The main goal of this joint intervention was to promote a new approach on the mother and child health service provision, including here the development and promotion of mechanisms and instruments of implementing the new regulative framework and the enforcement of systemic changes on the preventive M&Ch health care services, paying more attention on child growth and development, home visits, evaluation and consideration of not just the health status but also other environment factors where the child is living, and also the due planning of necessary protective services for vulnerable groups.

The “public health” concept has evolved and has been broadened during the last years. Previously, this concept had a

very narrow meaning, based mainly on the heath service activity, where besides therapeutic activities it included a rather limited number of preventive activities, especially those closely connected to environment hygienization and the controlling of infective diseases, aiming to protect the nation health. During the last years, this concept has acquired a wider meaning and its practical implementation requires a more holistic approach. It involves a wide range of actors and activities connected not only with health services, preventive and therapeutic, but also with other elements that impact on the conditions and behaviours of individuals and communities against health as well as ensuring a well functioning of a nation system for health improvement of the population.

The WHO’s strategic framework “Health 2020”, which is also the new framework of the European health policy, puts an emphasis on a wide range of health determinants going further than the traditional health system. As it is shown on the figure below, except the cases traditionally belonging to the health structures, there are also a large number of non-health related determinants (which are outside of the health system competences). Such determinants are related to: personal factors (age, gender, heritage, etc.); the individual approach toward his/her own health (alcohol, smoking, malnutrition, etc.); the awareness, education and the community behaviours toward health (traditions, customs, social integration, etc.); individual access to main knowledge and life condition resources (education, income, food, job conditions, housing, drinkable water, hygiene, etc.); the fairness in distribution of living resources and health services among the population (economic and social aid, access of social and health insurance, etc.) and also their quality; the general conditions of the surrounding environment, which can be divided into: (i) availability, access and quality of natural resources (like air, earth, water, plant, etc.); and (ii) availability, access and quality of human build environment (road infrastructure, building, waste management, parks, etc.).

Splified schema of main determining elements of public health

Although the health institutions play a major and irreplaceable role, they cannot improve the social, physical and economical determinants of public health. In the improvement of these determinants, the community and local government structures have a key role – a role which is becoming more important after the last territorial reform and the process of delegating and transferring more functions at the local government structures. The draft National Health Strategy 2016-2020 emphasises “There are growing evidence which state that health and welfare are not connected just on the performance of health systems. There are other social factors related to income, education, shelter and environment which have a strong impact in health and welfare and there is need for an integrated and inclusive approach at all government sectors and other actors in society.” With the implementation of territorial reform, the role of local government in health care is becoming more involving. “The health service cant been seen as a oasis separate from other public services” emphasizes the Inter sectorial Strategy for Decentralization and Local Government of 2015-2020 in justification of a greeted local government involvement and contribution to the health sector

Based on the new concept of public health, the project interventions have followed an integrated approach combining: (i) a direct public health approach through health care institutions, by improving their efficiency and having a better quality of health care service for mothers and children; and (ii) an indirect approach of health care reducing the risks related to other health care determinants from environment factors (social, physical and economical) through a stronger collaboration between institutions, better management of health care risk factors of M&Ch within local government, and also a higher community awareness and involvement of society in improvement of M&Ch health care.     

“Mothers and children are the most vulnerable part of every community. The engagement of local governance for mothers, children and babies is one of the most important investment, not just for the future, but also for the present, for the everyday life of our children …” Taken from the speech of the representative of Durrës municipality during the project closing conference. 15 December 2016

The increase of local governance and other local actors (e.g. civil society and community organizations) role and involvement in public health eases the implementation of reforms and innovative regional initiatives for resource redistribution and increases the chances for a greeted equality of access to health services. The local government is closer to problems, more informed and integrated in its own community, and also has available a wider range of instruments for action. Although it could participate as an alternative funding of the local health system, a big part of local government actions (social welfare, waste management, drinkable water and black water, environment management and waste reduction within the territory, etc.) are now part of local government functions, which are at the same time unavoidable preconditions for improving public health.

In this context, for the development of the social model of mother and child health in this area, based on the approach mentioned above, the main project interventions were focused on three levels (health institutions, local governance and the community) where it was build toward five main direction, mentioned below:

• Increasing the capacity of PHC’s personnel in Durrës following the approach foreseen in the protocols and standard consultancy service, especially focusing on prioritizing vulnerable groups, child growth, linkage with other sectors to strengthen their attention to health services and child welfare;

• Reviewing the data collecting system and documentation of M&Ch consultancy following the protocols and service standards and the Main Package of Primary Health Care;
• Strengthening of supporting supervision mechanisms to monitor and support correctly implementing of Guidelines of Clinical Practices (GCP) and Protocols Clinical Practices (PCP) and standard service quality;
• Promoting cross-sectorial and multi-institutional collaboration in the municipalities of Durrës and Shijak, and conducting of multi-disciplinary trainings on mother and child needs; and
• Sensibilising the community on practices for improvement of mother and child health.

Project Interventions

The project was conducted during the period November 2015 – December 2016. It was conducted by RHD Durrës and PfD Foundation, in cooperation with PHI, Durrës Municipality, Shijak Municipality and with the support of UNICEF and Ministry of Health.  The project started with a preparation phase (November 2015 – January 2016) during which detailed technical elopements and necessary collaborations were developed. The field implementation of project activities where conducted during the periods February – December 2016 and were concluded with a conference, in December 2016, with a wide participation from various institutions and local and national actors.