associations. A detailed report of results will be available in FY04. In addition, AIHA is preparing a series of
more in-depth success stories of selected INLI graduates, including one nurse from Russia.
Nursing Practice
¾ The Magnet Nursing Services Recognition Program (MP) aims to create centers of excellence and validate high
standards of nursing health care. These standards, developed by the American Nurse Credentialing Council of
the American Nurses Association, are a mark of excellence in nursing in the US. The AIHA program provides
intensive developmental assistance to the selected institutions that will enable them to meet the standards. The
program is being implemented by AIHA in collaboration with the Center for Health Outcomes and Policy
Research (CHOPR) of University of Pennsylvania, with assistance from American Nurses Credentialing Center
(ANCC) and volunteer US partners involved in the countries specified. At the end of the project an evaluation
will be conducted by the CHOPR to determine whether the project produced significant impact on the quality
standards as measured by higher levels of nursing and patient satisfaction in the hospital, and hence merits
replication in other hospitals across the NIS region. Sokolov Hospital and Central Hospital, both graduated
Russian hospital partners, were nominated in spring 2001 to participate in this two-year, multi-site pilot project.
¾ In order to measure improved nursing practice, AIHA incorporated questions related to introduction of new
models of nursing care and nursing roles into partnership self-assessment forms distributed during FY03. Six
partnership institutions in Russia indicated they have institutionalized new roles and responsibilities for nurses,
including independent patient assessment and care planning, infection control, patient education and counseling.
In addition, all of them except Volgograd and Schuche, reported they had institutionalized written standards for
nurses.
Nursing Resource Centers
¾ In the first quarter of FY03, AIHA conducted an assessment of all Nursing Resource Centers to determine the
extent to which the Centers are accomplishing the goals initially established for them and to identify factors
affecting their success. The assessment found that a continuing demand exists for the NRCs, with 21 of the 24
centers, including all five in Russia, still fully operational. Other key findings included the existence of strong
relationships with host institutions and recognition that dedicated staff constituted the center’s most important
resources. Lack of financial resources and translated materials were the main obstacles identified during the
assessment. All five of the Russia NRCs offer clinical skills training and provide access to the library and other
services. Four centers organize various meetings and three of them engage in various advocacy initiatives and
provide computer training. The centers are typically visited by nurses of various specialties, faculty members,
nursing students and, in some cases, by PHC physicians. A complete survey report is available on AIHA’s Web
site.
¾ The NRCs reported conducting a total of 273 courses in FY03, training 2,846 nurses and students. Courses
were offered in clinical practice, maternal and child heath, management, information systems and emergency
care.
¾ In May 2003, through AIHA’s Web site, the Sokolov NRC was contacted by a professor at the School of
Nursing Ana Guedes in Portugal. The contact resulted in the professor’s visit to Russia through the Russian
Nursing Association and a presentation on Modern Aspects of Development of Nursing in EU Countries.
EMERGENCY AND DISASTER MEDICINE
Overall Goal: To create sustainable capacity within countries to effectively respond to emergencies ranging from
routine medical cases to trauma to disasters involving mass casualties.
Objectives:
1. Increased capacity in targeted countries to provide quality training and education in emergency and disaster
medicine.
2. Improved knowledge and skills in first aid and emergency care among first responders, medical providers,
and other targeted groups trained through EMS Training Centers.
3. Increased sustainability of NIS/CEE partner efforts related to emergency and disaster medicine.
18
AIHA established two Emergency Medical Services Training Centers (EMSTCs) in Russia since 1994, with faculty
trained using a common EMS curriculum meeting international standards and tailored to the needs and conditions
specific to the NIS region.
During FY03, AIHA provided continued to provide limited direct support to the
EMSTCs in the form of Internet connectivity to enable the Centers to network with each other and to report to
AIHA on their activities and outcomes.
Capacity Building
¾ The Vladivostok EMSTC developed and piloted a new 50-hour course on providing emergency care in disaster
situations for physician/feldsher ambulance teams, and the Moscow EMSTC began working with the Institute
of Biophysics to administer courses on radiation safety.
