Increasing the Quality of Child Survival and Maternal
Care Services in the Navoi Oblast of Uzbekistan
Cooperative Agreement No.: FAO-A-00-99-00026-00
Final Evaluation Report
Project Duration: October 1, 2002 – September 30, 2007
Submitted to:
Jill Boezwinkle
Attn: Aimee Rose, Program Assistant
USAID/GH/HIDN/NUT/CSHGP
1300 Pennsylvania Avenue
RRB Room 3.7-74
Washington, DC 20523-3700
Janet Meyers
FP/RH Technical Advisor to the Flexible Fund
Macro International - CSTS+
11785 Beltsville Drive
Calverton, MD 20705-3119
Deborah Kumper
Administrative Assistant
ORC Macro – CSTS+
11785 Beltsville Drive
Calverton, MD 20705
Submitted by:
Project HOPE – The People-to-People Health Foundation, Inc.
Millwood, Virginia 22646
Tel: (540) 837-2100
Fax: (540) 837-1813
December 2007
HQ Contact Person:
Ruth Madison, MPH
Tech Advisor, HWC Unit
Field Contact Person:
Abdunabi Kuchimov, Program Manager
Project HOPE Uzbekistan
Prepared by:
Sandra Wilcox, Consultant
AKNOWLEDGMENTS
The principal author of this report would like to express her appreciation to Project
HOPE-Uzbekistan’s CS staff who gave so generously of their time and effort to improve
the health and well being of the women and children of Navoi Region (or Oblast) in
Uzbekistan. In like manner, they provided tremendous support and direction during the
final evaluation process through their participation in interviews and assessments, data
analysis and feedback. The author is also grateful to those who supported the FE team
during the evaluation process and made the work possible, including the directors and
staff of the Navoi Oblast and Rayon Health Departments. These stakeholders made
important contributions to this report and their observations and comments contributed to
the success of the evaluation.
Additional thanks go to those who conducted the final surveys and quantitative tools
found in the FE: Abdunabi Kuchimov, Program Manager for the CS project, Zafar
Alimjanov, Monitoring and Evaluation specialist and the entire CS team. Thanks also
goes to Ruth Madison, Technical Advisor for CS projects in the Millwood office, whose
facilitation skills and experience with CS projects greatly enhanced the Final Evaluation
process. A special thanks also to Sabohat Ergasheva and Seda Aleksanyan for their hard
work in organizing the final evaluation briefings and the associated logistics for the
evaluation activities.
The Navoi Project HOPE staff has demonstrated tremendous initiative and teamwork
throughout their work with this project. They have been enthusiastic, capable and as
open to new initiatives as they have been to share the results. It has been a real honor to
be part of this team for a short time and I thank them for their openness, insight and
generous hospitality.
TABLE OF CONTENTS
A. SUMMARY.............................................................................................................1
B. ASSESSMENT OF RESULTS AND IMPACT OF THE PROJECT.....................4
1. Results: Summary Chart ................................................................................4
2. Results: Technical Approach .........................................................................5
a. Overview of the Project .........................................................................5
b. Progress Report by Intervention Area....................................................6
c. New Tools or Approaches ...................................................................23
3. Results: Cross-Cutting Approaches .............................................................24
a. Community Mobilization.....................................................................24
b. Behavior Change Strategy ...................................................................28
c. Capacity Building Approach................................................................29
d. Sustainability Strategy .........................................................................32
4. Results: Family Planning .............................................................................34
C. PROGRAM MANAGEMENT..............................................................................42
1. Planning ........................................................................................................42
2. Staff Training................................................................................................43
3. Supervision of Program Staff........................................................................44
4. Human Resources and Staff Management....................................................45
5. Financial Management..................................................................................45
6. Logistics........................................................................................................46
7. Information Management..............................................................................46
8. Technical and Administrative Support .........................................................48
9. Mission Collaboration...................................................................................49
10. Management Lessons Learned......................................................................50
D. OTHER ISSUES IDENTIFIED BY THE TEAM.................................................50
E. CONCLUSIONS AND RECOMMENDATIONS ................................................50
ATTACHMENTS
A. Evaluation Team Members and Their Titles
B. Evaluation Assessment Methodology
C. List of Persons Interviewed and Contacted
D. List and description of IEC Materials used by the Project
E. Staff Development Tracking Sheet
F. Final KPC report
G. Project Data Sheet Form – Updated VersionHG. Monitoring Tools
ACRONYMS
AIDS Acquired Immune Deficiency Syndrome
ARH Adolescent Reproductive Health
ARSH Adolescents’ Reproductive and Sexual Health
ARI Acute Respiratory Infection
AVSC Association of Voluntary Contraception (now known as Engender
Health)
ADB Asian Development Bank
BCC Behavioral Change and Communication
BF Breast Feeding
BFHI Baby-Friendly Hospital Initiative
BL Baseline Survey
C-IMCI Community-IMCI
CAR Central Asian Republics
CDD Control of Diarrheal Disease
CHP Child Health Promotion
CHW Community Health Worker
CI Confidence Interval
COMH Central Oblast Maternity House
CRMH Central Rayon Maternity House
COH Central Oblast Hospital
CRH Central Rayon Hospital
CS Child Survival
CSHGP Child Survival and Health Grant Program
CYP Couple Years of Protection
DHS Demographic Health Survey
DIP Detailed Implementation Plan
EBF Exclusive BreastFeeding
EPI Expanded Program on Immunization
FAP Feldsher midwife post
FGD Focus Group Discussions
FP Family Planning
GP General Practitioner
HD Health Department
HF Healthy Family
HFA Health Facility Assessment
HIV Human Immunodeficiency Virus
HIS Health Information System
HOPE Health Opportunities for People Everywhere
ICD*10 International Classification of Disease, 10th edition
IEC Information, Education, Communication
IMCI Integrated Management of Childhood Illness
INGOs International non governmental organizations
IMR Infant Mortality Rate
IUD Intrauterine Device
KPC Knowledge, Practice, Coverage
LAM Lactational Amenorrhea Method
LQAS Lot Quality Assurance Sampling
MCH Maternal Child Health
MHC Mother’s Home Card
MOE Ministry of Education
MOH Ministry of Health
M&E Monitoring and Evaluation
MPS Making Pregnancy Safer
MSG Mother Support Group
MTE MidTerm Evaluation
NGO Non-Governmental Organization
ORS Oral Rehydration Solution
ORT Oral Rehydration Therapy
OHD Oblast Health Department
PEPC Promoting Effective Perinatal Care
PHC Primary Health Care
Prikaz Official (Government) order or decree
PTP Peer to Peer Counseling
QA Quality Assurance
QI Quality Improvement
RDH Rayon Health Department
RH Reproductive Health
SC Steering Committee
SM Safe Motherhood
SOW Scope of work
STD Sexually Transmitted Disease
STIs Sexually Transmitted Infections
SUB Rural community hospital
SVA Rural physician ambulatory
SVP Rural physician post
TAG Technical Advisory Group
TWG Technical Working Group
TOT Training of Trainers
USAID United States Agency for International Development
WHO World Health Organization
WRA Women of Reproductive Age
YFS Youth-Friendly Services
1
A. Summary
Project HOPE’s child survival (CS) project in the Navoi Oblast of Uzbekistan is an
extension of a child survival project that began in 1999. The current project, Increasing
the Quality of Child Survival and Maternal Care Services in the Navoi Oblast of
Uzbekistan, is the second phase of the original project and was extended from October
2003 to September 2007. The in-country portion of this final evaluation was conducted
in July and August 2007.
The purpose of the Project HOPE’s CS project in Uzbekistan was to: (a) reduce the
mortality and morbidity in children under five and women of reproductive ages and (b)
increase adolescents’ knowledge about reproductive and sexual health. The CS project
directly targets an estimated 36,716 children ages 0-5 years; 77,479 women of
reproductive age (15-49 years old), and 25,505 adolescents (16-18 years of age). The
Project has introduced and expanded the use of standard case management protocols in:
IMCI. Making Pregnancy Safer and Family Planning interventions, through which the
project intervened in the following areas. ARI/Pneumonia Control (10%), Control of
Diarrheal Diseases (10%), Child Nutrition (10%), Breastfeeding Promotion (10%),
Maternal/Newborn Care (30%), and Family Planning (30%).
By all accounts, the project has been quite successful. As the table in the following
section shows, many of the objectives have either been achieved or surpassed.
Furthermore, and perhaps more importantly, the project has successfully influenced the
Oblast Health Department (OHD) and Rayon Health Departments (RHD) to adopt such
strategies as IMCI and the Making Pregnancy Safer program, as their own and are
implementing those programs in other parts of the country. In addition, some of the
materials developed by the project are now being used by UNICEF and other INGOs in
other areas of the nation. The partnership between the project staff, the OHD and the
RHDs is very strong and the project has made tremendous strides in building the capacity
of the health department staff. This is one of the most important achievements of the
project.
Other noteworthy achievements include the organization and implementation of a
community health promotion strategy by training local makhalla and other informal
leaders who are then supervised by the Rayon Women leaders. These leaders have the
responsibility of organizing and overseeing family health promotion at the community
level. The project has successfully coordinated the leaders’ community awareness work
with that of the patronage nurses who have also received updated training by the CS
project to deliver MCH and FP home care services.
The following achievements are most noteworthy:
 Organization and support of 32 types of training courses: 4-IMCI, 4-BF, 7-Safe
Motherhood, 3 FP, and 4 ARH; 1 MPS +RH; 3 BF+ c-IMCI; 2 Community
Health Promotion; 1 Database Management.
 2,215 of health professionals trained – 493 - Safe Motherhood; 709 – IMCI and
BF-C-IMCI; 538 – Breastfeeding; 475 – Family Planning.
 1,811 adolescents directly exposed to reproductive health information.
 Development, production, and distribution of health education materials including
a Mothers Home Card (added to Prikaz 425) and 32-page pocket guide including
the IMCI 16 key practices.
2
 Development and support of several training centers.
 Development of protocols at local and national levels in support of IMCI,
maternal and neonatal health care and family planning.
 Streamlined Quality Improvement program that includes participation from the
MOH counterparts.
 Seven hospitals and two PHCs Certified as “Baby-Friendly”, each with mothers
support groups, private room for counseling and group meetings.
 Support for International Breastfeeding Week.
 Initiation of and support to New Parents Schools.
 Joint prikaz (government directive) between MOH and MOE to support
adolescent reproductive health activities facilitated by the project.
 The community health promotion strategy developed by the CS project has
become a tool for the local government to implement prikaz (decree) 242.
 ARH Guidelines developed by CS project and local partners (MOH and MOE)
accepted at national level and recommended to be replicated in other regions.
 IMCI booklet and posters developed by project accepted by other INGO projects
including “Healthy Family Project” in Uzbekistan and in the CAR.
 SM and IMCI trainers trained by CS Project have replicated the training to other
oblasts and countries (Kyrgyzstan).
 Quality Improvement Seminars provided by project and Zdrav Plus (a USAID
funded project, implemented by Abt Associates) trained 70 providers from 11
PHCs during three seminars.
 Trained 24 oblast and rayon HIS staff to manage child birth and mortality
database.
Many of the activities initiated by this CS project have already been “sustained” by the
MOH and are being scaled up in other parts of the oblast as well as other parts of the
country, including IMCI and the Making Pregnancy Safer initiative. Because the OHD
and RHD are an integral part of this project, all lessons learned are automatically shared
with them and applied by them to other rayons. In addition, there are requests to extend
the ARH training to schools in the non pilot rayons. Before closing the CS project, the CS
team should assist the oblast health and education departments with a plan to extend
programs to other areas.
Conclusions
 The FE has shown that the CS team has not only accomplished the activities that
were proposed in the DIP, but have surpassed many of them. One of the main
factors for such impressive achievements has been the close collaboration with
the OHD and RHDs. In some cases, Project HOPE was a catalyst for passage of
government prikazes, and in some other cases, it demonstrated new ideas and
approaches, which the government is considering implementing.
 The majority of the indicators achieved were at the service delivery level with
complementary indicators and strategies at the community level. Since the Uzbek
health system has a large infrastructure that reaches the majority of the
population, this dual-pronged approach has been successful. Thus, Project
HOPE’s strategy to work through the OHD, RHDs and communities was
3
appropriate in this context, and Project HOPE should be highly praised for its
work.
 At the time of the MTE, the community component of the project had only
reached the diagnosis and design stage, and some field testing. It had not
progressed beyond that because the CS team was too busy carrying out a large
number of training activities, and also because the strategies proposed for
community mobilization such as working with grandmothers, demanded a great
deal of effort from the team. Also, the community mobilization strategy presented
challenges in scale up, as it is a relatively new concept in Uzbekistan and required
more thought and planning in order to be implemented. Fortunately after the
MTE, Project HOPE’s regional technical advisor was able to provide assistance to
the team in developing an action plan for mobilizing communities. This plan
included work with existing partners including, patronage nurses and leaders in
the rayons and oblasts whose responsibility it was to educate families about
preventive health topics and provide links to the health facilities. Although late in
starting, this part of the project is impressive because it dovetails nicely with
exisiting local government structures. Specifically, the community mobilization
activities support Governmental decree #242, which uses community based
volunteers for information dissemination. It is hoped that these activities will be
sustained.
 The main recommendation is that if resources become available, it would be
important for the oblast HD to continue strengthening this community component.
Although the government supports the need for community work, there is not
much experience in the country for doing it and HOPE has only been supporting
community activities for a year and a half.
 The project was successful in implementing a wide variety of training activities to
support each of the CS interventions. Project HOPE was appropriately
monitoring the quality of the trainings at the time they were provided (via pre and
post tests), and in addition moved beyond training to monitor and supervise the
quality of service delivery by assessing the performance of health workers in
delivering services on regular 6-8 month intervals. One of the big successes of
the training program has been the upgrading of patronage (visiting) nurse skills,
thus increasing their motivation to conduct home visits. Although not able to train
all of the nurses, the project was able to train a substantial enough number to
make an impact. These nurses seem to be having a strong effect on increasing
access to health care at the community level. If additional financial resources
become available for this region, it is recommended that donors consider
strengthening this component.
 Another question is if the oblast will be able to continue the well organized
monitoring system that has been put in place by the CS and Oblast team. A
suggestion from the FE team is to encourage monitoring from the rayon levels
since monitoring from the oblast level may be too cumbersome. In order to get
this process started, the team recommends the project hold planning meetings
with each of the rayon HDs and develops plans and agendas for continued
monitoring visits.
4
B. Assessment of Results and Impact of the Project
1. Results: Summary Chart
Results from the baseline, the mid-term and the final surveys are compared below with
project targets. While the same methodology was used for the baseline and final surveys,
the midterm used LQAS and only interviewed mothers of children under 2 years of age.
The other surveys measured all the target populations including mothers of children
under 2, women of reproductive age, and adolescents. As the primary target group of the
project, mothers with children under 2 years of age (those evaluated in LQAS at
midterm) received more education interventions than the other target groups and that may
explain why some of their results are higher than those from the final survey.
Progress Towards Achievement of Program Objectives:
Indicators
KPC
Baseline*
(Feb 2004)
KPC
MTE**
(May 2005)
KPC FE*
(June 2007) Target
2007
Integrated Management of Childhood Illness (IMCI)
Percent of mothers of children aged 0-23 months who
know at least TWO signs of childhood illness that
indicate the need for treatment
48.6% 73.8% 95.3% 68%
Percent of mothers who know at least TWO signs
childhood diarrhea that indicate the need for
treatment/referral
36.9% 65.1% 96.0% 58%
Percent of children aged 0-23 months with diarrhea in
the last two weeks who received oral rehydration
solution (ORS) and/or recommended home fluids
31.8% 32.6% 47.1% 60%
Percent of children aged 0-23 months with diarrhea in
the last two weeks who were offered more fluids during
the illness
15.0% 42.7% 58.8% 40%
Percent of children aged 0-23 months with diarrhea in
the last two weeks who were offered the same amount or
more food during the illness
19.0% 51.0% 50.0% 30%
Percent and total number of children aged 0-23 months
with cough and fast/difficult breathing in the last two
weeks who were taken to a health facility or received
antibiotics from an alternative source
88.1% 38.9% 80.0% 90%
Breastfeeding
Percent of children aged 0-23 months who were
breastfed within the first hour after birth 62.6% 85.2% 93.1% 85%
Percent of infants aged 6-9 months who received
breastmilk and solid foods in the last 24 hours 19.8% 58.2% 60.3% 45%
Percent of children aged 20-23 months who are still
breastfeeding 33.9% 12.5% 66.8% 45%
Percent of infants aged 0-5 months who were fed
breastmilk only in the last 24 hours 62.7% 80.1% 90.0% 85%
Number of health facilities currently certified under the
National participation in the Baby-Friendly Hospital
Initiative (BFHI)
3 5 5 5
Safe Motherhood and Neonatal Care
Percent of mothers who had at least one prenatal visit
prior to the birth of her youngest child less than 24 99.8% 100.0% 99.7% 100%
5
Indicators
KPC
Baseline*
(Feb 2004)
KPC
MTE**
(May 2005)
KPC FE*
(June 2007) Target
2007
months of age
Percent of mothers who received/bought iron
supplements while pregnant with the youngest child less
than 24 months of age
54.1% 61.7% 73.4% 70%
Percent of mothers who know at least TWO signs of
danger during pregnancy that indicate the need for
treatment
46.9% 74.0% 97.0% 70%
Percent of mothers who had at least one postpartum
check-up 76.9% 95.1% 98.7% 92%
Family Planning
Adequate Birth Interval Between Youngest Surviving
Children: Percent of children aged 0-23 months who
were born at least 24 months after the previous surviving
child
48.3% 86.9% 84.7% 68%
Percent of WRA who report that women are likely to get
pregnant halfway between two menstrual periods 9.3% 72.8% 45.7% 45%
Percent of non-pregnant women who desire no more
children in the next two years, or are not sure, who are
using a modern method of child spacing
72.6% 91.5% 72.8% 85%
Percentage of respondents who report discussing FP
issues with somebody in the past 12 months 56.2% 82.5% 65.7% 75%
Counseling: Percentage of family planning clients who
receive counseling on contraceptive choices, common
side effects, and when to return for follow-up
62.7% 77.2% 86.6% 78%
* Baseline and Final Evaluation indicators were collected using a Cluster Sampling Methodology
** MTE indicators were collected using LQAS methodology
*** The change is calculated relative to the baseline value and then the movement towards or away (-) from the
objective
2. Results: Technical Approach
a. Overview of the Project
Project HOPE implemented CS-19 Phase 2 (2003–2007) of the USAID/CSHGP entitled,
“Increasing the Quality of Child Survival and Maternal Care Services Project in the
Navoi Oblast of Uzbekistan.” Project HOPE worked with the Navoi Oblast Health
Department to improve child health, safe motherhood and reproductive health services in
four rayons (districts).
This extension project covers four rayons - the two rayons that comprised the original
Phase 1 of the project (1999–2003) - Navoi and Kiziltepa, and the extension rayons of
Konimeh and Nurata, which were added during Phase 2. The four rayons are
predominantly rural, but the project also carried out activities in the oblast capital, Navoi
City.
The Navoi Oblast has been an area of considerable need. When the project began, the
statistics on childhood mortality estimated the rate to be 62 per 1,000 for the five-year
calendar period between 1998-2002. Neonatal mortality was 34 per 1,000 and post￾neonatal mortality 28 per 1,000, suggesting that there had been little change over the
6
previous ten years.1 Maternal mortality in Navoi is the highest in the country2
.
The country has an extensive network of medical services; however, there is an overall
lack of supervision and continuing education to provide health staff with new or
improved knowledge and skills. Stocking health care facilities with necessary equipment
and drugs to provide preventive and curative services was a challenge, but a new World
Bank and ADB project is being implemented to address those issues. In general, medical
personnel wait for patients to seek care. The patronage nurses, who carry out home
visitsand have a good understanding of the population, provide a limited number of
health services and counseling but otherwise refer patients to the health facilities.
The CS project targeted an estimated 36,716 children 0-5 years of age, 77,479 women of
reproductive age (15-49 years old), and 25,505 adolescents ages 16-18 years. Indirectly,
the project’s work at the oblast level supported an additional 35,949 children 0-5 years of
age, 81,241 women of reproductive age (WRA), and 28,335 adolescents, ages 16-18.
The Navoi CS project has sought to: (a) reduce the mortality and morbidity in children
under five and women of reproductive age and: (b) increase adolescents’ knowledge of
reproductive and sexual health by partnering with the Oblast and Rayons’ Health
Departments. The project has introduced and expanded the use of standard case
management protocols in: Making Pregnancy Safer; Family Planning interventions; and
IMCI. The level of effort for each intervention is as follows: ARI/Pneumonia Control
(10%), Control of Diarrheal Diseases (10%), Child Nutrition (10%), Breastfeeding
Promotion (10%), Maternal/Newborn Care (30%), and Family Planning (30%).
The focus of the second phase has been on capacity building, training, MOH systems
strengthening and training of the makhallah leaders. A Maternal and Child Health
Steering Committee, created during the first phase of the project, played an active role in
Phase 2 of the project with the creation of four technical working groups: maternal
health, child health, adolescent reproductive health and community health promotion.
Technical working groups are comprised of key decision makers in the MOH, makhallah
administrations, local and international NGOs, and community members.
b. Progress Report by Intervention Area
Project HOPE has successfully worked with the Oblast Health Department, the four
target Rayon Health Departments, Makhallah leaders, and four training centers in Navoi
City. Project HOPE strengthened the Oblast and Rayon Health Departments through the
Oblast Steering Committee and the four active Technical Working Groups – the IMCI,
Maternal/RH, adolescent reproductive health, and community health promotion working
groups. The steering committee is composed mainly of policy level decision makers,
whereas the technical working groups are made up of technical experts. The purpose of
the technical working groups will be discussed further in section 3.
Project HOPE assisted in the development and equipping of training centers, and the
development of protocols at the local and national levels related to IMCI, maternal and
1 Uzbekistan Health Examination Survey 2002. Analytical and Information Center, MOH, State
Department of Statistics, ORC Macro.
2
Ibid.
7
neonatal, and family planning. The results of these efforts are that 4,181 MOH
participants were trained at the various levels of the health system. In addition 422
makhalla leaders and trainers were trained.
To follow up on the training activities and to monitor results, Project HOPE introduced
and systematized a monitoring system to observe the quality of service delivery, provide
additional on-site training, give feedback to the health teams about how to improve their
services, and develop plans to overcome identified weaknesses. Monitoring was
conducted by integrated teams from the oblast, rayons and the project. The teams were
composed of trainers and other experienced staff who conducted the monitoring visits
every 6 to 8 months.
IMCI (ARI/ Pneumonia, Diarrheal Disease, Nutrition)
IMCI (Integrated Management of Childhood Illness) was the strategy used to address
child morbidity and mortality related to ARI/pneumonia, diarrheal disease and nutrition.
IMCI training started in 1999 under the Phase 1 project, which represented the first IMCI
training to be conducted in the country. The project implemented the first training in
Navoi and later held courses in Bukhara and Samarkand. IMCI is now being taught in 6-
7 regions of the country.
Objectives: (1) Increase the proportion of mothers who recognize fast breathing and
chest in-drawing as signs of pneumonia; (2) Increase the proportion of children with
signs of pneumonia who were assisted by a trained health provider; (3) Increase the ORT
use rate; (4) Increase the percentage of mothers who recognize danger and dehydration
signs; (5) Increase the percentage of mothers who give their child more/equal amounts of
liquids during diarrhea; (6) Increase the number of mothers who continued feeding the
child during a diarrhea episode; and (7) Increase appropriate complementary feeding
practices after six months of age; i.e., quantity and quality of foods, breastfeeding first
then foods, and introduction of micronutrients (Fe, iodine and Vitamin A.).
Main Strategies and Activities: Project HOPE has sought to improve access to and
quality of child health services by emphasizing health education and preventive measures
at the home level. The project strategies included: a) increase medical staff skills and
knowledge, b) facilitate organization of work through health system strengthening and
c) increase health awareness at the community level. Activities to achieve these
objectives included: (1) developing IMCI training curricula and training plans for both
the 11-day WHO standard IMCI training for health professionals, and a three-day
Community-IMCI (C-IMCI); (2) developing and implementing a Makhallah/
Community-Based IMCI program which included the dissemination of the 16 key
practices through health education and IEC materials; (3) developing a training curricula
and a training plan for primary health care workers (patronage nurses and feldshers); and
(4) emphasizing quality improvement of monitoring and supervision at the health facility
level; and (5) implementing a client-focused approach to providing child health
information and services.
8
KPC Results on ARI/pneumonia, Diarreheal Disease Control and Child Nutrition
Baseline Feb 2004 MTE (May 2005) KPC FE*
Indicators June 2007
% CI % CI % CI
Percent of mothers of children aged 0-23 months who know
at least TWO signs of childhood illness that indicate the
need for treatment
48.6% ±4.8 73.8% ±6.23 95.3% ±2.4
Percent of mothers who know at least TWO signs childhood
diarrhea that indicate the need for treatment/referral 36.9% ±4.6 65.1% ±6.47 96.0% ±2.3
Percent of children aged 0-23 months with diarrhea in the
last two weeks who received oral rehydration solution
(ORS) and/or recommended home fluids
31.8% ±19.5 32.6% ±12.14 47.1% ±16.8
Percent of children aged 0-23 months with diarrhea in the
last two weeks who were offered more fluids during the
illness
15.0% ±14.9 42.7% ±13.87 58.8% ±16.5
Percent of children aged 0-23 months with diarrhea in the
last two weeks who were offered the same amount or more
food during the illness
19.0% ±16.4 51.0% ±11.48 50.0% ±16.8
Percent and total number of children aged 0-23 months with
cough and fast/difficult breathing in the last two weeks who
were taken to a health facility or received antibiotics from an
alternative source
88.1% ±8.3 38.9% ±11.16 80.0% ±24.8
Project HOPE conducted several training courses in IMCI for GPs and pediatricians.
One course was a five-day IMCI Training of Trainers for participants who were selected
among those who took the 11-day IMCI training course. The TOT course was conducted
in Navoi by master trainers from the National Pediatric Institute. The IMCI TOT course
was directed towards rayon-level general practitioners and pediatricians who would
continue as trainers of health providers in their region. The course covered the principals
of adult education, how to organize training courses that included theory and practice,
and how to use the Trainers’ Guidelines and Participant Modules. During Phase 2, thirty￾six (36) pediatricians and general practitioners from the four rayons (Karmana, Konimeh,
Kizeltepa and Nurota) were trained and currently, are active trainers. In Navoi at the
Oblast Children’s Hospital, a training center was established to sustain training, which is
now wholly supported by the government (previously supported by the project). Also to
keep the center active, the oblast has provided an IMCI specialist to work with the
Center. This is the only region in Uzbekistan with a chief IMCI specialist, whose position
was created to coordinate IMCI training and monitoring activities.
During this Phase 2 project, 135 health providers from four rayons participated in the
standard 11-day IMCI training course on IMCI. Feldshers (physcians assistants) were
trained to provide services where doctors do not work. A total of 462 HPs received the
11-day training during the two projects. The objectives were to train HPs on proper IMCI
case management, including referral, counseling and follow up.
During the second half of the Phase 2 project, the staff realized that there was a problem
with the doctors at rayon and oblast hospitals who had not received IMCI training. When
patients were referred from IMCI trained HPs at primary care facilities to these hospitals,
they encountered the old style doctors who were not familiar with IMCI practices and
gave patients messages that conflicted with IMCI protocols about care of the sick child.
To address this imbalance, the project decided to provide hospital IMCI training to
9
hospital staff. In 2006, four training courses were conducted which trained 66 health
providers. The project coordinated with the National Pediatric Research Institute in
Tashkent which arranged the training using certified trainers and WHO manuals that
were adapted by the IMCI working group. There has been definite progress in the
adaptation of IMCI protocols by health providers and the FE team was able to verify that
this training was important in improving the quality of hospital care. However, the
project was not able to train all the hospital providers and interviews at the PHCs
confirmed that there are still problems with hospital referrals.
During the first phase and the early part of the second phase of CS Navoi, a three-day C￾IMCI course for patronage nurses3 was offered using an adapted WHO IMCI training
curriculum. The adaptation was carried out by Project HOPE, the Pediatric Institute, and
UNICEF in Tashkent. Since there had been no standard C-IMCI course curriculum to
use, it was necessary to adapt the curriculum which was based on 8 of the 16 IMCI key
family messages for healthy growth and development of children. This process required
some special adaptations as the C-IMCI audience is usually CHWs and not patronage
nurses. The course consisted of a reduction in the standard IMCI content with a focus on
management of diarrhea and pneumonia, growth monitoring, nutrition and micronutrients
education, and adult education techniques. After the midterm evaluation, the project
decided to extend the C-IMCI training to five days by combining the standard C-IMCI
training with the two-day breastfeeding training that was also being provided by the
project. Previously, the two courses were offered separately and the project decided it
was more efficient to combine them. Also the project monitors realized that the nurses
needed stronger breastfeeding and nutrition counseling skills. A total of 671 patronage
nurses were trained from the four rayons. This includes three nurses from each primary
health facility and represents 58 percent of the nurses in the project rayons. Since the
project did not have enough resources to train all the nurses, the plan was for the trained
nurses to reproduce the training for the other nurses who were unable to participate in the
original trainings. Thus, when the project and oblast conduct monitoring visits to the
facilities, they monitored all nurses, assuming that all nurses present had received some
training. During interviews at the facilities, the FE team found that in some PHCs, the
nurses had received updates from their trained colleagues but not all nurses received
updates. One observation is that adult learning methodologies should have been included
along with the C-IMCI training to facilitate the replication of trainings. To conduct all the
C-IMCI training, the project trained a total of 76 trainers: 36 are local trainers and 22 are
from the pilot rayons. An additional nine are from the non-pilot rayon in Navoi oblast
and the rest are from other regions that have IMCI programs.
For the 11-day IMCI training, the project started with the eight WHO manuals that had
been translated to Russian. These were adapted and translated to Uzbek. Training
materials for all courses included the following didactic materials: videos, transparences,
posters, flip charts, dolls, models, color paper, photos, among other materials. For all
courses, manuals and other IEC materials were distributed as well.
To reinforce the 16 key practices among mothers with young children, the project
distributed the 32-page pocket-sized booklet, “If You Want Your Child Healthy”. This
3
Patronage nurses have 3 years of college education. Main responsibilities include community education
and home visits. Usually, patronage nurses work 3 hours at SVP and 3 hours visiting homes.
10
booklet, which was developed during Phase 1 of the project, contains information about
the IMCI key messages. Patronage nurses interviewed for this evaluation reported that
they regularly use the booklet to promote behavior change and that the women respond
well to both the counseling provided by the patronage nurses and to the information in
the booklets. The nurses confirmed that almost all families in the target rayons have a
booklet. The success of the booklet is evidenced by the fact that it has been reprinted and
distributed in other regions of the country by partner organizations such as Counterpart
International and the Project HOPE USAID funded Healthy Family Project. Many
mothers interviewed during the FE had this booklet as well as others distributed by the
project (BF, diarrhea, etc.) and it was obvious by the way they responded to questions
that they had read and understood the information contained therein.
All of the training took place in the Oblast Health Department IMCI training site at the
Navoi Oblast Child Hospital, which was established during the Phase 1 with project
support.
Patronage nurses play a key role in promoting the household behaviors related to the
treatment and prevention of ARI/pneumonia, diarrheal disease and child nutrition. These
providers know everyone in their catchment area personally including knowledge of each
family member’s health status, especially those children due for immunizations and
women in need of prenatal care visits. According to the job description, a patronage nurse
is supposed to visit every new born child in the rayon at least once a week for 12 months
and each child 13–60 months of age at least twice a month. Pregnant women are visited
at least twice a month. Patronage nurses also work in teams with other health staff in
PHC centers and facilitate referrals to health facilities as well as recommend home visits
from other health providers.
Patronage nurses examine ill children but do not prescribe antibiotics. Most practices
examined for this evaluation appeared appropriate and in accordance with IMCI
protocols. During FE interviews, it was revealed that before receiving the training, most
patronage nurses did make the required home visits, but they did not provide in depth
home care because they had not been trained with practical skills to complete these tasks.
They simply inquired if everything was OK with a child and if not, they referred them to
a facility for follow up. After receiving the IMCI training, patronage nurses were able to
provide check-ups for mothers and children as well as education and counseling.
The focus group discussions with mothers of children under two years of age showed that
mothers know about danger signs in sick children. They mentioned frequent vomiting,
seizures, increased temperatures, unconsciousness, worsening of general condition, loss
of appetite, etc., as instances in when they should look for care. In those cases, the usual
response is to call the field doctor or patronage nurse. Mothers reported that they
received this information from health providers, through brochures provided by the
project and the IMCI booklet, “If You Want Your Child Healthy”. It was also noteworthy
that during interviews with community leaders, they indicated that there had been no
childhood deaths this year and they believed it was because families now knew what to
do when a child is sick.
Beyond working with the patronage nurses, implementation of the community
mobilization component of IMCI was delayed in part because the project team was
11
initially preoccupied organizing IMCI training. In addition, implementing behavior
change at the community level is a foreign and difficult idea to conceptualize for the
project staff and their Uzbek counterparts, and Project HOPE did not recognize the extent
to which this would affect timely implementation of the community mobilization plan.
To address this, in January 2005, Project HOPE brought back the outside consultant 4
who had conducted a community assessment in Phase 1, to assist the Navoi CS team and
their MOH partners in developing a community mobilization strategy based on the
original research. The consultant developed an ambitious plan that was refined and field￾tested by the project. Project HOPE’s Central Asia Regional Program Officer, based in
Kazakhstan, then followed up with the project, helping the team to develop materials,
action plans and training courses for community leaders (see section 3 for details).
Project HOPE has carried out several campaigns on diarrhea management and
breastfeeding practices. During these campaigns, the project organized contests to
reward and publically recognize families that had the best practices in breastfeeding and
home-based diarrhea management. Recently, the project organized competitions between
mother-in-law groups from different areas. This was a very innovative and effective
strategy and the oblast media (local TV, newspapers and radio broadcast) have provided
good coverage of all the event thus increasing knowledge of appropriate child care .
Project HOPE has addressed quality improvement of IMCI service delivery by carrying
out monitoring visits at all health facilities in the project rayons twice a year. Monitoring
visits are conducted by members of the IMCI Technical Working Group (TWG), with
participants from Project HOPE and MOH counterparts and the visits include a series of
checklists and interviews to be conducted at the facility. After the monitoring visit, the
team provides feedback regarding the results to health providers and a decision is made
regarding whether additional onsite training is needed. The project then conducts
refresher training on areas found to be problematic during the monitoring visit.
One of the dilemmas for implementing IMCI effectively is the need to provide the
essential medicines recommended for the different protocols. The FE team found that
some of these medicines were not available at the primary care facilities and project staff
inicated that there is a lack of essential medicines at all levels of the health care system.
In addition, because not all doctors at hospital levels are trained in IMCI, sometimes
patients receive conflicting information on the need for medicines for common childhood
ailments. This presents a challenge to IMCI trained doctors who are sometimes
mistrusted by mothers and other caregivers when they don’t prescribe as much medicine
as the old Soviet hospital-based system recommends.
Next Steps/Recommendations:
Although the CS project is ending, if additional resources should become available, the
FE team would recommend the following:
 As mentioned above, one of the concerns is that IMCI training is uneven.
Currently most of the primary care personnel have received the training but it
4
Judi Aubel, PhD, MPH. Consultancy Report: “Development of an integrated community health
promotion strategy.” Navoi Child Survival Program. Project HOPE. Jan. 11 to 19, 2005. Navoi,
Uzbekistan
12
was not provided at the same time to all primary care groups (nurses and doctors)
nor was it provided at hospital levels until 2006. Therefore, the FE team would
recommend that future training be planned and provided to similar levels of care
within a short timeframe. Also it is recommended that more hospital IMCI
training be provided to the other hospital providers in the rayons and oblast.
 The project staff and providers interviewed indicated the need for a standard
refresher training course based on the findings from the monitoring visits
conducted by project staff, TWG and MOH.
 Two child care prikaz’s (MOH directives) are in the process of having IMCI
added to them. Prikaz 538, which deals with the organization of inpatient child
care and was changed to include hospital IMCI, has been approved. Prikaz 537,
which deals with outpatient child care and will include the 11-day IMCI training,
has not yet been approved but is in the revision stage. Having these prikazes
approved will help in lobbying MOH health departments to implement IMCI.
Though there will still be problems acquiring funding to provide the training in
order to comply with the revised prikazes, at least when the investigators come
from the central MOH to review the programs, they will now include the IMCI
standards. Therefore, it is recommended that the project encourage passage and
dissemination of both these prikazes as soon as possible.
 It is advisable that in addition to furthering IMCI training, the project should
encourage the MOH to provide and prescribe the IMCI essential medicines at the
PHC services.
Breastfeeding Promotion
Objectives: (1) Increase the percentage of mothers who exclusively breastfeed their
infants for the first six months; (2) Increase the percent of infants being breastfed during
the first hour of birth; (3) and Increase the percent of newborns that have skin-to-skin
contact with the mother immediately after birth for at least 30 minutes.
Main Strategies and Activities: Project HOPE seeks to achieve the breastfeeding
objectives by improving the quality of mother and newborn care provided by health
workers. The strategy includes (1) assisting hospitals gain Baby-Friendly Hospital
Certification, which includes the WHO “10 Steps to Successful Breastfeeding;”
(2) Forming Breastfeeding Support Groups at maternity houses; (3) implementing a
behavior change strategy that involves makhallah/community-based groups when
developing an intervention with grandmothers, Mullah-Bibis, and other community
leaders; (4) participation in and endorsement of an annual “Breastfeeding Week”
activities, organized and implemented by the MOH and collaborating agencies; (5) the
provision of TV and VCR sets to the new rayon maternity houses; and (6) monitoring
adherence to Baby-Friendly protocols at maternity houses.
13
KPC Results on Breastfeeding and Child Nutrition
Baseline Feb 2004 MTE (May 2005) KPC FE*
Indicators June 2007
% CI % CI % CI
Percent of children aged 0-23 months who were
breastfed within the first hour after birth 62.6% ±4.6 85.2% ±5.15 93.1% ±1.8
Percent of infants aged 0-5 months who were fed
breastmilk only in the last 24 hours 62.7% ±9.0 80.1% ±9.74 90.0% ±3.9
Percent of children aged 20-23 months who are still
breastfeeding 33.9% ±12,1 12.5% n/a 66.8% ±6.4
Percent of infants aged 6-9 months who received
breastmilk and solid foods in the last 24 hours 19.8% ±8,2 58.2% ±10,97 60.3% ±6.4
Number of health facilities currently certified under the
National participation in the Baby-Friendly Hospital
Initiative (BFHI).
3 5 5
Project HOPE has accomplished all the targets that were proposed in the DIP. The project
has also shown steady progress and improvement of breastfeeding practices in the target
population.
Project HOPE translated the standard WHO Baby-Friendly Hospital Initiative (BFHI)
curricula, “Consultation on Breastfeeding” into Uzbek, including the trainers and
participants’ manuals, and these were subsequently adopted by the Healthy Family
Project and UNICEF for use in other parts of the country. With support from UNICEF,
the National Pediatric Institute also asked Project HOPE staff to serve as trainers and to
conduct monitoring/certification sessions. The project also developed a leaflet and poster
on breastfeeding practices for lactating mothers.
Project HOPE has successfully worked with the four project rayons and oblast maternity
houses to certify them as “Baby-Friendly.” The 10 Steps that a hospital needs to comply
with are based on quality standards, which means that hospitals have to improve the
delivery of services to an optimal standard. In addition, Project HOPE regularly
monitored and supervised all certified hospitals providing additional assistance and
making adjustments in refresher training based on the monitoring results. The
certification process has motivated the Oblast Health Department Chief to declare that all
hospitals in the Navoi oblast must be certified as Baby Friendly. This goal surpasses the
objectives stated in the DIP and is an indicator of sustainability that was not anticipated.
In addition to the four maternity hospitals, two pilot SVPs were also certified as Baby
Friendly during the second half of the project.
In 2004 at the end of Phase 1, the project found that despite all the training in
breastfeeding, not all BF practices were being implemented by providers. For example,
according to trained Oblast maternity and reproductive health physicians, only 20 percent
of mothers initiated BF within the first half hour of birth (this was in the new rayons).
During monitoring visits, the project encountered that the neonatologists in the hospitals
advocated separating newborns from the mother and giving them formula instead of
promoting breastfeeding. After several training programs and a big push from the Oblast
Health Department, the project managed to change the attitudes of practitioners so that
they now support EBF.
14
A lesson learned from the Phase 1 was that since the project only provided hospital level
BF training for providers, mothers weren’t adequately counseled at home on
breastfeeding nor were they counseled at the PHCs, where they were seen for prenatal
and postnatal care. Therefore, during the first half of Phase 2 the CS Project concentrated
on training PHC health providers, to introduce exclusive and continuous breastfeeding
practices. It did so by conducting several training courses related to breastfeeding as
shown in the table below, during which a total of 538 health professionals were trained.
Type of course Numbers/types of
Participants
Training Objectives
Five day course on BF
counseling
42 MDs, midwives and
nurses
Improve breastfeeding
counseling skills and
principles of baby-friendly
hospital
Five day BF TOT 35 maternity house
physicians and midwives
BF counseling, adult
education techniques, group
dynamics; training event
planning and implementation
on Baby-Friendly Hospital
certification; and formation
of BF support groups
Three day “Counseling
on Breastfeeding”
445 pilot rayon maternity
house physicians and
midwives and nurses
Improve breastfeeding
counseling skills and
principles of baby-friendly
hospital
Three day course on BF
follow up and
monitoring
16 hospital level physicians
an midwives
Prepare Technical Working
Group members to monitor
the Baby Friendly Hospitals,
to analyze results, to make
decisions based on the
results, to standardize the
monitoring instruments and
methods.
TOTAL trained on
Breastfeeding
538 health care providers
During the second half of the project, the Navoi CSP staff trained GPs and nurses to
support and counsel patients about breastfeeding during antenatal and postpartum visits.
Initially, project staff believed that the nutrition session in the IMCI training was enough
for the providers to adequately counsel mothers about breastfeeding. The project staff
soon discovered that GPs needed counseling skills training in order to talk to and
convince the mothers of the importance of breastfeeding and how to breastfeed
successfully. A total of 372 visiting nurses received the five-day course of breastfeeding
and IMCI and 67 who received TOT training.
The training materials used included the Uzbek version of Counseling on Breastfeeding
Guidelines produced by WHO and UNICEF; a handout on adult education techniques;
15
the criteria for hospitals to be certified as Baby-Friendly; and other teaching materials
such as slides, transparences, video movies, and mannequins.
The project and the Oblast Health Department (OHD) have started a technical committee
on Baby-Friendly Hospital certification whose primary responsibility is to oversee the
education provided to mothers and the certification process at the oblast and pilot rayon
levels. The OHD has recently created other Baby-Friendly committees for the non-pilot
rayons. In addition, all certified hospitals supported by the project have developed
mothers’ support groups and have set up a private room for counseling and group
meetings.
To monitor adherence to the Baby-Friendly Hospital protocols, a monitoring team was
formed by specialists from the Pediatric Research Institute, Project HOPE staff,
counterparts from oblast health department, and trainers from the target rayons.
Monitoring/supervision visits are conducted every six months as required by the local
prikaz, or directive. Monitoring instruments include interviews with health providers
(five questionnaires) to determine BF counseling knowledge and skills; observation of
counseling sessions; document reviews and client exit interviews.
The Oblast Health Department certified two more hospitals in 2006 in the rayons not
covered by the project. In addition, the Oblast health Department Chief has added a step
11 for the baby-friendly process, a mechanism by which already certified maternity
houses will not be re-certified unless they first help other maternities or PHC level health
facilities in the oblast to be certified as “Baby-Friendly.”
Community-based IMCI activities were carried out primarily by patronage nurses
through home visits. The FE focus groups with patronage nurses showed that they visit
the homes of newborn infants once a week up to the first year of life, as well as pregnant
women at least twice a month. Breastfeeding promotion and education is part of their
home-visit plan of activities.
Focus group discussions conducted among mothers of children less than one year old
revealed that mothers believe that if they exclusively breastfed their children for six
months, they could be protected from pregnancy (LAM) and their children will be
protected from different diseases. This is a good indication that the education mothers are
receiving has stressed the importance of breastfeeding for both the baby’s health and for
family planning. Mothers also reported reading the 32-page child health booklets as well
as the “Essentials of Breastfeeding” booklet.
