PRINCIPAL DIRECTIONS OF ACTIVITY AND FURTHER DEVELOPMENT OF THE CHAIN OF ORPHANAGES OF THE MINISTRY OF HEALTH CARE SYSTEM OF UKRAINE
R.A. Moiseenko, A.V. Tereschenko
The Ministry of Healthcare of Ukraine, Kiev, Ukraine
The results of the state policy about health care and social protection of orphans and children deprived of parental care, for the period 1999-2011yy. are analyzed. The directions and further development of the chain of orphanages of the Ministry of Health Care System of Ukraine are shown.
Key words: orphans, children deprived of parental care, health care, social protection, orphanage.
The best environment for a child — it is own family. The state creates conditions for this right, but not all children have the luck of living in a family.
Priority directions of activity in the branch of health care in the state policy implementation according to the orphans and children deprived of parental care are:
- prevention of social orphancy by the way of creation of conditions for the birth of desired healthy child (maintenance of adolescent health, a network of «Youth-friendly clinics»; improvement of family planning service, medical and genetic counseling and organization of health care for pregnant women, parturient women, new mothers and newborns);
- collaboration with social services according to the work with families, with children, who are turn out to be in the difficult real-life situations;
- rehabilitation of handicapped children;
- creation of conditions for effective medical care and rehabilitation of orphans with the aim of realization of the right on own family;
- influence for placement of children in foster family and family-type homes, providing them quality health care, participation in the control over the content of these children together with social services.
Ensuring of the right of orphans to have a family is a priority in the activity of orphanages of the Ministry of Health System of Ukraine. In the Ministry of Health System the 47 homes on 5044 seats are in use, including 42 specialized children's homes for seriously ill children. In the orphanages the medical and social protection of orphans and children deprived of parental care, including those who has physical and mental development from birth to four years is realized. For the end of the 2011year in the orphanages were 3433 orphans.
Since 1999 year in Ukraine, the number of children who for the end of the year are in orphanages, decreased on 1671, or on 32.7%, at the same time the proportion of specific weight of taken to the family children increased from 73.5% to 78.3% (table 1).
This is primarily the result of:
1. Sequential actions of the state in relation to responsible fatherhood and strengthening of the institute of family, the increasing of importance and respect for families with many children and prevention of social orphancy.
2. The introduction of social care to families at birth of a child.
3. Work which is carried out in the maternity and children's hospitals accompanied with regional Centers for Families, Children and Youth for prevention of mother's surrender of the child.
4. The introduction of new perinatal technologies which have influence on increase of child morbidity in hospitals.
5. Work which is carried out in the orphanages associated with the timely diagnosis, quality treatment and rehabilitation of children with serious illnesses.
Protection of the rights and legitimate interests of orphans and children deprived of parental care, in the state is carried out by the Ministry of Health Care in the close cooperation with the Ministry of Education and Science, Youth and Sports and the Ministry of Policy of Ukraine, which is now authorized to coordinate this activity.
Remains and increases the relevance of improving of orphans and children deprived of parental care alimentation system, with priority orientation on adoption and family-based education.
It must be taken into account the presence of abandoned seriously ill children who cannot be adopted or raised in the foster family or in the family-type orphanage for the reason of their extremely critical health status which is requires a number of therapeutic and rehabilitation measures.
An important indicator of the effectiveness of health care is a gradual state of child mortality decrease in orphanages, for the last ten years is almost in 4 times (Fig. 1).
The prevalence of disease among orphans is growing every year due to increased intake of children with diseases of the nervous system, and congenital malformations.
Morbidity is also growing (the first time in the life recorded disease). Among all registered for the first time in the life diseases the first place takes respiratory diseases (51.53%), the second — a disease of the nervous system (20.8%), the third — congenital malformations, deformations and chromosomal abnormalities (9.74% ), the fourth — a mental disorder and behavior (7.13%), the fifth — endocrine diseases (6.13%) (Fig. 2).
There is also important the reduction of gravity of respiratory diseases and acute intestinal diseases, the number of which for the decades has declined from 2.3 to 0.18 per 100 children of average cohort (Fig. 3).
According to the World Health Organization to the states, signs and symptoms may be included:
- cases when the more accurate diagnosis is not possible after consideration of all the evidence, which have been reported;
- transient signs or symptoms, the causes of which could not be ascertained;
- cases when the preliminary diagnosis cannot be confirmed, because the patient did not come for further examination or treatment;
- cases of patient direction to another facility for examination or treatment before a final diagnosis;
- cases when a more accurate diagnosis was not done for any other reasons.
In accordance with the aforementioned, the Order № 366 «On the creation of special expert committees for medical examination of orphans and children deprived of parental care, and confirmation of the procedure of its activities,» was issued by the Ministry of Health Care from 28.05.2009, which passed a state registration in the Ministry of Justice of Ukraine №562/16578 from 23.06.2009. This order provides a unified procedure of special medical commission activity for examination of orphans and children deprived of parental care, on which were assigned the functions of:
Positive evidence of the introduction of the new legislation is that for the period 2008–2011yy., due to better accurate orientation of orphans during annual preventive screening significantly reduced the level of morbidity of orphans on unspecified condition, the signs and symptoms from 5.58 in 2008 year to 2.24 in 2011year.