Skills Building
¾ The Vladivostok EMSTC continued to offer on-site trainings in rural settings. For example, this year, the center
trained feldshers at the Emergency Services in Nakhodka, at the Central Regional Hospitals in Chuguevka and
Fokino.
¾ The centers in Moscow and Vladivostok reported training a combined total of 2,711 persons during the year,
with trainees ranging from emergency physicians to primary care providers to students. This number is a slight
increase from the 2,647 persons trained in FY02. The range of courses offered and clients served by the centers
is demonstrated, for example, by the Vladivostok EMSTC’s training for rescue workers on how to evacuate
people from tall buildings, training for the staff of the Krai Blood Transfusion Station, and training for students
at local high schools, the Far East State Technical University, and Vladivostok Nursing College.
Distribution of EMS Trainees
Others
100%
80%
60%
40%
20%
0%
Students
Paramedics/Feldshers
Nurses
Physicians
Q1
Q2
Q3
Q4
FY03
¾
The EMSTCs continued to increase public awareness this year. For example, the TV program “Road Patrol,” a
daily broadcasted, showcases the staff of “Vladspas” who were trained at the Vladivostok EMSTC.
Sustainability
¾ Local and national governments continued to support the EMSTCs this year. For example, all participants who
completed the training, First Aid and Emergency Assistance during Disasters, at the Moscow EMSTC received
state-recognized certificates, and the Vladivostok EMSTC continues to provide training to cadets from the
Russian Ministry for Emergency Situations.
IV. Success Stories
PRIMARY HEALTH CARE:
¾ Seven-year-old Artyom was diagnosed with moderate-persistent asthma when he first became involved in the
Sarov/Los Alamos partnership project on asthma care in 2001. Artyom and his mother attended the asthma
patient school at Sarov Medical Sanitary Unit #50, where the curriculum was developed jointly by US and
Russian partners, and he received medications donated at first by the US partners and later by the Sarov City
Administration. Over the past two years, Artyom’s condition steadily improved, and recently his diagnosis was
changed to light-persistent asthma. This September, he enrolled in one of the city schools, and thanks to his
improved condition, his physicians say Artyom can be active, play sports and live the life of an ordinary boy.
19
WOMEN’S HEALTH:
¾ Vera, a 58 year-old woman, had heard several times a radio presentation by the Snezhinsk Women’s Wellness
Center director on the importance of breast self-exams and mammography screening. In June 2003, Vera came
to the Center for her regular check -up and, referring to the radio presentation, requested a clinical breast exam.
While the ob/gyn did not detect anything suspicious during the exam, considering the patient’s age, she advised
Vera to get a free mammography test, a service newly available at the WWC since February. The mammogram
showed stage-I cancer, which was confirmed by biopsy results, and Vera underwent a mastectomy at Snezhinsk
Medical Sanitary Unit #15. Now Vera participates in the breast cancer support group through the WWC, and
soon she will receive her individually tailored breast prosthesis. US partners had provided breast prostheses for
members of the breast cancer patient support group, but since the partnership’s graduation in December 2002,
the support group established relations with specialized companies in Moscow and Chelyabinsk to provide the
prostheses.
EMERGENCY AND DISASTER MEDICINE:
¾ Among students of the Vladivostok EMS Center are traffic police who take the paramedics course offered at the
Center. One day, the car of one of the EMS faculty was stopped by police for a document check. When the
policeman saw who the driver was, he said, “Thank you.” The driver did not understand the policeman’s
behavior and asked what he meant. The policeman explained that, “Instead of an icon my mother-in-law keeps
a picture of me, and that’s thanks to you.” He further explained that his mother-in-law had given a biscuit to
her 3-year-old grandson who started choking on the biscuit, stopped breathing and turned blue. At that moment
the boy’s father (the policeman) came in and saw his son’s condition. Immediately, he applied the first aid
skills he learned at the EMS center and saved his son’s life.