Project HOPE did not work with Mullah-Bibis (formal religious leaders) as was proposed
in the DIP, because it was found that the religious leaders do not deliver health messages
to the family, and they are not permitted to talk about sensitive topics (such as
breastfeeding) in public. However, as a result of the community assessment and strategy
developed, the project decided to work with formal and informal makhalla leaders in the
community health component. The government of Uzbekistan has released a prikaz
(directive) which gave community leaders the main responsibility for providing health
education to families. The team felt that given that a prikaz is a governmental order, the
community leaders might also include a political agenda in completing their education
tasks. Therefore, the project team decided to support these formally-selected leaders, but
16
expand training to include other informal, but naturally effective community leaders as
well. As will be discussed in section 3, these leaders have proven themselves to be
effective messengers for creating awareness of BF and other preventive health practices
among community members.
Each year, Project HOPE supports and endorses the International Breastfeeding Week. A
week of activities is organized with the rayon governments, the oblast and rayon health
departments, makhalla committees and NGOs. Activities include poster design
competitions, broadcasting video tapes (produced by Zdrav Plus (Abt Associates) and the
Healthy Family projects) through the local media and in maternity houses. The media
also support events by delivering messages in local newspapers, among other educational
activities.
Because of all the training the HPs at the four rayon primary health centers have received,
they could easily be certified as baby friendly. The monitoring and KPC results show that
these PHCs could meet certification requirements. However due to cost requirements of
bringing certifiers from the Central level, the certification of the PHCs hasn’t been done.
At the national level, EBF is only 22 percent. The MOH has set a goal of establishing
baby friendly programs in all PHCs and wanted to increase EBF to 60 percent. To date,
the project has achieved 90 percent EBF in its rayons.
Lessons Learned /Recommendations – Breastfeeding
 A key lesson learned was that breastfeeding training at the hospital level alone
was not enough - the project also needed to train primary level providers who can
provide education and counseling to antenatal and postpartum mothers.
 Another lesson validated in the grandmothers research activities, was that
community traditions such as giving water and sheep fat to newborns negatively
affect exclusive breastfeeding.
 Some maternity houses (hospitals) need 2-3 months to be certified, others need a
year in order to overcome attitudes opposed to the 10 steps for BF certification.
The main recommendation, if resources become available, is that the oblast Continue
Breastfeeding Training. The FE team recommended continuing training health providers
to be coordinated by the Oblast Health Department and TWGs. Also, breastfeeding
promotion and education need to continue reinforcing the concept of exclusive
breastfeeding, since the team has detected that social influences at the community and
family levels may be changing the concept of exclusivity; the team has also found out
that not all women (mothers-in-laws especially) understand that exclusivity means not
giving the child sweets, water nor any kind of food, no matter the amount. While
tremendous strides have been made through community education and the work of the
trained patronage nurses, the community program has only been going for a year and may
need reinforcement.
17
Safe Motherhood/Newborn Care (SM/NC)
Objectives: (1) Increase the number of mothers who received/buy iron supplements
while pregnant; (2) Increase the percent of mothers who had at least one postpartum
check-up; and (3) Increase the percent of mothers who know the danger signs during
pregnancy, delivery and postpartum that indicate the need for treatment.
Main Strategies and Activities: To achieve these objectives, the following activities
were planned: (1) conduct training courses for health providers (Ob/Gyns, GPs,
neonatologists, midwives and nurses) at both in patient and out patient care levels;
(2) conduct TOTs and then train health staff on Safe Motherhood; (3) improve health
provider’s knowledge and practices regarding the SM protocols, and in particular,
communicating essential information to patients; (4) monitor Health Providers’ behaviors
during supervisory visits; (5) Involve technical working group (TWG) members in
making changes that facilitate a health provider carrying out the Safe Motherhood
guidelines (for instance, the TWG will analyze the primary health facility monitoring
reports); (6) At the makhallah level, carry out an integrated makhallah-based MCH
strategy, which consisted of key messages in prenatal, delivery, neonatal and postpartum
care; and (7) focus on improving the quality of SM service delivery through close
monitoring and supervision of service delivery and the makhallah levels.
KPC Results on Perinatal Care
Baseline Feb 2004 MTE
(May 2005)
KPC FE*
Indicators June 2007
% CI % CI % CI
Percent of mothers who had at least one prenatal visit prior to
the birth of her youngest child less than 24 months of age 99.8% ±4.0 100.0% - 99.7% ±0.6
Percent of mothers who received/bought iron supplements
while pregnant with the youngest child less than 24 months of
age
54.1% ±4.8 61.7% ±7.03 73.4% ±5.0
Percent of mothers who know at least TWO signs of danger
during pregnancy that indicate the need for treatment 46.9% ±4.8 74.0% ±5.54 97.0% ±1.9
Percent of mothers who had at least one postpartum check-up 76.9% ±4.0 95.1% ±2.61 98.7% ±1.3
Since the beginning of the project in 1999, there have been many changes to maternal and
neonatal health protocols in Uzbekistan. Project HOPE has always been a leader in this
area and from the beginning, adopted and adapted WHO standard Safe Motherhood5
materials and protocols. In summary, the name and focus have slightly changed from
Safe Motherhood to Making Pregnancy Safer, reducing maternal mortality and improving
the quality of maternal and neonatal health services has been a priority since 2003.
Recent laws bring old Soviet practices up to date with standard practices.
Project HOPE began to introduce the New Parents’ Schools in 2004, which happened just
before Prikaz 425 was passed. This prikaz includes the formation of New Parents’
Schools, which used to focus on new mothers only, but now also includes a focus on the
family responsibility. The purpose of the Parents’ Schools is to educate expectant parents
about pregnancy, delivery, postpartum and newborn care, breastfeeding, family planning,
and use of mother home cards. Currently, Project HOPE has supported the formation of
5 New WHO/Euro maternal/neonatal care package is called Making Pregnancy Safer – and this is the
standard package that the project follows.
18
75 parents’ schools at primary health care facilities, which is 91.46% of all PHC
facilities.
Some of the mothers of children under one year of age interviewed in the focus groups
attended the New Parents’ Schools. The discussions showed that in general, mothers are
satisfied with the perinatal services they have received. Mothers have obtained
information about the prenatal period as well as what to expect during labor and delivery.
Women also reported that they were informed about different possible delivery positions,
the importance of skin-to-skin contact with the newborn and were happy to have the
opportunity to choose to have their partner participate during delivery.
The Parents’ School consisted of establishing a counseling area (called Parents’ School
Corner) in the health facility, where the expectant parents receive counseling from
midwives and Ob/Gyns. The education and counseling manual covers six topics: (1)
pregnancy and physiological changes during pregnancy; danger signs during pregnancy
and the development of the fetus; (2) labor and delivery and danger signs during delivery;
(3) new born care; (4) breastfeeding; (5) family planning; and (6) post-partum care.
The Parents’ School also includes a set of take-home materials, a doll for practicing
breastfeeding positioning, posters and a registration book. Also, the technical working
group and Project HOPE staff has carried out poster design competitions among health
providers, and the best posters were displayed at the Parents’ school corners.
Project HOPE funded and supported an intensive training program for health providers at
different levels of the health system. The project used adapted evidence-based medicine
protocols for Uzbekistan when available and when there was no adapted version, the
project used the standard WHO/Safe Motherhood protocols on antenatal care,
management of normal delivery, management of labor and delivery complications, post￾partum care, and care of the newborn.
All training activities at the Oblast level were carried out in the SM training center
developed by the OHD and Project HOPE under OHD’s Prikaz, with funds provided by
Project HOPE for equipment. The training center is used for breastfeeding, safe
motherhood and HIV/AIDS training (supported by the Global Fund), and OHD meetings.
Currently, the training agenda showed a high level of facility utilization. In addition,
Project HOPE created two new training rooms in new rayons during the second phase
and all trainings at the rayon level were conducted in these and two old rayons training
rooms. There is also a completely stocked and equipped training room at the Nurses
Association. The Association will continue providing training after the Navoi CS project
ends, as they have the materials and trainers available and believe they can cover
additional costs through their membership fees.
19
The following table summaries the courses and seminars conducted on Safe Motherhood:
Type of Training Numbers and Types
of Participants
Training Topics
Eight-day theory and
practice on Making
Pregnancy Safer
(MPS)
128 hospital level
physicians and
midwives
Improve knowledge and skills on antenatal,
delivery and postnatal care, use of partograph,
management of main obstetrical
complications, MPS package promotion
Nine-day course on
IMPAC
36 hospital level
Ob/GYNs
Improve knowledge and skills on
management of emergency obstetric care
Five-day TOT on
SM
17 Maternity house
physicians/midwives
Improve skills on SM and teaching/adult
education skills
Three-day course on
MPS follow up visits
and monitoring
17 hospital level
physicians and
midwives
Train local and regional specialist-supervisors
on PEPC monitoring; to identify problems
and barriers; devise solutions; provide
information about performance; standardize
supervision and monitoring
Five-day training on
SM
235 primary health
care physicians,
general practitioners
and midwives
Provide standard information on antenatal and
postnatal care; referral system; how to setup
“parents schools”, newborn home care,
management of some complications during
prenatal and postnatal periods
Four day TOT 13 PHC maternity
house physicians and
midwives
Improving training skills; adult education
skills
Three-day course on
follow-up
supervision and
monitoring at PHC
level
17 local specialist
supervisors
PEPC monitoring, identification of problems
and barriers, devise solution, provide
information about performance, standardized
supervision and monitoring
Essential Neonatal
Care
36 local health
providers of
Maternity Houses
Improve knowledge and skills of local health
providers on neonatal care and neonatal
resuscitation
TOTALS 499
The materials utilized were the guidelines for trainers on “Essential antenatal, delivery
and postnatal care/PEPC”, WHO 2002; and handouts on adult education principles;
Protocol of MOH on management of hypertensive syndrome during pregnancy, delivery
and postnatal period; “Guideline on effective assistance during pregnancy and labor;”
partographs of special cases, diagnostics of pelvic inflammation diseases and STIs,
diagnostics and treatment of sepsis; slides, transparences and video tapes; and
mannequins.
Iron supplementation among pregnant women is an essential part of safe motherhood. A
question was posed to women during the mid-term regarding actual consumption of iron
by pregnant women. However, the KPC results show that increasing percentages of
women (54 at baseline and 73 at FE) bought or received iron tablets during pregnancy.
Informal interviews during the FE confirmed that women had taken the iron during their
20
pregnancies. However as pointed out in the mid-term, neither the project, nor the MOH
have any control over iron supplementation, because they do not distribute them.
The same community mobilization strategy described in the above sections was adopted
for the safe motherhood intervention as well.
As part of this FE evaluation, focus group interviews of mothers of children under one
year of age demonstrated that mothers know about danger signs and had complete
information about complications including bleeding, edema, low abdominal pain, and
early rupture of amniotic fluids. This improved knowledge of danger signs is also
evidenced in the KPC findings (see above). The FE team believes that the the reason the
mothers knowledge improved was due to the project’s improved counseling skills
training of patronage nurses and GPs. The FE team believed this because when these
results were compared to the MTE findings, it showed dramatic knowledge gains (47 to
97 percent increased knowledge of danger signs)
In 2005, Project HOPE adapted a Mother’s Home Card incorporating lessons learned
from the Mothers’ Home Cards developed by the German aid agency, GTZ, in
Namangan Oblast. Use of the mother’s home card falls in line with Prikaz 425 on
antenatal care which includes the promotion and use of the Mother Home Card (MHC).
The card covers medical check up history, messages on danger signs, exclusive
breastfeeding, post partum contraception, iron tablets for 90 days, and newborn care. The
last week of the MTE (October 7), the MOH invited Project HOPE/Navoi to present the
adapted MHC to a national group of experts. Project HOPE pilot tested the card with the
Navoi OHD and RHD personnel, and it was then adopted by the MOH at the national
level and recommended for use by all the oblasts.
At the national level, the Safe Motherhood Initiative has a multi-agency Technical
Working Group (TWG) that coordinates and strengthens its implementation. The CS
project team has participated occasionally in this national TWG. In Navoi, the CS team
has worked in close collaboration with the TWG for the training of health providers,
monitoring safe motherhood implementation, and to make decisions regarding the
implementation of the program in the oblast. Participants on the Navoi TWG are staff of
the Oblast and Rayon Health Departments and Project HOPE.
The MOH used Navoi to field-test a protocol for the perinatal period under Prikaz 425,
which includes antennal consultation protocols and newborn care, which was officially
implemented at the end of 2005.
Institutionalizing semiannual monitoring and supervision visits has been a great
achievement of the CS Project. The instruments utilized consisted of a set of
questionnaires and checklists adapted from the WHO’s Safe Motherhood Health Facility
Assessment. All health facilities are visited by the TWG. The purpose of monitoring is:
(1) to reinforce training and provide additional in-service training; (2) health facility
assessment with a reduced number of questionnaires; (3) review data and make decisions
to address identified weaknesses in any program area.
According to interviews with project area Ob-Gyns, one of the improvements resulting
from the training is fewer C-sections and hospital infections. The Obs believe this is
21
because the practitioners are more knowledgeable about how to handle complicated
pregnancies and deliveries. Also, the role of midwives in managing normal deliveries has
increased after training. Before, all normal deliveries were managed by the Ob-Gyns.
Now the use of partographs has allowed nurses and GPs to identify manageable
complications earlier and this has helped increase the number of normal deliveries. The
use of partographs allows nurses to track labor progress and alert doctors promptly if
there are unusual progressions or changes. This in turn, allows the physician to deal with
the problem before it becomes complicated, which then requires a C-section. The HPs
and the makhalla leaders indicated that they believe there is less morbidity and mortality
among newborns and mothers. Also, the increased presence of partners at deliveries has
reduced complaints about the service in the maternity houses. Several of the practitioners
commented on improved working conditions due to the implementation of the national
policies and standards. In 2003, Project HOPE encouraged the MOH to change and
improve the prikaz’s related to breastfeeding, newborn care and management of hospital
deliveries. In 2005, the MOH also developed antenatal standards based on WHO
standards, which made it easier for the project to implement SM in PHC facilities.
The project and Health Department staff in the oblast and rayons believe that the
monitoring process has been very useful for improving and upgrading services. They also
believe that the monitoring visits will continue as they are leaving strong teams in place
and enough materials for both in patient and outpatient monitoring to continue.
Challenges and Recommendations:
 One of the challenges that the FE team sees is whether the oblast will be able to
continue the strong monitoring of services that has existed to date. Currently, the
monitoring has been conducted from the oblast level and is usually a 1-2 day
process with several teams. The work is very thorough with interviews, reviews
and checklists. A recommendation made by the team is that the Oblast Health
Department organize supervision activities from the rayon levels, rather than
trying to organize teams and logistics from the oblast levels. They could also
consider reducing the number of monitoring instruments to make the monitoring
process shorter and more practical.
If possible, it is recommended that the Project HOPE staff work with the Oblast
HD to organize agendas and teams at the rayons so that such a monitoring system
is left in place before the project closes.
 The MOH has been slow in approving prikazes related to safe motherhood, and
there is a need to approve protocols and standards for emergency obstetric care.
The MOH has approved two sets of protocols (for eclampsia and hemorrhage) but
there are 10 more waiting for approval. In some desperate circumstances, HPs
have used WHO protocols but it is dangerous to use protocols that are not
officially approved by the MOH, so there needs to be encouragement for
approving the outstanding prikazes.
 There has been considerable debate within the MOH regarding the definition of
live birth. Currently, Uzbekistan’s policy is that live birth begins at 28 weeks and
if a baby is born before then it is considered a natural abortion or stillbirth. There
22
is pressure to change this criterion to meet international standards in the ICD 10,
which state that live birth begins at 22 weeks. Although UNICEF and ADB
projects are equipping facilities to handle premature births, many practitioners are
concerned that the new live birth definition will be approved before they receive
the equipment and training to manage these premature births. In anticipation of
acceptance of the new criteria which is supposed to take place in 2008, and at the
request of the MOH, Project HOPE staff has printed the ICD 10 guidelines for
each health facility.
If possible, it is recommended that Project HOPE staff try to assure that systems
are in place for proper equipping of maternity facilities for premature births in the
Navoi Oblast before the close of project.
 Continue Training Health Providers. Project HOPE should be commended for
implementing such ambitious training plans to improve safe motherhood and
newborn care interventions. These trainings have also strengthened the capacity
of the Oblast Health Department and TWG to conduct training. As with the
monitoring, it would be helpful if Project HOPE staff could work with the Oblast
to leave a training plan in place for all the new personnel who will need training.
As indicated above, the Nurse’s Association has already indicated that they are
planning for the SM training needed for new nurses and appears to have the
resources for this. Since new nurses are coming on board frequently, this training
plan is important.
 One of the recommendations from the mid-tem evaluation concerns why there are
delays in obstetrical care seeking behavior on the part of community members and
at the facilities. The MTE recommended that the project conduct operations
research to find out more about the causes of the delays, but the project did not
have the resources to conduct this study. If future resources become available,
this study would be worth conducting, for although the MMR has come down
since the beginning of the project, it is still quite high when compared to
neighboring countries. Below is the recommendation from the MTE:
Women’s perceptions of obstetrical complications: In general terms, the perception of
women about an obstetrical complication is very subjective. Usually, signs and
symptoms are either overestimated or underestimated. In addition, the decision
making process to seek medical attention is not well understood by project staff or by
the TWG. It is recommended that the project conduct qualitative studies to determine
why some women arrive late to receive the proper level of care. The project should
determine the main causes for the Four Delays: (1) the time it takes to recognize the
obstetrical problem; (2) the time it takes from the recognition of the problem to the
decision to seek medical help; (3) the time it takes from home to the nearest health
facility that provides essential obstetric care; or (4) the time it takes from the arrival
of the patient to the health service until she receives medical attention.
The reasons may vary in rural remote areas from more accessible areas. The researchers
need to discover where the main problems are and propose feasible solutions. What
seems evident is that the PHC level in rural areas is unable to handle any severe
obstetrical complication and furthermore, the PHC provider could delay the proper level
23
of care. PHC providers need to act promptly, but also need transportation and emergency
drugs and training to prepare patients for referral. These are additional reasons why an
emergency obstetric care prikaz is needed.
Family Planning
See Section 3, Family Planning, for Flex Fund-supported activities.
c. New Tools or Approaches
Project HOPE has used several strategies that it utilized within the CS project that are
both innovative and that are being adopted by the national level, the OHD and RHDs.
Project HOPE has implemented a comprehensive monitoring plan that reinforces training
at the service delivery level. This approach has consolidated what health providers have
learned during the trainings. It allows the TWG to identify strong and weak areas that
need further inputs and/or in-service training. It also focuses on delivering quality
services and taking a comprehensive approach to the health system. Since the mid-term
evaluation, the project has encouraged the OHD and RHD to take stronger roles in the
evaluations but as mentioned above, there are still concerns about how the monitoring
will be continued after the CS Navoi project ends.
Project HOPE has also brought specialized technical assistance through a participatory
research study to determine the informal communication mechanisms at the community
and family levels; it identifies the family “gate-keeper” and the person(s) who makes the
decisions to seek medical care, and who provides information on health related issues.
The study particularly highlighted the role of grandmothers or mothers-in-law and their
role in influencing healthcare seeking behavior. This information has been used as the
basis of the community mobilization component, which focused on Women Leaders as
the key government organization to lead the community health education component.
During this process, the CS project staff has learned about qualitative assessment
methodologies and anthropological approaches to address community health issues.
Project HOPE used additional non-CS funds to develop behavior change communication
(BCC) materials for the Navoi project which have been reproduced and disseminated by
other partner organizations both in the country and throughout the Central Asian Region.
Project HOPE has taken advantage of this opportunity to develop materials with leading
expert groups in the country such as the National Pediatric Institute and the Technical
Working groups, UNICEF, and USAID partner organizations (the Healthy Family Project
and Zdrav Plus). The strategy also includes learning from existing, successful materials
developed by local and international NGOs. During the second half of the project,
an adolescent RH booklet for parents was developed and printed. The purpose was to
involve parents of adolescents in project activities and to obtain the support of parents for
ARH education activities. The booklet includes key ARH messages and 17,000 copies of
the booklets were printed in Uzbek and 3,000 were printed in Russian and have been
widely distributed by the project. During the FE, many adolescents, community leaders
and teachers referred to the booklet as a useful tool for talking with parents on such
sensitive topics as adolescent reproductive health.
24
The first IMPAC training was conducted during the second half of Phase 2. Seventeen
Ob/Gyns from maternity houses received the nine-day IMPAC training by Professor
Karimova, who is President of the Association of OB/GYNs, at the SM Center. Modern
methods for Management of Complications in Pregnancy and Childbirth were presented
and demonstrated to participants. As a result of this training, monitoring tools on IMPAC
were also developed and used.
Although not originally developed by the CS project, a WHO Decision-Making Tool for
Family Planning Clients and Providers was translated into Uzbek by the project team and
local health providers. This tool is a decision-making aid for clients and a job-aid and
reference manual for health providers that includes evidence-based technical information
on 14 family planning methods. Included in each section are medical eligibility criteria,
side-effects, when to start, and how to use each method. There is also a one page client
hand-out with helpful pictures and key points, and a corresponding page for providers
with key points and detailed reference information. Two hundred and fifty (250) copies
of the guideline were printed and distributed among FP/RH providers.
A Making Pregnancy Safer (MPS) guideline for visiting nurses was developed in 2007.
The purpose of this guideline was to improve counseling skills and it was used during the
four-day MPS/RH training course along with the other training materials. The first
MPS/RH training, using the new guideline was conducted for 17 visiting nurses in
Karmana rayon on March 15-18, 2007.
Recently, a four-day “New Electronic Technology for Data Collection and Analysis”
training was conducted on February 15-18, 2006. Twenty four (24) data specialists of
OHD/RHDs participated in the seminar from all Navoi Oblasts and learned how to
manage data on childbirth and death rates according to the ICD-10 definitions, using a
Microsoft Access program tool. The first follow up support was provided a month after
the training by the OHD’s chief data specialist and Project HOPE’s HIS specialist. To
date, all the project rayons are able to use this tool, thus preparing them for new
government orders that will be changing the live birth definition to conform with the
ICD-10 definition.
Other guidelines developed in the past two years include guidelines and training curricula
for the Community Health Promotion program as well as CHP monitoring tools. Also, in
collaboration with Abt association (ZdravPlus) the project launched a Quality
Improvement strategy at 19 primary care facilities. To help the two organizations
supervise activities, a QI monitoring tool was also developed.
3. Results: Cross-Cutting Approaches
a. Community Mobilization
The community mobilization activity took a long time to launch. This is not surprising
given that there are few models or resources in the country from which to design a
community mobilization component that is truly focused on community ownership, and
that was outside the old-soviet campaign approach..
25
The project contracted an anthropological consultant, Judy Aubel,PhD, who conducted a
study in 2003, which indicated that there were local resources in the country from which
to develop a community health promotion strategy. They brought her back in 2005
during Phase 2 to develop a strategy based on the previously conducted research. She
outlined what traditional groups to work with and suggested the project use both formal
and informal leaders with a focus on grandmothers. Based on this, the Project HOPE
staff completed an analysis of the socio-cultural dynamics affecting maternal and child
health in Navoi. Project staff realized that they should develop training and educational
events that are participatory, interactive, and that methodologies such as story telling are
more acceptable modes of information transmission in traditional Uzbek communities.
The project team developed a BEHAVE matrix plan and a strategy to move forward on a
BCC plan. At the time of the MTE, the staff completed guidelines that included twelve
areas of intervention and over 50 health messages. These guidelines proposed working
with both formal (i.e., those chosen by prikaz to work in health promotion) and non￾formal community leaders and utilization of six channels of communication: video tapes
(6 films); stories without an end ( 2 on diarrhea, 1 on BF, 1 on FP, and 1 on iron tablets);
pictures and discussions; stories from personal experience/discussion; small group
discussions; and lectures. At the time of the MTE, the team realized that the staff needed
assistance on how to operationalize the planned and rather complicated community
strategy. At that time, the Project HOPE Regional Program Director helped the project
redefine and simplify the community mobilization plan. With her help, the project was
able to operationalize the plan and develop a three-part training manual for community
leaders. The manual has sections that deal with 1) how to work with community groups,
2) adult education methodology, and 3) key information messages. The CAR Program
Director also worked with the project team to develop additional brochures and booklets.
The manual included nine health topics and each had different colors. In addition to the
manuals, the trained leaders were provided with materials for developing open ended
stories, role plays, discussions and videos.
The next step was to select three leaders from each makhalla. One was from the Religious
Council and two other informal leaders were selected. A special training binder was
developed whereby sections could be removed and used for educational activities as
needed. The leaders were taught how to organize meetings, using adult education
strategies, how to pick target audiences to educate (mothers of children under 2, WRA,
adolescents) and each leader was given a form for planning education sessions and
recording actual activities. The leaders planned and recorded activities on a six-month
planning instrument that was developed by Project HOPE and the FE team observed that
the planning instrument was being used by the leaders to track planned and accomplished
educational tasks by educational subject and number of participants. This tool is useful
for monitoring and supervision. Each volunteer leader provided two educational meetings
per month (six per makhalla total) and then brought their reports to the meetings with the
chief of the women’s committee at the rayon level, showing the methodologies used and
discussing what strategies were effective and which ones were not.
The Chief of the Women’s Committees at the rayons monitored and supported
community activities. The project works closely with the Deputy Oblast Governor who is
also the Chief of Women’s issues and on the Steering Committee. She also oversees the
work of the Women Chiefs at the rayons and receives their reports, which include the
work of the community leaders trained by the project. In this way, the project has
26
integrated the work of the community leaders into the work of the local government
structure. The Deputy Governor and Women Leaders are responsible for implementing
Prikaz 242, which is to increase health knowledge among families at all levels. Having
the women leaders supervise the work of the community leaders has provided a built in
supervision system; this activity will also be sustained because the women leaders are
part of the government system. Another advantage of the women leaders is that they tend
to be older women and have a lot of influence with the mother-in-laws and grandmothers
as well as the community leaders.
Between March 2006, when the community strategy began, and January 2007, the project
held 24 seminars in the four rayons and trained leaders from 126 of the 127 makhallas. In
all, there were 16 trainers composed of individuals from the Deputy Regional
Governors’s office, different chiefs from the rayons, project staff, and trainers from the
RH and IMCI training centers as well as others. Altogether 391 leaders have been
trained, thanks to the CS Navoi project.
In addition to the education system put in place with the community leaders and the
Women Chiefs/leaders, by strengthening the patronage nurses skills, the project has
completely linked the community and families with the local primary health services. The
counseling skills training allowed the nurses to do more antenatal, postpartum, family
planning and breastfeeding education with mothers in their homes. The mothers and
WRA interviewed by the FE team commented that they were receiving education from
community leaders and the nurses. Women had been counseled and provided with
educational materials that they had with them. Both leaders and mothers commented that
they thought there was better acceptance of family planning, recognition of danger signs
in pregnancy and child health. Both groups commented that they had not had severe
cases of diarrhea in their communities or infant or maternal deaths during the previous
year.
Overall the educational and training materials are considered very useful and user
friendly. The mother’s home card (discussed above) was accepted by the MOH as an
appendix to the national prikaz for antenatal care.
In addition, members of the FE team pointed out that that the educational methods and
strategies can be used by leaders in other sectors of their work besides health. These skills
include use of stories, video discussions, role plays and how to select target groups for
education activities.
Lessons Learned
 Initially, the project had difficulty in recruiting community leaders for training
and relied on the chiefs of the makhallas or the women’s committee to make
recommendations. Unfortunately, some of the leaders that were recommended
were elderly, respected individuals who could not easily learn the teaching
methodologies. After three groups (of the 24) were trained, the project asked the
health providers to recommend leaders for training and it turned out that they had
better results with them.
27
 Before the end of the project, the team will hold a conference to share community
strategies to promote health. They will invite representatives from the city and
non pilot rayons including individuals form the women’s committees, health
institutions and health promoters from the non pilot areas.
 In order to stimulate more learning among communities, the project decided to
hold poster drawing competitions on different health themes ( breastfeeding, STIs,
diarrhea prevention, etc.) for different groups (grandmothers, nurses, etc). The
project found that when local health providers made posters themselves, it gave
them a sense of ownership of the education process even if they weren’t very
artistic. The FE team noticed several “home made” posters at the health facilities
during the field visits.
Conclusions and Recommendations
 The older women community leaders appear to be great for working with mothers
and grandmother groups. They know most of the families in their makhallas and
are respected members of the community. For this reason, older women appear to
have had a positive impact on health knowledge among mothers of children under
2 and WRAs. However, because of their age, the FE team verified that they are
not as able to reach adolescents, who the leaders readily agree respond better
when receiving ARH information from their peers.
 It is often difficult for community leaders to organize education activities right
after training because of other community commitments, such as seasonal
agricultural campaigns. Therefore it is important during training to teach
participants how to integrate their educational activities into the other seasonal
activities. One example would be to take advantage of community gatherings, like
traditional weddings, as an opportunity for educating the participants.
 Currently, there are only a small number of male leaders. If resources become
available and further work is done in this area, it is recommended that strategies
be developed to recruit more men and develop educational sessions that
specifically target men. Men are key decision makers in the households and
therefore need to be educated as well about preventive health.
 Project staff has been concerned about the older ages of the formal community
leaders. They seem to understand key messages but lack teaching skills. When
the project conducted its first monitoring sessions, they found knowledge to be
low so they encouraged the leaders to study more and now seem to think their
levels have improved. The FE evaluators are not as concerned about whether the
leaders have in depth knowledge of the health subjects because the role of the
leaders is really one of making community members aware of preventive health
and then directing them to the patronage nurses or the health facilities in a timely
manner when there are problems. In order to be effective, however, periodic
updates of the training tools, such as new stories, pictures, videos, etc., need to be
incorporated. It is recommended that the project work with the oblast and rayon
women chiefs to help them develop a plan for updating tools.
28
 There is a need for the government and Oblast health and women’s issues
department leaders to create a team that can lead future trainings in community
methodology for new formal leaders. There is also a need to provide refresher
training for makhalla leaders. This team should also take responsibility for
updating community teaching materials and tools.
b. Behavior Change Strategy
The BCC strategy includes the following elements:
1. A community mobilization component discussed above.
2. Expanded work with patronage nurses that includes several training seminars -
MPS/FP and IMCI/BF.
3. Campaigns for diarrhea control, breastfeeding, reproductive health, Making
Pregnancy Safer, acute respiratory infection, ARH.
4. IEC materials creation and distribution.
5. ARH TOT and training.
Evaluation/observations:
The BCC strategy presented in the DIP was unclear, which lead to confusion over
expectations at the field level and delayed development of the BCC activities.
While for the most part Project HOPE has used or adopted existing IEC materials, some
materials were developed especially to achieve the project’s objectives. These include the
child health booklet that was distributed to all families; a maternal health card that
contains health messages; and several educational materials for the adolescent program.
There were also posters, leaflets and brochures developed or adopted for each of the
intervention areas. The materials, in some cases, were developed with partner institutions,
such as the National Pediatric Institute or borrowed from other projects such as Zdrav
Plus and were distributed among partner organizations and programs, such as the Healthy
Family project.
The content of the materials was reviewed by partner institutions in the country. All
materials were developed in the appropriate language (Uzbek) and were adapted as
needed. A complete listing of educational materials developed and adopted by the project
and a description of quantities produced and activities is located in Annex D.
Project HOPE has worked with patronage nurses to provide education and counseling in
the homes while visiting families with pregnant women and young children. The capacity
of the patronage nurses and their counseling activities have greatly increased since the
implementation of the community strategies after the mid-term evaluation.
Next Steps/Recommendations:
 As noted in the previous section, the materials and tools will need periodic
updating and reprinting. It has been suggested that the Oblast HD, Women’s
Issues department and the Health Institute be asked to take responsibility for this.
It is recommended that the project staff try to organize a meeting of these groups
to address this issue before the project closes.
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c. Capacity Building Approach
i. Strengthening the PVO Organization
The Navoi CS Project has provided Project HOPE a wealth of valuable lessons during its
eight-year duration. Through this project, Project HOPE learned that implementing
community development and community mobilization activities in the former Soviet
Union requires more guidance and creativity than in other parts of the world. The
concept of empowering and enabling community members to take charge of their health
is totally foreign in this part of the world and has required special effort on the part of the
project team.
Attention to detail in providing guidance on such things as sample selection for LQAS or
KPC surveys, FP and IMCI counseling and monitoring practices. Project HOPE￾Uzbekistan has learned that preventive activities introduced in Navoi can have an impact
at the national level including: the ARH guidelines that were developed by Project HOPE
that included a trainers manual, a participants manual and a reference book; also the
mothers Home Card was attached as an appendix to the national antenatal policy and; the
IMCI materials developed with the National Pediatric Institute have been used not only in
Uzbekistan but in Project HOPE’s project in Krygystan. In addition, the CS Navoi project
was a basis for the Healthy Family Program, which has been conducted in two southern
Oblasts in Uzbekistan as well as all Central Asian Republics except Kazahkstan. Through
the CS Navoi project, Project HOPE has strengthened its own programs in the region,
contributed to changes in the country as well and become a major player in public health
program implementation in Uzbekistan.
ii. Strengthening Local Partner Organizations
The focus of the project has really been in building the capacity of its local partners. The
Oblast and Rayon Health Departments have been the main partners in implementing this
project. Project HOPE has developed some strategies that are both innovative and could
be shared with other organizations. The overall approach of working directly with the
Oblast and Rayon Health Departments to improve their capacity is something that Project
HOPE has lead in Uzbekistan and may be one of the main reasons that Project HOPE is
the only US-based NGO still operating in Uzbekistan. All of Project HOPE activities and
interventions are based on this approach.
An example of this collaboration was witnessed in the meetings where the FE results
were presented, where Project HOPE asked Oblast and rayon chiefs to interpret the
information, and the Oblast Chief asked the health workers to make a commitment to
follow up on CS project activities after Project HOPE ends activities in Navoi. In
addition, Project HOPE will disseminate and discuss the FE report and recommendations
in a collaborative manner with the OHD and Steering Committee, stressing the areas that
need their continued attention.
Project HOPE assisted the OHD to upgrade the technical level of the health providers at
both rayon and makhallah levels. In the OHD Chief’s own words, Project HOPE staff
30
has worked hand-in-hand with the OHD and RHD health teams. Now the Oblast and
rayon health teams know how to supervise and monitor their work. The project has
prepared many monitoring specialists. Additionally, the project has encouraged health
teams to add training rooms to their rayon and oblast health departments and in doing so,
the project has equipped the OHD and RHD teams with materials and trained trainers.
Now there are also teachers who can teach ARH topics, which did not exist before the
project. Likewise, the capacities of the women leaders have been strengthened. After the
training they have received they can coordinate and monitor activities whereas before
they could not teach or organize classes or attract community members from the target
groups. The same is true for the patronage nurses who did not really have the practical
skills to provide home care before and now make regular visits and provide services and
counseling to all families with pregnant women and young children.
Project HOPE has led the KPC and LQAS implementation in the country through both
projects, the Navoi CS and the Healthy Family.
Project HOPE developed IEC materials for child, maternal care and adolescent health
activities. Project HOPE has used local expert groups such as the National Pediatric
Institute, UNICEF, WHO and PRIME II. The strategy also includes learning from
existing materials developed by local and international NGOs like Zdrav and Healthy
Family Project. Also, Project HOPE has made the final materials available to a wide
variety of organizations working in the area of maternal and child health in the country.
The opportunities to consolidate lessons learned and best practices of the CS Navoi
project and distribute them locally through the national working groups, and
internationally through channels such as CORE and CSTS will be of great benefit to the
CS community.
One drawback in the relationship with the OHD is that Project HOPE could not avoid
providing the resources the MOH lacked. This is always one of the trade-offs between
the sustainability Project HOPE was trying to create in the project versus the reality of
the resources the OHD was lacking.
Some lessons learned through the partnerships with the health system include:
1) When training health practitioners, it is important to involve the key officials (heads of
departments) in the process so that they will support the new training that their staff is
receiving. Otherwise the new methodologies will not be a priority for them and it will be
difficult to implement the new health practices.
2) A second lesson concerns the community strategy, which originally called for having
the project hire a rayon coordinator for each district. The project decided that it would be
more sustainable if they worked through the existing system of women leaders whose job
was to provide health education to makhalla families.
iii. Health Facilities Strengthening
As mentioned in the project interventions sections, the project has trained hundreds of
MOH personnel. Project HOPE has assisted the OHD and RHDs to carry out a health
31
facility assessment. In addition, Project HOPE has adapted monitoring tools (see Annex
H) to regularly assess the quality of the clinical interventions, which include the
evaluation of the health worker’s performance delivering project interventions, and cover
100 percent of project facilities.
The project staff indicated that at the beginning of the project it was hard to implement
use of the partograph. But eventually the project received the support of the chief Ob￾Gyn at the Oblast maternity house who saw the utility of the tool and insisted on
reviewing the previous day’s pantographs every morning. The FE team noticed that Ob￾Gyns and midwives mentioned the utility of pictographs and how the information
provided on the partographs has allowed the midwives to take more active roles in
deliveries and better track progress during pregnancies.
During the past year, the project has also worked with Zdrav Plus to implement a Quality
Improvement strategy in 10 PHC facilities. This methodology has taught providers how
to employ a team approach and use self-monitoring to improve the quality of services.
iv. Strengthening Health Worker Performance
As described in Section b. Progress Report by Intervention Areas, the major emphasis of
the project has been to train health providers of all levels of the health system through
training of trainers, training courses and seminars.
In addition to courses and seminars, Project HOPE has institutionalized monitoring and
supervision visits that include assessment of health providers’ knowledge and the
delivery of health services. The tools utilized are described in the reports by intervention,
but included questionnaires to determine the health providers’ knowledge; observation
checklists to assess the delivery of health services, and exit interviews. The results of
monitoring visits were fed-back to the services soon after the visit and served to improve
the delivery of CS interventions. One of the monitoring decisions made by the project
occurred after training visiting nurses. When they realized that they could not train all
the nurses since they only had funds for three from each facility, they asked that the
trained nurses teach their untrained colleagues at their home facilities. Therefore to see
how well this approach had gone, the monitors decided to randomly monitor all nurses as
well as other practitioners during their visits. The results indicated that in many cases the
training information and tools had been shared with colleagues. Some of the untrained
colleagues took interest and studied the materials and even surpassed the results of their
trained colleagues. In other cases, the project staff felt that the trained nurses needed
more teaching skills in order to better train their colleagues.
In discussing the monitoring needs after the project closes, the project staff believed that
continuing to monitor PHC activities from the Oblast level with large teams may be
unrealistic for the OHD to pursue. Instead they thought that monitoring should be
coordinated from the rayons. The staff has talked to the rayons about this suggestion and
the need to build monitoring capacity among staff to perform the inspections. However,
once the CS Navoi project ends, staff is unsure of the rayons ability to continue these
activities.
32
Lessons Learned/Recommendations
As mentioned above, a lesson learned was when the project realized it was unable to train
all the patronage nurses (there are 71,000 total with high turnover), the project decided to
train three nurses per facility, giving them skills and materials to train the other nurses at
their stations. Some shared the information with other nurses and others did not. The
lesson learned was that it might have been better to add one more day to the training that
included teaching skills to facilitate replication of the training to the untrained nurses.
Another lesson is that key decision makers such as chief nurses, PHC chiefs, chief Ob￾Gyns and pediatricians, should be included in training and monitoring so that the
activities will be followed up. The project is trying to involve these individuals in the
activities now but they think more effort needs to be made.
v. Training
Project HOPE’s purpose has been to strengthen the capacity of the Oblast and Rayon
Health Departments. To this end, Project HOPE developed an extensive training
program, focusing on the training of MOH personnel in IMCI, Safe Motherhood and
Family Planning, including the development of an adolescent reproductive health
education and services program.
As it has been described in detail in the Sections B and 4, the project included many
training courses which allowed it to meet most of it’s targets for the life of project. Much
of the training has been institutionalized by the OHD and RHDs. OHDs have their own
training rooms and centers that are fully equipped with materials and equipment
including computers and databases to monitor training. Health departments also have
their own training and monitoring teams in place. In fact, the Oblast has placed its own
IMCI training coordinator at the training center and the nursing association has its own
funds with which to continue training activities. What is left now is the need for a
training plan to be developed by the OHD and RHDs for maintenance of training
activities including updates, refresher courses and monitoring. They also need continued
reinforcement of the skills that have been learned in the classrooms. Since the project
staff turned the training responsibilities over to the MOH, they are not sure how often the
training databases are reviewed or used for planning future training.
d. Sustainability Strategy
Project HOPE has implemented a highly sustainable strategy for delivering health
services in Navoi. Rather than implement child survival activities, Project HOPE is
working with the OHD and RHDs to improve their capacity to manage personnel and
resources in Navoi to deliver high quality services.
At the oblast level, Project HOPE has assisted in the formation of Technical Working
Groups; has strengthened the training centers; has strengthened the school education
program on adolescent sexual and reproductive health; and has extended project activities
through local NGO counterparts. Lastly, at the oblast and rayon level, Project HOPE
trained master trainers (TOT) to train health providers and field staff in the project
interventions and adult education techniques.
33
At the rayon level, Project HOPE trained teachers on adolescent sexual and reproductive
health; has strengthened monitoring, follow-up and supervision visits for the health
delivery level; and has unified information based on key indicators and decision-making
through the TWGs.
At the community and makhallah level, Project HOPE trained patronage nurses in CS
interventions and counseling skills; promoted integrated and multidisciplinary visits to
PHC facilities; and strengthened schools to provide sexual and reproductive health
through brochures, booklets, and other materials.
The oblast level activities have been accomplished completely. The main impact Project
HOPE had was on the OHD, where there is evidence of mutual collaboration and
development of action plans. The next step is to collaborate with the OHD to submit
project proposals for funding.
The main efforts were directed to the rayon and makhallah level, where Project HOPE
worked in close collaboration with the health providers and their teams consisting of
doctors, nurses, patronage nurses and makhallah leaders. Almost all training sessions
were directed to this level, which included monitoring and supervision.
The community level began late but received considerable focus during the second half
of the project. Although it took a long time, the strategy was well thought out,
particularly in terms of sustainability. By selecting and training community leaders as
health promoters instead of hiring CHWs, the project avoided creating a parallel system
that would have no support after the program closed. Now the way the project is
organized with trained community leaders providing health awareness messages who are
supervised by trained Women Leaders from the rayon system, the project is again helping
the government fulfill its own mandates. The Wmen Leaders are responsible for
implementing Prikaz 242 to educate families about health. The only concern is that
because this part of the project is late in starting, the FE team wonders if there will be
enough support from the Oblast level to continue providing needed refresher training,
monitoring and supervision.
To address sustainability concerns, the project’s Steering Committee conducted an
exercise on sustainability “after HOPE” in January 2007. The committee divided into
groups (MH, CH, ARH) and each wrote plans and divided responsibilities for listed
training, monitoring and other activities and commitments to follow-up.
There were no formal sustainability objectives or phase over plans but the work plan
always included sustainability as a key element. One of the main purposes of the second
phase project was for HOPE to phase out and hand over its activities to the Health
Departments. For this reason, the training responsibilities were handed over to HD staff
during the second half of the project, with only minimal financial support provided by the
project.
34
4. Results: Family Planning
Objectives: (1) Increase the number of women/couples with a birth interval at least 24
months after the previous surviving child; (2) Increase the number of women/ adolescent/
couples’ knowledge of the reproductive cycle; (3) Increase the number of non-pregnant
women who desire no more children to space births and are using a modern method of
FP; and (4) Increase the number of family planning clients who received counseling on
contraceptive choices, common side effects, and when to return for follow-up.
Percent effort: 30%
Main Strategies and Activities: (1) Implement TOTs and train health staff in family
planning; (2) explore the possibility of continuing surgical contraception (minilap)
training for health providers; (3) BCC and makhalla/community-based work focused on
WRA and their partners by initiating sessions to orient makhalla committees and leaders
in reproductive health and family planning; (4) Adolescents’ Reproductive and Sexual
Health (ARSH) to increase adolescents’ knowledge about sexuality and reproductive
health and to develop an adolescent-friendly health services strategy; (5) BCC and
makhalla/community-based to increase knowledge of reproductive health and sexuality;
and (6) focus on improving the quality of FP service delivery through training,
community education and close monitoring and supervision.
