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Working from the Ground Up: AVSC's Moldova
Program
Anna Kaniauskene
AVSC has been working in Moldova since 1995, when the country's Ministry of Health (MOH) began looking for ways to revitalize the country's family planning program.
In only a few years' time and with a modest budget, AVSC's program has seen widespread success--demonstrating how much can be accomplished with few resources and much dedication.
Need for Training
Before the MOH initiative, access to family planning services and supplies was limited, providers were not informed about many methods, and abortion was relied on to limit and space childbirth.
The MOH invited AVSC to work with the Family Planning Association, a nongovernmental organization, to train the doctors and midwives in the country's 60 family planning rooms. During 1996 to 1998, AVSC provided training in reproductive health, family planning, counseling, minilaparotomy (a female sterilization technique), and management of family planning services to a total of 365 staff. From these workshops, 13 participants were selected to be trained as local trainers.
Providers attending a COPE training workshop in Chisinau, Moldova's capital. |
Learning New Ways
The workshops exposed the participants to completely
new approaches to service delivery.
As one example, a young doctor in
a 1996 counseling workshop was initially resistant, feeling that
she was already "doing everything right." But by the end of the
workshop, she admitted, "I was wrong. I will completely reorganize
my office and [use these skills]."
By the following year, improvements
in her practice were evident. Using her own money, she had added
partitions and furniture to provide client privacy and comfort and
had developed client-education posters using AVSC materials.
Building Capacity
In
addition to training local trainers, AVSC has engaged in efforts
to ensure the program's sustainability.
Last year, the Medical University of Moldova established a counseling
and management department and asked AVSC to provide a curriculum
and staff training. Now all medical students take these courses.
AVSC has also worked with local trainers to facilitate COPE--a quality-improvement
tool used to help health care staff solve problems at their sites--at
three family planning facilities. The participants have been eager
to find solutions and have proven innovative in their approaches.
Providers attending a counseling training workshop.
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Results Seen
Thanks to the MOH's efforts, important changes
have been seen at both the local and national levels.
In 1988, for example, the staff of
Drochia Regional Hospital performed 1,800 abortions, inserted 150
IUDs, and offered no oral contraceptive pills. In 1998, they performed
only 38 abortions, inserted 1,231 IUDs, and distributed 3,941 cycles
of pills. Today they perform one minilaparotomy each month.
Nationwide, from 1995 to 1998 the
abortion rate fell from about 53 to about 31 per 1,000 women of
reproductive age. While abortion remains the most widely used method,
during this period the percentage of contraceptive users using hormonal
methods rose from about 1% to about 5%.
Looking Ahead
In-country organizations have shown a strong commitment
to improving Moldova's health services. This summer, representatives
from Dalila (the Women's Health Center), Drochia Regional Hospital,
the Family Planning Association, and the MOH visited AVSC in New
York to show their appreciation for our contribution and to ask
us to continue our work.
To make the country's health care
program comprehensive, training has been requested in such areas
as STD counseling, postabortion care, reproductive health for adolescents,
and primary care.
Anna Kaniauskene is program officer
for AVSC's program in Moldova.
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