- annual planning of mandatory medical preventive examinations of the present category of children;
- oversight of mandatory medical preventive examinations;
- expert analysis of the report on the state of health, physical and mental development of children-orphans and children deprived of parental care, including those who have been passed into care to the family by the results of the mandatory medical preventative examination;
- monitoring of the implementation of the recommendations provided during the mandatory medical preventive examinations;
- annual compilation and analysis of mandatory medical preventive examinations of orphans and children deprived of parental care.
One of the aspects of the work always been and remains the provision of budgetary and extra-budgetary cost of Ukraine of all orphanages by a special rehabilitation equipment of domestic production, needful for children with disabilities.
On the period of 2011 year in the State Budget of Ukraine at first for the years of independence of Ukraine were allocated 10 million UAH for administration of the course of rehabilitation for children of receiving aid category, suffering from infantile cerebral palsy in the International Clinic of Rehabilitation.
First of all vouchers for treatment in the pointed clinic were given to patients with cerebral palsy from the number of orphans and children deprived of parental care and also children suffering from infantile cerebral palsy, children from lower-income families (receiving aid children). Totally 642 of receiving aid children had administrated rehabilitation.
In 2012 year by the Law of Ukraine «On the State Budget of Ukraine for 2012 year» was allocated the 16 million UAH for administration of rehabilitation of receiving aid children, children suffered from cerebral palsy in the International Clinic of Rehabilitation.
By the Ministry of Health Care of Ukraine was developed and approved (Order № 70 from 20.02.2010) the conception of reforming orphanages on the period until 2017 year according to which was prescribed the establishment in the structure of the existing orphanages with trained staff of rehabilitation centers system, which will have in its structure as a groups for children-orphans and children deprived of parental care so opened for use and rehabilitation groups for ill children from the families with ability of their short-term hospital stay.
One of the priorities is remaining staff training for the network of boarding schools. With this aim, the Ministry of Health Care has opened and holds the cross-sectoral training of medical, educational, and social workers on the basis of the Department of Neurology and Medical Social Rehabilitation of P.L. Shupyk National Medical Academy of Postgraduate Education.
An important component and prerequisite for the reform of the orphanages is also the fact that medical care to orphans begin to execute by specialists from
Pediatrics by 11 specialties and a non-stop medical supervision. Today, the workload per one person of medical and pedagogical orphanage staff is:
- 10.34 orphans per 1 doctor;
- 1.13 orphans per 1 secondary medical worker;
- 1.28 orphans per 1 junior medical worker;
- 3.07 orphans per 1 pedagogical worker.
Thus, the number of secondary medical workers per one child also increased almost twice, that's allowed:
- to improve the quality of medical monitoring of children;
- to provide permanent presence of nurse in the group;
- to make provision of primary predictor care;
- to make provision of performance of appointments of medical specialists;
- to increase the amount of rehabilitation;
- to keep up with demands of antiepidemic security to children with infectious diseases;
- to hold the level of incidence of acute respiratory diseases;
- to reduce the incidence of acute bowel disease;
- for the years of Ukrainian independence to reduce the mortality of children in orphanages in almost 5 times.
Positive changes in the health status of orphans occurred also for the result of timely detection of chronic diseases, the prevalence of which for this period has tripled, birth defects and other serious diseases that cause disability in children and require timely and total medical treatment and rehabilitation. In fact, 60% of orphans, who have health problems in need of careful examination and treatment, including surgery and intensive rehabilitation.
Today, just birth defects, nervous system and for the recent times more often HIV-infection are the reasons of failure of the child. The last problem requires the collaboration of all the ministries and departments, medical and non-medical community to ensure the rights of children with HIV.
In 2011year, in the orphanages were 169 (2008 year — 158) of children with disease caused by the Human Immunodeficiency Virus (HIV), this diagnosis was in 46 of them for the first time of life, in 27 children diagnosed before the age of 1 year.
The largest number of children with HIV lives in orphanages of Donetsk, Dnepropetrovsk, Zaporizhya, Mykolaiv, Odesa regions, AR Crimea and Kyiv.
Besides this, among the orphans were registered those, who has incomplete test of HIV by the age, the number of which on 2011 year was 177 persons (2008 year — 193 persons), the largest number of these children are in orphanages of Dnepropetrovsk, Odesa and Donetsk regions (Fig. 4).
The actual problem for today is the lack of willingness of boarding schools of the Ministry of Education System and the Ministry of Labor for receiving and education of such children. There is important in this problem the work of health care institutions with pedagogical and other staff of these orphanages and the bodies that managed them.