Adolescents’ Reproductive and Sexual Health (ARSH): This component had two
primary purposes: (1) to increase adolescents’ knowledge about sexuality and
reproductive health and (2) to develop adolescent-friendly health services.
KPC Results on FP and child spacing
Baseline (Feb 2004) MTE
(May 2005)
KPC FE*
Indicators June 2007
% CI % CI % CI
Adequate Birth Interval Between Youngest Surviving
Children: Percent of children aged 0-23 months who
were born at least 24 months after the previous surviving
child
48.3% ±18.2 86.9% ±6.13 84.7% ±5.8
Percent of women of RA who report that women are
likely to get pregnant halfway between two menstrual
periods
9.3% ±2.8 72.8% ±8.21 45.7% ±5.6
Percent of non-pregnant women who desire no more
children in the next two years, or are not sure, who are
using a modern method of child spacing
72.6% ±4.6 91.5% ±5.67 72.8% ±9.3
Percentage of respondents who report discussing FP
issues with somebody in the past 12 months 56.2% ±4.7 82.5% ±5.71 65.7% ±5.4
Counseling: Percentage of family planning clients who
receive counseling on contraceptive choices, common
side effects, and when to return for follow-up
62.7% ±5.8 77.2% ±5.86 86.6% ±6.8
Project HOPE successfully worked with several members of the TWGs, Oblast and
Rayon Health Departments and PHC services to provide family planning training courses
and to implement 6-8 month monitoring visits. The RH training courses conducted by
the project are shown below. In total, 475 health providers were trained in Reproductive
Health.
35
Type of Training Numbers and Types of
Participants
Training Topics
3 day TOT 16 Ob/Gyns, midwives, and
GPs
Improved skills on RH and
teaching/adult education
skills
4 day training on RH and
counseling (Note that in the
DIP this was anticipated to
be a 5-day course)
221 Ob/Gyns, GPs,
midwives, and feldshers
General counseling skills
and informed consent,
screening tests, provision of
contraceptive methods,
including method delivery
and follow-up; management
of secondary effects; Health
information system and
information management.
4 day RH course 238 Patronage nurses Content MPS and RH
includes above plus
antenatal and postpartum
skills.
In the DIP, reproductive health training for the patronage nurses was planned to be
separate from the maternal health care course; however great as the need was to train
patronage nurses, this methodology has been fused with basic outreach antenatal and
postpartum care topics.
Other activities successfully completed by the program include: completion of baseline,
mid-term and final KPC surveys, dissemination of KPC results to all stakeholders,
development of the DIP, finalization of collaborative agreements with all partners (TWG
and training center), and completion of joint supervisory visits with TWG staff.
The results of the baseline and final data surveys are not legitimately comparable with
those of the MTE survey because the profiles of the respondents were not the same. In
the baseline and final surveys, the respondents were women of child bearing age, while
the mid-term evaluation interviewed mothers of children under two years of age. Hence,
the higher MTE results might simply reflect differences in the surveyed populations. In
any case, the final results though generally not as high as the MTE show definite gains in
FP knowledge and behaviors. Although the percent of women using modern methods did
not change much from the baseline (72 percent), the percent of women who reported
receiving counseling on contraceptive choices, their side effects and when to return for
follow-up increased by more than 25 percent. This is a good indication that the
percentage of women informed about contraceptive choice rose significantly during the
project. The team pointed out that there has been real progress in the area of informed
choice. Before the project women used contraception because they were pushed to use it
but now they know about the different methods. Progress of informed choice is evidenced
by the fact that women can now list the advantages and disadvantages of the different
methods. Now if women are asked why they use the IUD, they can tell you all the
disadvantages of the other methods for them and the advantages for using the IUD and
36
when they should come to have it checked. Before the CS project, women were unable to
provide this level of detail regarding the IUD. The staff also believes that the HPs are
becoming more communicative and doing a better job of discussing contraceptives with
patients. The staff noted that before the project, the HPs were a real barrier to informed
choice. The pre and post tests from the training courses evidence this, showing that many
of them believed the myths about the different methods and propagated those myths to
clients.
The project and HD staff also indicated that quality of care improved, thanks to the
project. Counseling of clients improved through the provision of educational materials
and improved counseling skills delivered by trained HPs. The counseling skills were
greatly improved through the monitoring and supervision visits. Having standards and
protocols for new acceptors and continuing users also helped improve care. The project
also developed posters on counseling steps that are easy and clear to follow and assist
HPs in providing care. Results of the monitoring visits, have indicated that clients are
more satisfied with services, that there are fewer stock outs of contraceptives, and that
there is improved counseling by visiting nurses for both FP and antenatal care (before
they did not provide this counseling). Also, according to project monitoring data 91.4%
of all 83 SVPs offer mothers classes for antenatal care, which includes information about
FP.
The project and HD staff believe that FP access has improved because of improvements
in the supply system and informed choice. Before this project (2001-2) health facilities
had supplies of contraceptives but less access because women weren’t informed and
practitioners did not counsel them on the various FP methods available. Also now thanks
to the World Bank and ADB primary care program, there are more local level SVPs in
the oblast providing primary care.
The most preferred FP method in the project area is still the IUD. The following table
depicts the distribution of FP method utilization in Navoi:
Which of FP methods do you use or
used before Baseline (Feb 2004) MTE (May 2005) KPC FE* June 2007
Pill 15.7% 11,11% 14.4%
IUD 86.3% 64,33% 70.8%
Injection (DepoProvera) 13.2% 21,05% 16.8%
Norplant N/a 1,17% N/a
Sterilization 4.4% 2,34% 5.6%
Condom 12.9% 1,75% 13.6%
Spermicides 0.3% 0,00% 1.2%
Calendar method 13.5% 1,17% 17.2%
LAM 59.6% 5,85% 38.0%
While the use of IUDs has decreased since the baseline, it is still the preferred method.
There is a small increase in the use of injectables but the other methods are more or less
at the same levels of use. When interviewed by the FE team, women stated that while
they had been informed about other methods they preferred the IUD because they
believed it to be effective and convenient – i.e., they did not have to be reminded every
day to use it or have it changed or reapplied every three months. The additional questions
37
added to the final KPC also showed that 99 percent of women of reproductive age knew
of three or more modern methods of contraception. Interviews also showed that women
who were using other methods were using them because they had had problems with the
IUD. In other words their first choice was still the IUD. Because the FE team was
concerned that the bias for the IUD might be coming from the providers, we asked about
this and the GPs admitted that they had more faith in the IUDs and did not fully trust the
other methods. Project staff and some health department staff indicated that they thought
there was informal pressure coming from higher levels of the government to encourage
use of sterilizations and IUDs. However, the FE team was unable to verify further details.
According to project staff and interviews with the Ob-Gyns, at the start of the project,
there had been a few instances where women were found to have as many as three IUDs
inserted at one time. The project staff believes this happened because there was a
requirement that all women who delivered at Maternity Houses should have an IUD
inserted within five days. Later when women went to the PHC for follow-up care, HPs
would insert another one or two – depending on the number of visits the woman made.
Fortunately the project corrected this situation in Navoi by asking that the maternity
Houses not stock IUDs but give them to the PHCs to insert during postpartum visits.
The MTE evaluation noted that there had been shortages of contraceptives particularly
condoms at the health facilities. However, this situation improved with more monitoring
and the project and HD staff worked with SVP facilities to train a staff member in
logistics management. The oblast RH center staff has developed a table for calculating
stocks for the rayons. The FE team found during field visits that there were adequate
contraceptives at the health facilities visited. According to project and HD staff,
contraceptive supplies are monitored and maintained by the MOH and HDs.
Contraceptives are free of charge because they are donated by UNFPA and due to the
regular monitoring of services, the primary care facilities have been able to plan and
program adequate supplies. Despite this, the project staff still has concerns about
stockouts as they think the people responsible for logistics at rayon and oblast levels
haven’t been trained correctly. Logisticians at the rayon and oblast levels base their
estimates of the needs at each SVP on the numbers of WRA in each makhalla without
taking into account actual demand levels that are calculated at the SVPs. One concern
raised by this situation is that some of the remote rural clinics have had problems
maintaining condom stocks, which is problematic as there appears to be an increasing
demand for condoms.
The project realizes that free supplies of contraceptives will not always be available and
worries that the heavy reliance on the IUD method may impede donations of other types
of contraceptives.
The project complied with the Mexico City Policy by not funding any abortion services
or providing any training related to abortion. Also, as discussed throughout this report,
there was extensive attention paid to and training about informed consent. In addition,
the FE team observed numerous posters about the advantages and disadvantages of FP
methods at all facilities visited (Tiahrt Amendment).
An important lesson learned by the project was the importance of training the visiting
nurses to take a more active role in home based preventive health care. Patronage nurses
have proved to be a key link between the communities and the health services.
38
As described in the maternal care section, Parents’ Schools also serve to educate new
parents about LAM and modern family planning methods.
Adolescents’ Reproductive and Sexual Health (ARSH):
A portion of the ARH activities have been funded by the Swiss donor associated with
Project HOPE, the Foundation for Partnerships in Health. The CS project has partnered
with the MOH, MOE MOHSSE, the Oblast Health Department, Oblast Public Education
and OSSPED, the Healthy Family Project (Project HOPE) and other NGOs.
As mentioned at the beginning of this section, the objectives of the ARH activities were
to: 1) Increase the knowledge about reproductive and sexual health among targeted
adolescents; 2) Decrease the percent of targeted adolescents having unprotected sex; and
3) Increased knowledge among targeted adolescents who know how to correctly use a
condom.
The project worked to support the following program components: 1) Support the
Educational Sector in implementation of ARH education activities; 2) Support the Health
Sector in establishment of Adolescent friendly health services; 3) Support creation of a
network of all sectors involved into ARH promotion; 4) Increase community awareness
of ARH.
During the CS project, Project HOPE educated a large number of adolescents through
formal school classes and peer educators. The Adolescent Health Center at the Oblast
level and centers at the four rayons now offer services as a result of the Youth Friendly
Initiative. The work also involved school teachers and almost all community leaders. To
accomplish those activities, Project HOPE has developed and offered four types of
training events for adolescents and peer educators. These activities included:
Type of Course Participants Objectives
A five-day TOT
course on
“adolescent
reproductive and
sexual health
394 health providers
and school teachers
responsible for “ARH”
classes and counseling
to improve the health providers’ and
teachers’ knowledge about adolescent
reproductive health topics and to
develop their skills in providing classes
about ARH; to inform health providers
about youth friendly service
requirements; and to teach health
providers to provide youth friendly
counseling on reproductive measures.
Four-day “Peer to
peer” course on peer
education
405 Peer educators to provide correct adolescent
reproductive health information
through peer educators. Includes
counseling skills.
Two-day course on
ARH
1012 students and
youth
Taught principals of ARH includes
physiology of RH system,
consequences of early marriage,
advantages and disadvantages of
modern contraceptives, prevention of
39
STI/HIV and safe sex practices.
3 day course for
establishing Youth
friendly services
17 ob-gyns and youth
health providers
Taught principals of youth friendly
services and youth counseling skills.
Summer camp 140 adolescents
In summary, a total of 394 adult trainers, 405 peer educators and 1,527 adolescents have
been trained.
In general, adolescents do not have the opportunity and/or willingness to discuss their
reproductive health problems with adults. The project identified two types of adolescents;
those who just feel shy about talking about “ARH” with adults, and those who do not
believe adults can help them. The Project HOPE team believes that boys and girls prefer
to get information on reproductive and sexual health from their peers, and feel more
confident talking with them about intimate issues. This belief was confirmed by the FE
team when the interviewed adolescents, community leaders and teachers. The
evaluation’s focus group discussions with adolescent boys and girls demonstrated that
boys do talk about RH with their peers, while girls talk with peer-educators, except when
they have a problem; they go to a health provider or discuss the issues with a relative.
Although providers and adolescents stated that some youth are sexually active, it is
difficult to verify this through the surveys. Expectations from society on sexual
experience are dichotomous: youth are expected to be virgins before marriage but at the
same time, boys are expected to be experienced sexually before marrying. Boys are
encouraged to have their first sexual experience with a prostitute and many often contract
STIs.
The project developed instruments for monitoring youth-friendly services (YFS). The
monitoring helped evaluate effectiveness, friendliness, accessibility and the quality of
YFS services. It also helped determine if the service management was adequate; define
the work of health providers; define service conditions; identify the clients’ opinions of
the quality of services; and elucidate the strengths and weaknesses of the services.
Project HOPE has used the following materials for training of trainers, and for educating
adolescents:
 “Adolescents reproductive and sexual health” – training manual, school book and
informational source for health providers and school teachers responsible for
providing ARH classes and counseling (developed by Project
HOPE/CS/USAID/Navoi, Project HOPE/HF/USAID/Tashkent, Oblast Reproductive
Health Centre, Oblast Adolescents Reproductive Health Polyclinic staff, approved by
Uzbekistan MOH Deputy Chief).
 Short films: “Abortion prevention”, “Menace of early marriage”, “STI prevention”,
“and Drug addiction prevention” (developed by Project HOPE/CS/USAID/Navoi and
Navoi City administration).
 “Peer to peer” – guidelines for peer educators (developed by Project
HOPE/CS/USAID/Navoi staff).
 Short films on: “Modern contraception methods,” the cartoons “Karate Kids –
HIV/AID prevention”, and “Karate Kids –drug addiction prevention” (borrowed from
“Rainbow”, Kyrgyz Project working with adolescents).
40
 An adapation of the ARH booklet “ Me and my world” after conducting FGDs with
rural parents and teenagers.
 “Answers on some interesting for adolescents questions”- adolescents brochure is
developed by National “Health” Institute, “Navoi Oblast Reproductive Health
Center”, Project HOPE/CS/Navoi.
 Short films developed by peer educators through competitions. Used peer educators
as actors.
Project HOPE has distributed all educational and reference materials to the school
libraries, so that there will be permanent resources available at the schools. The
Administrators interviewed talked about the importance of the materials in providing
information to teens who may not want to talk to adults about RH but will read the
materials.
Youths interviewed for this evaluation stated that they like the ARH centers for services
and counseling. They use the counseling services, the library and they acquire
contraceptives for themselves and friends. Youth stated that they often get contraceptives
or counseling for friends who are too embarrassed to come for services. Some youth still
have problems asking for services as they feel there’s a stigma attached to young people
engaging in sexual activity. The adolescents stated that they had complete confidence in
the health providers at the ARH Center and had even tested them for confidentiality. The
peer counselors said they felt comfortable counseling peers themselves and when they
had questions they consulted the HPs at the center. They said they would also go to the
SVPs for general health consultation but preferred the youth centers.
Rayon and Navoi city youth said they liked all the ARH instruction and that it was the
first time that anyone had openly talked to them about puberty and sexuality. They
particularly liked the sessions about “physiology and the RH cycle,” “creating a healthy
family,” “contraception,” “advantages of delaying sexual debut and abstinence” and
“how to prevent STIs and HIV.” Both the students and the teachers commented that
before having these classes, boys and girls did not communicate very well. Now that
they have had the ARH classes together and learned to discuss this issue among
themselves, they have a better understanding of what it means to be male and female. The
teacher administrators also noted that now if they organize an event about early marriage
all students are interested and come to discuss it openly. Students are not as shy as before
and ask questions easily. Teachers also noticed that after the ARH classes, the boys were
more respectful of the girls. When asked what changes they would like in the ARH
classes, the students responded that they would like for the trained teachers to have more
leeway to teach ARH classes. They indicated that untrained teachers who did not
understand the purpose of ARH often put up barriers to the classes or did not let them or
the peer educators distribute materials. Since the ARH classes aren’t required classes, it is
more difficult to insist on having the classes- particularly if parents object. Students
wanted to have more information about sexual organs, fertile cycle, anti-retrovirus
therapy, oncological diseases and how to behave during the honeymoon. They also said
they wanted to know more about contraceptives.
The FE found that in the rayons the administrators of the health facilities do not support
the ARH trained HPs in providing youth friendly services. It’s not a focus area for them,
and although they provide counseling, they don’t stock contraceptives. They do have a
41
hotline and provide check-ups. This situation arises because in the rayon polyclinics, only
the Ob-Gyns provide contraceptives and the ARH specialists are pediatricians. The
pediatricians refer to the OB-Gyns but because the Obs are not trained to be youth
friendly, most of the adolescents don’t go to them for care.
The project only began talking to parents about sex education when the community
health component began in 2006. By then, project staff recognized the religious and
cultural barriers to talking about ARH. The administrators indicated that about half of
their vocational students come from rural areas that tend to be more traditional and do not
understand the purpose of ARH. Administrators and the students believe that there is a
need to convince parents to let teachers and providers talk to the students about ARH.
The administrators believe that the women leaders cannot really do this as they are too
old to reach the adolescents and do not seem real comfortable talking to the parents about
ARH. When the FE team asked community leaders about the parents, they responded that
they gave them the parents’ brochure to read and seemed to think that was enough.6
The Director of the ARH Center reported that the number of adolescents seeking services
at the ARH center is increasing, and that confidentially is being stressed. They also stated
that HPs liked the training and that before the training it had been hard to talk to the
adolescents. Now with their counseling skills, the youths come easily. Also waiting times
are shorter and youth appreciate the anonymity as the MDs don’t discuss the visits with
parents or ask students for their names when they come. Before the project intervention,
boys did not come for services, but how there are a large number who come with friends.
Also before they did not have a center but the Oblast renovated the current facility
they’re in and HOPE provided furniture, computers and materials.
Next Steps/Recommendations:
 If resources become available, it would be useful to investigate further why the
IUD is the preferred method among practitioners and what can be done to
persuade provider that it would be better to recommend a variety of methods to
family planning users.
 Another issue that was raised by the FE team was the high prevalence of anemia
in Uzbekistan. One question raised by the FE team is whether this high rate of
anemia is associated with or contributed to by the high use of the IUD among
women.
 Although there has been much progress about informed choice of contraception,
the FE team feels that there needs to be a concerted effort made to maintain this
focus. There needs to be continued training about informed choice and counseling
6
Parents brochure for city and pilot rayons entitled «If there is a teenager in your
house» brochure. It was developed by Republic “Health” Institute, Navoi Oblast ARH
Center and Project HOPE/CS/USAID/Navoi staff). 20 000 copies printed of which
19 900 copies were disseminated.
42
methods. It is recommended that the Steering Committee and Oblast HD
continue to encourage this training.
 If the government wants to encourage ARH in the schools, it would be important
to have it offered as a required credited class so that it will be offered regularly.
 There is a demand and need for more peer education training as there is high
turnover in the schools. If possible, it would be advisable for Project HOPE to
organize a peer education training plan with the MOE and the RH Center. They
already have trainers, peer educators, volunteers and a training center so this
should be easy to do.
 It would be useful to involve the school administrators in ARH promotion to get
them more involved in promoting ARH teaching.
 Pay more attention to adolescent services in the rayon polyclinics. Try to
encourage the Ob-Gyns to work better with the youth friendly practitioners. Also
recommended is that the Oblast ARH staff support the rayon youth centers. It
would help if the Oblast arranged regular meetings with rayon RH specialists on
the provision of youth services. Also it would be useful to advertise the youth
services in the rayons as they did at the Navoi Center by providing the center
addresses and hotline numbers on the brochures.
 The teachers want to implement the ARH program in the non-pilot rayons as
they’ve had several requests. This could be done through the ARSH center in
Navoi together with the Oblast education center. It is recommended that Project
HOPE coordinate a meeting between the Oblast education and Health
departments to plan for such an activity.
 There is also a continuing need to educate parents about ARH. It would be useful
to organize meetings between parents, the health center staff, the education sector
and makhalla sectors. Project HOPE can help the education sector organize an
agenda and plan for such a meeting.
C. PROGRAM MANAGEMENT
1. Planning
Project HOPE had a satisfactory planning process to develop the DIP. Project HOPE
headquarters and Navoi staff worked collaboratively to obtain baseline information and
use the information for designing the DIP. Then, HOPE Navoi involved the Oblast and
Rayon Health Departments, makhalla leaders, NGOs and trainers to provide additional
information and input to the DIP.
Groups involved in planning include the MOH and all partners, including the
USAID/Uzbekistan representative who spent two days collecting data through FGDs.
43
In addition, the project held quarterly meetings with the Steering Committee members
where the staff present the objectives for the past quarter discuss progress and plan
activities for the next quarter with specific dates and responsibilities. The staff use the
DIP work plan as a basis for the quarterly activity planning. The workplan is a useful
guide but each quarter the activity details need to be filled in.
The DIP workplan was changed quite a bit after the mid-term evaluation. Activities were
added such as the community health promotion component, database management on
child births and deaths. Another gap that was filled after the midterm evaluation was the
addition of Quality Improvement strategies that were implemented at 10 primary health
centers.
Another change from the original DIP was the formation of four technical working
groups whose mandates are technical not political. Their role is to provide technical
input to the project and review activities.
2. Staff Training
Project HOPE staff has participated in the following training events.
 Technical training in KPC survey methodology using cluster sampling and LQAS –
project manager, the HIS manager and the IMCI Coordinator.
 Qualitative survey methodologies, community-based education through story-telling
– project staff.
 Computer technology and MSOffice software 1 ½ hours a day for about a month for
all staff.
 English classes with private teacher to some key staff, and a Peace Corp volunteer
provided English classes for everyone.
 The staff responsible of reproductive health, family planning and ARH attended a
national TOT course on reproductive health at the National Reproductive Health
Center.
 The IMCI coordinator was trained in hospital IMCI.
 The IMCI coordinator and IEC specialist other staff also attended the C-IMCI regular
IMCI training by WHO and National Pediatric Institute.
 The Maternal and Neonatal Health Coordinator attended the GHC conference in
Washington DC and “Child Survival and Health Mini-University II” in John Hopkins
Bloomberg School of Public Health in Baltimore, in 2003, and visited other training
sites and health facilities in the USA for three weeks. Also attended Youth and Health
sessions at the Global Health Council meetings in Washington DC.
 RH staff attended breastfeeding training, TOT and monitoring courses provided by
Project HOPE in 2004.
 Program manager and IMCI coordinator attended Adult Education Methods training
provided by HOPE in 2004.
 The Program manager and Administrator attended Financial report training provided
by USAID/ Uzbekistan.
 The SM staff attended IMPAC training sponsored by PH in Tashkent in 2006.
 Community staff attended a HOPE seminar on CHP.
 SM/ARH, IMCI and data management staff attended summer MCH and Adolescent
health training sponsored by WHO in Italy in 2006 and 2007.
44
 The ARH staff attended HIV/AIDS prevention and Interactive teaching courses at the
East West AIDS Foundation in 2006.
 The program manager and Data manager attended project design, evaluation and KPC
training courses offered by CSTS in 2006.
 The project staff received Quality Improvement training provided by Project HOPE
and Zdrav Plus in 2006 2007.
 The ARH specialist and data manager attended the American Austrian Foundation for
medical seminars in 2007.
The CS staff appreciated the training and felt that it helped them improve their job
performance. For a complete list of staff training and dates, please see attachments.
The project manager believed that the training contributed to increased skills on the part
of the staff, allowing them to become more and more independent and able to manage
their own sections. At the beginning of the project, the staff asked the program manager
about every step, but staff now has the confidence to make most decisions on their own.
The program manager was very creative in his use of training resources. He had a limited
budget for international training but he was able to find many appropriate training
opportunities that either offered scholarships or did not charge for the training and thus
was able to stretch the training opportunities for all the staff. There were a total of eight
international training events during the last two years of which only two were
programmed. In addition, the program manager attended the annual leadership meetings
at Project HOPE headquarters in Millwood, Virginia. He felt these meetings were
particularly useful because in addition to the updating meetings, he was able to attend a
number of management related seminars which were relevant to his role in the project.
Also, Project HOPE organized regional public health meetings which were helpful,
particularly when they were in Uzbekistan and a number of staff could attend.
The program manager states that a major lesson learned was that if he were to do the
project again, staff development would be his first priority. This is because he learned
that he could not manage everything in a project like this by himself. He felt it was
critical to develop the staff’s skills so they could manage their own areas appropriately.
He felt that a big lesson learned was that he should not have waited so long to send the
staff to the international and other training courses that provided them with program
skills (he had waited until the last two years of the project before sending them for
training). He thinks it would have been best to do this earlier in the project and bring the
staff up to speed so they could take on more activities earlier on. For example, the HIS
specialist’s updated KPC skills have been useful for the final KPC but it would have been
even more useful to have used the skills at the midterm.
3. Supervision of Program Staff
Project HOPE has a satisfactory system in place to manage the activities of the field staff
from its U.S. headquarters. Staff supervision is based on the Project HOPE personnel
manual that was reviewed and implemented. The manual includes an annual
performance evaluation form which is conducted for all staff in order to adjust changes in
scopes of work and deliver promotions. In addition, the program manager was able to
attend Project HOPE’s annual meetings or “Fall Leadership Conferences,” where topics
45
covered included guidelines for staff performance evaluation and other management
related subjects. The program manager reviewed the performance of all CS project staff
and his performance is reviewed by the Regional Director for the CAR region. The staff
seemed to think the current management system works fine for them. Each program area
is managed by designated staff who supervises the work and reports to the director. This
team approach is also useful for developing the quarterly workplans and for discussion
during bi-weekly staff meetings. The program manager sees his job as integrating the key
areas of work and staff from the different program areas and coordinating activities
among them, such as site visits and training activities.
The project has one administrative project back-stop at Project HOPE headquarters, who
provides financial, administrative and technical backstopping, monitors program
activities and obtains and distributes reference materials. The CAR Operations
Accountant provides financial analysis and budgetary assistance.
Earlier in the project there had been a need for more expertise with monitoring and
evaluation and the project had difficulty recruiting HIS staff. After the midterm
evaluation, the team was able to identify an HIS person who was able to organize and
analyze project data.
4. Human Resources and Staff Management
The staff of Project HOPE is very competent and has achieved great results during the
life of the project. There has been little staff turnover; only the administrator
assistance/translator and the M&E Coordinator had been replaced. The reasons for
leaving were personal, and did not compromise Project HOPE’s level of commitment to
sound management of personnel.
Policies and procedures form HOPE headquarters are regularly updated and reviewed by
the project manager.
Unfortunately, given that Project HOPE is the only U.S. based (health) Private Voluntary
Organization (PVO) operating in Uzbekistan and the other major project they have had
there is closing at the same time as this one, there are not a lot of job opportunities for
staff to transfer to after the project closes. The IMCI coordinator was the Chief Oblast
Pediatrician before joining the project and will return to this role when the project ends,
which augers well for continuation of the IMCI program. The other staff is actively
searching for new positions and many have received job inquiries.
5. Financial Management
The budget for the project has been adequate to accomplish project objectives. The
spending of the budget by line item is on track, due to vigilant work plan adherence by
the field staff. In addition to the CS funding, the project received funding from the Swiss
donor associated with Project HOPE. Additional donor funding was procured by Project
HOPE headquarters for adolescent reproductive health and other related activities.
At the time of the mid-term evaluation, the financial backstopping from headquarters had
been somewhat challenging, with the provision of non-user-friendly reports. One of the
challenges is that Project HOPE does not follow the USAID grant budget fiscal year
cycle; Project HOPE’s fiscal year begins on the first of July. The HOPE-Center regional
46
backstop officer has been very accommodating, however, in trying to help interpret the
reports. The CS program manager had hoped to have clearer breakouts of line item
expenditures but this was not possible to do with Project HOPE’s accounting system.
Currently, systems are in place for local and regional government to continue community
health activities, monitoring, database management and training activities. In addition,
the ARH center and the IMCI, SM and other training centers will continue operations, as
staff is paid by the government.
Project HOPE headquarters helped the project plan for sustainability of interventions
from the beginning by making sure that the project used existing government staff
whenever possible instead of hiring parallel workers. They also instituted training and
community education programs that could be easily continued by these staff, by making
sure the training and education centers were equipped and adequately stocked with
reusable materials. Thus, all the interventions were centered around support of existing or
planned MOH services and infrastructure.
6. Logistics
Because of the good working relationship the project has with the MOH/ Oblast Health
Department, the MOH has provided office space for the project at no charge and also pay
electricity, heat and water for the project. In fact, the Oblast and the project moved into a
new modern office building a year ago. The project bought office furniture and
equipment during the first phase and the only office expenses incurred in Phase 2 were
for phone and internet. The project purchased one vehicle through project funds,
received another one from the Swiss Development Corporation support and received
another used vehicle from USAID after the HF project ended in Uzbekistan.
The project indicates that it has had enough logistics to make work effective and
sustainable. There has been enough equipment support that will be turned over to the
Oblast HD when the CS project ends, if approval is granted by USAID.
7. Information Management
The project implemented a comprehensive monitoring system to report on indicators in
IMCI, SM, RH, BF, ARH, and Quality Improvement strategy. The HIS specialist of the
project had previously worked on the Healthy Family project (a five-country, MCH
project funded by USAID) and replicated successful parts of the M&E system to the CS
Navoi Project. During his tenure with Healthy Family project, the HIS specialist attended
several trainings to increase his knowledge of project interventions and skills in
monitoring activities. These trainings included LQAS training and also attended an IMCI,
Safe Motherhood, BF, RH, Infection Prevention monitoring trainings sponsored by
Project HOPE and the KPC training in Washington, DC (Dec, 2006) sponsored by
USAID CSHGP. Additionally, the HIS specialist was awarded a scholarship by the
American-Austrian Foundation to attended a two week public health training in Trieste,
Italy in July 2006. The seminar provided him an understanding of public health
approaches to maternal, child and adolescent health, and how to improve quality
47
assessment. Additionally, the HIS specialist participated in a Family Medicine seminar
sponsored by Duke University which took place in Salzburg, Austria in July 2007, which
also strengthened his knowledge of primary healthcare approaches.
Monitorings, as monitoring visits were called, were an all day event, conducted at one
facility at a time, and were conducted every 6-8 months. The monitorings were divided
into two visits: the first visit would cover IMCI and breastfeeding and the second visit
would cover reproductive health and Safe Motherhood. Health professionals were
randomly selected to be ‘monitored’ and these included nurses trained by the CS project
and those that were not trained by the project but who were expected to be trained by
trained nurses. Monitorings were a multi-demension exercise utilizing observation,
interview, knowledge and treatment tools to ensure that health providers were applying
appropriate protocols for all project intervention areas and that mothers understood the
counseling being provided by health workers. Specific monitoring forms were created
for each intervention and consisted of the following tools: self assessments or checklists
for the GPs and nurses, exit interviews with moms, pre and post tests administered to
health professionals, and a review of health cards and medical records for application of
standard case management of IMCI. All results from the information gathered through
these methods were entered into a database for future analysis and decision making.
Information on indicators was collected from all four rayons which allowed the
monitoring team to determine which facility needed refresher training and on which
intervention themes. For example, in the analysis of data in the monitoring visit that took
place in December 2005, results revealed that only 59.8%9
of providers were measuring
the weight of a sick child again and recording it in the growth chart. Project staff
immediately conducted follow up visits to facilities to refresh their knowledge of proper
IMCI protocols regarding growth monitoring. In the same monitoring visit, data revealed
that only 35.9 percent10 of doctors encouraged mothers to provide additional food to the
sick child. By the last year of the project, monitoring visits indicated that 82.4 percent of
doctors encouraged mothers to provide additional food to the sick child 11. Again, project
staff used this information to decide about when to conduct follow up sessions with
health providers on proper implementation of IMCI protocols. Health professionals
underwent a three-day training course to learn how to perform the self assessments. All
of this was part of the quality improvement initiative. Quality improvement teams are
present in all SVPs and use information from the monitorings to analyze trends and
discuss challenges confronting their facility.
During the midterm evaluation, USAID requested that the CS Navoi project begin to
work closely with other USAID funded projects to increase synergies and maximize
dissemination of lessons learned and innovative approaches that might benefit both
projects. The CS Navoi project began collaborating with Abt Associates which is
implementing the Zdrav Plus project in Quality Improvement strategy (See ‘Quality of
Service’ section under Section E for more details). Sustainability of monitorings may
present a few challenges to MOH but they have begun monitoring activities on their own,
which is quite encouraging. The MOH sees the value in the information provided from
the monitoring visits and are currently conducting monitorings, but not with the same
intensity as the project. Instead of spending an entire day to monitor a SVP, MOH staff
9
Project Monitoring Data, IMCI, December 2005
10 Ibid.
11 Project monitoring data, April 2007
48
monitors approximately five SVPs in the span of one day, which averages out to the
MOH staff only spending about 1-2 hours in each SVP and they are not analyzing all
intervention areas as the project has done.
In terms of operations research, the project has conducted focus groups with key
informants, led by researcher, Dr. Judi Aubel. The objective of the operations research
was to identify the role and influence of family members in Uzbekistan society and
determine who the primary decision makers are in the traditional family. Several
separate focus groups with grandmothers/mothers in law, young women, and men were
conducted and the results revealed that grandmothers and mothers in law are actively
involved in child rearing and decisions regarding infants and children. Using the
information gleaned from the qualitative studies, Dr. Aubel returned to Uzbekistan to
assist the CS team in developing the IEC materials and strategy, ensuring that simple,
participatory and traditional approaches be used. The team developed several
methodologies, including open ended stories, video discussions, face to face discussions,
and role playing to introduce maternal child health topics. Visual aids were also used to
explore the differences and characteristics of ‘happy’ or ‘sad’ families. For example, a
picture showing a ‘happy’ family (well fed children, proper housing, grandmother,
husband present) was contrasted with a ‘sad’ family (malnourished child, single mother,
many children). Participants were then asked to describe what were the characteristics
that determined if a family was ‘happy’ or ‘sad’. These methodologies have been found
to be well received by the target population, as well as with grandmothers and mothers-in
-law.
In qualitative investigations with mothers, MOH staff, doctors, and other project
stakeholders, all individuals interviewed were quite aware of the project and quite
supportive of project activities. Even during the presentation of final evaluation results to
the stakeholders in Navoi, all commented that this project was the government’s project
and did not view the project as an external project. In depth interviews with the OHD
statistician revealed that the project has been instrumental in assisting the MOH in
implementing Prikaz 31, which calls for Uzbekistan to adapt the ICD 10 manual with the
live birth definition. The MOH approached Project HOPE for assistance in adapting the
definition.
Project HOPE assisted in the creation of the local Centers for IMCI, SM and RH in
several ways, including the provision of furniture, visual demonstration and training
materials, plaster molds and computer equipment. After the midterm evaluation, all data
collected from monitoring visits were incorporated into the monitoring database of these
Centers. Project HOPE shared the methodology for conducting monitoring visits
(including the monitoring tools), processing and analyzing of monitoring data with the
corresponding Centers and key personnel within the Navoi OHD. Project HOPE also
provided assistance to the Navoi OHD in the implementation of the childbirth and
mortality database (following ICD 10 definition) in the entire Navoi region and now the
OHD is effectively using this database routinely in their work.
8. Technical and Administrative Support
During the first half of the project, staff received several technical and administrative
assistance visits. These included external consultants to conduct the baseline survey,
49
development of the DIP as well as the community-based assessment and strategy
development. They also received visits from headquarters and the CAR Program
Director.
Before the MTE, some monitoring and evaluation technical assistance was provided
through a virtual class (Elluminate™) conducted by Project HOPE headquarters.
However, the staff noted that this session was not enough to address M&E system design
and implementation issues. In particular, the problem with selecting sampling units for
the LQAS methodology was not resolved during the midterm evaluation, which used this
methodology for the KPC.
During the MTE, project staff indicated that they were fairly well acquainted with Child
Survival, IMCI, Safe motherhood and Family Planning intervention strategies, but that
they did not have enough experience nor technical support in financial management,
Quality Improvement, BCC, and M&E strategies and methodologies. So during the
second half of the project, the M&E director from Project HOPE headquarters visited the
team to assist the project in the design of the final KPC survey. Staff from HOPE
headquarters also assisted in solving the LQAS sampling problem. After this assistance,
the project decided that instead of only monitoring the health practitioners, they would
also monitor the health facilities as a whole. The monitoring indicators and tools included
forms from WHO, checklists, direct observation and tests of HP knowledge.
Also after the mid-term evaluation, the project collaborated with the Zdrav Plus Project
(Abt Associates) that provided quality assurance training to 10 PHC facilities in the
project area.
The project also received help from the Regional and Deputy Program Manager from
Project HOPE headquarters. Also the CS Program Manager spent several days at HOPE
HQ receiving briefings and support from the finance manager, the regional director, the
maternal-child health director and administrative officers. The project also had quite a bit
of support from the regional technical advisor in the development of the BCC materials
and activities and application of the community strategy developed by consultant, Judy
Aubel. The M&E strategies for the program improved when the HIS officer was hired
after the MTE.
According to project interviews, the project staff received most of the support it
requested.. This support was either provided by HQ or arranged by them. In addition to
technical assistance needs, the project staff also participated in several external training
events, which greatly enhanced their skills (see staff training section).
9. Mission Collaboration
Project HOPE Uzbekistan consults regularly with USAID/Tashkent at a variety of levels.
The CS Project Manager, Dr Abdunabi Kuchimov, had regular communication with the
USAID Project Management Specialist/Health, Shukhrat Aripov until he left in 2007.
Also as a result of the MTE recommendation, Dr. Kuchimov attends quarterly meetings
at the USAID Mission. He has presented the MTE results, lessons learned and other
products created by the project.
50
The Mission commented during the FE that the CS project has been very helpful to them
because its close collaboration with the Oblast Health Department helped USAID
understand what the country needs were at local levels. The mission also feels that the CS
project fits well with its Strategic Objective that focuses on strengthening primary care
with an emphasis on Maternal-Child Health.
10. Management Lessons Learned
The key management lesson discussed by the project manager was he would have done
more of the national and international staff training activities during the first two years of
the project. He felt that the training prepared the staff to take on necessary responsibilities
for project implementation and that it would have been best to implement this earlier.
Another lesson the program manager learned was how helpful it was to delegate
management tasks to his qualified staff. He found that it was more efficient to delegate
management of the intervention areas to the specialists for each intervention area (IMCI,
SM, ARH and CM). That way tasks were accomplished in a timely manner and the
overall management burden did not fall entirely on him. The FE team realized from the
excellent organization of the project and the enlightened management style of the
program manager that he had also benefited from the management courses and TA that
he had received from HOPE headquarters.
Another management lesson concerns the development and use of the Technical Working
Groups (TWGs). The program manager realized that he would need buy-in and support
from the local Oblast and rayon health departments if his objective to strengthen
government services was to be realized. One strategy that proved useful was to develop
the TWGs. These working groups were composed of technical experts from the different
districts and regions and included chief pediatricians, chief Ob-Gyns, master trainers and
expert monitoring specialists. Their purpose was: to discuss achievements and obstacles
for implementation of the program strategies; help with the development of quarterly
work plans; review monitoring results and develop conclusions and recommendations;
help with the design of main events (i.e., conferences poster competitions etc.); review
IEC materials, review program updates and develop ways to share them with other local
HPs.
D. OTHER ISSUES IDENTIFIED BY THE TEAM
No issues outside of the realm of the DIP or the final evaluation were identified by the
evaluation team.
E. CONCLUSIONS AND RECOMMENDATIONS
The following conclusions and recommendations pertain to the overall results and
attainments of the Navoi CS project, since most sections of the report discuss specific
recommendations. The purpose of this section is to identify key project processes and
activities that have proven to be effective and to provide overall lessons learned and
recommendations that can be used if resources and opportunities become available to
continue this work in the future.
51
Overall design, project interventions and key indicators
The Navoi project is the result of two CS projects and several years of work with the
Oblast and Rayon Health Departments. After the first project, two more rayons were
added, as well as a large family planning component, which included an innovative
program with the adolescent population in the four rayons and Navoi City. At the time of
the MTE, the team leader, who also assisted the Navoi CS team to develop the DIP,
thought that the project was too ambitious and tried to convince the staff to reduce the
number of activities and strategies proposed, but the CS team was confident in what they
could achieve. The FE has shown that the CS team not only accomplished the activities
that were proposed in the DIP, but have surpassed some of them. One of the main factors
for achieving such impressive work has been the close collaboration with the OHD and
RHDs. In some cases, Project HOPE was a catalyst for passage of government prikazes,
and in some other cases, it demonstrated new ideas and approaches, which were adopted
by the government.
The majority of the indicators achieved were at the service delivery level with
complementary strategies at the community level. Since the Uzbek health system has a
large infrastructure that reaches the majority of the population, this dual pronged
approach was successful. Thus, Project HOPE’s strategy to work through the OHD,
RHDs and communities was the right one, and Project HOPE should be highly praised
for its work.
The MTE team revised the project objectives, targets and percent effort for each program
intervention. The new indicators were more focused in quality of service delivery and
less on access indicators, since Uzbekistan does not have a major problem with access to
health services. (see MTE Attachment B. Changes in the Objectives).
At the time of the MTE, the community component of the project had only reached the
diagnosis and design stage, and some field tests. It had not progressed beyond that,
because the CS team was too busy carrying out a large number of training activities, and
also because the strategies proposed for community mobilization; such as working with
grandmothers, would demand a great deal of effort from the team. Also the strategy itself
did not give adequate direction regarding how it could be scaled up throughout the
project rayons during the remaining time of the project. Unlike the health services
system, community mobilization is a relatively new concept in Uzbekistan and required
more thought and planning in order to be implemented. Fortunately after the MTE,
Project HOPE’s regional technical advisor was able to provide the help needed in order to
help the team develop an action plan for mobilizing communities. This plan included
work with existing structures, patronage nurses and leaders in the rayons and oblasts
whose responsibility it was to educate families about preventive health and provide the
link to the health facilities. Although late in starting this part of the project is impressive
because it has been thought through so that it fits within local government structures and
supports the governmental decree 242 to use community based volunteers and therefore it
will, hopefully, be sustained.
The main recommendation is that if resources become available, it would be important to
continue strengthening this community component. Although the government supports
52
the need for community work , there is not much experience in the country for doing it
and the HOPE supported community activity has only been going for a year and a half.
There is a need for the government and Oblast health department to create a team to
provide future training of new formal community leaders. This team also needs to update
teaching materials and tools. Another suggestion is to involve the Health Institute staff, a
government agency, and ask them to oversee and continue strengthening the link between
health services and the communities, particularly now that Project HOPE is leaving.
Training Activities
The project was successful in implementing a wide variety of training activities to
support each of the CS interventions. Project HOPE was appropriately monitoring the
quality of the trainings at the time they were provided (via pre and post tests), and in
addition moved beyond the trainings to monitor the quality of service delivery by
assessing the performance of health workers in delivering services. Learning from their
experience, the project changed its monitoring system from that of monitoring health
providers to monitoring whole facilities. This allowed the team to make a broader
assessment of not only personnel but also the systems at the facilities and client
satisfaction. The quality improvement strategies developed during the last part of the
project were also noteworthy in terms of improving individual facility capabilities for
monitoring and making decisions to improve care. Unfortunately, this training was not
able to be extended to all facilities. If more resources become available in the future, this
is an area the project should focus on.
One of the big successes of the training program has been the upgrading of skills and
motivation of the patronage nurses. Although the project was not able to train all of them,
it was able to train a substantial enough number to make an impact. These nurses seem to
be having a big effect on community family care. It is recommended if more resources
become available, that donors consider strengthening this component.
Another question is if the Oblast will be able to continue the well organized monitoring
system that has been put in place by the team. While it can be argued that this system
was installed to serve the project by being able to detect progress and challenges and
make adjustments to the strategy as needed, the monitoring is now viewed by health
providers and oblast as a very important piece of their work and most want it to continue.
The problem is that it requires resources to do it. A suggestion from the FE team is to
encourage monitoring from the rayon levels since the oblast level may be too
cumbersome. In order to get this process started, the team recommends that the project
hold planning meetings with each of the rayon HDs and develop plans and agendas for
continued monitoring visits.
Identify “Best Practices”
Good examples of successful intervention activities were examined during the Final
evaluation. The introduction of the Baby-Friendly certification had immediate positive
effects at health centers; the OHD committed itself to certify all hospitals in the oblast.
Another good example is the adolescent education program that was implemented
throughout the schools in the four project rayons. These best-practices are being
53
replicated and the school administrators would like to take the ARH programs to other
schools in the region.
Although it has begun recently, the community strategy and program using trained
community leaders who are supervised by the women leaders, is a new practice for
Uzbekistan. The activities are being hailed as very helpful and complementary to health
services. The FE found that leaders and HPs stated there was increased use of all
services and that there had been no child deaths during the year. The women leaders are
getting requests to expand this training and practice to other regions. If resources become
available this is a methodology that would be useful to replicate in other regions.