NEONATAL RESUSCITATION:
¾ AIHA organized an NRP TOT course for future instructors of Saratov NRTC in February 2002. Galina
Moskvina, head of newborn department of the maternity house in Balakovo, Saratov Oblast, was not selected
by the hospital chief physician to be a NRP instructor or to participate in the TOT course. However,
being highly motivated to improve her own knowledge in neonatal resuscitation, Galina took a week
of personal vacation time, traveled to Saratov, and joined the TOT group. Galina successfully passed the
course exam. In May 2002, the Saratov NRTC was opened and Galina is recognized as one of the most active
regional NRP instructors-- she has trained 40 health care providers in the Balakovo maternity hospital. Not
only is Galina active, she is valued for the quality of her training by the Director and instructors at the Saratov
NRTC. To further enhance her training skills, Galina applied for an advanced course for trainers organized by
USAID/Moscow and she was selected to participate in the five-day training conducted in September 2003.
¾
Due to a lack of physicians in the rural hospitals of the Buriat Republic, only a midwife attends deliveries at
the Turuntayevo district hospital (70 km from Ulan-Ude); a pediatrician and ob/gyn are only called if there is an
emergency complication. In March 2003, Valentina, a midwife from Turuntayevo, completed a training course
in neonatal resuscitation at the Ulan Ude NRTC. Almost immediately (in April), her newly learned skills were
needed. Although the delivery was not complicated and the newborn boy was fully matured, he did not cry
and breathe. When Valentina tried to reach the pediatrician he was not available and it would be an hour before
the specialists from Ulan-Ude would arrive. Valentina began artificial lung ventilation with an ambu bag and
mask as she was taught in the NRP course. She was successful in getting the baby to breathe and more than an
hour later when the pediatrician and Ulan-Ude neonatologists arrived, the baby had a healthy pink complexion
and was crying as expected.
V.
Attachments
Attachment I:
Russia Strategic Objective/AIHA Indicator Chart
Attachment II:
Data Tables
Attachment III:
New Health Practices
20
Attachment 1
SO 3.2
Use of Improved Health and Child Welfare
Practices Increased
IR 3.2.1
Access to more Effective
Primary Health Care
Services Increased
IR 3.2.1.1
Use of Evidence-Based
Practices in Women/Infants
Health and NonCommunicable Diseases
IR 3.2.1.2
Quality Improvement
Methodologies Applied to
Primary Health Care
IR 3.2.3.1
Awareness of Preventative
Health Care Benefits Increased
IR 3.2.3.2
Capacity to Mobilize for
Preventative Health
Increased
Primary Health Care
1.1 % of partnership
primary healthcare
institutions that meet
AIHA’s model.
Primary Health Care
4.1 % of PHC partnerships with
active community-based
initiatives
Primary Health Care
3.1 % of WWCs achieving a
threshold score on the WWC
patient satisfaction survey
4.1 % of PHC partnerships with
active community-based
initiatives
Primary Health Care
1.1 % of partnership primary
healthcare institutions that meet
AIHA’s model.
Primary Health Care
4.1 % of PHC partnerships
with active communitybased initiatives
Women’s Health
1.1 % of WWCs
established that provide
core services consistent
with the WWC model
Nursing
4.1 # nurses visiting
Nursing Resource
Centers (NRCs) each
year for information,
training or networking
Women’s Health
4.1 % of WWCs implementing
women’s health clinical practice
guidelines, as documented
through quality monitoring
procedures
5.1 % of center users of
reproductive age who wish to
avoid pregnancy and report
using a contraceptive method
Neonatal Resuscitation
2.1 # of countries where the
MoH has adopted, in full or
partially, NRP Guidelines as
the standard of care for
newborns
Learning Resource Centers
2.2 % of partner institutions that
have developed systems for
evaluating and developing
practice standards
Women’s Health
3.1 % of WWCs achieving a
threshold score on the WWC
patient satisfaction survey
4.1 % of WWCs implementing
women’s health clinical practice
guidelines, as documented
through quality monitoring
procedures
Women’s Health
2.1 % increase in preventive
visits as a total of all visits to
the WWC
5.1 % of center users of
reproductive age who wish to
avoid pregnancy and report
using a contraceptive method
Neonatal Resuscitation
1.1 % of centers that have
developed and implemented a
recertification process.
