Experiences of a health team working in a new urban settlement area in Istanbul.

ABSTRACT

A project aiming at creating a model for comprehensive maternal and child health care for urban underdeveloped areas was started in a new settlement area of migrants in the vicinity of Istanbul. The project had an impact on health care status, particularly among infants and children, but the results indicated that more effort was needed to reach the mothers. It was noted that building space and the appearance of the work place influenced the prestige of the team. Absentee problems could be partly surmounted by repeated home visits. Based on this experience, it was concluded that health services in underdeveloped areas need to be supported by non medical personnel to act as home visitors and as mediators between the community and the health team. It was also concluded that an established recording system to include both clinical data and attendance is needed to define the cases who need special care.

ABSTRACT

PIP The purpose of this study was to establish a model of comprehensive health care for women and children in slum areas of urban cities in Turkey. The initial startup began in December 1986 with an area population and health survey. Prevention and curative services were initiated in March 1987. Poor attendance was a major problem. Group interviews were conducted in early 1988. In February 1989 a daily computerized record system was set up to identify risk groups and nonattenders. Home visits were conducted with a medically equipped mobile van; new facilities and staff were added. 26% of the district population of 9760 were women of reproductive age. 69% were married and 7.8% pregnant. 1267 infants and children between 0-60 months lived in the area of which 230 were 1 year. The area represented mainly skilled workers in nuclear families in houses that were in good condition. 51% had 5 years of schooling, 26% were illiterate, and 15.4% of husbands were illiterate. 59.6% of children, 20.4% of nonpregnant women, and 25% or pregnant women came for a 1st appointment albeit not at the scheduled date. Those not attending were found to go to private physicians, and believed that a free service cannot be good and criticized the physical accommodations. After home visits, attendance rose to 79.7% for infants, 61.8% for children, and 38.6% for women. Attendance over a 24 month period revealed that visits were higher than expected for infants and children. The program impact was a higher immunization rate/age (87% lacking immunization were immunized) and increased well baby care (83.1%). Maternal health improved and family planning users increased. The baseline survey showed 71.1% receiving antenatal care vs. 93.7% of the 147 currently pregnant women having received at least 1 visit in the 1-year survey. Hospital births also increased from a baseline of 58.8% to 78.3%. Family planning increased from 22.9% to 34.0% which included the preferred IUD. IUD users rose from 12.3% to 19.8% of married women of reproductive age. 47% of nonusers who had been pregnant in the past 2 years were now modern contraceptive users. Clinic utilization was enhanced by regular home visits by health workers, and quality of care. The appearance of the building space and comfortable surroundings also were important. Quality of care improvements are suggested over expansion. Community support is essential. Personnel need strong communication skills. Flexibility is needed to meet people's needs, and reevaluation is required.