Quality of service delivery
The project, together with the OHD, has improved access to basic CS interventions in the
four rayons and Navoi city. The project also improved quality of care through the
introduction of a thorough supervision and monitoring system conducted every 6-8
months that focused on improved quality of service. In addition, the CS project
collaborated with the Zadrav Plus Quality Improvement project to bring the QI
methodology to 10 SVPs in the rayons. These SVPs underwent the five steps of training
and planning and practiced the self assessment methods. Zdrav Plus conducted an
evaluation after three months and found that the CS SVPs had been able to implement the
QI methodology more easily than SVPs in other regions of the country. Unfortunately,
the CS project is ending and it is unclear whether Zdrav Plus will be able to continue
supporting the SVPs. Again, if resources were to come available, it would be worthwhile
not only continuing to work with the 10 SVPs but to also extend the methodology to
other SVPs in the Oblast.
The project has made a good start in improving the quality of services in the Oblast.
However, there is an on-going need for follow-up and the project has received requests to
bring their training and TA to the other rayons. As stated above, the CS staff will try to
encourage continued monitoring activities from the rayon levels but at this point it is
unclear if that will be done regularly. The rayons and SVPs that are not doing so need to
be encouraged to use their data for making decisions about services and quality and to
expand use of self assessment methodologies such as are being encouraged by the QI
project.
54
ATTACHMENTS
A. Evaluation Team Members and Their Titles
B. Evaluation Assessment Methodology
C. List of Persons Interviewed and Contacted
D. List and Description of IEC Materials used by the Project
E. Staff Development and Training
F. Final KPC Survey Report
G. Project Data Sheet Form – Updated Version
H. Monitoring Tools
55
Attachment A. Evaluation Team Members and their Titles
1. Abdunabi Kuchimov – Program Manager
2. Nigora Muratova – MH Coordinator
3. Nuriddin Shaymanov – IMCI Coordinator
4. Lilya Djelilova – IEC specialist
5. Nasiba Bozorova – Midwife
6. Zafar Alimdjanov – HIS specialist
7. Nurdida Mardanova - ARH specialist
8. Sabokhat Ergasheva – Administrator
9. Seda Aleksanyan – Secretary/translator
10. Komil Boboev – driver
11. Ravshan Alimov – driver
12. Ruth Madison - Technical Advisor, HQ Representative
13. Sandra Wilcox – External Consultant
56
Attachment B. Evaluation Assessment Methodology
The Final Evaluation Team consisted of the Project HOPE Navoi staff members, a
headquarters representative and the external evaluator.
The final evaluation used two main sources of information; a KPC survey based on the
30 cluster methodology recommended by CSTS and a qualitative evaluation using
USAID guidelines conducted by the project team, the headquarters representative and the
external consultant.
Project HOPE staff developed the FE survey questionnaires and the external consultant
developed the FGD and in-depth interview guidelines. A two day briefing of the project
was held for the consultant and HQ representative. Another day was spent planning field
visits and preparing instruments. Field interviews and focus groups were held during
three days using two teams. After the field visits were completed, project staff and the
consultant conducted further interviews, then reviewed and analyzed findings listing
strengths, challenges and recommendations for each intervention area. Preliminary results
were presented to the project Steering Committee which included Oblast and rayon
directors and chief medical officers. A debriefing was also held with the USAID Health
Advisor in Tashkent to discuss preliminary findings.
In addition to the collection of the cross sectional survey and qualitative information, the
external evaluator received the following documents from Project HOPE: 1) project
proposal, 2) DIP, 3) annual work plans, 4) examples of training plans, 5) health
information system forms, 6) monitoring and evaluation instruments, 7) mid-term
evaluation report, 8) a qualitative Community Study about grandmothers (2003), final
evaluation of the ARH component (2006).
57
C. List of Persons Interviewed and Contacted
Navoi Child Survival Program Final Evaluation Meeting Schedule.
July 2007
Day Time Team Person / group Venue
10.00 1 Mothers of children <5: Focus-group discussion; Konimeh, Chordara
10.00 2 Mothers of children <5: Focus-group discussion; Nurota, Gazgon
14.00 2 Navoi Regional ARH Center staff; City, ARH Center
14.00 1 Adolescents: Focus-group discussion; City, ARH Center
July
2
6
16.30 1+2 Nazokat Ahmedova – Karmana rayon Administration
Deputy Hokim (Head), Head of Region Women’s
Committee;
Karmana rayon
(Administration)
9.00 2 Pediatricians (Child Health): Focus-group discussion; City, IMCI Center
9.00 1 Ob/Gyn (Maternal Health) Focus-group discussion; City, SM Center
11.00 1 ARH program Teachers: Focus-group discussion; City, CS office
11.30 2 Isomiddin Nodirov, OHD, Deputy Head, Chief of
Statistics Department;
City, OHD
15.00 2 GPs: Focus-group discussion; Karmana, Jaloyir
15:30 1 WRA: Focus-group discussion; Kiziltepa, Zarmitan
July
2
7
18.00 All Abdurahmon Nosirov – MOH Navoi OHD, Head; City, OHD
9.00 2 Karmana rayon ARH room; Karmana CRH
9.30 2 WRA: Focus-group discussion; Karmana, CRH
9.30 1 Makhalla leaders: Focus-group discussion; Nurota, makhalla
11.30 2 Trainers for all interventions: Focus-group discussion; City, RH Center
14.00 1 Muharram Murodova – Navoi OHD, Deputy Head, Chief
Nurse;
City, Nurses
Association
14.30 1 Nurses: Focus-group discussion; City, Nurses Ass.
July
2
8
15.00 2 Adolescents: Focus-group discussion; Karmana, Hazora
15.00 2 Shuhrat Urakbayev – MOE Navoi OSSPED, Head
Deputy;
City, OSSPED
July
3
0
17.00 All Musallam Ibragimova, Navoi Region Administration
Deputy Hokim (Head), Head of Region Women’s
Committee;
City, Oblast
Hokimiyat
(Administration)
9.00 1 Klara Yadgarova – MOH, Deputy Minister on MCH;
9.00 2 Asya Tolipova –Republican IMCI Center, Director;
11.00 1
Nilufar Rahmanova – Abt Associates, Zdrav+ Program,
QI Manager;
11.00 2 Sarah Porter – Project HOPE, MCH/RH Program,
Program Director;
A
u
g
ust 3
After￾noon
All Benjamin Mills – USAID Tashkent, Medical Programs
Director;
Tashkent
58
Navoi Child Survival Program Final Evaluation Meetings Participants. July 2007
Day Time Tea
m
Person / group Venue
10.00 1 Mothers of children <5: Focus-group discussion;
 SVP Chordara Chief, GP – Sadaf Togayeva
 + mothers
Konimeh, SVP
Chordara
10.00 2 Mothers of children <5: Focus-group discussion;
 SVP Gazgon Chief, GP – Dilbar Hojiyeva
 + mothers
Nurota, SVP
Gazgon
14.00 2 Navoi Regional ARH Center staff;
 Ob/Gyn - Sultanoy Siddikova
 Midwife – Ibodat Kodirova
City, ARH Center
14.00 1 Adolescents: Focus-group discussion;
 Adolescents
City, ARH Center
July
2
6
16.30 1+2  Nazokat Ahmedova – Karmana rayon Administration
Deputy Hokim (Head), Head of Region Women’s
Committee;
Karmana rayon
(Administration)
9.00 2 Pediatricians (Child Health): Focus-group discussion;
 IMCI Center Director – Nurmuhammad Alhamov
 OHD Chief Pediatrician – Ravshan Kalimbetov
 Oblast Childrens’ Hospital Chief Doctor – Nizom
Siddikov
 Karmana rayon Chief Doctor Deputy on MCH Istat
Himmatova
 SVP Chordara Chief, GP – Sadaf Togayeva
 Nurota Rayon Polyclinic paediatrician – Nigora
Gaybullayeva
City, IMCI Center
9.00 1 Ob/Gyn (Maternal Health) Focus-group discussion;
 Oblast Maternity House Chief Doctor – Gulom
Aslanov
 Kiziltepa Rayon Chief Ob/Gyn – Salima Adizova
 Konimeh Rayon Chief Ob/Gyn – Azamat Hojiyev
 Oblast RH Center Chief, Ob/Gyn – Muhabbat
Melikulova
City, SM Center
11.00 1 ARH program Teachers: Focus-group discussion;
 Nurota Social-Economy college Chief Deputy on
culture and education issues – Saida Soliyeva
 Navoi city building construction college Chief Deputy
on culture and education issues – Holbibi Sadinova
 Karmana agriculture college Chief Deputy on culture
and education issues – Oliya Fayziyeva
 Navoi city Medical college Chief Deputy on culture
and education issues – Gulchehra Mingliyeva
City, CS office
July
2
7
11.30 2  Isomiddin Nodirov, OHD, Deputy Head, Chief of
Statistics Department;
City, OHD
59
15.00 2 GPs: Focus-group discussion;
 SVP Zarafshon Chief, GP – Saida Abdiyeva
 SVP Madaniyat Chief, GP – Millioner Hayitov
 SVP Malikrabot Chief, GP – Soliha Sharopova
Karmana, Jaloyir,
SVP Zarafshon
15:30 1 WRA: Focus-group discussion;
 SVP Zarmitan Chief, GP – Jamila Atoyeva
+ WRA
Kiziltepa, SVP
Zarmitan
18.00 All  Abdurahmon Nosirov – MOH Navoi OHD, Head; City, OHD
9.00 2 Karmana rayon ARH room;
 Karmana rayon ARH room Chief, Ob/Gyn – Anvar
Iriskulov
Karmana, CRH,
Polyclinic
9.30 2 WRA: Focus-group discussion;
 Karmana rayon Women’s consultation Chief, Ob/Gyn
– Gulnora Ahmedova
 + WRA
Karmana, CRH,
Polyclinic
9.30 1 Makhalla leaders: Focus-group discussion;
 Rayon “Makhalla” Fund Chief Erkin Jurakulov
 Rayon Chief on religious and enlightenment issues
Gulruh Togayeva
 +Makhalla leaders
Nurota, makhalla
11.30 2 Trainers for all interventions: Focus-group discussion;
 SVP Chordara Chief, GP – Sadaf Togayeva
 Oblast RH Center Chief, Ob/Gyn – Muhabbat
Melikulova
 Navoi Regional ARH Center Ob/Gyn – Sultanoy
Siddikova
 Nurota Polyclinic pediatrician Nigora Gaybullayeva
 Karmana Rayon CRH Ob/Gyn – Gavhar Hujamova
 Oblast Maternity House Chief Nurse – Niyara
Ablyalimova
City, RH Center
14.00 1  Muharram Murodova – Navoi OHD, Deputy Head,
Chief Nurse;
City, Nurses
Association
14.30 1 Nurses: Focus-group discussion;
 Nurses
City, Nurses Ass.
July
2
8
15.00 2 Adolescents: Focus-group discussion;
 Makhalla Hazora, Deputy on religious and
enlightenment issues – Orzigul Rahmonova
 SVP Hazora Chief, GP – Burhon Hasanov
 + Adolescents
Karmana, SVP
Hazora
15.00 2  Shuhrat Urakbayev – MOE Navoi OSSPED, Head
Deputy;
City, OSSPED
July
3
0
17.00 All  Musallam Ibragimova, Navoi Region Administration
Deputy Hokim (Head), Head of Region Women’s
Committee;
City, Oblast
Hokimiyat
(Administration)
9.00 1  Klara Yadgarova – MOH, Deputy Minister on MCH;
A
u
g
ust 3
9.00 2  Dilbar Mahmudova – Republican Pediatrics
Scientific-Research Institute, Director;
Tashkent
60
11.00 1
 Nilufar Rahmanova – Abt Associates, Zdrav+
Program, QI Manager;
11.00 2  Sarah Porter – Project HOPE, MCH/RH Program,
Program Director;
After￾noon
All  Benjamin Mills – USAID Tashkent, Medical
Programs Director;
61
D. List and Description of IEC Materials
Information about IEC materials
№
Title of IEC material
Develo
ped
Accepted
b
y
A
u
dience
Q
u
a
ntity
Distributed
in Activities provided to community members
Activities on IMCI
1 phase 2 phase
2
0
0
2
4
0
0
1. Poster: «Nutrition of healthy
and seek children under 5»
2
0
05
4
0
0
2
0
0
2
4
0
0
2. Poster: «Common danger
signs in children»
2
0
05
Caretakers of children
u
n
der 5
4
0
0
H
Fs,
infant sch
o
ols, mahalla
2
0
0
2
30
0
0
0
3. Brochure: «If you want your
child be healthy»
2
0
05
Ministry
of Health, Scientific Research Institute of Pediatrics , Rep
u
blic
“Health” Institute
Family
with the child
un
der
5
210
0
HFs,
Patronage
nurses
distributed
to woman
recently
confined
during
discharge
from the
hospital
 Distribution of the brochures to
mothers/caretakers through
trained on 3 day C-IMCI
seminar patronage nurses on
their area.
 Conduction of orientation
meetings for mahalla formal
and informal leaders (9
meetings, 113 participants)
with the aim of informing them
about the brochure.
 Conduction of Competition «If
you want your child to be
healthy»
(15- Competitions on mahalla
level
4 – Competitions on Rural area
unit level (Village development
Committee)
1- Competition between rayons
in the oblast
 Distribution of posters to HFs,
infant schools, mahalla.
 Distribution of the brochures in
new pilot rayons through
patronage nurses, mahalla and
maternity houses.
 Distribution of the brochures to
mothers/caretakers through
trained on 5 day C-IMCI and BF
seminar patronage nurses on their
area.
 Distribution of 2 kind of posters
and brochure on CHP seminars
for each pilot rayon mahalla
 Distribution of the brochure is
continuing in pilot rayons’
maternity houses during mothers
discharge from the maternity
houses
62
4. Leaflet: «Keep your child
from diarrhea! »
Family
with the
child
u
n
der 2
30
0
0
0
HFs,
Patronage
nurses
5.
Poster: «Diarrhea
prevention»
Z
drav/Plus 2
0
0
4
Ministry
of Health, ,
Rep
u
blic “Health” Institute
50
0
6. Booklet: «Attention!
Diarrhea! » 2
0
0
4
10
0
0
7. Leaflet: «Keep your child
from diarrhea! » 2
0
05
О
H
D,Nav
oi o
blast brunch
of “Health” Institute
Caretakers of children
u
n
der 5
50
0
H
Fs,
infant sch
o
ols, mak
hallas
.
8. Film «First Sense» (About
Diarrhea) 1
 Conduction of Diarrhea Company from April to September Annually
from 2004. Goal of the activity to decrease mortality among children
under 5 in Oblast and to improve prophylactics measures at the
places. Trained HPs, makhalla leaders, rayons “Health” Centers
representatives are involved into the activity. The activity was planed
according to Oblast Government decree. Reports about the activity
are sent to CRH and OHD
 Conduction of orientation meeting. Work plan was developed. Due to
the plan 621 HPs from pilot rayons were trained and got IEC
materials about diarrhea
 Distribution of the following materials: 23015 copies of Leaflet
«Attention! Diarrhea!» to all families with the children under 2;
500 copies of Poster: «Diarrhea prevention», 981 copies of Leaflet
«Attention! Diarrhea!», 500 copies of Leaflet «Keep your child
from diarrhea!» to HFs, infant schools, makhallas
 Distribution of leaflets in CHP seminars to each participant
 Demonstration of «First Sense» Film and 6 short films due to the
work plan through the Oblast TV; in HFs, summer sanitary camps,
makhallas
 Spreading information about diarrhea prevention through Oblast TV
on Sundays, seasonably.
9. Film «Golden fish» (about
ARI) Z
drav/Plus 2
0
0
4
Ministry
of Health, , Rep
ublic
“Health” Institute
Caretakers of children
u
n
der 5
1 O
blast T
V
N
urita ray
o
n
T
V
 Demonstration of “Golden fish” Film and other short
films due to the work plan through the Oblast TV; in
HFs, makhallas
 Spreading information about respiratory infections
prevention through Oblast TV on Sundays,
seasonably.
Activities on BF
10.
Poster:
«Breast feeding advantages»
2
0
0
4
Ministry
of
Health, ,
Rep
u
blic
“Health”
Conduction of BF week annually. Goal of the activity to: BF promotion
Objectives:
 To increase % of mothers practicing 6 month exclusively
breastfeeding
 To increase % of practicing LAM
 To increase % of mothers continuing breastfeed a child until 2 years
63
11. Leaflet: «Long and pleasant
breastfeeding bases» 2
0
0
4
25 0
0
0
distrib
ute
d to
w
o
man
recently
co
nfined
12. Film «First-born» (about
advantages of breast milk) 2
0
0
4
Z
drav
Plus
1
13. Film on BF advantages «Она
сути -куёш нури» 2
0
05
Health
y
Family
Project H
O
P
E
Family
with the child
un
der 2
1
O
blast T
V, N
urota ray
o
n
T
V. Bab
y
Frien
dly
Clinics
Demonstration of Films is going on in accordance with work plan through
Oblast TV and Nurota rayon TV; in Baby Friendly Clinics; in makhallas
Activities on ARH
14. Poster: «Risky behavior
prevention» 2
0
0
4
2
0
0/2
0
0
15. Poster: «STI signs»
2
0
0
4
2
0
0/2
0
0
16. Brochure for adolescents «Me
and my world» 2
0
0
4
Ministry
of Health, , Rep
ublic
“Health” Institute, Project H
O
P
E
A
d
olescents at the age of 16-18
2
6
0
0
/550
0
H
Fs, sch
o
ols
Materials develo
p
ment
Development, testing, printing and dissemination of
posters to HFs, Navoi city and pilot rayons schools
Development, testing, printing and dissemination of
adolescent brochure to Navoi city schools adolescents
Poster competition among Navoi city schools on such
topics as: STI, Contraceptive methods and Risky Behavior
Prevention in the Palace of Culture “Farhad”; premiere of
ARH short films was conducted at the place for 800
adolescents
17. Short film -1 “Early
marriages prophylactics” 2
0
0
4
-
18. Short film -2 “Prevention of
adolescents Abortions” 2
0
0
4
Ministry
of Health, ,
Rep
u
blic “Health”
Institute, Project
H
O
P
E,
T
o
A
d
olescents
18-Nav
oi city sch
o
ols
1-O
blast T
V
2
4- v
ocatio
nal sch
o
ols
134- O
blast
G
o
vern
ment, Ray
o
ns
G
o
vern
ment, mak
halla
leaders, “Health”
-
Short films scenario Competition
Demonstration of short films through the Oblast TV
Dissemination of tapes and CDs with short films to Navoi
city schools and Navoi city and pilot rayons vocational
schools, makhallas
Dissemination of tapes and with short films to “Health”
64
19. Short film -3 “STI
Prevention” 2
0
0
4
-
20. Short film -4 «Drug
addiction prevention» 2
0
0
4
-
2
0
05
810
0
21.
Brochure for adolescents:
«Answers on some
interesting for adolescents
questions»
2
0
0
6
30
0
0
37
0
0
0
Development, testing, printing and dissemination of adolescents brochure
for city and pilot rayons adolescents
22.
Brochure for parents: «If
there is a teenager in your
house»
F
or
parents
2
0
0
0
0
Sch
o
ols/v
ocatio
nal sch
o
ols
mak
hallas
Development, testing, printing and dissemination of parents brochure for
city and pilot rayons parents who has adolescent children at the age of 16-18
23. Poster: «STI Prevention» 4
0
0
24. Poster: «HIV/AIDS
transmission ways»
2
0
0
6
Ministry
of Health, ,
Rep
u
blic “Health” Institute
F
or ad
olescents
4
0
0
Sch
o
ols/v
ocatio
nal sch
o
ols
Development, testing, printing and dissemination of ARH posters for city
and pilot rayons schools/vocational schools
Activities on RH
2
0
03
З
д
рав/П
л
юс
2
0
0
25. Poster: «Do you know your
opportunities in FP?»
2
0
05
З
д
рав/П
л
юс
M
O
H
T
o
W
RA
4
0
0
H
Fs, makhallas
Poster Competition on Modern
contraceptive methods
Meeting with the community,
conversation about Modern
contraceptive methods and STIs
Community meetings, conversation
about modern contraceptive
methods, STI, HIV/AIDS
Poster Competition on Modern
contraceptive methods and STI in
Primary Health Care level and
between CRH departments of pilot
rayons
65
26. Leaflet: «Healthy Family
Planning»
1p
hase - 2
0
03
2
p
hase - 2
0
05
1p
hase - 50
0
0
0
2
p
hase - 25 0
0
0
H
Fs,
Patro
nage n
urses
Printing and dissemination of the
«Healthy Family Planning» Leaflet
to WRA in pilot rayons
Каrmana -18442 copies
Кiziltepa -31358 copies
Dissemination on RH trainings
Printing and dissemination of the
«Healthy Family Planning»
Leaflet to WRA in pilot rayons
Nurota -19260
Konimeh -9760
Dissemination on RH and CHP
trainings
27. Film: “Family Happiness”
(about RH) 2
0
0
4
Z
drav
Plus
1
Demonstrated by Oblast
and Nurota rayon TV due
to work plan
-
Demonstration of the short film in CRHs,
Maternity Houses and makhallas
Objectives:
 to increase interval between
deliveries
 to inform community about modern
 contraceptive methods; their
advantages and disadvantages
Activities on SM
28. Mother’s Passport
2
0
05
T
o
preg
nant
w-n
15 0
0
0
HFs
maternity
welfare
centre,
midwife
-
Mother’s Passport development, testing, printing and
dissemination to pilot rayons pregnant women
29. Poster: “Danger signs in
pregnancy” 2
0
05
4
0
0
-
30. Poster: «Healthy nutrition
pyramid» 2
0
05
4
0
0
-
31. Poster: «Anemia Prevention»
2
0
05
M
O
H
T
o co
m
m
u
nity
4
0
0
H
Fs, makhallas
-
Poster Competition on SM
During the activity:
- HPs get new information and skills, shared experience,
improve quality of visual aids in HF
-developing posters HPs seek and learned new information
about the issue
-Mass Media is involved into promotion of the topics
Printing of all IE materials and distribution to HFs and
makhallas of the pilot rayons
Trained volunteers (formal and informal leaders) from
makhallas provide regular meetings with the community and
use all mentioned IEC materials
32. Film «Simple truth» (about
anemia)
2
0
0
4
Z
drav
Plus
-
Demonstration of the film through Oblast and Nurata rayon TV;
demonstration in CRHs, Maternity Houses, makhallas with the
aim of anemia prevention
66
2
0
0
6
50
0
33. Brochure «Facts for Life»
19
93г. UNIC
E
F, W
H
O,
UN
E
S
C
O, UN
F
P
A, UN
AID
S,
W
orld
Ban
k
2
0
0
7
T
o co
m
m
u
nity
350
H
Fs, makhalla
Uses as informational source on key issues:
SM; BF; RH; Child development; Correct nutrition and growth;
Immunization; Diarrhea; ARI; HIV/AIDS etc.
Dissemination to Primary Health Care level and hospitals-98;
To makhallas-127; Village Development Committee-32,
391 – to CHP trainings participants
Dissemination to patronage nurses in RH, BF and C-IMCI
trainings
67
E. Staff Training
Staff Development Tracking Sheet
Name (Last Name, First
Name) Name of Event/Class
Begin
Date
mm/dd/yy
End Date
mm/dd/yy Host Organization
Paid
by
HOPE
(Y/N)
Nigora Muratova
Adolescents Reproductive and
Sexual Health” peer to peer TOT
course
November
3, 2003
November 6,
2003
Project
HOPE/Jalalabad Y
Mardanova Nurdida “Adolescents Reproductive and
Sexual Health” TOT course
December
15, 2003
December 19,
2003 Project HOPE
Y
Bozorova Nasiba “Adolescents Reproductive and
Sexual Health” TOT course
December
15, 2003
December 19,
2003 Project HOPE
Y
Shaymanov Nuriddin LQAS methodology training March1,
2004 March 10, 2004 Project HOPE Y
Abdunabi Kuchimov LQAS methodology training March1,
2004 March 10, 2004 Project HOPE Y
Mardanova Nurdida
“Adolescents Reproductive and
Sexual Health” peer to peer TOT
course
March 10,
2004 March 13, 2004
Rainbow/Adolescents
Informational
Center/Kirgizia &
Project HOPE
Y
Mardanova Nurdida “ARH Monitoring and follow up”
course
May 21,
2004 May 24, 2004 Project HOPE Y
Muratova Nigora Youth & Health May 31,
2004 June 4, 2004
Global Health
Council, The USA,
Washington, D.C
Y
68
Muratova Nigora Child Survival and Health Mini￾University II
June 7,
2004 June 11, 2004
Johns Hopkins
Bloomberg School
of Public Health
Y
Bozorova Nasiba "40 hours Breastfeeding" training September
6, 2004
September 10,
2004 Project HOPE Y
Bozorova Nasiba "Breastfeeding" TOT course September
20, 2004
September 24,
2004 Project HOPE Y
Djelilova Lilya LQAS methodology September
27, 2004
September 30,
2004 Project HOPE Y
Mardanova Nurdida “LQAS” course September
27, 2004 October 1, 2004 Project HOPE Y
Bozorova Nasiba “LQAS” course September
27, 2004 October 1, 2004 Project HOPE Y
Djelilova Lilya "Reproductive Health" TOT course October
12, 2004 October 16, 2004 Project HOPE Y
Bozorova Nasiba “Reproductive Health and
counseling provision” course
October
12, 2004 October 15, 2004
Tashkent
Governmental
Reproductive Health
Center & Project
HOPE
Y
Mardanova Nurdida “Reproductive Health and
counseling provision” course
October
12, 2004 October 15, 2004
Tashkent
Governmental
Reproductive Health
Center & Project
HOPE
Y
Bozorova Nasiba "Reproductive Health" TOT course November
29, 2005
December 3,
2004 Project HOPE Y
Bozorova Nasiba "Breastfeeding" monitoring course December
13, 2004
December 16,
2004 Project HOPE Y
69
Shaymanov Nuriddin Adult Education Methodology December
20, 2004
December 22,
2004 Project HOPE Y
Abdunabi Kuchimov Adult Education Methodology December
20, 2004
December 22,
2004 Project HOPE Y
Bozorova Nasiba "Safe Motherhood and prenatal
care" monitoring course
February
7, 2005 February 16, 2005 Project HOPE Y
Nigora Muratova Methodology of confidential inquiry
of Maternal Mortality and Morbidity
February
28, 2005 – March 4, 2005 UNFPA/WHO
workshop, Tashkent Y
Shaymanov Nuriddin Hospital IMCI TOT May 23,
2005 May 28, 2005 WHO N
Sabokhat Ergasheva Financial Meeting June 3,
2005 June 3, 2005 USAID Y
Abdunabi Kuchimov Financial Meeting June 3,
2005 June 3, 2005 USAID Y
Bozorova Nasiba Essential antenatal, prenatal and
postnatal care" TOT course
June 7,
2005 June 10, 2005 Project HOPE Y
Abdunabi Kuchimov Technical Support in Sustainability
Planning
August 8,
2005 August 17, 2005
Project HOPE/Jalal￾Abad Child Survival
Program
Djelilova Lilya IMCI TOT course
August 22,
2005 August 24, 2005 WHO N
Shaymanov Nuriddin IMCI TOT course
August 19,
2005 August 24, 2005 WHO N
Alimdjanov Zafar Using of BABIES Matrix training October
24, 2005 October 27, 2005 Project HOPE Y
Mardanova Nurdida “Reading and Writing for Critical
Thinking” TOT course
November
21, 2005
November 25,
2005
Tashkent Center for
Modern Education
Technologies
N
70
Abdunabi Kuchimov Salzburg Public Health seminar April 2,
2006 April 8, 2006
American Austrian
Foundation, Inc.
(AAF)
N
Seda Aleksanyan Regional Meeting May 14,
2006 May 17, 2006 Project HOPE Y
Sabokhat Ergasheva Regional Meeting May 14,
2006 May 17, 2006 Project HOPE Y
Nigora Muratova IMPAC May 22,
2006 May 31, 2006
Project
HOPE/Tashkent
Medical Advanced
school
Y
Shaymanov Nuriddin CHP seminar June 19,
2006 June 21, 2006 Project HOPE Y
Muratova Nigora
Summer Public Health course of
the European School for
Maternal, Newborn Child and
Adolescent Health
July 17,
2006 July 28, 2006
WHO Collaborating
Centre for Maternal
and Child Health.
Burlo Garofolo
Pediatric Institute
Y
Mardanova Nurdida
Summer Public Health course of
the European School for
Maternal, Newborn Child and
Adolescent Health
July 17,
2006 July 28, 2006
WHO Collaborating
Centre for Maternal
and Child Health.
Burlo Garofolo
Pediatric Institute
Y
71
Alimdjanov Zafar
Summer Public Health course of
the European School for
Maternal, Newborn Child and
Adolescent Health
July 17,
2006 July 28, 2006
WHO Collaborating
Centre for Maternal
and Child Health.
Burlo Garofolo
Pediatric Institute
N
Mardanova Nurdida HIV/AIDS prevention TOT course October 1,
2006 October 3, 2006 East-West AIDS
Foundation N
Mardanova Nurdida “Basis of Interactive teaching
process” TOT course
October
30, 2006
November 3,
2006
AIDS Foundation
East West N
Kuchimov Abdunabi Program Design, Monitoring and
Evaluation (PDME) training
December
4, 2006
December 12,
2006
CSHGP Backstop
Institute Y
Alimdjanov Zafar KPC Training of Survey Trainers
training
December
4, 2006
December 14,
2006
CSHGP Backstop
Institute Y
Muratova Nigora Quality Improvement training December
5, 2006
December 7,
2006 Project HOPE Y
Shaimanov Nuriddin Quality Improvement training December
5, 2006
December 7,
2006 Project HOPE Y
Bozorova Nasiba Quality Improvement training December
21, 2006
December 23,
2006 Project HOPE Y
Alimdjanov Zafar Quality Improvement training December
21, 2006
December 23,
2006 Project HOPE Y
Djelilova Lilya Quality Improvement training January
23, 2007 January 26, 2007 Project HOPE Y
Nigora Muratova Reproductive Health' Quality
Improvement
May 28,
2007 June 1, 2007 Zdrav/Plus&MOH Y
Bozorova Nasiba KPC Survey Training June 12,
2007 June 14, 2007 Project HOPE Y
72
Djelilova Lilya KPC Survey Training June 12,
2007 June 14, 2007 Project HOPE Y
Mardanova Nurdida Salzburg Adolescent Medicine
seminar
June 10,
2007 June 16, 2007
American Austrian
Foundation, Inc.
(AAF)
N
Alimdjanov Zafar Salzburg Family Medicine
seminar
July 2,
2007 July 7, 2007
American Austrian
Foundation, Inc.
(AAF)
N
Shaymanov Nuriddin
Summer Public Health course of
the European School for
Maternal, Newborn Child and
Adolescent Health
July 2,
2007 July 14, 2007
WHO Collaborating
Centre for Maternal
and Child Health.
Burlo Garofolo
Pediatric Institute
Y
Definitions
Name of Event/Class: List the title or subject of the class, conference, workshop, training, or other event attended
Begin Date: List the date that the event began
End Date: List the date that the event ended
Host Organization: List the name of the organization that is hosting the event. For example, for the Spring Leadership Conference, list
Project HOPE. For health systems strengthening training provided by Zdrav Plus, write ZdravPlus. Do not put where the event was held, but
rather who organized and lead the event.
Paid for by Project HOPE: Did Project HOPE pay for the professional development training or did the participant receive
sponsorship/scholarship or funding from an alternative source? Yes or No.
F. Final KPC Survey Report
Increasing the Quality of Child Survival and Maternal
Care Services in the Navoi Oblast of Uzbekistan
Cooperative Agreement No.: FAO-A-00-99-00026-00
Final KPC Report
Project Duration: October 1, 2002 – September 30, 2007
Submitted to:
Jill Boezwinkle
Attn: Aimee Rose, Program Assistant
USAID/GH/HIDN/NUT/CSHGP
1300 Pennsylvania Avenue
RRB Room 3.7-74
Washington, DC 20523-3700
Janet Meyers
FP/RH Technical Advisor to the Flexible Fund
Macro International - CSTS+
11785 Beltsville Drive
Calverton, MD 20705-3119
Deborah Kumper
Administrative Assistant
ORC Macro – CSTS+
11785 Beltsville Drive
Calverton, MD 20705
Submitted by:
Project HOPE – The People-to-People Health Foundation, Inc.
Millwood, Virginia 22646
Tel: (540) 837-2100
Fax: (540) 837-1813
December 2007
HQ Contact Person:
Ruth Madison, MPH
Tech Advisor, HWC Unit
Field Contact Person:
Abdunabi Kuchimov, Program Manager
Project HOPE Uzbekistan
Prepared by:
Sandra Wilcox, Consultant
With assistance from Zafar Alimdjanov, HIS Specialist, Project HOPE Uzbekistan
TABLE OF CONTENTS
EXECUTIVE SUMMARY .................................................................................................1
1. INTRODUCTION ......................................................................................................2
II. METHODOLOGY .....................................................................................................5
III. RESULTS ...................................................................................................................6
SECTION 1. IMCI AND SAFE MOTHERHOOD INTERVENTION ....................7
SECTION 2. FAMILY PLANNING: WOMEN OF REPRODUCTIVE AGE .....16
SECTION 3. ACOLESCENT HEALTH.................................................................22
IV. GENERAL CONCLUSIONS...................................................................................30
ANNEXES
ANNEX A: Questionnaire 1: IMCI and Safe Motherhood Interventions
ANNEX B: Questionnaire 2: Family Planning
ANNEX C: Questionnaire 3: Adolescent Health
ANNEX D: Questionnaire 4: Questionnaire for over sampling for
Breastfeeding indicators
ACRONYMS
AIDS Acquired Immune Deficiency Syndrome
ARH Adolescent Reproductive Health
ARI Acute Respiratory Infection
AVSC Association of Voluntary Contraception (now known as Engender
Health)
ADB Asian Development Bank
BCC Behavioral Change and Communication
BF Breast Feeding
BFHI Baby-Friendly Hospital Initiative
BL Baseline Survey
CAR Central Asian Republics
CDD Control of Diarrheal Disease
CI Confidence Interval
COMH Central Oblast Maternity House
CRMH Central Rayon Maternity House
COH Central Oblast Hospital
CRH Central Rayon Hospital
CS Child Survival
CSHGP Child Survival and Health Grant Program
CYP Couple Years of Protection
DHS Demographic Health Survey
DIP Detailed Implementation Plan
EPI Expanded Program on Immunization
FAP Feldsher midwife post
FE Final Evaluation
FGD Focus Group Discussions
FP Family Planning
GP General Practitioner
HF Healthy Family
HFA Health Facility Assessment
HIV Human Immunodeficiency Virus
HIS Health Information System
HOPE Health Opportunities for People Everywhere
ICD*10 International Classification of Disease, 10th edition
IEC Information, Education, Communication
IMCI Integrated Management of Childhood Illness
INGOs International non governmental organizations
IMR Infant Mortality Rate
IUD Intrauterine Device
KPC Knowledge, Practice, Coverage
LAM Lactational Amenorrhea Method
LQAS Lot Quality Assurance Sampling
MCH Maternal Child Health
MHC Mother’s Home Card
MOE Ministry of Education
MOH Ministry of Health
MOHSSE Ministry of Higher Secondary Special Education
M&E Monitoring and Evaluation
MPS Making Pregnancy Safer
MSG Mother Support Group
MTE Mid Term Evaluation
NGO Non-Governmental Organization
ORS Oral Rehydration Solution
ORT Oral Rehydration Therapy
OHD Oblast Health Department
PEPC Promoting Effective Perinatal Care
PHC Primary Health Care
Prikaz Official (Government) order or decree
PTP Peer to Peer Counseling
QA Quality Assurance
QI Quality Improvement
RDH Rayon Health Department
RH Reproductive Health
SC Steering Committee
SDM Standard Days Method
SM Safe Motherhood
STIs Sexually Transmitted Infections
SOW Scope of Work
STD Sexually Transmitted Disease
SUB Rural community hospital
SVA Rural physician ambulatory
SVP Rural physician post
TAG Technical Advisory Group
TWG Technical Working Group
TOT Training of Trainers
USAID United States Agency for International Development
WHO World Health Organization
WRA Women of Reproductive Age
1
EXECUTIVE SUMMARY
Project HOPE conducted the final KPC survey in four project rayons (districts) of the
Navoi Oblast (region) in June 2007. This was the conclusion of the second Child Survival
project awarded to Project HOPE for work in this region. A survey conducted in March
2004 served as a final survey for the first project and baseline for the current project. The
results of these surveys are presented and compared in this report.
Project HOPE began its activities in Uzbekistan in 1998. Its Child Survival activities
have included work with mothers of children under two, women of reproductive age,
adolescents and communities. Oblast and rayon level management committees as well as
monitoring and evaluation systems have been important tools for institutionalizing
project gains and encouraging replication of lessons learned and best practices for other
rayons in the oblast as well as the national level.
For the KPC surveys the methodology used was a cross sectional study conducted at the
household level. To collect the information, three questionnaires were developed for:
1) mothers of children under 24 months of age; 2) women of reproductive age (15-49);
and 3) the adolescent population, which is characterized in Uzbekistan as those 16-18
years of age. The study questionnaires were developed by Project HOPE based on the
KPC 2000+ and the Flexible Fund questionnaires for the different intervention areas. The
questionnaires were then tailored to address the different interventions in the project
areas. The household level questionnaires were translated into Uzbek and used by
interviewers during the survey. The sample populations for the final survey were a) 300
mothers of children under 24 months of age; b) 300 women of reproductive age and;
c) 300 adolescents 16-18 years of age.
As demonstrated in this report, significant improvements in health knowledge and
behavior occurred in all project intervention areas during the life of the project. For
example, the percent of children born at least 24 months after the previous surviving
child almost doubled during the life of the project. Likewise, levels of exclusive breast
feeding increased by 30 percent and the levels of children 6-9 months who breastfed and
received complementary foods increased from 20 to 60 percent. Also levels of children
12-23 months who were fully vaccinated rose from 50 to 81 percent. In addition, findings
indicate that preventive health knowledge levels in intervention areas rose significantly
during the time of the project. Knowledge gains were made in all project areas including
recognizing danger signs for pregnancy, diarrhea, pneumonia and STIs. Significant
knowledge was also gained concerning how to prevent transmission of STIs and
HIV/AIDS (rising from 36 to 96 percent) among women of reproductive age. There is
also evidence that mothers and WRA received improved counseling on sick child care
and family planning, which lead to better child care and higher use of family planning
methods beginning during post partum periods. Significant gains in knowledge were
made by adolescents in the area of STI and HIV/AIDS prevention. There is also evidence
that sexually active adolescents are using condoms correctly. By the time of the final
evaluation, 83 percent of adolescents could name at least three contraceptive methods.
2
I. INTRODUCTION
Project HOPE began its activities in Uzbekistan in 1998, and opened a country office
within the National Tuberculosis Institute on October 4, 1998. The TB Management
project collaborates actively with USAID, CDC, WHO and the World Bank, and partners
with the Ministry of Health (MOH), National TB Institutes and Universities. The
program provided and installed the equipment for the National Laboratory, and has been
training and monitoring TB doctors in DOTS in Fergana Valley, Andijan, Samarkand and
Tashkent Oblasts and may gradually expand this geographical coverage.
Project HOPE’s CS-15 project started in December 1999 in the Navoi Oblast. A small
add-on IEC/BCC project which was part of a nine-country community IMCI effort
financed by GlaxoSmithKline, complemented the project. The purpose of the project was
to develop a “parent reminder tool” also known as the Child Health booklet. This booklet
teaches new parents how to: 1) recognize common child health danger signs; 2) manage
common childhood illnesses at home; 3) prevent common childhood illnesses and;
4) provides them with breastfeeding and complementary feeding instructions and an
immunization schedule.
In September 2002, a Project HOPE led consortium, including Save the Children, the
American Red Cross, the Futures Group, JHPIEGO, and the American College of Nurse
Midwives, was awarded a five-year cooperative agreement “Expanding Maternal and
Child Health and Reproductive Health Services in Uzbekistan and Tajikistan
(MCH/RH)” or the “Healthy Family Project” by USAID-CAR. For this new program,
Project HOPE and Save the Children used their existing USAID/ Global Health
supported CS-15 and CS-18 projects in Uzbekistan and Tajikistan, respectively as models
to scale up successful approaches and innovations to USAID-CAR priority oblasts and
zones of these countries.
In accord with national laws, Project HOPE has established agreements with the MOH
and other Government offices to implement assistance and development programs in
Uzbekistan.
The CS-19 (expansion) project has built on the successes of the CS-15 project with the
purpose of expanding and institutionalizing the CS intervention activities into two new
rayons (districts) in the Navoi Oblast (region). Previously the project worked in two
Rayons, now they work in four. Navoi City is approximately a six-hour drive from
Tashkent. Approximately 90 percent of the oblast is desert. The oblast consists of eight
Rayons and two urban centers, and approximately 278 makhallas (municipalities), some
of which contain nearly 500 families. Navoi is primarily an industrial oblast and a major
source of gold and other minerals (mined in Zarafshan). The four districts where the
project is located, focus on agriculture (e.g. Kiltepa), or depend on herding along with
nomadic Kazakh populations who live in yurts without electricity, gas or running water.
Many Kazakhs are moving back to Kazakhstan because the government has promised
them land, good salaries and additional benefits. Approximately 80 percent of the
3
population in the oblast is Uzbek or Kazakh and 20 percent are Russian. The majority of
the population is Muslim, but religious practices and beliefs are not obvious in daily life.
The CS-19 project comprises both Child Survival and Reproductive Health interventions,
including work with adolescents, target groups, community leaders and mothers-in-law in
order to promote greater community involvement. Oblast and rayon level management
committees and monitoring and evaluation systems have continued to be important in
institutionalizing project gains and capturing replicable lessons for the rest of the region
and the country.
2. Background and Description of the Problem
The Oblast (regional) Health Department (OHD) is led by the oblast chief and his
technical team. Tertiary-level specialty hospitals are located in Navoi City. Rayons have
their own administration and manage a health system consisting of a central rayon
hospital (CRH), polyclinics in the rayon capital, SUBs (rural hospitals that are gradually
being phased out), SVPs (Village Health Centers with general practitioner [GPs] and
midlevel providers), and the FAPs (health posts staffed by a feldsher) that are also being
phased out in all but the most rural areas. Before the project, most of these rural
providers had not received refresher courses on primary health care, though they are the
sole source of care for mothers and children. During Soviet times, many providers were
Russians and many of them have returned to Russia after the fall of communism in 1992.
The capacity of the remaining health workers was very low. Essential medications were
not generally available at health facilities, but are free-of-charge for hospitalized children,
and therefore provide a strong incentive for referral. A network of home-visiting nurses
(patronage nurses) from the MOH and the Red Crescent Society provide home care and
support to special groups (new mothers, large families, the disabled and/or chronically ill,
elderly), but lacked health education materials and guidance about how to counsel
patients. Roads in the target area can be impassable during summer and winter months,
making emergency transport difficult. Temperature changes are extreme, and water,
electricity, and phone services are not consistently available.
The 2001 Navoi Oblast statistics provide a picture of the poor health status of young
children and women of reproductive age that the project encountered at the start of
activities. The Oblast Health Department (OHD, 2001) reported that the IMR in Navoi
was 17/1,000 live births (similar to the official national rate), but the actual rate was
probably at least three times higher, using standard international definitions. ARIs,
diarrheal diseases, measles, anemia, and malnutrition account for 55 percent of under five
deaths; the remainder being due to neonatal and peri-natal conditions (19 percent), other
infections (12 percent), non-infectious diseases (9 percent), and trauma (5 percent)
(OHD, 2001). The poor nutritional status of young children (12 percent of children under
five are moderately to severely underweight and 84 percent are anemic) is an underlying
factor in many infant and childhood illnesses and deaths (OHD, 2001). According to the
oblast health department (2000), 12 percent of under-five deaths occur at home,
compared to 8 percent for all of Uzbekistan (NPRI, 2001). An additional 20 percent of
4
deaths took place during the first day of hospitalization (compared to 11 percent for
Uzbekistan [OHD and NPRI, 2001]).