1.2 % of instructors recertified
Nursing
3.1 # of partnership sites that
have institutionalized new
roles, responsibilities and
written standards for nurses
21
ATTACHMENT II: SELECTED PRIMARY HEALTH CARE DATA - RUSSIA
Objectives & Indicators
Russia
FY'03*
FY'99 FY'02
Increased capacity to deliver quality primary care services in targeted communities
71%*
n/a
% of partnership primary healthcare institutions that meet AIHA's
model
# of PHC centers opened
# of PHC patient visits
# of trainees by profession on PHC-related topics
# of PHC training courses conducted
# of trainers trained in PHC
0
3*
553,774*
197,714**
853*
66
165*
1,026**
55*
96**
Increase patient satisfaction with PHC services
n/a
n/a
% of PHC institutions using patient satisfaction survey that maintain
threshold level of patient satisfaction
# of institutions using patient satisfaction surveys as a quality
n/a
n/a
improvement tool
Increase acceptance and availability of PHC evidence-based practices and clinical
practice guidelines
% of partnerships that have developed systems for evaluating and
57%*
63%**
developing practice standards
# of trainees in CPG-related topics
0
# of products developed on CPG initiative (manuals, guidelines, etc.)
0
# of training courses in CPG-related topics
0
Increased community participation in improving the health of the community
% of PHC partnerships with active community-based initiatives
71%*
88%**
5*
# of community health councils/ boards/ committees established
through partnership that remain active
# of training programs in community development
# of community members trained in community development
# of patient clubs/ support groups established through AIHA
partnership that remain active
# of individuals actively involved in patient clubs/support groups
493
10*
19
0
0
*5 out of 7 based on partnership self-assessment: Sarov¹, Samara, Sakhalin,
Shchuche, Tomsk (however, Shchuche is not strictly a PHC center);
Khabarovsk and Volgograd did not meet AIHA’s PHC model based on selfassessment criteria; Snezhinsk graduated.
* Shchuche center no longer meets PHC criteria although services at the
polyclinic are provided; Samara center temporarily closed in June and is
expected to reopen in FY04.
*data includes Shchuche polyclinic; **data since April 2002
*134 MDs, 559 RNs, 160 other; **data since April 2002
*data since April 2002
*data from Sarov (144 teachers from schools and kindergartens and 21 school
psychologists); **data since April 2002
3 centers (Samara, Kislovka, Sakhalin) have completed only the first round of
survey; Svetly HEC also conducted the survey.
as above
*4 out of 7: Sarov (+), Samara (+), Tomsk (+), Volgograd (+), Shchuche (-),
Korsakov (-), Khabarovsk (-); Snezhinsk excluded
**5 out of 8 partnerships (in the last year Annual Report Volgograd was
accidentally omitted)
*Tomsk (1), Sarov (4), Korsakov (2), Snezhinsk (1), Samara (2)
*5 out of 7 PHC partnership sites (excluding Pereyaslavka and Volgograd)
**7 out of 8 (except for Volgograd)
* Korsakov , Samara , Tomsk , Sarov , Shchuche ; We do not have information
about Snezhinsk and Pereyaslavka is no longer active
11
157
5
60+*
Comments
*Not all PHCs were providing monthly statistics. Some data regarding patient visits,
professional and patient education are incomplete.