It is clear that in case of the effectiveness of these measures and a positive result of rehabilitation child will get more chances to be adopted. In most cases, healthy children are adopted and taken on alimony to foster families and family-type homes. Therefore the function of rehabilitation facilities for such children and children with disabilities health who are raised in the families and under the age of 7 years will continue to perform the orphanages with having professional human capacity, correspondent equipment and conditions for the provision of quality health care for children, that will increase the chance to realize the right of the child to have a family.
The need for review of traditional approaches to orphanages first of all due to:
The aim of the Concept of orphanages reforming on the period up to 2017 year is to improve the prevention system of social orphancy by the way of providing medical and social protection of children from the families who had found themselves in difficult life circum-stances, the guaranteed right for every child, in spite of its social origin, age, mental and physical health, to live and grow up in the family.
- implementation of the state targeted social program in the reforming of a system of institutions for orphans and children deprived of parental care, by the Order of the Cabinet of Ministers of Ukraine approved from 17.10.2007 Reg. № 1242;
- the tendency of reducing the level of entrance for care to the orphanages of children who had found themselves in the difficult life circumstances;
- a significant number of children who are deprived of mothers in maternity hospitals (2007 year — 1027, 2008 year — 909 2009 year — 865 2010 year — 719 2011 year — 599 children) and entered to orphanages (2007 year — 2705, 2008 year — 2543, 2011 year — 2571 children);
- the sustainable tendency of increase of sick children in orphanages in Ukraine, who are requiring longterm medical monitoring, treatment and rehabilitation (in 94.6% of children who are entered for care to orphanage the retardation in the physical and mental development is found; for the period 2001–2011 years the frequency of registration of birth defects development, deformations and chromosomal abnormalities in the orphanages has increased in some areas in 2–7 times.)
It is allowed by conception the reform of orphanages into an entirely new organizational model. The model, which must include two main business units: the orphanage in the temporary means, where the orphans and children deprived of parental care in under four years are growing, — closed type and the medical and social rehabilitation center, which is created as a part of orphanages — open type.
The institution should not duplicate the functions of existing rehabilitation centers. It must be fundamentally and ideologically new model of rehabilitation of children and parents, the main tasks of which are:
— Prevention of social orphancy;
— Support for family-type orphanages, where children grow up with disabilities.
Rehabilitation activities of the center should be directed to:
— Providing of comprehensive medical and individual approach to each patient for the purpose of disclosure of its natural potential and adaptation to normal life in society;
— Providing of staff training and re-training for the work in health and social centers;
— Organization of information and legal, analytical and methodological institutions support;
— Strengthening of public willingness for reintegration of children with disabilities to the society;
— Formation of conscious paternity skills not only for families, who are wishing to adopt a child or take her into papillary, foster care, family-type, but also as a biological parents;
— Methodically and consulting work and software in case of indications of further treatment, medical
rehabilitation and habilitation of children after the end of their stay in the institutions.
Organizational structure of medical and social rehabilitation center can be:
- administrative and economic unit;
- organizational and methodological department;
- diagnostic and treatment unit;
- medical diagnostics and physical therapy rehabilitation department;
- pedagogic and logopedic correction department
- department of Social infection (for HIV-infected children, tuberculosis infected children, suffering from hepatitis C, TORCH-infections, etc.);
- prevention of social orphancy department («Branch Family Crisis»);
- common stay of mother and child department
- department of physical rehabilitation for disabled hildren in the age of 7 years;
- day care department, etc..
Consequently, the expected results of reforming of a system of institutions for orphans and children deprived of parental care should be:
— improving of the health of children who had found themselves in difficult life situations, increasing their chance to be adopted, arranged in foster care, family-type orphanages reintegrated into their biological families;
— Reduction of mortality level in children under 5 years;
— The prevention of disability among young children;
— Extensive training of parents by methods of rehabilitation for ensuring of continuity of the process
— Improving the child's adaptation to normal life in society by the way of their individual needs in the psychological, medical and social rehabilitation.
1.Today, thanks to the introduction of new socially oriented to the child of the model orphanages there the clear steady tendency to:
— reintegration of children who are raised in orphanages, to the family environment — from 73.53% in 1999 year to 86.35% in 2011year;
— reduction in 4.2 times of mortality among inmates of orphanages which in absolute numbers state in value 43 in 2011year against 182 in 1999 year;
— reduce by half the number of children placed in other boarding school institutions (1999 year — 26.47, 2011year — 13.6).
2. The introduction of social and psychological support and help to the woman who has intended to make surrender from her newborn- an essential component in the prevention of failures that allowed halve the number of children abandoned by their parents in obstetric hospitals — from 1027 in 2007 year to 599 in 2011year.
3. Introduction in Ukraine of the state model of early prevention of the early social orphancy became possible and successful thanks to cooperation with nongovernmental and international organizations and also with effective inter-agency cooperation mechanisms.
4. The rehabilitation model «Tandem-partnership» in orphanages was introduced in total
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