Navoi has had one of the highest maternal mortality rates in the country at 73/100,000
live births compared to a national rate of 34/100,000 live births (MOH, 2001). Ninety￾five (95) percent of pregnant women are anemic (39 percent severely anemic) - a strong
contributor to perinatal and maternal deaths (MOH, 2001). Primary causes of maternal
mortality are pregnancy-induced hypertension/toxemia, hemorrhage, and infection.
While health conditions have improved in the Navoi districts during the project period,
the preceding section served to summarize existing conditions at the start of the project.
3. Problem Solution
In order to address the above health problems in the four rayons, Project HOPE’s goals
for CS-19 were to (1) reduce the mortality and morbidity in children under five and
women of reproductive age; (2) Consolidate and institutionalize effective approaches in
the CS-15 target area and scale these up to include other oblast rayons; and (3) Continue
to develop innovative, effective, and efficient approaches that could be adapted and
scaled up in Project HOPE’s MCH/RH projects in Uzbekistan and Kyrgyzstan.
During the life of the project, Project HOPE continued to consolidate achievements in its
CS-15 pilot rayons, Navoi and Kiziltepa focusing on (a) testing and implementation of
SM/FP/IMCI; (b) strengthening the sustainability of other interventions through
continued oblast mentoring and capacity building; increased community involvement;
monitoring, supervision, and impact assessments; and performance-based refresher
trainings for providers; and (c) developing additional innovative approaches. In the two
new extension Rryons, Konimeh and Nurata, Project HOPE implemented the project
interventions, including (a) TOT development; (b) provider training; (c) development of
supervision and monitoring systems; and (d) extensive community IEC/BCC, utilizing
NGO and media involvement.
4. Final KPC Objectives
The objectives of the KPC survey like the baseline study, were to provide Project HOPE
and counterparts with information on the following issues:
At the household level:
 Changes in knowledge and practice of mothers of children under two years of age
about their reproductive health, and the proper role of child health interventions;
target groups for health education action messages; and assess coverage rates for
main reproductive and child health services;
 Changes in knowledge and practice of women of reproductive age regarding their
reproductive and sexual health; and access and coverage of family planning services;
 Changes in knowledge and practice of boys and girls of 16-18 years of age regarding
their reproductive and sexual health; abortion, STDs, HIV/AIDS and family planning
services.
5
The final KPC analysis and results demonstrate how knowledge and health practices were
improved during the life of project. A comparison with baseline indicators is presented
along with results so the reader can view the levels of change that have occurred, thanks
to the project.
II. METHODOLOGY
As with the baseline study, the methodology used for the final KPC survey was a cross
sectional study at the household level. By repeating the study at the end of the project, it
highlights the project's success in communicating health messages to women, men and
family, and training community and facility-based health providers in quality
reproductive, maternal and child health services.
(An LQAS survey was administered at the time of the mid-term but there were problems
with the sampling and it only measured information from mothers of children under 2. It
did not oversample for any of the specific populations. Therefore, this report only
compares the findings of the baseline and final surveys which used the same, comparable
methodologies. Findings of the LQAS will be included in the final evaluation report.)
1. The Questionnaires
To collect information at these two levels, three questionnaires were developed for:
(1) mothers of children under 24 months of age, (2) women of reproductive age, and
(3) the adolescent population. The questionnaires were developed by Project HOPE
based on the KPC 2000+ and the Flexible Fund’s questionnaires for the various
intervention areas. The questionnaires were then customized to make the finalized
versions appropriate to the actual projects interventions and the project areas.
The questionnaires for the household level were translated into Uzbek, and the questions
were applied in Uzbek at the time of the interviews.
2. Sample Size and Study Population
The selected sample population was based on the following calculations:
Household level questionnaires
 300 Mothers of children less than 24 months of age; 300 women of reproductive age,
and 300 adolescent 16-18 years of age. Thus a total of 900 interviews were carried
out in the pilot rayons, Navoi and Kiziltepa, and the two new extension rayons,
Konimeh and Nurata.
 Oversampled for the breastfeeding questions by selecting an additional 468 mothers
of children under 24 months of age to answer a short BF questionnaire.
 WHO 30-Cluster Study, where p=0.5, d=0.1 and z=95percent (Henderson, et al.,
1982).
 List of communities under the NGOs coverage area.
 Random selection of first household -- next was the third household.
6
3. Study Implementation
The final survey process included the design of the household level questionnaires, based
on the questionnaires used at baseline and their translation into Uzbek. Some additional
indicators that were added at the mid-term were also added to the final questionnaire. The
team of surveyors was comprised of the Project HOPE team, health providers from the
oblast and rayon-level health facilities, and community members. The team and its
supervisors carried out the first validation of the questionnaire translation. This was
conducted at the end of the 3-day training in a non-project rayon. By the end of the
training, Project HOPE and supervisors developed an action plan to implement the
survey.
Project HOPE staff provided further support in monitoring and implementing the study.
They entered data into an analysis package (Epi-Info) and carried out the overall analysis.
Once the final evaluation has been completed, Project HOPE will organize a series of
meetings with the various steering committees and working groups that the project has
been working with (adolescent health, maternal health, child health) to present the final
results and discuss further steps. The meetings will include supervisors and interviewers,
oblast and rayon department chiefs, and community members and leaders.
III. RESULTS
Key Indicators
TABLE 1. KEY INDICATORS: THE RAPID CORE ASSESSMENT TOOL ON
CHILD HEALTH (CATCH) Baseline
2004
%
CI
Final
KPC
2007
%
2007 CI
Sentinel Measure of Child Health and Well-being
1. Percentage of children age 0–23 months who are underweight (-2 SD from the
median weight-for-age, according to the WHO/NCHS reference population)
7.7 ±3.0
Prevention of Illness/Death
2. Percentage of children age 0–23 months who were born at least 24 months
after the previous surviving child
48.3 ±18.2± 84.6 ±5.8
3. Percentage of children age 0–23 months whose births were attended by skilled
health personnel 98.1 ±1.3± 99.3 ±0.9
4. Percentage of mothers with children age 0–23 months who received at least
two tetanus toxoid injections before the birth of their youngest child**
5. Percentage of children age 0–5 months who were exclusively breastfed during
the last 24 hours 62.7 ±9.0 90.0 ±3.9
6. Percentage of children age 6–9 months who received breastmilk and
complementary foods during the last 24 hours 19.8 ±8.2 60.3 ±6.4
7. Percentage of children age 12–23 months who are fully vaccinated (against the
five vaccine-preventable diseases) before the first birthday*** 50.3 ±7.2 81.3 ±6.9
8. Percentage of children age 12–23 months who received a measles vaccine*** 88.1 ±4.7 82.1 ±6.8
9. Percentage of children age 0–23 months who slept under an insecticide-treated
net (in malaria risk areas) the previous night No malaria areas No malaria areas
10. Percentage of women of reproductive age who cite at least two known ways of
reducing the risk of HIV infection 36.5 ±4.7 84.0 ±4.1
7
11. Percentage of mothers with children age 0–23 months who report that they
wash their hands with soap/ash before food preparation, before feeding
children, after defection, and after attending to a child who has defecated
Management/Treatment of Illness
12. Percentage of mothers of children age 0–23 months who know at least two
signs of childhood illness that indicate the need for treatment
48.6 ±4.8 95.3 ±2.4
13. Percentage of sick children age 0–23 months who received increased fluids
and continued feeding during an illness in the past two weeks 22.7 ±17.5 64.4 ±14.0
** The Uzbekistan MOH does not provide TT to pregnant women, only immunoglobulin to suspected cases
of tetanus infection.
*** The MOH does not provide immunization cards to families; therefore, except during the final KPC
where the project did review clinic cards, the above indicators were calculated based only on the mothers’
recall.
The results from the final survey will be presented in three sections, each section devoted
to a specific component of reproductive, maternal and child health. The first section will
discuss the results of mother-child health issues; the second section will discuss
reproductive and family planning aspects; and the third will discuss adolescent
reproductive and sexual health issues. The first questionnaire will examine the responses
of 300 mothers of children under two years of age, the second will examine 300
responses of women of reproductive age (15-49 years of age), the third will examine 300
responses of the adolescent population (16-18 years of age). Moreover, each section will
attempt to examine the following issues:
 What services are being offered and where do people seek assistance in case of
illness? Has this changed since the beginning of the project?
 What new services are offered?
 What are the current knowledge and practices in the community that may be affecting
demand and utilization of health care services and has this changed?
 How have health services increased coverage and quality to better reach their target
populations?
SECTION 1. IMCI AND SAFE MOTHERHOOD INTERVENTIONS (MOTHERS
OF CHILDREN LESS THAN 24 MONTHS OF AGE)
a. Mother’s Background Characteristics
Because the demographic characteristics of the project rayons have not changed during
the life of the project, this part of the KPC was not repeated during the final survey. This
background information is taken from the baseline survey results.
Table 1 shows some of the basic characteristics of the mothers of children less than 24
months of age sample population. Of the women interviewed all (100 percent) had some
level of education, and 7.9 percent had only primary education. There were no
significant differences among the four rayons.
8
When asked about what language interviewees feel most comfortable communicating
with, Uzbek was the most common language used (90.6 percent) followed by Kazakh
(7.2 percent) and then by Tajik (5.0 percent). When comparing the new and old rayons,
in Konimeh and Nurata, 14.5 percent of the population felt more comfortable
communicating in Kazakh. However, there was an overlap of results, meaning that
although people can speak more than one language, Uzbek is the most preferred language
for communicating.
When examining the nature of the head of household, 66.3 percent reported that the
respondent’s father-in-law is the head of the family, meaning also that the majority of the
population lives in an extended family context. Over thirty percent (30.3) reported that
their husbands were the heads of the household. The majority of women interviewed
were housewives, and a small percent (3 percent) being salaried workers. There were no
significant differences when comparing old and new project rayons.
Finally, the average age of the women interviewed was 26 years old, and 11 months was
the average age of their youngest child.
TABLE 2. GENERAL CHARACTERISTICS OF THE INTERVIEWED MOTHERS: SCHOOLING, LANGUAGE, HEAD OF
HOUSEHOLD, AND OTHER CHILD CARETAKERS
Navoi &
Kiziltepa
Konimeh &
Nurata Total June 2007 Indicators
percent
(n=210)
percent
(n=210)
percent
(n=420)
(n=300)
Highest level of education attained
Primary
Incomplete secondary
Secondary/special secondary
Higher
11.0
27.3
54.1
7.7
4.8
35.9
52.6
6.7
7.9
31.6
53.3
7.2
No data
Language interviewees feel most comfortable communicating
Uzbek
Tajik
Kazakh
Russian
99.0
5.2
0.0
0.5
82.1
4.8
14.5
0.0
90.6
5.0
7.2
0.2
No data
Head of household
Mother (respondent)
Husband/Partner
Relative
Father in law
1.0
31.6
1.9
65.5
3.3
29.0
0.5
67.1
2.2
30.3
1.2
66.3
No data
Work outside of home to earn money and type of work:
Housewife
Handicrafts
Harvesting/Field Worker
Shop Keeper/Street Vendor
Salaried Worker
96.2
0.0
0.0
0.0
3.8
97.6
0.0
0.0
0.0
2.4
96.9
0.0
0.0
0.0
3.1
No data
Continuous Variables Average
(n=210)
Average
(n=210)
Average
(n=420)
Average
(n=300)
Age of mothers (years) 25.7 26.9 26.3 26.4
Age of children under two (months) 11.4 10.5 11.0 10.7
9
b. Breastfeeding Promotion and Infant/Child Nutrition
An important component of infant health is the prompt initiation of breastfeeding and
exclusive breastfeeding until the infant is six months of age (World Health Organization).
This practice significantly reduces disease and malnutrition in infants. Of the mothers
interviewed during the final evaluation, 93 percent initiated breastfeeding in the first hour
after birth as compared with 62.6 percent at baseline. Ninety (90) percent of women with
infants less than six months of age reported they were exclusively breastfeeding at the
time of the interview (Table 3) as compared with 62.7 percent at baseline.
The World Health Organization also recommends gradually introducing solid/semi-solid
foods to infants at six months of age, and that the mothers continue breastfeeding until
the infant is two or more years of age. The introduction of solid/semi-solid foods is an
important step in infant growth, and it is important that mothers know how and when to
introduce foods to their infants. The percentage of infants aged six to ten months old that
were being given solid foods was 60.3 percent, up significantly from 19.8 percent at
baseline. Also, the majority of infants between 20 and 23 months of age (66.8 percent)
were still being breastfed. This is up from 33.9 percent at the baseline. During the life of
the project, the number of mothers that are exclusively breastfeeding and feeding for
longer periods has jumped dramatically. The complementary feeding rate has also
improved, all of which denote important improvements in child nutrition.
It is noteworthy that the project oversampled for these questions to obtain reliable
numbers about breastfeeding and young children’s complementary feeding practices.
TABLE 3. BREASTFEEDING AND INFANT/CHILD NUTRITION
Navoi &
Kiziltepa
Konimeh &
Nurata Total June 2007 Indicators
% (n=208) % (n=209) % (n=417) CI % (n=753)
Breastfeeding Initiation: Percent of children aged 0-23
months who were breastfed within the first hour after birth 81.7 43.5 62.6 ±4.6 93.1±1.8
% (n=48) % (n=62) % (n=110) CI (n=231)
Exclusive Breastfeeding Rate: Percent of infants aged 0-5
months who were fed breastmilk only in the last 24 hours 81.3 48.4 62.7 ±9.0 90.0±3.9
% (n=49) % (n=42) % (n=91) CI (n=224)
Complementary Feeding Rate: Percent of infants aged 6-9
months who received breastmilk and solid foods in the last 24
hours
8.2 33.3 19.8 ±8.2 60.3±6.4
% (n=36) % (n23=) % (n=59) CI (n=205)
Continued Breastfeeding: Percent of children aged 20-23
months who are still breastfeeding 36.1 30.4 33.9 ±12.1 66.8±6.4
Continuous Variables Average
(n=209)
Average
(n=208)
Average
(n=417) (n=219)
Times infant/child eat semi-solid foods yesterday during the
day or at night 3.0 2.7 2.8 4.4
Although the question was not asked during the baseline survey, the project did ask about
duration of skin-to-skin contact at the final survey since this indicator had been added
10
during the project. As can be seen from the information below, the project’s key message
about skin-to-skin contact seems to have reached the mothers.
Desired Result:
Adopt/Strengthen appropriate feeding practices for improving child nutrition and
growth.
Indicators FE % (n=300) CI
Skin-to-skin contact for at least 30 minutes in the first hour after delivery 90.3%±3.3
c. Childhood Immunization
In Uzbekistan, immunization cards are kept at health services. Families do not possess
any type of written information about their children’s immunization status. Although
some programs are trying to change this situation by providing immunization cards to the
beneficiary population, this has not occurred in the project areas. Therefore parents and
caretakers are not able to easily keep track of what vaccines and doses their children have
received. As a result, both the baseline study and the final survey obtained information
as recalled and reported by the mother. These data are confusing for although
immunizations were not the main focus of this project, according to the KPC final survey,
the percentages of children who received DPT1 and who received measles dropped from
the baseline figures, as well as those who received full EPI coverage. Part of the
explanation is that these percentages are based on mother’s recall and not immunization
cards but there is quite a difference from the levels reported at baseline.
However, because the mother’s recall results showed low levels of immunization, the
project decided to cross check the accuracy of these reports by reviewing the
immunization records at the primary health clinics and these results were noted here
below. Table 4 displays the immunization status of children 12-23 months of age
according to verified records at the health centers. However, the results may not be
strictly comparable to the baseline results as the baseline was based on mothers recall.
See footnote for KPC data recorded from mother’s recall.
The one figure that was lower than the baseline was for measles coverage. One
explanation for this is that measles is only administered in the rayons twice a year and the
project staff thought that this percentage would be higher if they had measured three
months later. Also when examining the table it is evident that at baseline the old rayons,
which are close to Navoi city and have more access to regular immunizations, had higher
levels than the new rayons whose coverage is similar to the final levels for all four
rayons. With the new figures, it is clear that the DPT1 coverage has stayed high, full
coverage moved from 50 percent to 81 percent and BCG coverage was slightly higher
than baseline.
11
TABLE 4. CHILDHOOD IMMUNIZATION
Navoi &
Kiziltepa
Konimeh &
Nurata Total June 2007 Indicators 1
percent
(n=96)
percent
(n=89)
percent
(n=185) CI
% (n=298)
EPI Access*: Percent of children aged 12-23 months who
received DPT1 94.8 97.8 96.2 ±2.8 96.7±3.2
Measles Vaccination Coverage*: Percent of children aged 12-23
months who received measles vaccine 94.8 80.9 88.1 ±4.7 82.1±6.8
EPI Coverage I*: Percent of children aged 12-23 months who
received BCG, DPT3, OPV3, and measles vaccines before the
first birthday
58.3 41.6 50.3 ±7.2 81.3±6.9
BCG Vaccination Coverage*: Percent of children aged 12-23
months who received BCG vaccine 99.0 92.1 95.7 ±2.9 99.2±1.6
d. Childhood Illness
One of the main objectives of the community IMCI strategy is to educate mothers to
recognize signs and symptoms of severe childhood illness so that they know when it is
necessary to seek the services of a health provider. At the time of the final evaluation,
95.3 percent of mothers recognized at least two of those signs (up from 48.6 at baseline),
and 96 percent recognized at least two danger signs when children have diarrhea (up from
36.9).
Diarrheal illnesses were not prevalent in the communities interviewed at the time of the
baseline survey. Because the survey was not conducted during the diarrhea season, only
5.2 percent of the mothers interviewed in the baseline study reported that their child
(under 2 years of age) had been ill with diarrhea in the last two weeks (Table 5).
Although the final survey was conducted during the diarrhea season, the project did not
oversample for diarrhea cases and the number of cases is still relatively low (34), though
the percent of cases had increased slightly from 5.2 to 11.3 percent. When interviewed,
many community leaders believed that because of improved health practices, they are not
seeing severe forms of diarrhea in children even during the diarrhea season.
Mothers with children under two years of age who had been ill with diarrhea in the last
two weeks before the interview were asked about the eating and drinking practices of
their children during that period. While 58.8 percent of the mothers said their children
drank the same amount of fluids or more fluids than usual (up from 15 percent at
baseline), 50 percent (19 percent at baseline) of the children ate the same amount of food
or more food than usual.
*These are results from immunization records at service centers as the mothers reported KPC results were
lower than expected: According to the oral KPC survey: 81.5% of mothers said their children 12-23
months had been vaccinated with DPT1; 43.9 said their children 12-23 months had been vaccinated for
measles and; 34.5 reported receiving full vaccination schedule. 99% said their children received BCG
vaccine.
12
In order to prevent dehydration, which often occurs in children with diarrheal illnesses,
oral rehydration therapy (ORT) is the recommended treatment for all children with
diarrhea. Of the mothers who sought treatment, oral rehydration therapy increased from
31.8 percent at baseline to 47.1 percent at the final.
It is interesting to note the influences regarding care seeking decision making. At the time
of the baseline survey, the key decision makers for seeking care were the respondent
(mother), 58 percent and the mother-in-law 47 percent, with the husband at 29. At the
time of the final evaluation, the mother was a little higher at 67 percent, the husband had
increased to 40 percent and the mother-in-law had dropped to 37 percent. This may be a
reflection of educational strategies that are directed towards the couples. There has also
been an effort to empower mothers to make decisions about their children’s care.
TABLE 5. CHILDHOOD ILLNESS & DIARRHEA CASE MANAGEMENT (DCM)
Navoi &
Kiziltepa
Konimeh &
Nurata Total June 2007 Indicators
percent
(n=210)
percent
(n=210)
percent
(n=420) CI
percent
(n=300) CI
Maternal Knowledge of Child Danger Signs: Percent of mothers
of children aged 0-23 months who know at least two signs of
childhood illness that indicate the need for treatment
65.2 31.9 48.6 ±4.8 95.3 ±2.4
Maternal Knowledge of Child Danger Signs: Percent of mothers
who know at least two signs childhood diarrhea that indicate the
need for treatment
54.3 19.5 36.9 ±4.6 96±2.3
Percent of children who had diarrhea in the last two weeks prior
to the survey 4.8 5.7 5.2 ±2.1 11.3±3.6
percent
(n=10)
percent
(n=12)
percent
(n=22) CI
percent (n=34)
CI
ORT Use During a Diarrheal Episode: Percent of children aged 0-
23 months with diarrhea in the last two weeks who received oral
rehydration solution (ORS) and/or recommended home fluids
50.0 16.7 31.8 ±19.5 47.1 % ±16.8
Increased Fluid Intake During a Diarrheal Episode: Percent of
children aged 0-23 months with diarrhea in the last two weeks
who were offered more fluids during the illness
37.5 0.0 15.0 ±14.9 58.8 %±16.5
Increased Food Intake During a Diarrheal Episode: Percent of
children aged 0-23 months with diarrhea in the last two weeks
who were offered the same amount or more food during the
illness
22.2 16.7 19.0 ±16.4 50±16.8
Percentage of sick children age 0–23 months who received
increased fluids and continued feeding during an illness in the
past two weeks
30.0 16.7 22.7 ±17.5 64.4±14.0
Care-seeking for Diarrhea: Percent of children aged 0-23 months
with diarrhea in the last two weeks whose mothers sought outside
advice or treatment for the illness
0.0 0.0 0.0 0.0
% (n=10) % (n=12) %(n=22) CI %(n=45) CI
Percentage of sick children age 0-23 months who received
increased fluids and continued to feeding during any illness in the
past two weeks 30.0 16.7 22.7±17.5 64.4±14.0
13
%(n=10) %(n=12) %(n=22) %(n=300)
Care seeking decision making: Person who decided seeking
outside advise or treatment for the illness
Respondent
Husband/Partner
Respondent’s Mother
Mother-in-law
Friends/Neighbors
50.0
37.5
0.0
37.5
0.0
66.7
22.2
0.0
55.6
0.0
58.8
29.4
0.0
47.1
0.0
67.0
40.0
2.0
37.0
0.3
At the time of the baseline survey, acute respiratory illness (ARI), especially pneumonia,
was one of the most prevalent health problems in the communities interviewed. Of the
mothers interviewed, 54 percent said their child had suffered from some type of lower
respiratory illness with rapid breathing and chest in drawings in the two weeks prior to
the interview (Table 6). Eighty-eight (88) percent of mothers sought some type of
treatment for their child's illness. The final evaluation was not conducted during ARI
season. However the knowledge level of mothers was much higher at the final
evaluation: 85 percent of mothers knew at least one danger sign and could indicate a need
for treatment. As evidence of this awareness, despite it not being the season for ARI and
a low number of cases, 80 percent of mothers of children 0-23 months who had cough or
fast breathing within the previous 2 weeks, took the children to a health facility for
treatment. As with the diarrhea cases, mothers interviewed reported that the key decision
makers for seeking treatment were the husbands, next the mother and then the mother-in￾laws, but this is from a small number of respondents and may not reflect the reality.
TABLE 6. ACUTE RESPIRATORY INFECTIONS
Navoi &
Kiziltepa
Konimeh
& Nurata Total June 2007 Indicators
percent
(n=210)
percent
(n=210)
percent
(n=420)CI
% (n=300) CI
Maternal Knowledge of Child Danger Signs: Percent of mothers
who know at least one sign childhood respiratory illness that
indicate the need for treatment
18.1 11.9 15.0 ±3.4 85.3 ±4.0
Percent of children with cough and fast/difficult breathing in the
last two weeks prior to the survey 57.4 51.6 54.1 ±4.8 3.3 ± 2.0
percent
(n=27)
percent
(n=32)
percent
(n=59)
% (n=10)
ARI Care-seeking: Percent of children aged 0-23 months with
cough and fast/difficult breathing in the last two weeks who were
taken to a health facility or received antibiotics from an
alternative source
85.2 90.6 88.1 ±8.3 80 ± 24.8
14
e. Maternal and Newborn Care
Respondents were asked questions concerning the care they sought and received during
their last pregnancy.
Both at baseline and final surveys, ninety nine (99) percent of the women interviewed
had attended a health service for at least one prenatal exam during their last pregnancy
(Table 7). It is interesting that the final KPC found that of these, 83 percent had 8 to 12
visits or more and an additional 13 percent had 5-7 visits, which means that 96 percent of
pregnancy women received at least five visits. The Uzbekistan MOH does not provide
Tetanus Toxoid to pregnant women, but only immunoglobulin to suspected cases of
infection. Most (97%-90%) women reported to live less than one hour away from health
center, which facilitates attending prenatal care visits. Little more than half had received
iron supplementation at baseline but this increased to 73.4 percent by the final. Most of
these women had received orientation and counseling during pregnancy, but only 47
percent knew danger signs during pregnancy at baseline. By the final evaluation, 97
percent of women were able to name danger signs in pregnancy.
Ninety eight (98) percent at baseline and 99 percent at final reported that a trained health
professional had attended their delivery. Whereas 69 percent placed the baby right
besides the mother after delivery at baseline, this percent jumped to 94 by the final
survey.
At baseline, 77 percent of women interviewed had had a postpartum check up and by the
time of the final survey, 99 percent of women had gone for pp check-ups.
In sum, although the women in the Navoi region have traditionally attended maternal care
services, it appears that the quality of that care and the resulting attendance at post partum
services have improved remarkably.
Maternal Care
TABLE 7. CARE DURING PREGNANCY, DELIVERY AND POSTPARTUM
Navoi &
Kiziltepa
Konimeh &
Nurata Total June 2007 Indicators
percent
(n=210)
percent
(n=210)
percent
(n=420) CI
percent
(n=300)CI
CARE DURING PREGNANCY
Prenatal Care Coverage: Percent of mothers who had at least one
prenatal visit prior to the birth of her youngest child less than 24
months of age
100.0 99.5 99.8 ±0.4 99.7 ±0.6
Iron Supplementation Coverage: Percent of mothers who
received/bought iron supplements while pregnant with the
youngest child less than 24 months of age
65.6 42.6 54.1 ±4.8 73.4 ±5.0
15
Prenatal Care Counseling: Counseling given to pregnant women
on last pregnancy by theme
Delivery preparations
Breastfeeding
Child spacing/FP
EPI
Danger signs of pregnancy
STIs Prevention
94.7
95.2
90.3
76.3
81.6
81.6
94.0
78.6
76.2
66.1
63.1
57.1
94.4
87.7
84.0
71.7
73.3
70.9
99.3
92.6
92.3
88.0
90.3
87.6
Prenatal Care Geographical Access: Percent of pregnant women
who report living less than ONE hour from nearest health facility 97.6 96.7 97.1 ±1.6 89.7percent
Maternal Knowledge of Pregnancy Danger Signs: Percent of
mothers who know at least TWO signs of danger during
pregnancy that indicate the need for treatment
60.5 33.3 46.9 ±4.8 97percent
±1.9
DELIVERY AND IMMEDIATE NEWBORN CARE
Delivery by Skilled Health Personnel: Percent of children aged
0-23 months whose delivery was attended by a skilled health
personnel
100.0 96.2 98.1 ±1.3 99.3 ±0.9
Placement at Birth: Percent of children aged 0-23 months who
were placed with the mother immediately after birth 82.4 55.7 69.0 ±4.4 94.0 ±2.7
POSTPARTUM CARE
Postpartum Contact: Percent of mothers who had at least one
postpartum check-up 89.0 64.8 76.9 ±4.0 98.7 ±1.3
Postnatal Care Counseling: Counseling given to postpartum
women on last pregnancy by theme
Breastfeeding
Lactational Amenorrhea Method
Family planning
99.0
68.9
63.6
93.5
43.3
52.7
96.3
56.3
58.3
98.3
52.3
80.3
Although the baseline only asked mothers about knowledge of 2 pregnancy danger signs,
the final survey also asked about knowledge of three danger signs. The results are below.
Indicators FE % (n=300) CI
Percent of mothers who know at least three signs of danger during pregnancy that
indicate the need for treatment
89.0%±3.5
In the Baseline results
table mothers
requested to mention
two signs: Result for
FE: 97.0%±1.9
f. Post partum Child Spacing
Of women interviewed, 70 percent at baseline and 75 percent at final started using a FP
method right after the last delivery. The percent of post partum mothers who started using
FP methods within six weeks of delivery jumped from 37 percent at baseline to 56
percent at the final. This percentage increase of about 20 percent may be reflective of
better quality of services and attendance at post partum care.
16
TABLE 8. CHILD SPACING
Navoi &
Kiziltepa
Konimeh &
Nurata Total June 2007 Indicators
percent
(n=210)
percent
(n=210)
percent
(n=420)CI
percent
(n=250)CI
Birth Spacing: Percent of mothers who started using a FP method
after last delivery 78.6 62.4 70.5 ±4.4 75.2 ±5.4
percent
(n=165)
percent
(n=131)
percent
(n=296)
percent
(n=188)
Time when mothers started using FP method:
During first 6 weeks
After 7 weeks
Other
44.2
54.5
1.3
28.6
70.6
0.8
37.5
61.5
1.0
56.4
39.4
4.3
SECTION 2. FAMILY PLANNING: WOMEN OF REPRODUCTIVE AGE (15-49
YEARS OLD)
a. Women’s Background Characteristics
Ninety-nine (99) percent of the reproductive age women interviewed had some level of
education and 7.4 percent at baseline and 9.4 at final had higher education levels. Also a
higher percentage had completed secondary by the final than had at baseline. Ninety￾three (93) percent felt more comfortable speaking Uzbek and the average age was 32
years.
TABLE 9. GENERAL CHARACTERISTICS OF THE INTERVIEWED MOTHERS: SCHOOLING, LANGUAGE,
HEAD OF HOUSEHOLD, AND OTHER CHILD CARETAKERS
Navoi &
Kiziltepa
Konimeh &
Nurata Total June 2007 Indicators
percent
(n=209)
percent
(n=209)
percent
(n=418)
percent
(n=300)
Highest level of education attained
Primary
Incomplete secondary
Secondary/special secondary
Higher
1.9
30.6
58.9
8.6
0.5
27.3
66.0
6.2
1.2
28.9
62.4
7.4
0.0
6.7
83.7
9.7
Language interviewees feel most comfortable communicating*
Uzbek
Tajik
Kazakh
Russian
96.7
3.3
0.0
0.5
90.9
8.6
0.0
1.0
93.8
6.0
0.0
0.7
No data
Continuous Variables Average
(n=210)
Average
(n=210)
Average
(n=420)
Average
(n=300)
Age of interviewed women 30.9 32.5 31.7 32.0
* Note: Given that multiple answers were allowed, the table represents the number of respondents, not
responses.
17
b. Reproduction and Child Spacing
At baseline, 48 percent of the population had a birth interval of at least 24 months
between their last two children. This had increased to 84 percent by the time of the final
evaluation. Also even though this was not a project indicator, it is interesting that the
percent of children born at least 36 months after the previous child increased from 13 at
baseline to 28 at final, indicating that spacing is being extended beyond 24 months in a
number of cases. At the baseline, when women interviewed were asked whether there are
days in which women are most fertile, 36.9 percent responded affirmative, but only 9.3
percent of these reported that those days are halfway between menstrual cycles. However,
by the time of the final evaluation, 80 percent affirmed that there were fertile periods in
their cycle and of these 46 percent knew when it was.
TABLE 10. REPRODUCTION AND CHILD SPACING
Navoi &
Kiziltepa
Konimeh
& Nurata Total June 2007
Total
Indicators
percent
(n=14)
percent
(n=15)
percent
(n=29) CI
percent
(n=32) CI
Adequate Birth Interval Between Youngest Surviving Children:
Percent of children aged 0-23 months who were born at least 24
months after the previous surviving child
50.0 46.7 48.3 ±18.2 84.4 ±12.6
Adequate Birth Interval Between Youngest Surviving Children
(Less Stringent Criteria): Percent of children aged 0-23 months
who were born at least 36 months after the previous surviving
child
21.4 6.7 13.8 ±12.6 28.1 ±15.6
percent
(n=210)
percent
(n=210)
percent
(n=420)
percent
(n=300)
Knowledge of the Reproductive Cycle: Percent of women who
report that there are days in their menstrual cycle when are most
likely to get pregnant
30.5 43.3 36.9 ±4.6 79.7 ±4.6
Knowledge of the Reproductive Cycle: Percent of women who
report that women are likely to get pregnant halfway between two
menstrual periods.
11.9 6.7 9.3 ±2.8 45.7 ±5.6
c. Knowledge and Ever Use of Contraception
At baseline, when women were asked about knowledge of FP methods, where to obtain
them and if she ever used them, IUD, LAM pills and injectables were the methods
commonly known. Emergency contraception and male sterilization were the least known.
By the time of the final, most modern methods and where to obtain them were known
(female sterilization, pill, IUD, injectables, condoms and LAM). Again, emergency
contraception and male sterilization were least known. The same trend was observed
when asked about where to obtain them and if ever used. The percentage of women who
know where to obtain at least one method is close to hundred percent, and although the
method mix is still dominated by a preference for the IUD, the percentage of women
using the IUD has come down from 86 to 70 percent. Use of injectables has increased
from 13 to 17 percent. It appears that use of LAM has dropped from 60 to 38 percent but
at the same time, use of standard days method (SDM) has increased from 13 to 17
18
percent and use of rhythm or periodic abstinence has increased from 11 to 20 percent.
Other methods such as female sterilization, condoms, foam, and emergency contraception
appear to have increased slightly. Hence, there continues to be good physical access to
FP services, and a larger variety of methods are being used, though there continues to be
a preference for the IUD.
TABLE 11. KNOWLEDGE OF FP METHODS; WHERE TO OBTAIN THEM;
AND EVER USED A FP METHOD*
Total June 2007
percent
Indicators
percent (n=420) (n=300) (n=250) (n=250)
knows obtain Used knows obtain Used
Female Sterilization 69.2 59.1 4.1 85.0 87.6 5.6
Male Sterilization 12.5 8.6 0.3 32.7 33.2 0
Pill 80.5 75.4 15.7 97.0 98.0 14.4
IUD 98.3 96.6 86.3 99.3 98.8 70.8
Injectables 79.6 75.7 13.2 98.7 96.4 16.8
Condom 64.4 58.0 12.9 90.7 88.8 13.6
Foam or Jelly 16.6 12.8 0.3 42.0 44.0 1.2
Lactational Amenorrhea
(LAM) 81.3 80.6 59.6 80.7 88.4 38.0
Standard Days Method 48.8 44.5 13.5 73.7 72.8 17.2
Rhythm or Periodic
Abstinence 28.6 27.8 11.3 62.3 67.2 20.4
Withdrawal 44.7 43.2 22.5 63.3 68.0 18.8
Emergency Contraception 9.9 8.6 1.1 39.0 42.0 2.8
d. Access to Family Planning
At both the baseline and final evaluations, 97 percent of the interviewed population
reported to know a source of FP methods within their communities and 93 and 91 percent
respectively, reported living within 5 km. of a FP distribution point.
TABLE 12. ACCESS TO FP SERVICES AND DISTANCE FROM SDP
Navoi &
Kiziltepa
Konimeh &
Nurata Total June 2007 Indicators
percent
(n=197)
percent
(n=199)
percent
(n=396) CI
percent
(n=300) CI
Access: Knowledge of sources of child spacing methods
within interviewees’ communities 97.6 97.6 97.6 ±1.5 97.0 ±1.9
Access: Percentage of population who live within 5 km of a
family planning/reproductive health service delivery point 95.4 91.0 93.2 ±2.5 91.3 ±3.2
19
e. Use of Family Planning
At both the baseline and final surveys, 73 percent of women of reproductive age, who do
not want another child in the next two years and were not pregnant were using a FP
method. This figure is slightly higher than the national rate for contraceptive use among
married women according to the 2002 DHS which was 67.7 percent, 69 percent for urban
and 65 percent for rural women2
. When observing the method mix, the IUD continues to
be the most widely used though the 82 percent baseline figure has dropped to 70 percent
use by the time of the final. This method is followed by female sterilization (up from 3.3
percent to 6.4 percent), the pill (up from 1.5 to 6 percent) and injectables (up from 2.2 to
6.4). Use of all methods has shown an increase since the baseline. Use of LAM has also
increased. At baseline, 62 percent of women interviewed had received proper counseling
(including contraceptive choice, common side effects, and when to return for follow-up);
this increased to 86 percent by the final survey which reinforces the fact that counseling
and informed choice is increasing at the service delivery level, and may be having some
effect in improving the method mix.
TABLE 13. CHILD SPACING INDICATORS
Navoi &
Kiziltepa
Konimeh &
Nurata Total June 2007 Indicators
percent
(n=178)
percent
(n=190)
percent
(n=368) CI
percent
(n=88) CI
Contraceptive Use Among WRA Who Want to Limit or Space
Births: Percent of non-pregnant women who desire no more
children in the next two years, or are not sure, who are using a
modern method of child spacing
73.6 71.6 72.6 ±4.6 72.8 ±9.3
% (n=178) % (n=190) % (n=368)
CI % (n=233)
Contraceptive Use: Current of FP methods by type*
Female Sterilization
Male Sterilization
Pill
IUD
Injectables
Implants
Condom
Foam/Jelly
Lactational Amen. Method
Standard Days Method
Periodic Abstinence (Other Than Standard Days
Withdrawal
2.3
0.0
1.5
87.1
2.3
0.0
3.0
0.0
1.5
1.5
0.8
0.0
4.3
0.0
1.4
78.4
2.2
0.0
2.2
0.7
2.2
2.2
0.7
6.5
3.3
0.0
1.5
82.7
2.2
0.0
2.6
0.4
1.8
1.8
0.7
3.3
6.4
0.0
6.0
70.8
6.4
0.0
3.0
0.0
4.7
0.9
1.7
3.0
percent
(n=131)
percent
(n=136)
percent
(n=267) CI
percent
(n=97) CI
Counseling: Percentage of family planning clients who receive
counseling** on contraceptive choices, correct use of method
accepted, common side effects, and when to return for follow-up
73.5 52.2 62.7 ±5.8 86.6 ±6.8
2 Uzbekistan Health Examination Survey 2002. Preliminary Report. Ministry of Health of Uzbekistan,
State Department of Statistics, MEASURE DHS+ ORC Macro. May 2003.
20
Continuous variable Average
(n=131)
Average
(n=136)
Average
(n=267)
Average
(n=235)
Average duration of respondent’s or husband/partner has been
using CURRENT METHOD in months 42.4 40.3 41.4 41.4
*Note: Given that multiple answers were allowed, the table represents the number of respondents, not
responses.
**Note: “Adequate counseling” is defined as whether client has received information on: a) contraceptive
choices, b) correct use of the method accepted, c) common side effects, and d) when to return for follow-up
services, however, the current survey, only collected data on options “a,” “c” and “d.”
f. Diffusion of Family Planning Messages
More than half (56 percent at baseline and 66 percent at final) of women interviewed had
discussed FP issues in the previous year. It is interesting that at baseline the most
common person talked to were friends, followed by husband or partner. Whereas at the
final, a large majority (82 percent) said they conferred with husband or partner followed
by mothers-in-law (33), and friends were hardly mentioned. At the final, 89 percent of
women reported that they had been visited by a health worker to discuss family planning,
which was up from 57 at baseline, and 84 percent (up from 60) had visited a health
facility. While the most popular media for receiving family planning messages at baseline
was television, and even though it continues to be an important information source, by
the time of the final survey, health fairs were even more popular (up by 30 percentage
points). In sum, it appears that women are discussing family planning more with their
husbands and that they are getting a significant amount of FP information from health
fairs.
TABLE 14. DIFFUSION OF FAMILY PLANNING MESSAGES
Navoi &
Kiziltepa
Konimeh &
Nurata Total June 2007 Indicators
percent
(n=210)
percent
(n=210)
percent
(n=420) CI
percent
(n=300) CI
Percentage of respondents who report discussing FP
issues with somebody in the past 12 months 63.3 49.0 56.2 ±4.7 65.7 ±5.4
percent
(n=122)
percent
(n=102)
percent
(n=224)
percent
(n=197)
Persons respondents have chosen to discussed FP issues
in the past 12 months:
Husband/Partner
Mother
Father
Sister(S)
Brother
Daughter
Son
Mother-in-law
Friends/Neighbors
Makhalla activists
Other
46.7
6.6
0.8
24.6
7.4
2.5
11.5
69.7
41.2
10.8
0.0
17.6
2.0
1.0
21.6
68.6
44.2
8.5
0.4
21.4
4.9
1.8
16.1
69.2
82.7
11.7
0.5
17.3
12.7
3.0
0.0
33.5
2.5
3.0
1.5
21
percent
(n=210)
percent
(n=210)
percent
(n=420)
percent
(n=300) CI
Percentage of respondents who reported that were visited
by a health worker to talk about family planning 71.7 43.1 57.2 ±4.7 89.0 ± 3.5
Percentage of respondents who reported that visited
health a health facility for care of herself (or her child) 69.0 52.4 60.7 ±4.7 84.3 ±4.1
Percent of respondents who have seen or heard any
messages about family planning by any of the following
means
Radio
Newspaper
Television
Health Fair
No visit
Other
20.4
29.6
73.5
69.9
13.5
25.8
77.3
38.7
17.3
27.9
75.2
55.7
11.7
32.0
60.0
85.3
1.0
0.0
Additional indicators measured at the Final survey only:
Although not measured at baseline, one can see that by the time of the final survey, 80
percent of mothers with children under 12 months had received adequate family planning
counseling according to Flex Fund criteria, 99 percent of WRA knew at least three
modern FP methods, there was a 14 percent unmet need for family planning among
married women or women in union.
Indicators FE %±CI
Percentage of mothers with children less than 12 months who received
counselling about birth spacing**
80.3%±4.5
(n=300)
Percentage of women of reproductive age (WRA) 15-49 who have heard about at
least three modern methods of family planning**
Type of method: the program may be interested in knowing what methods people
have heard about, especially if the program is interested in introducing it or
increasing its use (for example, LAM, IUDs, SDM, etc)
This indicator added to Project indicators list as FF indicator
98.7%±1.3
(n=300)
Unmet Need for Family Planning**
(The indicator is limited to women in union/married. If you are working in a
context where there is widespread sexual activity outside of marriage or stable
unions, you might want to consider calculating the percentage of sexually active
unmarried women with an unmet need for family planning.)
13.8%±4.6
(n=217)
* Rapid Catch
** FF Required
22
g. HIV/AIDS and Use of Condoms
At the baseline and final surveys, 97 and 99 percent of the WRA in the surveyed areas
had heard about HIV/AIDS. Ninety-six (96) percent (up from 36.5 percent at baseline)
reported knowing at least two ways to avoid AIDS. Ninety-six (96) percent (90 at BL)
admitted that it can be transmitted from mother to son, and 83 percent (76 at BL)
believed it occurs during pregnancy, 31 percent (21 at BL) during delivery and 74 percent
(47 at BL) during breastfeeding. The DHS-2002 reported that 90.1 percent of the
population had ever heard about HIV/AIDS (93.5 percent urban and 87.9 percent rural).
During the life of the project, there has been a significant increase in knowledge among
women of reproductive age in the project rayons concerning HIV/AIDS transmission and
how to prevent it.
TABLE 15. HIV/AIDS PREVENTION AND USE OF CONDOMS
Navoi &
Kiziltepa
Konimeh &
Nurata Total June 2007 Indicators
percent
(n=210)
percent
(n=210)
percent
(n=420) CI
percent
(n=300) CI
Percent of respondents who ever heard of an illness called AIDS 98.6 95.7 97.1 ±1.6 99.3 ±0.9
percent
(n=207)
percent
(n=201)
percent
(n=408)
percent
(n=263)
Respondents Knowledge of HIV/AIDS Prevention: Percent of
respondents who know of at least two ways of avoiding
HIV/AIDS transmission (abstain from sex, use condoms, avoid
contact with contaminated blood)
33.8 39.3 36.5 ±4.7 95.8 ±2.4
% (n=207) %(n=201) % (n=408) % (n= 300)
Percent of respondents who know that the HIV can be transmitted
from mother to son 90.3 91.5 90.9 ±2.8 96.3 ±2.1
Respondents who know that HIV can be transmitted during:
Pregnancy
Delivery
Breastfeeding
74.9
21.4
41.2
77.6
21.9
47.0
76.2
21.6
47.0
82.7
31.0
74.7
percent (n=5) percent (n=4) percent (n=9)
Percent of respondents who used condom during last sexual
intercourse with other than spouse/stabile partner 83.3 100.0 90.0 No data
SECTION 3. ADOLESCENT HEALTH (16 -18 YEARS OF AGE)
a. Respondent’s Information
Four hundred twenty (420) adolescents were interviewed during the baseline (36 percent
boys and 63 percent girls) and 300 at the final (43 percent boys and 57 percent girls), 80
percent at baseline and 86 percent at final were going to a school and most (92 percent)
felt more comfortable communicating in Uzbek. The average age of the adolescents
interviewed at both baseline and final surveys was 16 years.