excluding 4 patient education schools
535
*25 adolescents involved in peer to peer education groups in Sarov; 10+ people in AH
22
and 10 people in BA patient support group in Tomsk; 15 women involved in breast
cancer support group in Snezhinsk
22,234
14,632*
# of people who participate in health education/promotion courses and
other activities organized by PHC institutions
# of health education/promotion courses
1,201
303*
¹Sarov was formally developed by AIHA as a WWC but it offers a wide range of PHC services
23
ATTACHMENT II: SELECTED WOMEN’S HEALTH DATA – RUSSIA
Russia
FY'03
Comments
FY'99 FY'02
Increased capacity to deliver comprehensive, outpatient health service to women of all
ages
% of WWCs established that provide core services consistent with
the WWC model
# of WWCs opened
1*
4**
# of patient visits
# of WWC staff trained on WH-related topics in AIHA-sponsored
programs
260,435
152,063*
9*
95**
# of workshops AIHA has offered on WH topics
1*
8
Increased utilization of health promotion and prevention services within the WWC
% increase in preventive visits as a total of all visits to the WWC
7%
114,687
42,101*
# of preventive visits
# of participants in WWC-sponsored educational programs
16,897
8,138*
Maintenance of a high level of patient satisfaction with the WWC and its services
% of WWCs achieving a threshold score on the WWC patient
33%*
n/a
satisfaction survey
7*
n/a
# of WWCs administering a patient satisfaction survey as a quality
improvement tool
Increased implementation of women’s health clinical practice guidelines
# of women’s health CPGs developed and disseminated to WWCs
1*
10**
# of WWCs with a quality improvement procedure in place to enable
8*
n/a
determination that clinical practice guidelines are being used (or not)
Increased use of contraceptive methods among women of reproductive age who wish to
avoid pregnancy
% of center users of reproductive age who wish to avoid pregnancy
60%*
n/a
and report using a contraceptive method
see self-assessment results under WH “Program Accomplishments” section
*WWC in Snezhinsk (Oct. 23, 2002)
**4 other centers were opened before October 1998
**data since April 2002
*all 9 people (WWC directors and physicians) participated in AIHA-sponsored
events prior FY03
**this number includes staff trained in the period of 10/98-09/01
* WWC CPG and PMTCT workshop, September 2003, Odessa
comparison of the 4th quarter of FY02 and FY03 (39% vs. 46%)
n=3
*based on WWC self-assessment
* Translated Guidelines on Medical Care for HIV Positive Women
**between FY99 and FY01
*based on WWC self-assessment
*percent of women who use contraceptive methods
24
ATTACHMENT II: SELECTED NEONATAL RESUSCITATION PROGRAM DATA – RUSSIA
Russia
FY’03
Comments
FY’99 –
FY’02
Increased capacity to provide training in evidence-based neonatal resuscitation care
as the standard of clinical practice
83%*
50%
% of centers that have developed and implemented a recertification
process.
6
# of AIHA NRTCs established
# of new instructors trained
# of providers trained
# of providers recertified
# of NRP Training centers with annual schedules of activities
Improved sustainability of the NRP
# of countries where the MoH has adopted, in full or partially, NRP
Guidelines as the standard of care for newborns
# of replication sites, established at the request of the local health
administration, that have adopted the AIHA NRTC model
15
769
1,337
158*
5,643
29
* 5 out of 6 NRTCs (excluding Moscow)
6
The Russian MOH issued Prikaz # 372 (on neonatal care in delivery room) based on
AAP/AHA NRP Guidelines in December 1995. Currently, the MOH reviews a proposal
submitted by the NRTCs to change Prikaz # 372 according to the NRP 2000 Guidelines.
adopted
0
4*
*Perm, Arkhangielsk, Saratov, and Smolensk
25
ATTACHMENT II: SELECTED LEARNING RESOURCE CENTER DATA – RUSSIA
Russia
FY02
FY02
Increased access to up-to-date health care knowledge resources
% of targeted health professionals using (computer-based) knowledge resources
75%
76%
% of literature-based health information needs met through computer-based knowledge
resources
32%
34%
% of health professionals trained to use computers and the Internet
45%
46%
# of health professionals trained to use computers and the Internet
596
562
# of information requests from health professionals/patients
2,620
2,129
# of health professionals with access to the LRC
22,463
26,935
# of LRC visitors
4,430
4,434
Increased promotion of evidence-based practice.