23
Respondent’s Information
TABLE 16. GENERAL CHARACTERISTICS OF THE INTERVIEWED ADOLESCENT: SCHOOLING,
LANGUAGE AND AGE
Navoi &
Kiziltepa
Konimeh &
Nurata Total June 2007 Indicators
percent
(n=210)
percent
(n=210)
percent
(n=420)
percent
(n=300) CI
Gender of interviewees
Boys
Girls
34.3
65.7
39.5
60.5
36.9
63.1
43.0
57.0
Currently school/lyceum/college/institute attendance by
gender
Boys
Girls
80.6
76.6
86.7
78.0
83.9
77.3
89.9
84.8
Language interviewees feel most comfortable
communicating
Uzbek
Tajik
Kazakh
Russian
96.7
4.8
1.0
1.9
89.0
5.2
4.3
1.0
92.9
5.0
4.3
1.0
No data
Continuous Variables Average
(n=210)
Average
(n=210
Average
(n=420)
Average
(n=300)
Age of adolescents
Boys
Girls
16.5
16.7
16.4
16.8
16.5
16.7
16.9
16.9
b. Family Size and Marriage
Cultural family traditions and values in Uzbekistan are of extreme importance, and an
important one concerns marriage. At the baseline, 64 percent of adolescent boys believed
that they themselves should choose the person they marry, while 46 percent of adolescent
girls believed they should choose their husband; on the other hand, 15 percent of boys
believe their parents should choose, while 24 percent of girls believed the same.
When adolescents were asked what they would do if a girl became pregnant, 87 percent
of the boys responded that they should marry her, while 76 percent of the girls believed
the same thing. Six (6) percent of the boys would seek abortion services while 9 percent
of the girls would.
When asked about the ages that men and women should get married, adolescents
responded 22 years of age for men and 20 for women. When asked at what age they
believed that couples were actually getting married, they indicated ages 21 for men and
19 for women; there were small differences between what they thought should be the age
of marriage and the actual age, meaning that adolescents do not believe early marriage is
a problem. Finally, when adolescents were asked about the ideal number of children to
have in a family, both stated that three is the appropriate number.
24
Unfortunately there was no follow-up data collected on these attitudes during the final
survey so we do not know if the opinions changed during the life of the project.
TABLE 17. ADOLESCENTS’ PERCEPTION OF FAMILY SIZE AND MARRIAGE
Navoi &
Kiziltepa
Konimeh &
Nurata Total June 2007 Indicators
percent
(n=210)
percent
(n=210)
percent
(n=420)
no data
Marriage: Adolescent perception as to who should decide
whom to marry:
For Boys
Choose own husband/wife
Parents should decide
Both
For girls
Choose own husband/wife
Parents should decide
Both
63.9
15.3
20.8
44.2
29.7
26.1
65.1
15.7
19.3
49.6
19.7
30.7
64.5
15.5
20.0
46.8
24.9
28.3
No data
No data
Marriage: Adolescents preferred options when getting
pregnant/getting a girl pregnant
For boys
Marry her
Abortion
Other
For girls
Marry him
Abortion
Other
86.9
8.2
4.9
76.3
11.3
12.4
87.3
5.6
7.0
77.1
8.3
14.6
87.1
6.8
6.1
76.7
9.8
13.5
No data
No data
Continuous Variables Average
(n=210)
Average
(n=210)
Average
(n=420) June 2007
Age of Marriage: Adolescents’ perception of the
appropriate age.
men should marry
women should marry
22.5
20.6
22.4
20.1
22.5
20.3 No data
Age of Marriage: Adolescents’ perception of the age men
and women are currently marrying:
men
women
21.1
19.1
22.3
19.2
21.7
19.2
No data
Ideal Number of Children: Adolescents’ perception of the
ideal number of children for a family:
For boys
For girls
3.2
3.1
3.3
3.1
3.2
3.1
No data
c. Knowledge of FP Methods and Where to Obtain Them
Table 18 shows that at the time of the baseline survey adolescents had very limited
knowledge of FP methods and where to obtain them. The most widely known FP method
was the IUD with 84 percent, but the second most known was pills at 42 percent, then the
numbers continued decreasing for all other FP methods. In contrast, by the time of the
final survey, adolescent knowledge increased dramatically particularly of modern
methods such as pills (74 percent), IUDs (83 percent), injectables (72 percent) and
25
condoms (68 percent). Similar percentage levels showed that adolescents also knew
where to obtain them. Fifty (50) percent knew about female sterilization and where to
obtain it but fewer (20-28 percent) knew about the “natural” methods, such as LAM,
standard days, rhythm and withdrawal – though knowledge levels were higher than at
baseline (5-8 percent). About 20 percent also knew about emergency contraception and
where to obtain it, which was higher than baseline (4 percent).
According to the final KPC interviews, only a small percent of adolescents have used
contraception with .4 using the pill, .8 using of IUD and 4.4 using condoms.
TABLE 18. KNOWLEDGE OF FP METHODS; WHERE TO OBTAIN THEM;
AND EVER USED A FP METHOD*
Total June 2007
percent
Indicators
percent (n=420) (n=300) (n=250) (n=250)
knows obtain Used knows obtain Used
Female Sterilization 35.6 29.1 n/d 49.7 50.4 0.0
Male Sterilization 6.8 2.7 n/d 31.0 29.6 0.0
Pill 42.7 41.3 n/d 78.3 74.0 0.4
IUD 84.0 74.0 n/d 83.3 76.8 0.8
Injectables 34.5 31.4 n/d 72.0 66.0 0.0
Condom 27.8 27.4 n/d 68.0 64.8 4.4
Foam or Jelly 1.8 0.9 n/d 20.0 21.2 0.0
Lactational Amenorrhea
(LAM) 8.9 8.5 n/d 25.3 27.2 0.0
Standard Days Method 7.8 8.1 n/d 28.0 25.6 0.0
Rhythm or Periodic
Abstinence 6.0 7.6 n/d 23.0 20.8 0.0
Withdrawal 5.0 4.5 n/d 20.0 20.8 0.0
Emergency Contraception 3.9 4.5 n/d 21.7 19.6 0.0
The adolescents were asked about sexual attitudes regarding FP use and knowledge of the
reproductive cycle. At baseline, 17% of the boys replied that women should decide what
FP method to use and 33% of boys indicated that is a decision of both, while 34% of the
girls replied that woman should decide and 32 percent with both partners. By the time of
the final survey, these responses had changed some with 24 percent of boys saying that
girls should decide the method and 44 percent saying it was the decision of both partners.
However, 55 percent of girls thought that the methods should be the woman’s decision
and only 32 percent continued to think (same as baseline) it should be the decision of
both partners. So this seems to indicate that by the end of the project, both boys and girls
are recognizing the importance of the woman’s role in FP decisions.
When asked about knowledge of the reproductive cycle at the time of the baseline study,
only 3% of the boys knew that there are days when women are more likely to get
pregnant, and only .13% of the girls, and when specifically asked when those days were,
only 1.9% of the boys knew it was half way between menstrual cycles, and 0.8% of the
girls. In contrast, by the time of the final survey, 42 percent of boys and 60 percent of
26
girls knew that there is a period in the menstrual cycle when women are more likely to
get pregnant and 26 percent of boys and 40 percent of girls correctly stated when it was.
These findings also attest to the program’s success in educating adolescents about their
reproductive health.
TABLE 19. FP METHOD DECISION AND REPRODUCTIVE CYCLE KNOWLEDGE
Navoi &
Kiziltepa
Konimeh &
Nurata Total June 2007 Indicators
% (n=210) % (n=210) % (n=420) % (n=300)
Adolescents perception as to whom should decide what FP
method to use:
For boys
Woman
Man
Both partners
For girls
Woman
Man
Both partners
19.7
29.6
36.6
35.6
8.9
28.9
16.0
33.3
30.9
32.3
13.4
37.0
17.8
31.6
33.6
34.0
11.1
32.8
% (n=129)
23.6
30.2
44.3
% (n=171)
55.3
7.1
31.9
Knowledge of the Reproductive Cycle: Percent of boys and
girls who know that there is a period when women are more
likely to get pregnant:
For boys
For girls
2.8
13.8
4.8
12.6
3.9
13.2
41.9% (n=171)
59.6% (n=171)
Knowledge of the Reproductive Cycle: Percent of boys and
girls who report that women is likely to get pregnant
halfway between two menstrual periods:
For boys
For girls
1.4
0.7
2.4
0.8
1.9
0.8
25.9% (n=171)
39.8% (n=171)
d. Initiation of Sexual Life and Family Planning
Table 20 shows the adolescent perception as to when to start sexual relations and the
importance of being virgin at the time of marriage. These responses regarding
appropriate ages for sexual debut have not changed much in the duration of the project.
Likewise, the importance of a girl remaining a virgin until marriage is slightly higher
than at baseline for both boys and girls. Only a few adolescents had initiated sexual life,
though there are a few more at the final (boys 11.6%) than at the baseline (boys 5.8%)
thus the number of people using FP methods was very small (10 at baseline and 18 at the
final). The percentages of FP users were equally divided between boys and girls.
27
TABLE 20. INITIATION OF SEXUAL LIFE
Indicators Navoi &
Kiziltepa
Konimeh
& Nurata Total June 2007
Continuous variable Average
% (n=210)
Average
% (n=210)
Average
% (n=420)
% (n=300)
Sexual Initiation: Adolescents perception of the age men and
women can start sexual activity:
Men
Women
18.1
18.6
17.2
18.2
17.7
18.4
19.3
20.7
% (n=210) % (n=210) % (n=420) % (n=300)
Sexual Initiation: Adolescents perception of the importance for a
woman to be virgin until marriage
For boys:
Important
Not Important
Don’t Know
For girls:
Important
Not Important
Don’t Know
91.7
6.9
1.4
92.0
5.8
2.2
84.3
7.2
7.2
93.7
2.4
4.0
87.7
7.1
4.5
92.8
4.2
3.0
% (n=129)
93.0
3.9
3.1
% (n=171)
96.5
2.9
0.6
Family Planning: Percent of adolescents with active sexual life by
gender:
Boys
Girls
11.1
0.0
1.2
0.8
5.8
0.4
11.6
1.8
% (n=8) % (n=2) % (n=10) % (n=18)
Family Planning: Percent of adolescents using contraception:
Boys
Girls
37.5
0.0
100.0
100.0
44.4
50.0
% (n=15)
66.7
% (n=3)
66.7
% (n=210) % (n=210) % (n=420) % (n=300)
Percent of adolescent who reported that his/her close male friends
had sexual intercourse with prostitutes, according to
Boys
Girls
24.6
15.2
10.4
7.6
16.9
11.5
% (n=129)
33.3
% (n=171)
12.4
e. Teenage Pregnancy
At both the baseline and final surveys, there were no girls with a past pregnancy, and
most (95 percent at BL and 90 percent at FE) did not agree that having sex would make
them more popular among their peers.
28
TABLE 21. TEENAGE PREGNANCY: QUESTIONS ONLY FOR GIRLS AND QUESTIONS FOR BOYS AND GIRLS
Navoi &
Kiziltepa
Konimeh &
Nurata Total June 2007 Indicators
% (n=210) % (n=210) % (n=420) % (n=300)
Teenage Pregnancy: Percent of girls who have ever been
pregnant 0.0 0.0 0.0 0.0
Teenage Pregnancy: Perception of adolescents who agree or
disagree with the following statement: “Having sex while I’m a
teenager would be a way to be popular”
For boys:
Disagree
Not Sure
Agree
For girls:
Disagree
Not Sure
Agree
88.9
5.6
5.6
96.4
1.4
2.2
92.7
1.2
6.1
95.3
3.1
1.6
90.9
3.2
5.8
95.8
2.3
1.9
% (n=129)
86.0
2.8
11.2
% (n=171)
90.2
2.1
7.7
f. Abortion
According to the DHS 20003
, total abortion rates (TAR) for all of Uzbekistan is 0.9
abortions per woman (0.9 in rural and 1.1 in urban areas). The baseline and final surveys
attempted to ask questions about abortion prevalence, but were only able to obtain
information about perceptions of abortion practice. As noted in table 22, at the baseline,
52% of boys and 57% of girls thought abortion was common among adolescent friends.
By the time of the final survey, the percentages had dropped a bit with 43 percent of boys
and 37 percent of girls thinking that abortion was common among teenagers.
TABLE 22. FREQUENCY OF ABORTION
Navoi &
Kiziltepa
Konimeh &
Nurata Total June 2007 Indicators
% (n=210) % (n=210) % (n=420) % (n=300)
Abortion: Adolescents perception that abortion is common among
teenage girls: According to boys:
According to girls:
54.2
60.1
50.6
54.3
52.3
57.4
% (n=129
43.4
% (n=171)
37.4
g. Sexually Transmitted Infections
One of the main purposes of educating adolescents about reproductive health, is for them
to protect themselves when initiating sexual activity and therefore, knowing and
preventing STI is key. During the baseline survey, 76% of adolescent respondents had
heard about the existence of sexually transmitted infections (STIs), however, 97.8% were
3 Uzbekistan Health Examination Survey 2002. Preliminary Report. Ministry of Health of Uzbekistan,
State Department of Statistics, MEASURE DHS+ ORC Macro. May 2003.
29
referring to HIV/AIDS; the second highest percentage was for syphilis (12.3%); and
when asked specifically about HIV/AIDS, 91.9% responded that they knew the disease;
44.2% could name at least two ways of transmitting HIV/AIDS and 54.1% mentioned at
least one way of preventing infection. Only 19.3% knew what a condom was and out of
those, only 26.5% knew how to use one.
By the time of the final survey, 95 percent of the adolescents had heard of STIs. Of these
91 percent spontaneously reported knowing of HIV/AIDS, 47 percent knew of syphilis
and 17 percent knew of gonorrhea. Less was known about Chlamydia, genital herpes and
hepatitis but still more than at the baseline (6-8 percent versus 1-2 percent). The percent
of adolescents who could name at least 2 ways HIV/AIDs is transmitted has increased
from 44 to 91 and the percent of respondents who know at least one way to prevent
HIV/AIDs transmission rose from 54 to 84. Although there was no data in this section of
the final survey about knowledge of condom use, there was a question asking for steps in
condom use, noted in the extra indicators below that were added to the final survey,
which indicates that 17 percent of adolescents or 50 of 300 respondents could name at
least 6 steps of correct condom use. This is actually a higher number and percent of
respondents than the 21 (or 26.5% of n=81) out of 420 who stated that they knew how to
use condoms at the baseline. Also, information in table 18 indicates that 68 percent of
adolescent respondents know about condoms, 64 percent know where to obtain them and
that 4.4 percent actually use them.
TABLE 23. KNOWLEDGE OF STIS AND PREVENTION
Navoi &
Kiziltepa
Konimeh
& Nurata Total June 2007 Indicators
% (n=210) % (n=210) % (n=420) % (n=300)
Adolescents Knowledge of STIs: Percent of respondents who
have heard about STIs 81.9 71.4 76.7 94.7
% (n=170) % (n=146) % (n=316) % (n=284)
STIs adolescent respondents spontaneously reported knowing:
Gonorrhea
Syphilis
Genital Herpes
Hepatitis
Chlamydia
HIV/AIDS
Condiloma
1.8
14.7
0.6
3.5
1.8
97.1
0.0
9.6
0.7
0.7
0.0
98.6
0.9
12,3
0.6
2.2
0.9
97.8
17.3
46.7
4.0
8.3
6.0
91.0
1.0
% (n=210) % (n=210) % (n=420) % (n=300)
Adolescents Knowledge of HIV/AIDS: Percent of respondents
who have heard about HIV/AIDS 95.2 88.6 91.9 97.7
% (n=200) % (n=186) % (n=386) % (n=293)
Adolescents Knowledge of HIV/AIDS Transmission: Percent of
adolescent respondents who can name at least two ways how
HIV/AIDS is transmitted
34.5 33.9 44.2 90.7
Adolescents Knowledge of HIV/AIDS Prevention: Percent of
respondents who can name at least ONE way to prevent
HIV/AIDS transmission
61.0 46.8 54.1 84.3
% (n=210) % (n=210) % (n=420) % (n=300)
Adolescents Knowledge of HIV/AIDS Prevention: Percent of
adolescent respondents who report knowing what is a condom 20.5 18.1 19.3 No data
30
% (n=43) % (n=38) % (n=81) % (n=300)
Adolescents Knowledge of HIV/AIDS Prevention: Percent of
adolescent respondents who report knowing how to use a condom 35.6 15.8 26.5 No data
Additional Indicators added to the Final Survey
Because not all the Flex Fund required questions had been measured in the baseline
survey, they as well as other indicators were added for the final KPC survey to show
additional levels of achievement. The indicators listed below show that about 83 percent
of targeted adolescents surveyed can name at least three contraceptive methods and; 48
percent can name at least three signs of STIs; 80 percent can name at least two means of
protecting themselves from STIs. Eighty three (83) percent of sexually active adolescents
report using a condom during last sexual intercourse, which is well beyond the target of
50 percent. Almost 17 percent (target 15) could correctly name six steps associated with
correct condom use.
Indicators FE %± CI
Percent of targeted adolescent population who can name at least three methods of
contraceptive methods**
82.7%±4.3
(n=300)
Percent of targeted adolescent population who can name at least 3 signs of STIs 48.0%±5.7
(n=300)
Percent of targeted adolescent population who can name at least 2 means of
protecting themselves against contracting STIs
80.3%±4.5
(n=300)
Percent of targeted adolescent population report having used (or whose sexual
partner used) a condom during last sexual intercourse (Target=50%)
83.3%±21.1
(n=12)
Percent of targeted adolescents who can correctly name at least 6 steps associated
with correct use of a condom (Target - 15%)
16.7%±4.2
(n=300)
* Rapid Catch
** FF Required
GENERAL CONCLUSIONS
The findings in this report demonstrate that significant improvements in health behavior
occurred in all project intervention areas during the life of the project. For example, the
percent of children born at least 24 months after the previous surviving child almost
doubled during the life of the project. Likewise, levels of exclusive breast feeding
increased by 30 percent and the levels of children 6-9 months who breastfed and received
complementary foods increased from 20 to 60 percent. Also levels of children 12-23
months who were fully vaccinated rose from 50 to 81 percent. The percentage of sick
children who received increased fluids and food during illness increased from 23 to 64
percent and use of ORT during diarrhea episodes rose from 31 to 47 percent. In addition,
findings indicate that preventive health knowledge levels in intervention areas rose
significantly during the time of the project. Knowledge gains were made in all project
areas including understanding of danger signs for pregnancy, diarrhea, pneumonia and
31
STIs. Significant knowledge was also gained concerning how to prevent transmission of
STIs and HIV/AIDS (rising from 36 to 96 percent) among women of reproductive ages.
There is also evidence that mothers and WRA received improved counseling on sick
child care and family planning, which lead to better child care and higher use of family
planning methods beginning during post partum periods. Significant gains in knowledge
were made by adolescents in the area of STI and HIV/AIDS prevention. There is also
evidence that sexually active adolescents know how and are using condoms. By the time
of the final evaluation 83 percent of adolescents could name at least three contraceptive
methods.
In sum, significant improvements in health behavior and knowledge levels were
evidenced by the target populations (mothers of children under 2, women of reproductive
ages and adolescents) in this study.
1
Project HOPE, Navoi, Uzbekistan
FINAL EVALUATION.
Questionnaire 1: IMCI and Safe Motherhood Interventions
All questions are to be addressed to a mother with a child less than
24 months of age
Identification number: ……………………………………………………..[____ / ____ / ____]
Rayon (1= Karmana; 2=kiziltepa;3=Konimeh ; 4=Nurota)
Mahallla’s name……………………………………………………
Cluster number…………………………………………………….
……………………………………………………………………….[ ]
____________________________________________________
…………………………………………………………………….[ / ]
Interview date (day/month/year)………………………………… ……………………………………………………[____ / ____ / ____]
Informed Consent
Hello, my name is ______________________ and I am working for the Navoi Oblast health Department. We are conducting a survey
about your health and of your child. We would very much appreciated your participation in the survey, since this information will help us
improve the existing health services. The survey is going to take us about 30 minutes to complete
Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions.
All discussed information will be keep confidentially.
At this time, would you like to ask me anything about the survey?
Name of mother (interviewee)
Age of mother in years
____________________________________________________
…………………………………………………………………….[ / ]
How many children living in this household are under age two?
…………………………………………………………………….[ / ]
Name of youngest child (under 24 months of age)………….
____________________________________________________
Child’s Background Characteristics
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
1 Birth date (day/month/year)……………………………………….
[____ / ____ / ____]
1A Classification by child’s age 0-5 month.....................................................1
6-9 month.....................................................2
20-23 month..................................................3
Other.. ..........................................................4
2 Do you have elder child than (name)
YES ..........................................................1
NO ............................................................2  5
3 If Yes, his/her date of birth
[____ / ____ / ____]
4 Birth spacing
Less 24 months (23 months 29 days)……..1
24 months and more…………………………2
5
Child weigh ___ ___, ___ kg
6
Child height ___ ___, ___ cm
2
Breastfeeding and Infant/Child Nutrition
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
7 Did you ever breastfeed (NAME)? YES......................................................... 1
NO .......................................................... 2 ──12
8 How long after birth did you first put (NAME) to the breast?1
IMMEDIATELY/WITHIN FIRST
HOUR AFTER DELIVERY .................... 1
AFTER THE FIRST HOUR ..................... 2
DON=T KNOW........................................ 3
9 During the first three days after delivery, did you give (NAME)
COLOSTRUM?
YES......................................................... 1
NO .......................................................... 2
DON=T KNOW........................................ 8
10 During the first three days after delivery, did you give (NAME) anything
else to eat or drink before feeding him/her breastmilk?
YES......................................................... 1
NO .......................................................... 2
DON=T KNOW........................................ 8
11 Are you currently breastfeeding (NAME)? YES......................................................... 1
NO .......................................................... 2
12 I would like to ask you about the types of liquids and foods that
(NAME) consumed yesterday during the day or at night. Did (NAME)
have. . .
READ EACH OF THE FOLLOWING AND PLACE A CIRCLE EACH
ITEM CONSUMED.
BREAST MILK..........................................A
INFANT FORMULA………………………..B
ANIMAL MILK………………………………C
PLAIN WATER.................................... D
OTHER LIQUIDS.....................................E
MASHED, PUREED, SOLID OR SEMI￾SOLID FOODS........................................F
Anything
else_____________________________G
SPECIFY
13
How many times did (NAME) eat semi-solid (mashed or pureed) food
yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD >7'.
NUMBER OF TIMES…………………{ }
DON=T KNOW……………………………..8
Childhood Immunization
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
14
Did (NAME) ever receive any vaccinations to prevent him/her from
getting diseases, including vaccinations received in a national
immunization day campaign?
YES..........................................................1
NO............................................................2
DON=T KNOW.........................................8
16
15 Please tell me if (NAME) received any of the following vaccinations
15A
A BCG vaccination against tuberculosis, that is, an injection in the arm
or shoulder that usually causes a scar?
YES..........................................................1
NO............................................................2
DON=T KNOW.........................................8
15B
Polio vaccine, that is, drops in the mouth? YES..........................................................1
NO............................................................2
DON=T KNOW.........................................8
15E
15E
15C
When was the first polio vaccine received, just after birth or later? FIRST 15 DAYS AFTER BIRTH ...............1
LATER 15 days ........................................2
15D
How many times was the polio vaccine received?
NUMBER OF TIMES………………….{ }
15E
DPT vaccination, that is, an injection given in the thigh or buttocks,
(sometimes at the same time as polio drops)?
YES..........................................................1
NO............................................................2
DON=T KNOW.........................................8
15G
15G
15F
How many times?
NUMBER OF TIMES………………….{ }
15G
An injection to prevent measles? YES..........................................................1
NO............................................................2
DON=T KNOW.........................................8
3
Childhood Illness
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
16
Sometimes children get sick and need to receive care or
treatment for illnesses. What are the signs of illness that
would indicate your child needs treatment?
RECORD ALL MENTIONED.
DON=T KNOW………………..……………………….A
LOOKS UNWELL OR NOT PLAYING NORMALLY..B
NOT EATING OR DRINKING……………………….…C
LETHARGIC OR DIFFICULT TO WAKE……………..D
HIGH FEVER…………………………………………….E
FAST OR DIFFICULT BREATHING…………………..F
VOMITS EVERYTHING…………………………………G
CONVULSIONS………………………………………….H
DEHYDRATION………………………………………….I
BLOOD IN STOOLS……………………………………..J
OTHER _______________________________..........K
(SPECIFY)
16A
Correctly answers If any 2 and more answers from B-J……………….1
Less than 2……………………………………………2
Diarrhea Case Management (DCM)
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
17
Has (NAME) had diarrhea in the last 2 weeks? YES..........................................................1
NO ...........................................................2
DON=T KNOW.........................................8
 25
 25
18
What was (NAME) given to treat the diarrhea?
Anything else?
RECORD ALL MENTIONED.
NOTHING ............................................... A
FLUID FROM ORS PACKET................... B
HOME-MADE FLUID............................... C
PILL OR SYRUP ..................................... D
INJECTION............................................. E
(IV) INTRAVENOUS.................................F
HOME REMEDIES/
HERBAL MEDICINES……………………..G
OTHER__________________________ H
(SPECIFY)
18A Correctly using of fluids If answer A or/and B…………………….1
Another……………………………………2
19
When (NAME) had diarrhea, did you breastfeed him/her less than usual,
about the same amount, or more than usual?
LESS........................................................1
SAME.......................................................2
MORE ......................................................3
CHILD NOT BREASTFED........................4
DON=T KNOW.......................................88
20
When (NAME) had diarrhea, was he/she offered less than usual to
drink, about the same amount, or more than usual to drink?
LESS........................................................1
SAME.......................................................2
MORE ......................................................3
NOTHING TO DRINK...............................4
DON=T KNOW.......................................88
21
Was (NAME) offered less than usual to eat, about the same amount, or
more than usual to eat?
LESS........................................................1
SAME.......................................................2
MORE ......................................................3
NOTHING TO EAT...................................4
DON=T KNOW.......................................88
22
Did you seek advice or treatment from someone outside of the home for
(NAME=S) diarrhea?
YES..........................................................1
NO ...........................................................2  25
4
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
23
Where did you go for advice or treatment? HEALTH FACILITY
OBLAST HOSPITAL ............................... A
CENTRAL RAYON HOSPITAL ............... B
CENTRAL RAYON POLYCL................... C
RURAL HOSP (SUB) .............................. D
SVP......................................................... E
SVA..........................................................F
FAP......................................................... G
DON’T KNOW/DON’S REMEMBER........ H
OTHER SOURCES
TRADITIONAL PRACTITIONER………….I
SHOP………………………………………...J
PHARMACY…………..……………………K
COMMUNITY DISTRIBUTORS………….L
FRIEND/RELATIVE……………………….M
OTHER _________________________ N
(SPECIFY)
23A
Take sick child to health facility / health provider If any from answers A-G ……………….1
Another ………………………………….2
24 Who decided that you should go there for (NAME=S) illness?
RECORD ALL MENTIONED.
RESPONDENT ....................................... A
HUSBAND/PARTNER............................. B
RESPONDENT=S MOTHER................... C
MOTHER-IN-LAW................................... D
FRIENDS/NEIGHBORS .......................... E
OTHER _________________________ F
(SPECIFY)
25
What signs/symptoms would cause you to seek advice or treatment for
(NAME)'s diarrhea?
DOESN'T KNOW…………………………..A
VOMITING………………………………….B
FEVER……………………………………..C
DRY MOUTH, SUNKEN EYES, SUNKEN
FONTENELLE, DECREASED URINE
OUTPUT (DEHYDRATION)………………D
DIARRHEA OF PROLONGED DURATION
(AT LEAST 14 DAYS)……………………..E
BLOOD IN STOOL…………………………F
LOSS OF APPETITE…………………..…G
WEAKNESS OR TIREDNESS…………...H
OTHER………………………………………I
(SPECIFY)
Acute Respiratory Infections
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
26
Has (NAME) had an illness with a cough at any time in the last two
weeks?
YES ........................................................ 1
NO .......................................................... 2
DON=T KNOW........................................ 8
33
33
27
When (NAME) had an illness with a cough, did he/she have trouble
breathing or breathe faster than usual with short, fast breaths?
YES ........................................................ 1
NO .......................................................... 2
DON=T KNOW........................................ 8
 33
 33
28
Did you seek advice or treatment for the cough/fast breathing? YES ........................................................ 1
NO .......................................................... 2  32
29 How long after you noticed (NAME=s) cough and fast breathing did
you seek treatment?
SAME DAY ............................................. 0
NEXT DAY.............................................. 1
THREE OR MORE DAYS ....................... 2
5
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
30
Where did you go for advice or treatment? HEALTH FACILITY
OBLAST HOSPITAL ............................... A
CENTRAL RAYON HOSPITAL ............... B
CENTRAL RAYON POLYCL................... C
RURAL HOSP (SUB) .............................. D
SVP ........................................................ E
SVA .........................................................F
FAP......................................................... G
DON’T KNOW/DON’S REMEMBER........ H
OTHER SOURCES
TRADITIONAL PRACTITIONER………….I
SHOP………………………………………...
J
PHARMACY…………..……………………K
COMMUNITY DISTRIBUTORS………….L
FRIEND/RELATIVE……………………….M
OTHER _________________________ N
(SPECIFY)
30A Take sick child to health facility / health provider If any from answers A-G ……………….1
Another ………………………………….2
31 Who decided that you should go there for (NAME=S) illness?
RECORD ALL MENTIONED.
RESPONDENT ....................................... A
HUSBAND/PARTNER............................. B
RESPONDENT=S MOTHER ..................C
MOTHER-IN-LAW...................................D
FRIENDS/NEIGHBORS .......................... E
OTHER _________________________ F
(SPECIFY)
32
Which medicines were given to (NAME) ?
RECORD ALL MENTIONED
NOTHING ............................................... A
ASPIRIN ................................................. B
PANADOL............................................... C
AMOXICILLINE....................................... D
ERITHROMICINE ................................... E
AZITROMICIN..........................................F
OTHER_________________________ G
(SPECIFY)
DON’T KNOW......................................... H
33
What are the signs/symptoms of respiratory infection that would cause
you to take (name of child) to a health facility?
RECORD ALL MENTIONED
FAST OR DIFFICULT BREATHING…….A
CHEST INDRAWING……………………..B
LOSS OF APPETITE……………………..C
FEVER……………………………………..D
COUGH…………………………………….E
OTHER _________________________ F
(SPECIFY)
DON’T KNOW......................................... G
34 When (NAME) had an illness with a cough, did you breastfeed him/her
less than usual, about the same amount, or more than usual?
LESS........................................................1
SAME.......................................................2
MORE......................................................3
CHILD NOT BREASTFED........................4
DON=T KNOW.......................................88
35 When (NAME) had an illness with a cough, was he/she offered less
than usual to drink, about the same amount, or more than usual to
drink?
LESS........................................................1
SAME.......................................................2
MORE......................................................3
NOTHING TO DRINK...............................4
DON=T KNOW.......................................88
36 Was (NAME) offered less than usual to eat, about the same amount,
or more than usual to eat?
LESS........................................................1
SAME.......................................................2
MORE......................................................3
NOTHING TO EAT...................................4
DON=T KNOW.......................................88
6
Home Care
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
37
Has (NAME) had any other illnesses at any time in the last two weeks? YES ........................................................ 1
NO .......................................................... 2
DON=T KNOW........................................ 8
41
41
38 When (NAME) had this illness, did you breastfeed him/her less than
usual, about the same amount, or more than usual?
LESS........................................................1
SAME.......................................................2
MORE......................................................3
CHILD NOT BREASTFED........................4
DON=T KNOW.......................................88
39 When (NAME) had this illness, was he/she offered less than usual to
drink, about the same amount, or more than usual to drink?
LESS........................................................1
SAME.......................................................2
MORE......................................................3
NOTHING TO DRINK...............................4
DON=T KNOW.......................................88
40 Was (NAME) offered less than usual to eat, about the same amount,
or more than usual to eat?
LESS........................................................1
SAME.......................................................2
MORE......................................................3
NOTHING TO EAT...................................4
DON=T KNOW.......................................88
41 Who are deciding that you should go there for (NAME=S) illness?
RECORD ALL MENTIONED.
RESPONDENT ....................................... A
HUSBAND/PARTNER............................. B
RESPONDENT=S MOTHER ..................C
MOTHER-IN-LAW...................................D
FRIENDS/NEIGHBORS .......................... E
OTHER _________________________ F
(SPECIFY)
Prenatal Care
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
42
Did you see anyone for prenatal care while you were pregnant with
(NAME)?
IF YES: Whom did you see?
Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS
MENTIONED BY THE MOTHER.
OBLAST HOSPITAL................................ A
CENTRAL RAYON HOSPITAL................ B
CENTRAL RAYON POLYCL................... C
RURAL HOSP (SUB) .............................. D
SVP......................................................... E
SVA......................................................... F
FAP.........................................................G
TRADITIONAL PRACTITIONER ............. H
OTHER__________________________ I
(SPECIFY)
NO ONE...................................................J ──45
43
How many times did you see someone for care during (NAME)’s
pregnancy? NUMBER OF TIME……………………{ }
44
During your prenatal check, were you counseled on the following: YES NO
Delivery preparations......................1 2
Breastfeeding.................................1 2
Child spacing/FP ............................1 2
EPI .................................................1 2
Danger signs of pregnancy.............1 2
STI Prevention ...............................1 2
45
When you were pregnant with (NAME) did you take iron tablets? YES......................................................... 1
NO .......................................................... 2
DON=T KNOW.........................................8
46
How far are you from the nearest health facility? METER …………………..[___ / ___ / ____]
Km……………………..[___ / ___ / ____]
46A
Classification of distance 5 km and less……………………………..1
5 km and more……………………………2
DON=T KNOW…………………………….3
7
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
47
How would you get there?
RECORD ALL RESPONSES.
WALK...................................................... A
CAR ........................................................ B
ANIMAL................................................... C
BICYCLE................................................. D
TRACTOR............................................... E
OTHER__________________________ F
(SPECIFY)
48
How long would it take you to get there? LESS THAN 1 HOUR...............................1
1 TO 3 HOURS ........................................2
MORE THAN 3 HOURS ...........................3
DON=T KNOW.........................................8
49
Who would decide that you should go there, in case of health needs?
RECORD ALL MENTIONED.
RESPONDENT ....................................... A
HUSBAND/PARTNER............................. B
RESPONDENT=S MOTHER................... C
MOTHER-IN-LAW ................................... D
FRIENDS/NEIGHBORS .......................... E
OTHER _________________________ F
(SPECIFY)
DON=T KNOW……………………………G
50
What are the symptoms during pregnancy indicating the need to seek
health care?
RECORD ALL MENTIONED.
CONVULSIONS .......................................1
HEAVY AND CONTINUOUS VOMITING..2
VAGINAL BLEEDING...............................3
SEVERE ABDOMINAL PAIN....................4
FEVER.....................................................5
FOUL SMELLING DISCHARGE...............6
DIMINUTION OR STOPPING
MOVEMENTS OF FETUS........................7
SWELLING OF THE
BODY/HANDS/FACE …………………..8
HEADACHE ……………………..………..9
EARLY WATER BREAK………………..10
SHORTNESS OF BREATH....................11
OTHER__________________________12
I
(SPECIFY)
DON=T KNOW.......................................13
50A Named danger signs 2 signs………………..………………….1
3 and more………………………………2
Less than 2………………………………3
51
Where is the first place you would you go for care if you had these
symptoms?1
OBLAST HOSPITAL................................ A
CENTRAL RAYON HOSPITAL................ B
CENTRAL RAYON POLYCL................... C
RURAL HOSP (SUB) .............................. D
SVP......................................................... E
SVA......................................................... F
FAP.........................................................G
TRADITIONAL PRACTITIONER ............. H
DON’T KNOW/DON’T REMEMBER ..........I
OTHER _________________________ ..J
(SPECIFY)
8
Delivery and Delivery Attendants
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
52
Where did you give birth? OBLAST HOSPITAL................................ A
CENTRAL RAYON HOSPITAL................ B
CENTRAL RAYON POLYCL................... C
RURAL HOSP (SUB) .............................. D
SVP......................................................... E
SVA......................................................... F
FAP.........................................................G
DON’T KNOW/DON’T REMEMBER ........ H
OTHER _________________________ ..I
(SPECIFY)
53 Who assisted you with (NAME=S) delivery? 1
RECORD ALL MENTIONED.
HEALTH PROFESSIONAL
DOCTOR ............................................. A
NURSE/MIDWIFE................................ B
TBA/MOMO......................................... C
OTHER _________________________ D
(SPECIFY)
54
Where was (NAME) put immediately after birth? UPON THE MOTHER ............................. A
BESIDE THE MOTHER........................... B
INFANT BED/SWADDLE TABLE ............ C
BATHED ................................................. D
TAKEN TO ANOTHER ROOM ................ E
OTHER _________________________ ..F
(SPECIFY)
DON’T KNOW/DON’T REMEMBER…….G
54A
55
55
55
55
55
55
54A How much time after birth? IMMEDIATELY/WITHIN 30 MINUTES OF
FIRST HOUR AFTER DELIVERY………1
AFTER THE FIRST HOUR...................... 2
Postpartum Care
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
55
After (NAME) was born and you left the hospital, did anyone
check on your health again?
YES ......................................................... 1
NO........................................................... 2  58
56
How many days or weeks after you left the health service for
delivering did the first check take place?
RECORD >00' DAYS IF SAME DAY.
DAYS AFTER DEL………………….. { } ░░
WEEKS AFTER DEL……………….. { }
DON=T KNOW ........................................ 0
57
Where did you go for the health checks? 1 OBLAST HOSPITAL…………………………….A
CENTRAL RAYON HOSPITAL………………..B
CENTRAL RAYON POLYCL…………………..C
RURAL HOSP (SUB)…………………..……...D
SVP………………………………………………E
SVA………………………………………………F
FAP………………………………………………G
DON’T KNOW/DON’T REMEMBER………….H
OTHER _________________________..........I
(SPECIFY)
58 At that time, did the person check on (NAME)=s health as well? YES ......................................................... 1
NO........................................................... 2
59
During your postpartum check, were you counseled on the
following?
RECORD ALL MENTIONED
BREASTFEEDING……………………………...A
LACTATIONAL AMENORRHEA METHOD
(LAM)………………………………….…………B
FAMILY PLANNING…………………………...C
OTHER _________________________.........D
(SPECIFY)
DID NOT COUNSELED………………………..E
60 After (NAME) was born, did you start to use a method of family
planning?
YES……………….……………………………..1
NO……………………….………………………2 finish
61 Did you start to use the method within the first 6 weeks of after
the first 6 weeks following (NAME’s) birth?
6 WEEKS OR EARLIER……………….………1
7 WEEKS OR LATER…………………….……2
DON’T KNOW…………………………………..3
DON’T APPLY…………………………………..4
9
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
62 Which method are you (or your husband/ partner) using? FEMALE STERILIZATION………..……1
MALE STERILIZATION……………..…2
PILL……………………………………....3
IUD……………………………………….4
INJECTABLES…………………………5
IMPLANTS………………………………6
CONDOM……………………………….7
FEMALE CONDOM………………….…8
DIAPHRAGM…………………………..…9
FOAM/JELLY………………………….…10
LACTATION AMEN. METHOD……..…11
STANDARD DAYS METHOD……….…12
PERIODIC ABSTINENCE (OTHER
THAN STANDARD DAYS)…….…….13
WITHDRAWAL………………..………..14
OTHER………………………………..…15
(SPECIFY)
THANK YOU!
1
Project HOPE, Navoi, Uzbekistan
FINAL EVALUATION.
Questionnaire 2: Family Planning
All questions are to be addressed to a woman of reproductive age
(15-49 years old)
Identification number: ……………………………………………………..[____ / ____ / ____]
Rayon (1= Karmana; 2=kiziltepa;3=Konimeh ; 4=Nurota)
Mahallla’s name……………………………………………………
Cluster number…………………………………………………….
……………………………………………………………………….[ ]
____________________________________________________
…………………………………………………………………….[ / ]
Interview date (day/month/year)………………………………… ……………………………………………………[____ / ____ / ____]
Informed Consent
Hello, my name is ______________________ and I am working for the Navoi Oblast health Department.. We are conducting a survey
about your health. We would very much appreciated your participation in the survey, since this information will help us improve the existing
health services. The survey is going to take us about 30 minutes to complete
Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions.
All discussed information will be keep confidentially.
At this time, would you like to ask me anything about the survey?
Woman’s Background Characteristics
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Name of woman (interviewee)
___________________________
1 How old were you at your last birthday? AGE IN COMPLETED YEARS [ / ]
2
What is the highest level of school you attended: primary, secondary, or
higher?
PRIMARY……………………………...1
SECONDARY unfinished…………….2
SECONDARY…………………………3
HIGHER………………………………..4
Reproduction and Child Spacing
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
3
Have you ever given birth? YES……………………………………..1
NO………………………………………2  8
4
How many children have you given birth to? Include any children
born alive, including those who cried or showed signs of life but
did not survive.
TOTAL NUMBER OF CHILDREN EVER BORN
ALIVE………………………└───┴───┘
5
How many children living in this household are under five years of
age?
NONE……………………………………...………..0
ONE CHILD………………………………………..1
TWO CHILDREN………………………………….2
THREE OR MORE………………………………..3
 8
 8
6
How many of those children are your biological children? ONE CHILD…………………………………..…… 1
TWO CHILDREN…………………………………..2
THREE OR MORE…………………………….…..3
 8
2
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
7
What is the date of birth of your two youngest children? YOUNGEST CHILD
DATE OF BIRTH
i__i__i i__i__i i___i___i___i___i
DAY MONTH YEAR
SECOND YOUNGEST CHILD
DATE OF BIRTH
i__i__i i__i__i i___i___i___i___i
DAY MONTH YEAR
7A Birth spacing
Less 24 months (23 months 29 days)………………………..1
24 months and more…………………………………………2
8 Are there days in your menstrual cycle when you are most likely to
get pregnant?
YES……………………..…………..…………….1
NO…………………………………………….…..2  10
9
When is a woman more likely to get pregnant between two
menstrual cycles?
JUST BEFORE HER PERIOD BEGINS……….1
DURING HER PERIOD………..………………...2
RIGHT AFTER HER PERIOD HAS ENDED.…3
HALFWAY BETWEEN TWO PERIODS……...4
OTHER_______________________________5
(SPECIFY)
DON’T KNOW……………………………………6
Knowledge and Ever Use of Contraception
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Now I would like to talk about family planning—the various ways or methods that a couple can use to delay or avoid a pregnancy.
ASK THE QUESTION 10 (FIRST COLUMN):
Which ways have you heard about?
FOR EACH METHOD LISTED MENTIONED SPONTANEOUSLY, CIRCLE “1” (YES) IN THE COLUMN C1 TO INDICATE THAT WOMAN
HAS HEARD OF METHOD. THEN PROCEED DOWN THE LIST OF METHODS, READING THE NAME AND DESCRIPTION OF EACH
METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE “1” IN COLUMN C1 IF THE METHOD IS RECOGNIZED, AND CODE “2”
IF NOT RECOGNIZED.
THEN, FOR EACH METHOD WITH CODE “1” IN COLUMN C1, ASK BOTH QUESTIONS C2 AND C3 “DO YOU KNOW OF A PLACE YOU
COULD OBTAIN (METHOD)?” AND “HAVE YOU EVER USED (METHOD)?” FOR BOTH THESE QUESTIONS, CODE “1” IF THE
ANSWER IS “YES” AND CODE “2” IF THE ANSWER IS “NO”.
C1 C2 C3
10
Which ways have you heard about?
PROBE: Have you
heard of (METHOD)?
Do you know where to
obtain (METHOD)?
Have you ever used
(METHOD)?