% of LRCs producing practice standard reviews using evidence-based methodologies
52%
52%
% of partner institutions that have developed systems for evaluating and developing
practice standards
20%
NA
# of active information coordinators trained in evidence-based practice/critical
information quality assessment
16
13
# of practice standard reviews conducted at partner institutions
15
34
% of staff using Ovid/MEDLINE
37%
37%
% of staff using Cochrane Library
39%
35%
Demonstrated ability to sustain access to knowledge resources independent of AIHA funding.
% of active LRCs no longer receiving funding from AIHA for Internet connectivity
40%
32%
% of LRCs that have received grants from external sources to support access to
knowledge resources
24%
12%
% of LRCs that are generating revenues and/or recovering costs from outside sources
24%
12%
% of LRCs applying for grants
28%
20%
# of information coordinators trained in grant proposal-writing and sustainability
strategies
18
21
Increased development and use of information and communication technology tools and applications.
% of partner institutions that have developed and are using databases to manage
administrative and/or health care information
68%
68%
% of partner institutions that have developed local area networks that enable expanded
access to knowledge resources
72%
64%
% of partner institutions that have developed an institutional Web site
96%
84%
% of partner institutions using LRC for telemedicine, including remote e-mail-based
teleconsultations
76%
76%
# of active information coordinators trained in database design
17
18
# of active information coordinators trained in Web page design
17
18
FY99FY01
Comments
76%
34%
46%
1,530
6,994
26,935
5,742
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
26
ATTACHMENT II: SELECTED INFECTION CONTROL DATA – RUSSIA
Russia
FY’03
Comments
FY’99 –
FY’02
Improved surveillance and assessment capacity in the areas of nosocomial infections
and a/b resistant microorganisms
# of hospitals from a pre-selected sample that demonstrate an active
infection control program
% of WHONET centers that generate valid data on an on-going basis.
92%*
n/a
# of hospital IC surveillance protocols developed
3
1
# of WHONET centers developed
6
Strengthened training capacity in infection control, clinical epidemiology and evidencebased medicine
% of trainees with improved knowledge after training
# of IC Training Centers established
1
6*
2
# of curricula developed for IC, clinical epidemiology and evidencebased medicine
#of trainers trained at ICTCs
69
414
# of health professionals trained at ICTCs
749*
17
# of courses conducted at ICTCs
30
Improved infection control practices based on evidence-based clinical and management
practice protocols
% of hospitals (from pre-selected sample) targeted by AIHA Infection
Control Program with improved infection control practices of clinical
staff.
43%*
n/a
% of AIHA PHC partnerships with improved infection control practices
at PHC facilities
# of infection control manuals distributed
500
n/a*
# of AIHA workshops on infection control in PHC settings
# of trainees trained in AIHA workshops on IC in PHC setting
Enhanced sustainability of Infection Control program
# of countries where ministries of health have demonstrated support for
adopting evidence-based infection control practices at a national level
# of ICTCs generating revenue and/or recovering costs through outside
sources
Regulatory documents developed for review by ministries of health
1*
30
5
156
1
see assessment results under IC “Program Accomplishments” section
n=13
Due to staffing limitations, it was not possible to conduct this survey during FY03.
*2 new curricula in IC, 2 – clinical epidemiology and 2 EBM
15 new trainers were trained in FY03
*data since October 2000
*3 centers out of 7 based on partnership self-assessment: Sarov, Samara,
Tomsk;
*the 1st edition of the IC Manual was available on the AIHA website and thus it
is not possible to track the number of distributed manuals
*(11/02) workshop on IC-related issues in Tomsk
drafts of two regulations were submitted to the RF MoH for approval
1
yes
three drafts were developed and are currently under review
27
ATTACHMENT II: SELECTED NURSING DATA – RUSSIA
Russia
FY’03
Comments
FY’99 FY'02
Enhanced capacity for professional nursing education that meets international standards.
# nurses serving as faculty in nursing schools involved in AIHA
30*
79
partnerships
# of new nursing curricula developed by AIHA partner institutions
Increased status of nursing as a profession.
# of INLI nurses promoted to leadership positions after receiving AIHA’s
leadership training
# of nursing associations and related organizations created or strengthened
through AIHA
4*
22**
0
1
3*
3
0
8
# nurses trained in leadership skills through INLI
# new NIS/CEE members of int’l nursing associations & other
n/a
24
membership organizations
Improved nursing practice through nurse training and introduction of new models of
nursing care and nursing roles.
6*
n/a
# of partnership sites that have institutionalized new roles, responsibilities
and written standards for nurses
% increase in patient satisfaction at “Magnet Program” hospitals
0
107
# nurse participants in AIHA workshops
“Magnet Program” sites achieve recognition of meeting international
standards of nursing care excellence
Increased access of nurses to information resources and networking opportunities
through sustainable Nursing Resource Centers.
n/a
# nurses visiting Nursing Resource Centers (NRCs) each year for
~2,600*
information, training or networking purposes
% of NRCs operating w/o AIHA funding
100%*
n/a
# NRCs established
5
# of participants in AIHA’s NRC workshops
0
11
# of training courses offered annually by NRCs
273
307
# of nurses trained by NRCs
2,846
4,749
*10 nursing faculty at Samara Nursing College, 3 nursing faculty at Pavlov
Nursing School (Saint Petersburg), 17 nursing faculty at Sokolov Center of
Postgraduate education
*3 by Sokolov and 1 by Pavlov; **8 by Sokolov; 6 by Pavlov; 6 by
Vladivostok NRC; and 2 by Korsakov (Sakhalin) PHC partners
*Nursing Association of Primorsky Krai, Nursing Association of Kurgan
Oblast, Nursing Association of Sakhalin Oblast
*2 of the partnerships: Volgograd & Schuche institutionalized new roles but
have no written job descriptions
assessment will be implemented in FY04
assessment will be implemented in FY04
* Estimate based on NRC assessment
*4 centers receive funds for Internet connectivity
28
ATTACHMENT II: SELECTED EMERGENCY AND DISASTER MEDICINE DATA - RUSSIA
Russia
FY'03
Comments
FY'99 FY'02
Increased capacity in NIS/CEE countries to provide quality training and education in
emergency and disaster medicine (EDM).
100%
% of EMS Training Centers (EMSTCs) regularly offering courses
based on curricula developed through AIHA
% of EMSTCs that have developed and are offering courses beyond the
100%
basic courses developed through AIHA
2
# of EMSTCs established
# of EMSTC trainers trained and working at EMSTCs
28
# of curricula independently developed and offered by EMSTCs
4*
Vladivostok and Moscow EMSTC
Vladivostok and Moscow EMSTC
10
# of trainers trained in nuclear disaster preparedness and response
0
2
(IAEA training)
Improved knowledge and skills in first aid and emergency care among first responders,
medical providers, and other targeted groups trained through AIHA's EMSTCs.
129*
66
# of classes held by AIHA’s EMSTCs – disaggregated by types of
curricula
# of emergency healthcare professionals trained – disaggregated by
2,711* 11,175**
professional affiliation
Increased sustainability of NIS/CEE partner efforts in EDM
# of countries where EDM-related policies have been adopted and/or
EDM integrated into health care and health education systems
% of EMSTCs officially recognized and fully funded through
government sources
% of EMSTCs generating revenue from non-governmental sources
yes
20 trainers trained at Moscow EMSTC (10 full-time trainers including 1 new,
and 10 part-time); 8 trainers trained at Vladivostok EMSTC.
*1 curriculum was developed at Moscow EMSTC, and 3 at Vladivostok
EMSTC
*a breakdown is available
* a breakdown is available
**data since October 2001
In FY03 Moscow EMSTC course on Emergency Cardiology has been
introduced into curriculum of post-graduate institute.
100%
100%
29

Document 6534280

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