A
FEMALE STERILIZATION
Women can have an operation to avoid having any
more children
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
B
MALE STERILIZATION
Men can have an operation to avoid having any more
children
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
C
PILL
Women can take a pill every day to avoid becoming
pregnant
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
D
IUD
Women can have a loop or coil placed inside them by
a doctor or nurse
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
E
INJECTABLES
Women can have an injection by a health provider
which stops them from becoming pregnant for one or
more months
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
F
CONDOM
Men can put a rubber sheath on their penis before
sexual intercourse
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
G
FOAM OR JELLY
Women can place a suppository, jelly, or cream in their
vagina before intercourse
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
3
H
LACTATIONAL AMENORRHEA (LAM)
Up to 6 months after childbirth, a woman can use a
method that requires that she breastfeeds frequently,
day and night, and that her menstrual period has not
returned
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
I
STANDARD DAYS METHOD
A woman who is sexually active abstains (or uses a
condom) on days 8 through day 19 each menstrual
cycle
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
J
RHYTHM OR PERIODIC ABSTINENCE
Every month that a woman is sexually active can avoid
pregnancy by not having sexual intercourse on the
days of the month she is most likely to get pregnant
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
K
WITHDRAWAL
Men can be careful and pull out before ejaculation
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
L
EMERGENCY CONTRACEPTION
Women can take pills up to three days after sexual
intercourse to avoid becoming pregnant
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
M
Have you heard of any other ways or methods that
women or men can use to avoid pregnancy?
YES……………….1 
NO………………..2
If yes,
___________________
(SPECIFY)
YES……………….1
NO………………..2
YES……………….1
NO………………..2
10A Number of known methods 3 and more………………………………..1
Less than 3 ……………………………….2
Access to Family Planning
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
11 Please tell me where could I obtain a method of family planning in your
community
RECORD ALL MENTIONED.
OBLAST HOSPITAL……………………A
CENTRAL RAYON HOSPITAL………..B
CENTRAL RAYON POLYCLINIC……..C
RURAL HOSP (SUB)…………………..D
SVP………………………………………E
SVA………………………………………F
FAP………………………………………G
DON’T KNOW/DON’T REMEMBER….H
OTHER ________________________I
(SPECIFY)
H 14
12
How far away from your home is the place you can obtain a method of
family planning: 5 kms or less or more than 5 kms?
5 KMS OR LESS ……………………1
MORE THAN 5 KMS………………..2
DON’T KNOW……………………… 3
13
How long does it take you to get to the place where you can obtain a
method of family planning?
LESS THAN 1 HOUR….………….. 1
1 HOUR UP TO TWO HOURS…….2
2 HOURS UP TO 4 HOURS……….3
MORE THAN 4 HOURS……………4
Desire for Future Children
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
14
Are you currently pregnant? YES……………………………………….1
NO………………………………………...2
UNSURE…………………………………8
 31
15
Do you want to have a/another child? YES…………..…………………………..1
NO………………..………………………2
DON’T KNOW………..…………………8
 17
 17
16
When do you want to have your next child? WITHIN 2 YEARS………..……………..1
MORE THAN 2 YEARS FROM NOW...2
UNSURE WHEN………………………..8
4
Current Use of Family Planning
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
17
Are you currently doing something or using any
method to delay or avoid getting pregnant?
YES………………………………….1
NO………………………………….. 2
 19
18
Can you please tell me the reason you are not using
a method?
RECORD ALL MENTIONED
NOT MARRIED……………………………………………A
FERTILITY-RELATED REASONS NOT HAVING
SEX……………………………………..…………………B
INFREQUENT SEX .…………………………………….C
MENOPAUSAL/HYSTERECTOMY………………….…D
SUBFECUND/INFECUND…………………………..…..E
POSTPARTUM AMENORRHEIC………………….......F
BREASTFEEDING………………………………………G
FATALISTIC…...…………………………………………H
RESPONDENT OPPOSED……………………….…….I
HUSBAND/PARTNER OPPOSED…………………….J
OTHERS OPPOSED……………………………………K
____________________________________
(SPECIFY)
RELIGIOUS PROHIBITION……………………….…….L
KNOWS NO METHOD……….…………………..…….M
KNOWS NO SOURCE………………………………….N
METHOD-RELATED REASONS/ HEALTH
CONCERNS……………………………………………..O
FEAR OF SIDE EFFECTS……………………….…… P
LACK OF ACCESS/TOO FAR…………………………Q
COSTS TOO MUCH…………………………………….R
INCONVENIENT TO USE………………………………S
INTERFERES WITH BODY’S NORMAL
PROCESSES……………………………….…….………T
OTHER________________________U
(SPECIFY)
After all
answers
Skip to 31
19
Which method are you (or your husband/ partner) using? FEMALE STERILIZATION…..……….……A
MALE STERILIZATION……..………….….B
PILL…………………………..……………..C
IUD………………………….….……………D
INJECTABLES……………….…………….E
CONDOM…………………………………..F
FOAM/JELLY…………………….…..…….G
LACTATIONAL AMEN. METHOD…...…..H
STANDARD DAYS METHOD…….………I
PERIODIC ABSTINENCE (OTHER
THAN STANDARD DAYS)…….…….….M
WITHDRAWAL………………..…………..N
OTHER___________________________O
(SPECIFY)
 20
 21
 22
 22
 22
 26
 26
 26
 26
 27
 27
20
Before your sterilization, were you told that you could not have any
(more) children because of your operation?
YES………………………………….………..1
NO…………………………………………..…2
 22
 22
21
Before the sterilization operation, was your husband (or partner) told
that he would not be able to have any (more) children because of the
operation?
YES………………………………….………..1
NO…………………………………………..…2
DON’T KNOW……………………3
 25
 25
 25
22
At the time you first started to use (CURRENT METHOD), were you
told about side effects or problems you might have with the method?
IF STERILIZED, ASK:
At the time you were sterilized, were you told about side effects or
problems you might have with the operation?
YES……………………….………….………..1
NO…………………………………………..…2  25
23
Were you ever told by a health or family planning worker about side
effects or problems you might have with the method?
YES………………………………….………..1
NO…………………………………………..…2
24
Were you told what to do if you experienced side effects or problems? YES………………………………….………..1
NO…………………………………………..…2
25
Were you told when you should return for follow-up (or when
someone should be back to see you?)
YES……………………………..….………..1
NO…………………………….…………..…2
5
26
When you obtained (CURRENT METHOD) from (SOURCE OF
METHOD) were you told about other methods of family planning that
you could use?
IF USING LAM OR STANDARD DAYS METHOD, ASK: “When you
first learned (METHOD) were you told about other methods of family
planning that you could use?”
YES………………………………….………..1
NO…………………………………………..…2
27
Were you ever told by a health or family planning worker about other
methods of family planning that you could use?
YES………………………….……….………..1
NO…………………………………………..…2
28
For how long have you (or your husband/partner) been using
(CURRENT METHOD) now without stopping?
PROBE: In what month and year did you start using (CURRENT
METHOD) continuously?
IF STERILIZED, ASK: In what month and year was the sterilization
performed?
i__i__i i__i__i i___i___i___i___i
DAY MONTH YEAR
WRITE >44' IN >DAY= COLUMN IF DON’T
KNOW/DON’T REMEMBER
29
Where did you obtain (CURRENT METHOD) when you started using
it?
IF THE WOMAN OR HER HUSBAND/PARTNER WAS STERILIZED,
ASK:
Where were you (your partner) sterilized?
IF THE WOMAN IS USING LAM OR THE STANDARD DAYS
METHOD, ASK:
Where did you learn to use your method?
OBLAST HOSPITAL……………………A
CENTRAL RAYON HOSPITAL………..B
CENTRAL RAYON POLYCLINIC……..C
RURAL HOSP (SUB)…………………..D
SVP………………………………………E
SVA………………………………………F
FAP………………………………………G
DON’T KNOW/DON’T REMEMBER….H
OTHER ________________________I
(SPECIFY)
30
Before using (CURRENT METHOD), did you ever use another
method of family planning?
YES……………….………………….………..1
NO…………………………………………..…2
Diffusion of Family Planning Messages
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
31
In the past 12 months, have you discussed family planning with your
husband or partner, friends, neighbors, or relatives?
YES………………………………………1
NO………………………………………..2  33
32
With whom?
Anyone else?
RECORD ALL PERSONS MENTIONED
HUSBAND/PARTNER…………………A
MOTHER………………………………..B
FATHER……………………………… C
SISTER(S)………………………………D
BROTHER(S)………………………… E
DAUGHTER…………………………..F
SON…………………………………… G
MOTHER-IN-LAW……………………..H
FRIENDS/NEIGHBORS……………….I
MAHALLA ACTIVISTS………………..J
OTHER…………………………………..K
(SPECIFY)
33
In the past 12 months, have you discussed the number of children that you
want with your husband or partner?
YES………………………………………1
NO………………………………………...2
DOES NOT HAVE HUSBAND/PART…3
34
In the past 12 months, were you visited by a community health
worker/promoter or did staff member at the health facility (during visiting of
health facility) talked to you about family planning?
YES………………………………………1
NO………………………………………..2
35
In the past 12 months, have you visited a health facility for care for yourself
(or your child?)
YES………………………………………1
NO………………………………………..2
6
36
In the past month, have you seen or heard any messages about family
planning from the following means? RECORD ALL MENTIONED
RADIO?
NEWSPAPER?
TELEVISION?
HEALTH FAIR?
RADIO……………………………………A
NEWSPAPER…………………………..B
TELEVISION……………………………C
HEALTH FAIR………………………….D
NO………………………………………..E
OTHER…………………………………..F
(SPECIFY)
Sexual Activity
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
37 Are you currently married or living with a man?
YES, CURRENTLY MARRIED……….1
YES, LIVING WITH A MAN.…………..2
.
NO, …………………..…………………3
REFUSED TO ANSWER …………….4  42
38
When was the last time you had sexual intercourse?
RECORD ‘YEARS AGO’ ONLY IF LAST INTERCOURSE WAS ONE OR
MORE YEARS AGO. IF 12 MONTHS OR MORE, RECORD ANSWER IN
YEARS
DAYS AGO……………….1
WEEKS AGO……………..2
MONTHS AGO…………..3
YEARS AGO……………..4
39
What is your relationship to the man with whom you last had sex? SPOUSE/COHABITATING
PARTNER………………………….1
MAN IS BOYFRIEND/FIANCE…..2
BELOVED PERSON……………..3
CASUAL AQUAINTANCE………..4
PROSTITUTE…………………….5
OTHER________________________6
(SPECIFY)
40
The last time you had sex, was a condom used? YES…………………………………1
NO …………………………………..2  42
41
What was the main reason a condom was used on that occasion? TO PREVENT STI/HIV…..…………… 1
TO PREVENT PREGNANCY…………2
TO PREVENT BOTH STI/HIV
AND PREGNANCY…………………….3
DOESN’T TRUST PARTNER/
PARTNER HAS OTHER PARTNERS..4
PARTNER INSISTED…………………..5
OTHER _______________________ 6
(SPECIFY)
DON’T KNOW…………………………..7
REFUSED TO ANSWER………………8
7
Sexually Transmitted Infections
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
42
Have you heard about infections that can be transmitted
through sexual intercourse?
YES………………………………….……………………….1
NO…………………….………….…………………………..2  50
43
What kind of STIs do you know? GONORRHEA………………………………………….……A
SYPHILIS……………………………………………...…..…B
GENITAL HERPES………………………………...…….…C
HEPATITIS…………………………………………………..D
CHLAMYDIA……..…….…………………………………...E
HIV/AIDS……………………………………………….…….F
OTHER___________________________________ G
(SPECIFY)
Don’t know………………………………………………H
44
In a male or female, how do you know that he/she has such an
infection?
Any others?
RECORD ALL MENTIONED
LOWER ABDOMINAL PAIN………….………….………..A
GENITAL DISCHARGE/DRIPPING………….…………...B
FOUL SMELLING DISCHARGE………….……………….C
BURNING PAIN ON URINATION………….……………D
FREQUENT URINATION………..………….………….….E
REDNESS/INFLAMMATION IN GENITAL AREA…….…F
PAIN/SWELLING IN GENITAL AREA…………….……G
GENITAL SORES/ULCERS………….………….………H
GENITAL WARTS………….………….………….………..I
BLOOD IN URINE………….………….…………………..J
IMPOTENCE………….………….………….……………..K
INFERTILITY ………….………….………….……………..L
OTHER _____________________________________M
(SPECIFY)
DON’T KNOW………….………….…………...………….N
45 Named symptoms 3 and more………………………………..1
Less than 3 ……………………………….2
46 Where could patient with STI go to be treated for such an
infection?
Any others?
CIRCLE ALL MENTIONED.
PRIVATE HOSPITAL………….………….………………...A
DISTRICT HOSPITAL………….………….……………….B
PRIVATE PRACTITIONER……….………….……………C
SVP (RURAL MEDICAL PUNCT) ………….……………..D
POLYCLINIC……………………..………….………………E
SUB…………………………………………….…………….F
SVA………………………………….………….………….…G
FAP………….………….………….………….……………...H
TRADITIONAL PRACTITIONER.………..…………..…….I
TBA………….………….………….………….………..…….J
VENEREAL DISPENSARY……....………….………..…..K
GYNECOLOGIST…..……………………………………...L
REPRODUCTIVE CENTER……………………..………M
OTHER_____________________________________N
(SPECIFY)
DON’T KNOW……………………..………….………….O
47 Is there anything a male or female can do to avoid getting an
STI?
YES………………………………….……..……………….1
NO…………………….………….………..………………..2
DON’T KNOW..…………….………………………………8
48 How can you avoid getting an STI?
Anything else?
CIRCLE ALL MENTIONED.0
0ABSTAIN FROM
SEX…………….…………….…………..A
USE CONDOMS…………….…………….………………..B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO
ONE PARTNER………………….…………….……….…...C
AVOID CONTACT WITH PROSTITUTES………………D
AVOID CASUAL SEX………………. ……………………...E
AVOID SEX WITH PERSONS WHO HAVE MANY
PARTNERS…………….…………….…………….………..F
AVOID SHARING RAZORS,BLADES……………………G
OTHER ______________________________________H
(SPECIFY)
DON’T KNOW…………….…………….……..……………I
8
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
49 Named methods 2 and more………………………………..1
Less than 2 ……………………………….2
HIV/AIDS
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
50
Have you ever heard about HIV/AIDS? YES………………………………….……….……………….1
NO…………………….………….………….………………..2  57
51
Do you know transmission ways of HIV/AIDS? SEXUAL WAY…………..………..………..………..………..A
BLOOD TRANSFUSION…………..………..…………….…B
FROM MOTHER TO CHILD…………..…….…..………..…C
OTHER_______________________________________D
(SPECIFY)
DON’T KNOW………..………..………..………..…………E
51A Named ways If named two ways from the answers A,B,C…………….1
Less than 2…………………………………………………2
52 Can the virus that causes AIDS be transmitted from a mother
to a child?
YES...........................................................1
NO…………………………………………. 2  54
53
How the virus can be transmitted from a mother to a child?
RECORD ALL MENTIONED.
During pregnancy………………………….A
During delivery…………………………….B
During breastfeeding……………………..C
53A If mother is HIV positive is it possible to avoid her child from
HIV infection
YES...........................................................1
NO.............................................................2
DON’T KNOW ..........................................8
54
Is there anything a person can do to avoid getting AIDS or the
virus that causes AIDS?
YES...........................................................1
NO.............................................................2
DON’T KNOW ..........................................8
 56
 56
55 What can a person do?
Anything else?
RECORD ALL MENTIONED.
ABSTAIN FROM SEX……………………………….…….A
USE CONDOMS……………………………………….…..B
LIMIT SEX TO ONE PARTNER......................................C
AVOID SEX WITH PROSTITUTES……..…………….…D
AVOID SEX WITH PERSONS WHO HAVE MANY
PARTNERS ……………………………………..………...E
AVOID CONTACTS WITH NARCOTICS USERS……..F
AVOID CONTACT WITH CONTAMINATED BLOOD
NEEDLES FOR INJECTIONS OR TRANSFUSION…. G
AVOID SHARING RAZORS, BLADES…... . . . . …. . . . H
AVOID SEX WTH SAME GENDERS……………………I
AVOID BLOOD TRANFUSION………………..….....J
OTHER ___________________________________ K
DON’T KNOW……………………………………………L
55A Named methods 2 and more………………………………..1
Less than 2 ……………………………….2
56
Can a person who has AIDS be cured? YES..........................................................1
NO............................................................2
DON’T KNOW .........................................3
Topics for Health Education
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
57
Where have you received the information about
contraception, HIV/AIDs and STI?
CIRCLE ALL MENTIONED.
HEALTH PROVIDER…………………………………………A
PARENTS…….…………………………………………….…B
FRIENDS........................……………………………………C
RELATIVES……..…………………………………………….D
BROTHER/SISTER……..……………………………………E
BOOKS/LEAFLETS ……………………..……………………F
NEWSPAPERS ……………………..….……………………G
TV ……………………….….………………………………….H
RADIO ………………..……………………..…………………I
TEACHER……………………………………………………..J
MAHALLA ACTIVIST….……………………………………..K
OTHER______________________________________ L
(SPECIFY)
DON’T KNOW/ DON’T REMEMBER……………………..M
9
SECTION: CERVICAL AND BREAST CANCER
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
58 Did you get any routine test of your health
status during last 24 month?
YES ...................................................1
NO.....................................................0  59
58A If yes, what kind? Blood test………….………1
Syphilis test……………….2
Smear test………….….….3
Urine test………….………4
Breast exam…………….…5
Other________________96
Don’t know……….………88
59 Have you ever been screened for Cervical
cancer?
YES ...................................................1
NO…………………………. 0
Don’t know……….………88
 61
60 What kind method/test was used? Vaginal smear test ............................1
Colposcopy .......................................2
Vaginal speculum exam.....................3
Other.__________________________________
_____________________________________96
61 What kind symptoms of the precancerous
lesions of cervix have you heard?
Unknown vaginal bleeding/ grume……………..1
Low abdominal pain ........................................2
Other___________________________________
_____________________________________96
Don’t know……….………88
62 Can such precancerous lesions of cervix
happen without any symptoms in women?
YES ...................................................1
NO………………………………….0
DON’T KNOW…………………….88
63 Do you know about major cause of
cervical cancer?
Viral infection…………………………..1
Other___________________________________
_____________________________________96
Don’t know……….………88
64 Have you had a breast exam during last
12 month made by health provider?
YES ...................................................1
NO…………………………. 0  66
65 Have you referred by health provider for
the X-Ray breast exam during last 2
years?
YES ...................................................1
NO…………………………. 0
66 Did you give yourself a breast exam
during last 12 month?
YES ...................................................1
NO…………………………. 0
THANK YOU FOR PARTICIPATING IN THE SURVEY
1
Project HOPE, Navoi, Uzbekistan
FINAL EVALUATION.
Questionnaire 3: Adolescent Health
All questions are to be addressed to adolescents 16 -18 years of age
Identification number: ……………………………………………………..[____ / ____ / ____]
Rayon (1= Karmana; 2=kiziltepa;3=Konimeh ; 4=Nurota)
Mahallla’s name……………………………………………………
Cluster number…………………………………………………….
……………………………………………………………………….[ ]
____________________________________________________
…………………………………………………………………….[ / ]
Interview date (day/month/year)………………………………… ……………………………………………………[____ / ____ / ____]
Informed Consent
Hello, my name is ______________________ and I am working for the Navoi Oblast health Department. We are conducting a survey about
your health. We would very much appreciated your participation in the survey, since this information will help us improve the existing health
services. The survey is going to take us about 30 minutes to complete
Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions.
All discussed information will be keep confidentially.
At this time, would you like to ask me anything about the survey?
Name of young men or woman (interviewee)………………………..
How old were you at your last birthday?  END IF <16 or > 18
YEARS
Gender (1=male; 2=female)…………………………………………...
____________________________________________________
AGE IN COMPLETED YEARS ………………..………………[ / ]
……………………………………………………………………….[ ]
Respondent’s Information
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
1
Have you ever attended school? YES…………………………………………………….1
NO……………………………………..………………2  7
2
What is the highest level of school you attended: primary,
secondary, or higher?
PRIMARY……………………………………………...1
INCOMPLETE SECONDARY
SECONDARY/SPECIAL SECONDARY……………2
HIGHER………………………………………………..3
3
Do you attend any kind of school/institution now? YES…………………………………….………………1
NO……………………………………………………..2  7
4
Where do you study? SCHOOL…………………………………..………..…1
LICEY………………………..…………………………2
COLLEGE…………………..…………...…………….3
INSTITUTE/UNIVERSITY……………...…………….4
OTHER__________________________________8
(specify)
5 Did you study the lessons on “Healthy life and family”? YES…………………………………….………………1
NO……………………………………………………..2  7
6 Did you study on these lessons the theme on adolescent’s
reproductive health?
YES…………………………………….………………1
NO……………………………………………………..2
Teenage Pregnancy
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
7 Are there any reasons why pregnancy/childbirth should be
avoided when you are a teenager?
YES……………………………………………...………….1
NO…………………….………….……………..…………..2
DON’T KNOW/DON’T REMEMBER…………………..8
 9
 9
2
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
8
What are the reasons? (PROBE Anything else?)
RECORD ALL MENTIONED
HIGH BLOOD PRESSURE………………………….A
QUICK SWELLING………………………B
STOP GROWING OF FETUS……………………….C
EARLY DELIVERY….D
ABORTION……………………………….…E
ANEMIA OF MOTHER AND NEWBORN….F
BORN OF DIFECTIVE BABIES………………G
COMPLICATED DELIVERIES CAN BE CAUSE OF
MATERNAL DEATH……...H
DON’T KNOW……………………..………………….I
OTHER____________________________________J
(SPECIFY)
Knowledge and Ever Use of Contraception
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
9 Are there days in woman’s menstrual cycle when she is most
likely to get pregnant?
YES……………………..…………..…………….1
NO…………………………………………….…..2
DON’T KNOW……………………………………3
 11
 11
10
When is a woman more likely to get pregnant between two
menstrual cycles?
JUST BEFORE HER PERIOD BEGINS……….1
DURING HER PERIOD………..………………...2
RIGHT AFTER HER PERIOD HAS ENDED.…3
HALFWAY BETWEEN TWO PERIODS……...4
OTHER_______________________________5
(SPECIFY)
DON’T KNOW……………………………………8
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Now I would like to talk about family planning—the various ways or methods that a couple can use to delay or avoid a pregnancy.
ASK THE QUESTION 11 (FIRST COLUMN):
Which ways have you heard about?
FOR EACH METHOD LISTED MENTIONED SPONTANEOUSLY, CIRCLE “1” (YES) IN THE COLUMN C1 TO INDICATE THAT WOMAN
HAS HEARD OF METHOD. THEN PROCEED DOWN THE LIST OF METHODS, READING THE NAME AND DESCRIPTION OF EACH
METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE “1” IN COLUMN C1 IF THE METHOD IS RECOGNIZED, AND CODE “2”
IF NOT RECOGNIZED.
THEN, FOR EACH METHOD WITH CODE “1” IN COLUMN C1, ASK BOTH QUESTIONS C2 AND C3 “DO YOU KNOW OF A PLACE YOU
COULD OBTAIN (METHOD)?” AND “HAVE YOU EVER USED (METHOD)?” FOR BOTH THESE QUESTIONS, CODE “1” IF THE
ANSWER IS “YES” AND CODE “2” IF THE ANSWER IS “NO”.
C1 C2 C3
11
Which ways have you heard about?
PROBE: Have you
heard of (METHOD)?
Do you know where to
obtain (METHOD)?
Have you ever used
(METHOD)?
A
FEMALE STERILIZATION
Women can have an operation to avoid having any
more children
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
B
MALE STERILIZATION
Men can have an operation to avoid having any more
children
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
C
PILL
Women can take a pill every day to avoid becoming
pregnant
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
D
IUD
Women can have a loop or coil placed inside them by
a doctor or nurse
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
E
INJECTABLES
Women can have an injection by a health provider
which stops them from becoming pregnant for one or
more months
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
F
CONDOM
Men can put a rubber sheath on their penis before
sexual intercourse
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
G
FOAM OR JELLY
Women can place a suppository, jelly, or cream in their
vagina before intercourse
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
3
H
LACTATIONAL AMENORRHEA (LAM)
Up to 6 months after childbirth, a woman can use a
method that requires that she breastfeeds frequently,
day and night, and that her menstrual period has not
returned
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
I
STANDARD DAYS METHOD
A woman who is sexually active abstains (or uses a
condom) on days 8 through day 19 each menstrual
cycle
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
J
RHYTHM OR PERIODIC ABSTINENCE
Every month that a woman is sexually active can avoid
pregnancy by not having sexual intercourse on the
days of the month she is most likely to get pregnant
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
K
WITHDRAWAL
Men can be careful and pull out before ejaculation
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
L
EMERGENCY CONTRACEPTION
Women can take pills up to three days after sexual
intercourse to avoid becoming pregnant
YES……………….1 
NO………………..2
YES……………….1
NO………………..2
YES……………….1
NO………………..2
M
Have you heard of any other ways or methods that
women or men can use to avoid pregnancy?
YES……………….1 
NO………………..2
If yes,
___________________
(SPECIFY)
YES……………….1
NO………………..2
YES……………….1
NO………………..2
11A Number of known methods 3 and more………………………………..1
Less than 3 ……………………………….2
12 Who should decide what method to use?
CIRCLE ONLY ONE ANSWER
WOMAN…………………………………………………1
MAN………………………………………………………2
BOTH PARTNERS…………………………..………….3
MOTHER-IN-LAW………………………….……………4
RELATIVE……………………………………..…………5
DOCTOR/NURSE………………………….……………6
TBA……………………………………………………….7
OTHER____________________________________8
(SPECIFY)
Initiation of Sexual Life
13
In what age woman and man can start sexual life?
AGE IN YEARS WOMEN ..……………….……[ / ]
AGE IN YEARS MEN..……………….……[ / ]
14
Nowadays, how important is it for a woman to be a virgin until
she gets married?
WOULD YOU SAY IT IS………
IMPORTANT………………...………..……………………..1
NOT IMPORTANT…………………………………………..2
DON’T KNOW………………………..……………………..3
15 Do you know of any sexual intercourse with prostitutes among
your male close friends?
YES……………………………….………………..……….1
NO…………………….………….……………….………..2
Family Planning
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
16
Are you sexually active? YES…………………………………………….………….1
NO…………………….………….………………………..2  21
17
Are you using contraception? YES………………………………….…………………….1
NO…………………….………….………………………..2  21
4
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
18
Which method are you using? FEMALE STERILIZATION……………..….……….……A
MALE STERILIZATION……..…..……..…………….….B
PILL…………………………..………..…………………..C
IUD………………………….….……..……………………D
INJECTABLES…………………………………………….E
IMPLANTS…………………………………………………F
CONDOM………………………………………………....G
FEMALE CONDOM………………………………………H
DIAFRAGM………………………………………………..I
FOAM/JELLY/SPERMICIDES.…..…………………..….J
LACTATIONAL AMEN. METHOD……………….....…..K
STANDARD DAYS METHOD……………….…..………L
PERIODIC ABSTINENCE (OTHER THAN
STANDARD DAYS)… ……………………….……….….M
WITHDRAWAL………………..…………………………..N
OTHER_____________________________________.O
(SPECIFY)
19 Do you know disadvantages of methods you mentioned? YES………………………………….…………………….1
NO…………………….………….………………………..2
20 Did you use the condom during your last sexual contact? YES………………………………….…………………….1
NO…………………….………….………………………..2
21 Could you name the steps of correct using of condom? Should be obtain from the health facility/drugstore……,1
Should pay attention on the warranty period……………2
Packing safety………………………………………………3
Packing should be open by hands, no sharps/nails……4
Using during sexual intercourse ………………………….5
To insure no air inside by fingers…………………………6
Using only during erection of penis……………………….7
To take off more far from female genitals by fingers……8
To avoid spilling of sperm to tie in a bungle and waste..9
To not using Vaseline or any lubricates ………………..10
To use one time only……………………………………11
21A Correctly named steps 6 and more………………………………..1
Less than 6 ……………………………….2
Teenage Pregnancy: Questions only for Girls
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
22
Have you ever been pregnant? YES…………………………………………….………….1
NO…………………….………….………………………..2 25
23
How old were you when you got first pregnancy? AGE IN YEARS..… ……………………………[ / ]
DON’T KNOW..……… ……………………..………….00
24
What was the result of pregnancy? ABORTION …………………………….……..……………1
MISCARRIAGE ……………………….……..……………2
LIVE BIRTH …………………………….……..…………..3
OTHER____________________________________4
(SPECIFY)
DON’T KNOW/DON’T REMEMBER………………….5
Reproductive and sexual rights
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
25 Do you know you had reproductive and sexual rights? YES…………………………………………….………….1
NO…………………….………….………………………..2 27
5
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
26
I am going to read you your reproductive and sexual rights,
please tell me which ones you are familiar with
RECORD ALL MENTIONED
THE RIGHT ON LIFE …………………………………….A
THE RIGHT ON INDIVIDUAL SAFETY AND LIBERTY.B
THE RIGHT ON EQUALITY………………………………C
THE RIGHT ON INDIVIDUAL LIFE………………………D
THE RIGHT ON FREEDOM OF WORLD VIEW……....E
THE RIGHT ON RECEPTION OF INFORMATION AND
KNOWLEDGE……………………………………………..F
THE RIGHT ON FAMILY PLANNING…………………...G
THE RIGHT TO HAVE A CHILD…………………………H
THE RIGHT ON RECEPTION HEALTH SERVICES……I
THE RIGHT ON PROTECTION FROM VIOLENCE……J
OTHERS___________________________________K
(SPECIFY)
DON’T KNOW ……………………..…………………….L
27
Tell me if you agree or disagree with the following statement:
“Having sex while I’m a teenager would be a way to be
popular”
DISAGREE …………………………………....……………1
NOT SURE ……………………….………..….……………2
AGREE …………………………………….……………..…3
28
About how many of your friends have had sexual intercourse? NONE OF THEM………………………………………….1
A FEW OF THEM…………………………………………2
ABOUT HALF OF THEM…………………………………3
MOST OF THEM………………………………………….4
ALL OF THEM…………………………………………….5
DON’T KNOW
Abortion
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
29
In your opinion, how common is abortion in your area among
teenage girls that get pregnant?
NOT COMMON…………………………………………..1
SOMEWHAT COMMON………………………………...2
VERY COMMON…………………………………………3
DON’T KNOW……………………………………………4
30
What are the complications of the abortion? DEATH……………………………………………………..A
STERILITY …………………………………………………B
INFLAMMATORY DISEASES OF GENITAL
ORGANS……………………………………………………C
COMPLICATED DELIVERIES IN FUTURE. …………...D
VAGINAL BLEEDING……………………….…………….E
TO GET INFECTION……………………………………..F
DESTROYING OF MENSES ……………………………G
UTERUS INJURY…………………………………………H
OTHERS____________________________________I
(SPECIFY)
DON’T KNOW……………………..………………………J
Sexually Transmitted Infections
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
31
Have you heard about infections that can be transmitted
through sexual intercourse?
YES………………………………….……………………….1
NO…………………….………….…………………………..2  38
32
What kind of STIs do you know? GONORRHEA………………………………………….……A
SYPHILIS……………………………………………...…..…B
GENITAL HERPES………………………………...…….…C
HEPATITIS…………………………………………………..D
CHLAMYDIA……..…….…………………………………...E
HIV/AIDS……………………………………………….…….F
OTHER___________________________________ G
(SPECIFY)
Don’t know………………………………………………H
6
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
33
In a male, how do you know that he has such an infection?
Any others?
RECORD ALL MENTIONED
LOWER ABDOMINAL PAIN………….………….………..A
GENITAL DISCHARGE/DRIPPING………….…………...B
FOUL SMELLING DISCHARGE………….……………….C
BURNING PAIN ON URINATION………….……………D
FREQUENT URINATION………..………….………….….E
REDNESS/INFLAMMATION IN GENITAL AREA…….…F
PAIN/SWELLING IN GENITAL AREA/SCROTUM……G
GENITAL SORES/ULCERS………….………….………H
GENITAL WARTS………….………….………….………..I
BLOOD IN URINE………….………….…………………..J
IMPOTENCE………….………….………….……………..K
INFERTILITY ………….………….………….……………..L
OTHER _____________________________________M
(SPECIFY)
DON’T KNOW………….………….…………...………….N
33A Named symptoms 3 and more………………………………..1
Less than 3 ……………………………….2
34 In a female, how do you know that she has such an infection?
Any others?
CIRCLE ALL MENTIONED.
LOWER ABDOMINAL PAIN………….………….………..A
GENITAL DISCHARGE/DRIPPING………….…………..B
FOUL SMELLING DISCHARGE………….………………C
BURNING PAIN ON URINATION………….……………..D
FREQUENT URINATION. ………….…………………….. E
REDNESS/INFLAMMATION IN GENITAL AREA………F
PAIN/SWELLING IN GENITAL AREA…………..………..G
GENITAL SORES/ULCERS………….…………..………..H
GENITAL WARTS………….………….………….………..I
BLOOD IN URINE………….………….…….…………….J
INFERTILITY……..……….………….…….………………K
OTHER ___________________________________ L
(SPECIFY)
DON’T KNOW………….………….………….………….M
34A Named symptoms 3 and more………………………………..1
Less than 3 ……………………………….2
35 Where could patient with STI go to be treated for such an
infection?
Any others?
CIRCLE ALL MENTIONED.
PRIVATE HOSPITAL………….………….………………...A
DISTRICT HOSPITAL………….………….……………….B
PRIVATE PRACTITIONER……….………….……………C
SVP (RURAL MEDICAL PUNCT) ………….……………..D
POLYCLINIC……………………..………….………………E
SUB…………………………………………….…………….F
SVA………………………………….………….………….…G
FAP………….………….………….………….……………...H
TRADITIONAL PRACTITIONER.………..…………..…….I
TBA………….………….………….………….………..…….J
VENEREAL DISPENSARY……....………….………..…..K
ADOLESCENTS’ DOCTOR/GYNECOLOGIST…..……..L
ADOLESCENTS’ REPRODUCTIVE CENTER…………M
OTHER_____________________________________N
(SPECIFY)
DON’T KNOW……………………..………….………….O
36 Is there anything a male or female can do to avoid getting an
STI?
YES………………………………….……..……………….1
NO…………………….………….………..………………..2
DON’T KNOW..…………….………………………………8
38
38
37
How can you avoid getting an STI?
Anything else?
CIRCLE ALL MENTIONED.
ABSTAIN FROM SEX…………….…………….…………..A
USE CONDOMS…………….…………….………………..B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO
ONE PARTNER………………….…………….……….…...C
AVOID SEX WITH SEX WORKERS………………………D
AVOID CASUAL SEX………………. ……………………...E
AVOID SEX WITH PERSONS WHO HAVE MANY
PARTNERS…………….…………….…………….………..F
AVOID SHARING RAZORS,BLADES……………………G
OTHER ______________________________________H
(SPECIFY)
DON’T KNOW…………….…………….……..……………I
37A
Named methods 2 and more………………………………..1
Less than 2 ……………………………….2
38 Have you visited any health facility during last 12 months YES…………………………………….……….…………….1
NO…………………….………….…………………………..2
7
HIV/AIDS
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
39
Have you ever heard about HIV/AIDS? YES………………………………….……….……………….1
NO…………………….………….………….………………..2  46
40
Do you know transmission ways of HIV/AIDS? SEXUAL WAY…………..………..………..………..………..A
BLOOD TRANSFUSION…………..………..…………….…B
FROM MOTHER TO CHILD…………..…….…..………..…C
OTHER_______________________________________D
(SPECIFY)
DON’T KNOW………..………..………..………..…………E
40A Named ways If named two ways from the answers A,B,C…………….1
Less than 2…………………………………………………2
41 Can the virus that causes AIDS be transmitted from a mother
to a child?
YES...........................................................1
NO…………………………………………. 2  43
42
How the virus can be transmitted from a mother to a child?
RECORD ALL MENTIONED.
During pregnancy………………………….A
During delivery…………………………….B
During breastfeeding……………………..C
43
Is there anything a person can do to avoid getting AIDS or the
virus that causes AIDS?
YES...........................................................1
NO.............................................................2
DON’T KNOW ..........................................8
 45
 45
44 What can a person do?
Anything else?
RECORD ALL MENTIONED.
ABSTAIN FROM SEX……………………………….…….A
USE CONDOMS……………………………………….…..B
AVOID SEX WITH PROSTITUTES................................C
AVOID CASUAL SEX ………………………………….…D
AVOID SEX WITH PERSONS WHO HAVE MANY
PARTNERS ……………………………………..………...E
AVOID CONTACT WITH CONTAMINATED BLOOD
NEEDLES FOR INJECTIONS OR TRANSFUSION..…F
AVOID SHARING INSTRUMENTS FOR TATTOO
OR PIERCING ………………………………..……...…G
AVOID SHARING RAZORS, BLADES…... . . . . . . . . H
OTHER ___________________________________ I
DON’T KNOW……………………………………………J
45
Can a person who has AIDS be cured? YES..........................................................1
NO............................................................2
DON’T KNOW .........................................8
Topics for Health Education
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
46
Where have you received the information about
contraception, HIV/AIDs and STI?
CIRCLE ALL MENTIONED.
HEALTH PROVIDER…………………………………………A
PARENTS…….…………………………………………….…B
FRIENDS/CLASSMATE.……………………………………C
RELATIVES……..…………………………………………….D
BROTHER/SISTER……..……………………………………E
BOOKS/LEAFLETS ……………………..……………………F
NEWSPAPERS ……………………..….……………………G
TV ……………………….….………………………………….H
RADIO ………………..……………………..…………………I
TEACHER……………………………………………………..J
MAHALLA ACTIVIST….……………………………………..K
PEER EDUCATOR ………………………………..…………L
OTHER______________________________________M
(SPECIFY)
DON’T KNOW/ DON’T REMEMBER……………………..N
47 How do you understand the term Safe sex life?
CIRCLE ALL MENTIONED.
USING CONTRACEPTION METHODS….……..………….A
STAY FAITHFUL TO ONE PARTNER…………..…………B
AVOID SEX WITH SEX WORKERS………….……………C
AVOID CASUAL SEX…………………….………..………...D
OTHER_______________________________________E
DON’T KNOW………………………………………………..F
THANK YOU FOR PARTICIPATING IN THE SURVEY
1
Project HOPE, Navoi, Uzbekistan
FINAL EVALUATION.
Questionnaire 4: BF Interventions
All questions are to be addressed to a mother with a child 0-5, 6-9, 20-23
months of age
Identification number: ……………………………………………………..[____ / ____ / ____]
Rayon (1= Karmana; 2=kiziltepa;3=Konimeh ; 4=Nurota)
Mahallla’s name……………………………………………………
Cluster number…………………………………………………….
……………………………………………………………………….[ ]
____________________________________________________
…………………………………………………………………….[ / ]
Interview date (day/month/year)………………………………… ……………………………………………………[____ / ____ / ____]
Informed Consent
Hello, my name is ______________________ and I am working for the Navoi Oblast health Department. We are conducting a survey
about your health and of your child. We would very much appreciated your participation in the survey, since this information will help us
improve the existing health services. The survey is going to take us about 30 minutes to complete
Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions.
All discussed information will be keep confidentially.
At this time, would you like to ask me anything about the survey?
Name of mother (interviewee)
Age of mother in years
____________________________________________________
…………………………………………………………………….[ / ]
How many children living in this household are under age two?
…………………………………………………………………….[ / ]
Name of youngest child (under 24 months of age)………….
____________________________________________________
Child’s Background Characteristics
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
1 Birth date (day/month/year)……………………………………….
[____ / ____ / ____]
1A
Classification by child’s age 0-5 month.....................................................1
6-9 month.....................................................2
20-23 month..................................................3
Other.. ..........................................................4
2
Breastfeeding and Infant/Child Nutrition
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
2 Did you ever breastfeed (NAME)? YES......................................................... 1
NO .......................................................... 2 ──7
3 How long after birth did you first put (NAME) to the breast?1
IMMEDIATELY/WITHIN FIRST
HOUR AFTER DELIVERY .................... 1
AFTER THE FIRST HOUR ..................... 2
DON=T KNOW........................................ 3
4 During the first three days after delivery, did you give (NAME)
COLOSTRUM?
YES......................................................... 1
NO .......................................................... 2
DON=T KNOW........................................ 8
5 During the first three days after delivery, did you give (NAME) anything
else to eat or drink before feeding him/her breastmilk?
YES......................................................... 1
NO .......................................................... 2
DON=T KNOW........................................ 8
6 Are you currently breastfeeding (NAME)? YES......................................................... 1
NO .......................................................... 2
7
I would like to ask you about the types of liquids and foods that
(NAME) consumed yesterday during the day or at night. Did (NAME)
have. . .
READ EACH OF THE FOLLOWING AND PLACE A CIRCLE EACH
ITEM CONSUMED.
BREAST MILK..........................................A
INFANT FORMULA………………………..B
ANIMAL MILK………………………………C
PLAIN WATER.................................... D
OTHER LIQUIDS.....................................E
MASHED, PUREED, SOLID OR SEMI￾SOLID FOODS........................................F
Anything
else_____________________________G
SPECIFY
8
How many times did (NAME) eat semi-solid (mashed or pureed) food
yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD >7'.
NUMBER OF TIMES…………………{ }
DON=T KNOW……………………………..8
THANK YOU!
74
G. Project Data Sheet Form





75
H. Monitoring Tools
The General Monitoring Results on the “Safe Motherhood” Program
in the Maternal Complex
Check-list
Date__________________ Name of the facility______________________________
Quantity of the
Form № Content implemented criteria Quantity of the
observed criteria
Absolute # %
Form №1
Introduction of the “Safe
Motherhood” program
%
Form №2 Knowledge and skills of
OB/GYNs %
Form №3 Knowledge and skills of
neonatologists %
Form №4 Knowledge and skills of
midwives %
Form №5 Conversation with mother %
Form №6 Existence of proper protocols
and WHO recommendations %
Form №7 Statistics, record
documentation and
epidemiology of the
observation results
%
Form №8 Medical supply of HF
according to WHO
recommendations
%
Form №9 Events on education and
personnel training %
Form №10 Equipping and expenditure of
the materials %
MNC1 Percentage of the normal
deliveries according to WHO
protocols
%
MNC2 Percentage of the complicated
deliveries according to WHO
protocols
%
MNC3 Percentage of women whose
post delivery state is observed
according to WHO
%
MNC4 Percentage of infants whose
post delivery state is observed
according to WHO
%
Total %
Evaluation List of the follow-up Observation of the health facilities on the Hospital IMCI strategy
Date of conduction:……/……./…….. Oblast, rayon……………………………………….
Experts …………………………………….…… Name of the facility ………………………….
№ Indexes-indicators YES=1
NO=0
No need ①
Knowledge of personnel
1 Testing procedure of the medical workers, the average sum on all tested medical workers
(0=<11; 1 score=12-14; 2 scores=15-17; 3 scores=18-20 right answers)
Sorting of children, medicine supply and equipment
2 Emergency aid organized properly for sorting of children (CL 1)
3 The correct rendering of emergency medical aid (CL 2)
4 Existents of main medicines for children in the admission department at the time of
observation (CL 3)
5 Existents of main medicines for children in the children department at the time of
observation (CL 4)
6 Existents of the equipment and expenditure materials for oxygen supply in the admission
department (CL 5)
7 Equipment and the system of oxygen supply are in operational status (CL 6)
8 The main laboratory analyses are carrying out (all 5 types) (CL 7)
Accordance to the standards of IMCI strategies
9 Pneumonia classification (SAF 1)
10 Oxygen prescription (SAF 2)
11 Pneumonia treatment (all stages of severity) (SAF 3)
12 Valid prescription of antipyretic remedies for fever (SAF 4)
13 The children nutrition status is carrying out (SAF 5)
14 General quantity of prescribed remedies and administration way of the medicine (SAF 6)
15 Validity of hospitalization of children with pneumonia (SAF 7)
16 Differentiated diagnostics of the obstructive syndrome (SAF 8)
17 Prescription at the obstructive syndrome (SAF 9)
18 Patients with diarrhea diagnosis or any other diagnosis accompanying dehydrated are
evaluated at the existents of dehydrate syndrome (SAF 10)
19 Rehydration is carried out for Patients with diarrhea diagnosis or any other diagnosis
accompanying dehydrated are evaluated at the existents of dehydrate syndrome (SAF 11)
20 The status of nutrition for children is carried out (SAF 12)
21 The general quantity of prescribed preparations and the way of inputting the prescribed
preparations (SAF 13)
Total: scores
Scores: total right/23*100%
General score in percentage___________
Evaluation List no the Follow-Up Observation of Medical Workers Trained on IMCI
Check-list
Oblast …………………… Rayon……………………………………….
Monitor …………………… Medical Worker……………………………..
Date of conduction:………… Name of the facility…………………………….
Was he/she trained at the special seminar or not?: yes =1 no=0
№ Indexes-indicators YES=1
NO=0
No need ①
Information on the patient evaluation
1 Greeting of the mother
2 Filling up general data of the child.
3 The patient was evaluated correctly by all symptoms of danger
4 The patient was examined by the existents of 3 main symptoms (cough, diarrhea, fever)
5 The patient was examined according to the throat problems
6 The patient was examined according to the ear problems
7 The patient was examined according to nutrition and anemia problems
8 The weight of the patient was examined correctly using growth chart
9 Vaccination status was examined correctly
10 Mothers with children under two years of age were interviewed on the breastfeeding and
additional nutrition.
Skills of medical workers
11 Was the sick child sent to the in-patient health facility IF he/she has had the complicated
classification?
12 Was the patient prescribed IF he needs in oral preparations (antibiotics/ORS/iron
preparations/paracetamol
13 Was the child evaluated and his mother consulted If a sick child is more than 2 and he
needs in nutrition evaluation.
14 Was the mother instructed about the additional fluid and food when the child is sick and
when to return immediately.
Mothers consultation
15 Were the main skills used at the time of consulting: listening and asking
16 Encouragement
17 Recommendations
18 Checking mother’s knowledge
Knowledge of mothers
19 The mothers know how much, how many times and how many days the oral preparation
must be consumed.
Conclusion
20 The correct evaluation of sick child
21 The correct classification of sick child
22 The correct prescription for treatment
23 The consultation is appropriate
24 Appropriate knowledge of mothers
25 Existence of functioning post of oral rehydration
Total evaluation
General score in percentage ……
Evaluation List on the Follow-Up Observation in the Maternal Complexes by the IMPAC Strategy
Date:……/……./…….. Oblast, rayon/city……………………………….
Name of the Maternal Complex.............................................................................………………….
Experts……………..................................................................................……………………….……
№ Indexes - Indicators YES=1
NO=0
Scores
Knowledge of personnel
1 Testing process of medical workers: average sum of all tested medical workers
(0=<20; 1 point=21-25; 2 points=26-30; 3 points=31-36 answers)
Observation of skills of medical workers
2 Skills evaluation of the abdominal aorta squeeze. OBSIM-1
3 Evaluation of the bimanual squeezing of uterus. OBSIM-2
4* Delivery managing skills. OBSIM-3, OBSIM-4
5 Skills of managing of post delivery period, medical examination (of mother and child) and basic care. OBSIM-5
6 Skills of newborn infant examination (<12 hours). OBSIM-6
7 Skills of newborn infant examination (>12 hours). OBSIM-7
8 Evaluation of the manual vacuum aspiration procedure (MVA). OBSIM-8
9* Evaluation skills of executing of bed test OBSIM-9
10 Evaluation skills of the Emmet's operation. OBSIM-10
11 Managing of labor with pelvic presentation of baby. OBSIM-11
12 Vacuum extraction evaluation. OBSIM-12
13* Evaluation of the manual separation of placenta. OBSIM-13
14* Evaluation of the neonatal intensive care. OBSIM-14
15* Skills evaluation on HELLP syndrome. OBSIM-15
16* Skills evaluation on the of baby shoulders dystocia. OBSIM-16
17* Skills evaluation of delivery stimulation.OBSIM-17
18 Skills evaluation of the delivery problem solving by the means of obstetrics pincers adjustment. OBSIM-18
19* Evaluation of managing of the pregnant women with light pre-eclampsia OBSIM-19
20* Evaluation of managing of the pregnant women with complicated pre-eclampsia. OBSIM-20
21* Evaluation of managing of the pregnant women with impending or developed eclampsia. OBSIM-21
22* Skills evaluation of emergency aid while post-delivery bleeding. OBSIM-22
23* Skills evaluation of emergency aid at the septic state. OBSIM-23
Total: quantity of scores
Quantity of scores/24*100%
General indicator in percentage ___________
Evaluation List no the Follow-Up Observation of Medical Workers Trained on Breastfeeding
Check-list
Time of monitoring____/_____/_____ Health Facility name ________________________
Oblast _________________________ Health worker name ________________________
Rayon __________________________ Name of the monitor ________________________
The age of the interviewing child
(in months): ___ ___
Was health worker trained on seminar?:
Yes=1, No=0
№ Indicator
Yes=1, No=0,
Improper 
1 The proper usage of the BF history (BFO7)
2 Has the HP examined the mother’s breasts? (BFO8)
3 Evaluation of the right apposition of the breast? (Was the BF observation form
used? (BFO9)
4 The ability of HP in giving the right and proper advice? (BFO10)
5 The effective usage of communication skills during the consultation (BFO15)
6 HP was tested: (0=<55%; 1=55%-69%; 2=70-84%; 3=85-100%)
7 The mother began breast feeding as soon as she delivered, within first hour. (BFI￾2)
8 Does the mother still continue breastfeeding at the time (BFI-3)
9 Giving complimentary semi-solid (solid) nutrition including breastfeeding (BFI-6)
10 The proper conception of mothers about only breastfeeding term (BFI-7)
11 The immediate skin-to-skin contact of infant and mother within 30 minutes after
delivery. (BFI-9)
12 Visiting the house of the delivered mother within a month by HP (BFI-10)
13 Supporting the proper information and advices on breastfeeding by HP during
home visit. (BFI-12)
14 The effective usage of the book named “ The principles of long and effective
breastfeeding” (item №6)
Total answers 1 and 
Percentage:
%
The items 7 and 11 are not considered while making the total calculation!
(Total score of the correct answers is 14)
14 -----------100% Х= total*100/14= __,_%
Total------- Х
CHund2BF-int
Project HOPE/CS/Navoi Page 1 of 3
QUESTIONNAIRE FOR MOTHERS
WITH CHILDREN UNDER 2
Questionnaire for mothers with children under two years of age at the frame of the monitoring
for breastfeeding program carried out for primary healthcare health providers
NAME OF THE MOTHER SEX OF THE CHILD: (1 = male; 2 = female) 
NAME OF THE CHILD DATE OF BIRTH: _____/______/__________
day month year
AGE OF THE CHILD (in months): ___ ___
(stop the interview if the child’s age is more than two years of age)
CLASSIFICATION ACCORDING TO THE AGE (0-6 months)
(0-23 months)
SECTION A: Background information of the respondent (BI)
NO. Questions and Filters Category Code Skip
BI-1 Level of your education: None............................................................1
Primary........................................................2
Secondary....................................................3
Secondary specialized .................................4
Higher..........................................................5
BI-2 Do you work outside of home?
If “YES”, Where do you work?
Housewife/don’t work.................................1
Permanent work...........................................2
Seasonal work…………………...................3
 BFI-1
BI-3 Who takes care (NAME) when you are away home? Mother / respondent.....................................1
Husband / Partner ........................................2
Older children..............................................3
Relatives______________ ..........................4
(Specify)
Neighbors/ Friends ......................................5
Maid/ Kindergarten ....................................6
others_______________________............96
(specify)
Questionnaire
Identification number__________
FOR OFFICE USE
ONLY RECORD # _ _ _ _
Oblast________________________________
Rayon__________________________________
Name of the facility____________________________
Date _______/______/__________
Full name of the interviewer _________________
Full name of the health provider __________________
INTRODUCTION AND CONSENT
Hi, my name is ___ I work on behalf of the Project HOPE. We are having questionnaire process about maternity
and child health. We would be very glad if you take part in this questioning. I’d like to talk to you about your health. The
information given by you will be very helpful in the planning of the medical service for the population. Usually it takes 10
minutes to answer the questions.
It is up to you to take part in this questionnaire, you can decide if you should answer the question or not. Nevertheless,
we hope you will participate in the questionnaire, because your opinion is very important for us. Are you going to ask us
anything right now? Aren’t you against?
CHund2BF-int
Project HOPE/CS/Navoi Page 2 of 3
QUESTIONNAIRE FOR MOTHERS
WITH CHILDREN UNDER 2
NO. Questions and Filters Category Code Skip
Knowledge and skills on breastfeeding (BF)
BFI-1 Do you ever breastfeed your (NAME)? YES ........................................................ 1
NO.......................................................... 0  BF7
Where and when did you begin breastfeeding your
(NAME)? _____________________________________
_____________________________________
_____________________________________
_____________________________________
BFI-2
Be attentive while listening the answer and mark the
most appropriate answer
AS SOON AS AFTER DELIVERING,
WITHIN FIRST HOUR ........................ 1
NO.......................................................... 0
BFI-3 Do you still breastfeed your (NAME)? YES ........................................................ 1
NO.......................................................... 0
 BF5
BFI-4 If you do not breastfeed, tell the reason of it.
Write the answer.
_____________________________________
_____________________________________
BFI-5 What kind of nutrition did you give to your (NAME)
within the last 24 hours?
Mark only one version without reading the answers
Only breastfeeding ................................. 1
Breastfeeding+ complementary.............. 2
Other food without breastfeeding ........... 3
 BF7
 BF7
BFI-6 If you feed your (NAME) with additional food except
breastfeeding, what kind of consistence is it?
Be attentive while listening the answer and mark the
most appropriate answer
Breastfeeding + semisolid (solid) nutrition..1
Other versions ...................................... ..2
How do you understand the meaning of “Only
breastfeeding? _____________________________________
_____________________________________
_____________________________________
BFI-7
Write the answer and decide if the mother define that
meaning correctly:
YES ........................................................ 1
NO.......................................................... 0
BFI-8 Was your (NAME) put on your abdomen as soon as you
delivered?
YES ........................................................ 1
NO.......................................................... 0  BF10
BFI-9 How long was your baby on your abdomen?
Be attentive while listening the answer and mark the
most appropriate answer
Within 30 minutes of the first hour, the skin￾to-skin contact ...................................... 1
Wrong..................................................... 0
BFI-10 Has the visiting nurse visited you within a month after
you had delivered?
YES ........................................................ 1
NO.......................................................... 0  end
BFI-11 Has the visiting nurse supported you with the information
of breastfeeding?
YES ........................................................ 1
NO.......................................................... 0  end
BFI-12 If she supported you with that information, what
particularly topics did you discuss with her/him? _____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
CHund2BF-int
Project HOPE/CS/Navoi Page 3 of 3
QUESTIONNAIRE FOR MOTHERS
WITH CHILDREN UNDER 2
NO. Questions and Filters Category Code Skip
_____________________________________
_____________________________________
Write the answer and decide if the medical provider gave
proper information about breastfeeding:
YES ........................................................ 1
NO.......................................................... 0
Show the book, brochure
QUESTION YES NO DETAILED ANSWERS
1. Have you ever seen the book
named “The principles of long and
efficient breastfeeding”?
Stop if the answer is “no”.
2. Do you have this very book?
3.How do you like the appearance
and the book itself?
Why?
4.Which part of the book you think is
the most interesting?
If “yes” which one?
5. In your opinion, what other
information we can add in this book?
Or what kind of information we must
cut?
If “yes” which one?
6.For Monitors:
According to the above answers, give
a summary of the efficient usage of
the book and brochure among
mothers.
Thank you!
BFOBS
Project HOPE/CS/Navoi
1
BREASTFEEDING CONSULTATION OBSERVATION FORM
Monitoring date: _____/_______/________ Oblast Rayon
Name of the HP: Name of the facility:
Name of the observer: Date of birth of the child ____/_______/________
Age of the child ___ ___ months Time of the consultation start: ___ ___
INDICATOR Evaluation
BFO1. Identification the nutrition of the child at present time? YES ............................1
NO.............................0
BFO2. Identification the state and activeness of the child? YES ............................1
NO..............................0
BFO3. Identification the pregnancy, delivery, first breastfeeding
experience?
YES ............................1
NO..............................0
BFO4. Identification mother’s state and family planning? YES ............................1
NO.............................0
BFO5. Identification the former experience of breastfeeding? YES ............................1
NO.............................0
BFO6. Identification the attitude and support of family members
towards the BF?
YES ............................1
NO.............................0
BFO7. Identification of the correct usage of BF history (mark
“yes” if from 6 items 4 items were fully carried out)
YES ............................1
NO.............................0
BFO8. Has the health provider examined the breast? YES ............................1
NO.............................0
IMPROPER ...............1
BFO9. Evaluation of the correct apposition for the breastfeeding?
The usage of the BF observation form?
YES ............................1
NO.............................0
BFO10. The ability of HP in giving the right and proper advice? YES ............................1
NO.............................0
Evaluation of communication skills using:
BFO11. Answering and listening? YES ............................1
NO.............................0
BFO12. Encouraging? YES ............................1
NO.............................0
BFO13. Advising? YES ............................1
NO.............................0
BFO14. Checking? YES ............................1
NO.............................0
BFO15. The effective usage of communication skills during the
consultation: (mark “yes” if from 4 items 3 items were
fully carried out correct)
YES ............................1
NO.............................0
The time of consultation end _____________________ DURATION______________
Project HOPE/CS/Navoi 1
Test Questions on Breast Feeding
1. What are the advantages of breast feeding?
2. What are the advantages of mouth milk?
3. What do you understand under exclusive breast feeding?
4. What is the correct time to start feeding a child under exclusive breast feeding with additional
food?
5. Which is the correct way of feeding a child between 6 to 12 months?
6. What is the correct way of feeding a child between one to two years old?
7. Please, name the indicators of the correct breast feeding?
8. Please, name the sings of a child being correctly positioned for the breast feeding
9. What are the reasons for the breast getting rigid?
10. What are the causes of the pain in breast nipple?
11. What are the rules of lactation amenorrhea?
12. Please, name the causes of not having enough milk
13. What would be your advice to a mom to increase the amount of milk?
14. What are the true signs of child not getting enough milk?
COMMUNITY HEALTH PROMOTION PROGRAM IMPLEMENTATION ON
MAHALLA LEVEL
CHECKLIST
Oblast ______________________ Rayon _______________________
Curator _____________________ Fukarollar yig’ini_______________________
Date of conduction ______________ Name of mahalla
_________________________
№
Indicators Yes=1, No=0,
N/a=
1 Appropriate management of registration book (Tool - 1) on educational sessions
conduction
2 Level of knowledge of trained leader (Tool – 2)
(0=<55%; 1=55%-69%; 2=70-84%; 3=85-100%)
3 Level of learning key messages gotten by participants in the sessions (Tool – 3, КМ￾1) (0= 0-19%; 1= 20-39%; 2=40-59%; 3=60-100%)
4 Understanding of given information in the sessions (Tool -3, SI-7)
5 Level of using trainer skills by trained mahalla leader
(Tool – 4, item 1)
6 Level of using interactive method of communication during the sessions
(Tool – 4, item 2)
7 Level of explanation of themes by trained mahalla leader (Tool – 4, item 3)
Total sum of 1 and  /11 and %
Events logbook
# Date Topic Used
methodology* Venue Participants
#
Name, Surname Comments
1.
2.
3.
4.
5.
6.
7.
8.
9.
1.
10.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
2.
13.
* 1- Story without an End; 2 – Video and Discussion; 3 – Photo and Discussion; 4 – Scenic Play and Discussion.
Plan and carrying out of Events. For 6 months
October November December January February March
# Topic Methodology Plan In fact Plan In fact Plan In fact Plan In fact Plan In fact Plan In fact
1* 2** 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2
Story without an
End
Video and
Discussion 1. Exclusively
breastfeeding
Photo and
Discussion
Story without an
End 2.
Breastfeeding and
complementary
feeding Photo and
Discussion
Video and
Discussion
Photo and
Discussion 3. Pneumonia
Story without an
End
Video and
Discussion
Photo and
Discussion 4. Diarrhea
Story without an
End
Photo and
Discussion 5.
Danger signs
during pregnancy
and what is
needed to do
Scenic Play and
Discussion
6. Cycled changes in
our body
Photo and
Discussion
Story without an
End
Video and
Discussion 7. Childbirth spacing
and contraception
Photo and
Discussion
Video and
Discussion 8.
Adolescence and
adolescence age
problems Scenic Play and
Discussion
9.
Complications of
STDs, STDs
prevention
Video and
Discussion
*1-Date of planned/conducted event ** 2-Planned/participated persons number
Navoi, Uzbekistan
M&E.
Instrument 1: Management of registration book on educational sessions conduction.
I.
Method of giving information # Date Topic Place of
conduction
Number of
participants 1 2 3 4
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
1-Story without end; 2 – Video discussion; 3 – Picture discussion; 4 – Sketch playing and discussion
II. Presence of current plan on educational sessions conduction Yes No
1
CHPP: Test for mahalla leaders.
List of questions
1. How do you understand the term “Exclusively breastfeeding”?
2. What answer is not right for explanation of advantages of breastfeeding?
3. How we should correctly feed the baby under 6 months old?
4. Identify the correct answer for feeding of child in age from six months to 1 year.
5. What kind of meal we should give to child in age from 1 year to 2 year?
6. What are the general dangerous sings for child’s life?
7. What answer is not the sign of cold?
8. What kind of signs appearance are evidence necessities of taking child with cold to health provider
urgently?
9. Identify the correct answer for care after child with cold at home.
10. What kind of signs appearance are evidence necessities of taking child with diarrhea to health
provider urgently?
11. Identify the signs of dehydration.
12. Identify the answer for using correct method of Rehydron solution preparation for child with
diarrhea at home.
13. What kind of signs appearance are not evidence necessities to appeal to health provider during
pregnancy?
14. What kind of signs appearance are evidence necessities to appeal woman to health provider in the
period after childbearing?
15. What kind of modern contraception methods do you know?
16. What intergeneric (child spacing) interval should be occur if woman is healthy?
17. In a male, how do you know that he has the STD?
18. In a female, how do you know that she has the STD?
19. What can a male or female do to avoid getting an STD?
20. What days of menstrual period are more likely to get pregnant?
CHPP Int Interview – Eng
Project HOPE
1
Tool – 3
INTERVIEW WITH PARTICIPANT OF EDUCATIONAL SESSION OF CHPP IN
MAHALLA
ID # _________________
Viloyat (Oblast)______________________ Tuman (Rayon)____________________
Date of interview _______/______/________
Name of mahalla ______________________________
Name of fukarolar yig’ini ________________________________
Name of interviewer (monitor)________________________
Informed Consent
Hello, my name is ______________ and I am working for the rayon hokimiyat department of women.
We are conducting a questioning survey regarding community health promotion. We would very much
appreciated your participation in the survey, since this information will help mahalla leaders in planning and
improving activities on community health promotion. The survey is going to take us about 10 minutes to
complete.
Participation in this survey is voluntary and you can choose not to answer any individual question or all
of the questions.
At this time, would you like to ask me anything about the survey?
PREFACE
Your name Your age (In full years) ___ ___
Sex: Female Male
FOR MONITORS:
Define, which target
group aimed for
1. Caretakers for children under 5 years old
2. Females in fertile age
3. Adolescents
SECTION SI: INFORMATION ON EDUCATIONAL SESSIONS CONDUCTION IN MAHALLA
№ Questions and filters Category codes Skip
SI 1
Have you heard about conducting
educational sessions on health
promotion by mahalla leaders?
YES…………………………………1
NO…………………………………..0 If “NO”,
stop the
interview
SI 2
Did you participate in such educational
sessions yourself?
YES…………………………………1
NO…………………………………..0 If “NO”,
stop the
interveiw
SI 3
If “Yes”: When did you participate in
such educational session last time?
(Mark the most appropriate answer)
1. During last 2 weeks
2. During last month
3. During last 1-3 months
4. Other______________
CHPP Int Interview – Eng
Project HOPE
2
№ Questions Answers
SI 4
What’s the last educational session
topic’s name?
(For monitors: Listen the participant’s
answer carefully and mark the most
appropriate answer)
1.Exclusive Breastfeeding
2.Breastfeeding and complementary feeding
3.Pneumonia
4.Diarrhea
5.Dangerous signs during pregnancy and what
need to do
6.About age-specific changes of our body
7.Child spacing and contraception
8.Adolescence and age-related problems
9.Consequences of sexual-transmitted diseases
SI 5
Who conducted the session?
(For monitors: Listen the participant’s
answer carefully and mark the most
appropriate answer)
1. Prepared mahalla leader
2. Health provider
3. Other____________________________
SI 6
In what way the information was given?
(For monitors: Listen the participant’s
answer carefully and mark the most
appropriate answer)
1. Video-demonstration and discussing
2. Story without end
3. Picture discussion
4. Sketch playing and
5. Other___________________________
1. Good
2. Not so good
3. Bad
4.Quite incomprehensible
SI 7 Insofar understandable was the given
information ?
If answer 1 – Good, then mark ………….…1
For others .….................................................0
SECTION KM: DIGESTION OF KEY MESSEGES BY THE PARTICIPANT
What key messages did you learn during last educational session?
(What else?)
(For monitors: enter to needed box and mark the certain key messages)
KM-1
Pregnant women,
mothers with
children, which
are feeding
breastmilk and
their grandmother
or mother in low
For monitors:
count up %
X/4______
Session 1. 2. 3.
1. Mothers, your baby needs ONLY breastmilk for the first 6 months.
No other liquid or food is needed.
2. Mothers your baby wants your breast immediately, give baby
breastmilk within one hour of birth.
3. The volume of your breastmilk producing depends on how often do
you feed with breast; usually each mother can feed her child herself.
4. Usually breastmilk prevents your newborn and young baby from the
dangerous illness. Breastfeeding can also increase the interrelation
between mother and baby and maternal love.
CHPP Int Interview – Eng
Project HOPE
3
Mothers with
children, which
are feeding
breastmilk,
caretakers after
children under 5
For monitors:
count up %
X/3______
Session 4. 5.
1. Mothers, your baby needs ONLY breastmilk for the first 6 months.
After 6 months your baby needs a complimentary feeding.
2. Mothers your baby 6-9 months is ready for more foods. Give
breastmilk and semi-solid foods.
3. Mothers your baby can benefit from breastmilk up to 23 months. Keep
giving breastmilk to your baby until 23 months and give other food 5
times per day.
Caretakers after
children under 5
For monitors:
count up %
X/7______
Session 6. 7. 8.
1. Mothers, fast or difficult breathing, and a sinking chest are danger
signs for pneumonia. If you see these signs, take your child to the
health clinic.
Following signs are the evidence to take your child to the health clinic
urgently.
2. Breathing is fast than usually
3. Child has a difficult or suffocate breathing
4. Child has a sinking low part of chest or abdomen
5. Child has a cough more than 2 weeks
6. Child cannot feeding breast or to drink
7. Child has a very often vomiting
Caretakers after
children under 5
For monitors:
count up %
X/17______
Session 9. 10. 11.
If you see the following signs, take your child to the health provider
urgently. If you can define the showed sings in time and take your
child to the health provider you will save the life and healthy of your
child.
1. Diarrhea
2. Blood in the stool
3. Lethargic or unconscious
4. Vomit everything
5. Fever or feels hot
6. Not able to brestfeed, to drink or drinking poorly
7. Status becomes worse, restless or capricious more than usually
Signs of dehydration:
8. Debility
9. Weakness and drowse
10. Restless, irritable
11. Low volume of urina or tawny coloure of urina
12. Low weight
13. Dry mouth, thirst
14. Sunken eyes
15. Bulging fontanelle
16. Mothers your child NEEDS fluids and food when sick to help
recover quickly. Give more home made fluids and/or
rehydron/ORS for child with diarrhea.
17. For child under 6 months who are feeding breastmilk give boiled
water or rehydron/ORS together with breastmilk
CHPP Int Interview – Eng
Project HOPE
4
Pregnant women
and her family
members
For monitors:
count up %
X/9______
Session 12. 13.
Women, you have to know the following dangerous signs during
pregnancy, if one or more of these signs appear address to health
provider immediately:
1. Convulsions
2. Visual impairment
3. Vaginal bleeding
4. Difficult breathing
5. Headache
6. Quick incipient and evanescent edema
7. Fever
8. Severe abdominal pain
9. Changing in fetus movements
Women in fertile
age, adolescents￾lasses
For monitors:
count up %
X/4______
Session 14.
1. A woman’s most fertile period for getting pregnant is 10th to 17th
days after your last period.
2. A woman’s most fertile period for getting pregnant is the days in
the middle between two menstruations
3. You and your partner can talk about the choices for family
planning together. Your patronage nurse or family doctor can
advise you about family planning choices.Тўлиқроқ
маълумотга эга бўлишни истасангиз патронаж хамшира ёки
шифокорга мурожаат қилинг.
4. You and your partner can talk about the choices for family
planning together. Especially in the days of most fertile period
for getting pregnant.
Women and men
in fertile age,
adolescents
For monitors:
count up %
X/6______
Session 15. 16. 17.
1. Pregnancy of woman in age under 18 or more than 35 can
increase the dangerous for her health and/or for fetus’ health.
2. Families, 24 months is a healthy rest period for mothers between
pregnancies to give a healthy rest to mothers and to have a
healthy child.
3. Pregnancies and then labor more than 4 times could have
dangers for the mothers’ health.
4. There are a lot of safety contraceptive methods. Have counseling
with health providers.
5. The family planning is a responsibility of males and females
both. Each person have to be informed about useful information
related health.
6. Each local health facility have got the following contraceptives:
 Condom
 Tablets
 Injections
 IUD
CHPP Int Interview – Eng
Project HOPE
5
Parents with
children￾adolescents
For monitors:
count up %
X/4______
Session 18. 19.
1. Each parent have to keep in mind that the purpose of sexual
education not pushing adolescents to be sexual active, the purpose is
to prevent the unwanted pregnancy, STI, AIDS infection and other
problems.
2. The most effective and right way to prevent the unwanted
pregnancy, STI, AIDS infection is sexual abstinence or chastity!
3. Prevention of the unwanted pregnancy is usage of contraceptives.
The local health facility have got the following contraceptives:
 Preservatives
 Tablets
 Injections
 IUD
4. It is advised you to read the schoolbook “Adolescents’
reproductive and sexual health” and “Answers for some interesting
to adolescents questions” brochure which is distributed in schools
for your child. These sources of information include the topics
about prevention of unwanted pregnancy, what to do in case of
abortion and other useful information. The responsibility of each
parent is good comprehension of such problems and their
prevention. It is necessary to keep in mind that for adolescent the
most intimate in the light and black days are parents.
Parents with
children￾adolescents
Women and men
in fertile age
For monitors:
count up %
X/17______
Session 20/
General signs of sexually transmitted diseases:
1. Objectionable odor foamy and purulent discharges from the
genitals
2. Burning and itching in the genital area
3. Abnormal vaginal bleeding
4. Rash and warts in the genital area
5. Pain during passing water
6. Pain in the low part of abdomen
7. Headache, weakness, fever
8. Loss weight
For the prevention of the sexually transmitted diseases:
9. Using preservative
10. Abstinence of the sexual intercourse
11. Limitation with the one sexual partner
12. Avoid of the casual sexual relations
13. Avoid of the sexual contacts with
14. Avoid of using of non-sterile medical equipment and shaving
things
15. Avoid of sex during treatment period
16. The purpose of giving information to adolescent on STD and
AIDS is to increase the skills of prevention dangers of STI,
AIDS, to avoid of the unprotected sexual contact. Remind them
the general and prevention ways of the sexually transmitted
diseases.
CHPP Int Interview – Eng
Project HOPE
6
17. It is necessary to underline that the most effective and right way
to prevent the unwanted pregnancy, STI, AIDS infection is
sexual abstinence or chastity!
SI 8 How is possible to improve this sessions? __________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
____________________________
THANK YOU FOR THE PARTICIPATION IN CONVERSATION!
1
Navoi, Uzbekistan
M&E.
Instruments 4: Observation for conduction of educational sessions with community
The Form is used as part of evaluation of mahalla leader’s skills
Oblast:_________________________ Rayon:_______________________________
Date of
conduction:______________________
Name of
mahalla________________________________
Interviewer____________________ Mahalla leader:______________________
Evaluate skills of mahalla leader on the following:
Criteria
Was observed/
unacceptably
«√»
Was not
observed
«√»
ITEM 1 - TRAINER SKILLS
Selection of adequate place for conducting session
Selection of target audience in accordance with theme
Greeting of the session participants
Introducing with: goal and session theme
Telling about session duration
Communication
Motility
Gesticulation
Listening skills
Speech sound level
Intonation
Actor skills
Energy
Stimulation of audience
Communication with difficult participants
Solving a problem with boredom
Work with talkers
Assistance during work small in groups
Encouragement of participants
2
Creating well coordinated process
Giving «key messages»
To show interest in follow up promotion of «key messages» by
listeners
For using 10 steps – 1 point. Total «√» «_____» Point_____
ITEM 2 – USING OF INTERACTIVE METHODS OF TEACHING
ENERGIZERS
MINI - LECTURE
WORK IN SMALL GROUPS
BRAIN STORM
DEMONSTRATION
PRACTICES
CASE STUDY
ROLE PLAYING
GROUP DISCUSSION
USING VISUAL AIDS
DAY SUMMING UP
EXPLANATION (during the session there must be
used at least 3 interactive methods). Total «√» «_____» Point_____
POINT 3 – EXPLANATION OF THEME
Clear knowledge and understanding of a goal of the session
The theme is explained in understandable way
Detail explanation of main paragraphs of the theme
Clear and available answering to the listeners’ questions
Asking questions for defining level of theme understanding
материала
Clear determination of tasks
Using practices on strengthening /repeating of learned themes
Using of summing up method
For using 4 steps – 1 point. Total «√» «_____» Point_____
The evaluation list on the follow-up for the monitoring of Community-IMCI program
Check-list
Time of monitoring____/_____/_____ Health Facility name ________________________
Oblast _________________________ Health worker name ________________________
Rayon __________________________ Name of the monitor ________________________
The age of the interviewing child
(in months): ___ ___
Was health worker trained on seminar?:
Yes=1, No=0
№ Indicators
Yes=1, No=0,
Improper 
Information about child
1 The health of a child was asked (1-1.6)
2 The dangerous symptoms for baby’s life were explained (2-2.4)
3 Applying to a physician at any case of baby’s illness were explained (3-3.4)
4 Treatment the child from cough and cold at home were explained (5-5.5)
5 The rules of preventing cold were explained (6-6.5)
6 Treatment the child from diarrhea at home were explained (8-8-5)
7 The rules of preventing diarrhea were explained (9-9.6)
8 The information about the problems because of the improper feeding were
explained (10.1)
9 Consultation on feeding according to a child’s age were explained (12-14.5)
10 The information about the importance of the vaccination were explained (15)
11 The information about anemia were explained (16-16.3)
12 Using skills and experience while consulting: (the average of 19.1-19.4 is
>75%)
13 HP was tested (examined): (0=<55%; 1=55%-69%; 2=70-84%; 3=85-100%)
Knowledge of mothers
14 Knowledge of mothers on necessity to visit to physician in case if there are
symptoms of the illness and danger of a baby’s life (See: CHUND 5: SC-1)
15 Knowledge of mothers on taking care after a sick child (See:
CHUND 5: RI 7, 8, 9 (VN 7, 8, 9) / (D 4, 5 да – answer: more than usual/3)
16 Using book (point №6)
Total answers 1 и 
Percentage: %
(Number of the correct answers is 18)
18 -----------100% Х= total*100/18= __,_%
Total------- Х
CHUND5RIOBS
Project HOPE/CS/Navoi Page 1 of 3
Consultation Observation form for monitoring of Community-IMCI program
date: oblast rayon
Interviewer : Name of the facility
Full name of the
nurse:
Child’s age ___ ___ month Start time of the consulting: ___ ___
№ Question Answer Code
1 Was the question given about the health of the child? Yes No 1 2
1.1 Difficult breathing / Cough / Cold Yes No 1 2
1.2 Diarrhea Yes No 1 2
1.3 Fever Yes No 1 2
1.4 Ear problems Yes No 1 2
1.5 Sore throat problems Yes No 1 2
1.6 Other problems Yes No 1 2
2 Information on the general symptoms of danger:
2.1 If the child can not drink or breastfeed? Yes No 1 2
2.2 Frequent vomiting? Yes No 1 2
2.3 Convulsions? Yes No 1 2
2.4 Sleeping more than usual or being unconscious? Yes No 1 2
3 Was it explained that a child with any disease should be
delivering to the physician?
Yes No 1 2
3.1 If a child’s condition gets worse? Yes No 1 2
3.2 If he has a high temperature? Yes No 1 2
3.3 If the child can not drink or breastfeed? Yes No 1 2
3.4 If the child’s excrements are liquid and frequent than usual/if
there is blood
Yes No 1 2
4 If a child has a cough and cold? Yes No 1 2
Go
6
4.1 Frequent/Difficult breathing? Yes No 1 2
5 Treatment the child from cold at home conditions:
5.1 Was it explained how to treat/eliminate cough and soften sore
throat?
Yes No 1 2
5.2 Was the dose of paracetamol explained? Yes No 1 2
5.3 Was it explained to drink more liquid than usual? Yes No 1 2
5.4 Was it explained to feed more meals than usual? Yes No 1 2
5.5 Not to give any antibiotics without physician prescription? Yes No 1 2
6 Preventing cold? Yes No 1 2
6.1 Proper nutrition? Yes No 1 2
6.2 To keep distance from sick people? Yes No 1 2
6.3 To wear a child warmly? Yes No 1 2
6.4 Only breastfeeding until 6 months? Yes No 1 2
6.5 To have immunization in proper time? Yes No 1 2
7 If a child has diarrhea? Yes No 1 2
Go
9
7.1 If the excrements is liquid and frequent? Yes No 1 2
CHUND5RIOBS
Project HOPE/CS/Navoi Page 2 of 3
№ Question Answer Code
7.2 If the excrements is with blood? Yes No 1 2
8 Treatment the child from diarrhea at home conditions:
8.1 Continue breastfeeding daily and nightly, frequent and
longer?
Yes No 1 2
8.2 Was it explained to drink more liquid than usual? Yes No 1 2
8.3 Was it explained to feed more meals than usual? Yes No 1 2
8.4 The preparation and usage of rehydron? Yes No 1 2
8.5 Not to give any antibiotics without physician prescription? Yes No 1 2
9 Preventing diarrhea?
9.1 Only breastfeeding until 6 months? Yes No 1 2
9.2 Only give boiled water? Yes No 1 2
9.3 To wash hand after toilet and before having meal? Yes No 1 2
9.4 How to use cup and a tea-spoon? Yes No 1 2
9.5 To fight with insects? Yes No 1 2
9.6 The rules of giving complementary food? Yes No 1 2
10 Nutrition:
(give necessary consultation according to the age of a child)
10.1 The reasons/problems causing wrong feeding? Yes No 1 2
11 0 – 6 months:
11.1 Was the phrase “Only breastfeeding” explained? Yes No 1 2
11.2 Was it explained the advantageous of breastfeeding both for
mother and baby?
Yes No 1 2
12 6 month – 1 year:
12.1 Was it explained the necessity of complementary feeding? Yes No 1 2
12.2 The rules of giving additional food? Yes No 1 2
12.3 How to use payola (cup) and kosacha (bigger cup)? Yes No 1 2
12.4 Effective feeding? Yes No 1 2
12.5 Using local food? Yes No 1 2
12.6 Recommendations on cooking for child? Yes No 1 2
12.7 Was it explained not to give tea? Yes No 1 2
13 1 – 2 year:
13.1 Recommendations on feeding? Yes No 1 2
13.2 Effective feeding? Yes No 1 2
13.3 Using local food? Yes No 1 2
13.4 Recommendations on cooking for child? Yes No 1 2
13.5 Was it explained not to give tea? Yes No 1 2
14 2 year and more:
14.1 Recommendations on feeding? Yes No 1 2
14.2 Effective feeding? Yes No 1 2
14.3 Using local food? Yes No 1 2
14.4 Recommendations on cooking for child? Yes No 1 2
14.5 Was it explained not to give tea? Yes No 1 2
15 The importance of immunization? Yes No 1 2
16 Anemia:
16.1 Problems occurring from anemia? Yes No 1 2
16.2 Preventing anemia? Yes No 1 2
16.3 Was it explained not to give tea? Yes No 1 2
17 Were the consultations given on how to care after baby for
his/her effective developing?
Yes No 1 2
CHUND5RIOBS
Project HOPE/CS/Navoi Page 3 of 3
№ Question Answer Code
18 Was it explained to prevent accidents? Yes No 1 2
19 Using skills and experience while consulting:
19.1 Asking and listening? Yes No 1 2
19.2 Encouragement? Yes No 1 2
19.3 Giving advices? Yes No 1 2
19.4 Examining? Yes No 1 2
The end of the consultation time____ ____ duration ____ ____ (in minutes)
Show the book, brochure
Question Yes No Additional answers
1. Have you ever seen the book
“If I want my baby to be
healthy”?
If “no”-end.
2. Do you have this book?
3. Did you like the appearance
and the book itself?
Why?
4. Which part of this book you
consider the more interesting?
If “yes”, which one?
5. In your opinion what kind of
other information should be added
in this book? Or what kind of
information should be cut out?
If “yes”, which one?
6. For monitoring:
Basing on the above answers for
questions, give a summary of
effective using of handout
materials handed to mothers.
Thank you!
CHUND5RI
Project HOPE/CS/Navoi Page 1 of 4
QUESTIONNAIRE FOR MOTHERS
WITH CHILDREN UNDER 5
The questionnaire for mothers for the monitoring of Community-IMCI program
MOTHER’S NAME ____
AGE (full year) ___ ___
NAME OF THE CHILD ____
SEX OF THE CHILD: (1 = boy; 2 = girl) 
DATE OF BIRTH: _____/______/__________
date month year
AGE OF THE CHILD (in months): ___ ___
(Stop the interview if the child’s age is more than 5)
Additional information
__________________________________
__________________________________
__________________________________
SECTION A: INFORMATION ABOUT THE RESPONDENT (BI)
NO. QUESTIONS AND SELECTORS CATEGORY CODE PASS
BI-1 Level of your education: No education................................................1
Primary ........................................................2
Secondary ....................................................3
Secondary specialized .................................4
Higher education .........................................5
BI-2 Do you work anywhere beside your household?
If “yes”, where?
Housewife/don’t work anywhere.................1
Working constantly......................................2
Working seasonally......................................3
 SC-1
BI-3 Who takes care after your (NAME) when you are at work? Herself .........................................................1
Husband / partner.........................................2
Elderly children ...........................................3
Relatives ______________ .........................4
(identify)
Neighbors / friends ......................................5
Server / in the kindergarten .........................6
others_______________________............96
(identify)
SECTION D: SICK CHILD (SC)
NO. QUESTIONS AND FILTERS CATEGORY CODE PASS
OBLAST ________________________________
RAYON___________________________________
NAME OF THE FACILITY ____________________________
DATE OF THE QUESTIONNAIRE GIVEN _______/______/__________
FULL NAME OF THE MONITOR _________________
FILL NAME OF THE HEALTH PROVIDER __________________
INTRODUCTION AND CONSENT
Hi, my name is ___ I work on behalf of the Project HOPE. We are having questionnaire process about maternity
and child health. We would be very glad if you take part in this questioning. I’d like to talk to you about your health. The
information given by you will be very helpful in the planning of the medical service for the population. Usually it takes 10
minutes to answer the questions.
It is up to you to take part in this questionnaire, you can decide if you should answer the question or not. Nevertheless,
we hope you will participate in the questionnaire, because your opinion is very important for us. Are you going to ask us
anything right now? Aren’t you against?
CHUND5RI
Project HOPE/CS/Navoi Page 2 of 4
QUESTIONNAIRE FOR MOTHERS
WITH CHILDREN UNDER 5
SC-1 Sometimes your baby gets sick and you have to see a
doctor. What symptoms as they occur could be cause to
apply to a doctor immediately?
MARK ALL VERSIONS OF ANSWERS GIVEN TO
THE QUESTION
I DON’T KNOW…….............................................88
IF HE GETS WORSE…............................................1
IF HE CANNOT BREASTFEED OR DRINK….......2
SLEEPING MORE THAN USUAL/ INHIBITION…3
HAVING HIGH TEMPERATURE…......…….……..4
FREQUENT AND DIFFICULT BRETH…….…….5
FREQUENT VOMITING...........................................6
CONVULSIONS……………....….....……………....7
HAVING COGH AND COLD ………………..…….8
FREQUENT AND LIQUID FAECES OR BLOOD IN
THE FAECES…...................................……………..9
OTHERS _______________________________ 96
(identify)
OTHRES _______________________________ 97
(identify)
SECTION RI: RESPIRATORY INFECTION (RI)
NO. QUESTIONS AND FILTERS CATEGORY CODE PASS
RI-1 Have you noticed a cough in your (name) during last two weeks?
YES.............................................................1
NO ..............................................................0
I DON’T KNOW ......................................88
VN1
VN1
RI-2 Have you ever noticed your (name) difficult breathing while
coughing or frequent breathing than usual?
YES.............................................................1
NO ..............................................................0
I DON’T KNOW ......................................88
RI-3 Have you gone to anywhere when your (name) had difficult
breathing while coughing or frequent breathing than usual?
YES.............................................................1
NO ..............................................................0 RI-6
RI-4 After your (name) began coughing when did you go to a doctor?
ON THAT SAME DAY .............................0
THE NEXT DAY .......................................1
TWO DAYS LATER..................................2
3 AND MORE DAYS LATER...................3
RI-5 Who did you apply in order to treat your baby?
MARK ONLY ONE ANSWER
PHYSICIAN ...............................................1
HEALTH PROVIDER................................2
FELDSHER ................................................3
HEALER ………....……....…..........4
FRIEND/RELATIVE .................................5
OTHERS________________________ 96
(IDENTIFY)
I DON’T KNOW/I DON’T REMEMBER 88
RI-6 What did you use to treat your baby from cough??
MARK ALL VERSIONS OF ANSWERS GIVEN TO THE
QUESTION
NOTHING ..................................................1
DRUGS PREPARED AT HOME...............2
MEDICINES OR SYRUP .........................3
INJECTION................................................4
BOILED DRUGA OF HEALER’S
METHODS .................................................5
I DON’T KNOW/I DON’T REMEMBER...88
OTHERS________________________ 96
(identify)
RI-7
When your child (name) had a cough did you breastfeed him/her as
usual, more or less than usual?
LITTLE....................................................... 1
AS USUAL................................................. 2
MUCH ........................................................ 3
I DON’T BREASTFEED............................ 4
I DON’T KNOW ...................................... 88
RI-8
When your child (name) had a cough did you give him/her liquid as
usual, more or less than usual?
LITTLE....................................................... 1
AS USUAL................................................. 2
MUCH ........................................................ 3
I DON’T GIVE LIQUID............................. 4
I DON’T KNOW ...................................... 88
RI-9 When your child (name) had a cough did you feed him/her as usual,
more or less than usual?
LITTLE....................................................... 1
AS USUAL................................................. 2
MUCH ........................................................ 3
I DON’T FEED ..............................4
ONLY BREASTFEEDING .......5
I DON’T KNOW..........................................88
SECTION (VN) WORK OF THE PATRONAG NURSE
NO. QUESTIONS AND FILTERS CATEGORY CODE PASS
CHUND5RI
Project HOPE/CS/Navoi Page 3 of 4
QUESTIONNAIRE FOR MOTHERS
WITH CHILDREN UNDER 5
VN1 When did the patronage nurse visit your house last? DURING THE LAST WEEK.……1
A WEEK BEFORE…………....………2
2 WEEKS BEFORE ……….…………..3
3 WEEKS BEFORE..………………..…4
4 AND MORE WEEKS BEFORE …....5
DIDN’T VISIT……..… ………………6
I DON’T KNOW ……..……………..88
VN3
VN3
VN2 When he visited your place what kind of information did he
give?
COUGH AND COLD …………1
DIARRHEA………….……….……….2
ANEMIA…………….….……………3
NUTRITION…….……………..…….4
DANGEROUS SYMPTOMS .5
I DON’T KNOW …………..88
VN3
What do you do to prevent cough and cold?
PROPERLY FEEDING.........1
ONLY BREASTFEEDING UNTIL 6
MONTH..............................2
TEMPERING THE
BABY….........................................3
KEEP DISTANCE FROM SICK
PEOPLE….........................................4
WEAR HIM IN WARM
CLOTHES...............................5
USE SEPARATE
DISHES…....................6
I DON’T KNOW...................................88
OTHERS________________________ 96
(IDENTIFY)
OTHERS________________________ 97
(IDENTIFY)
VN4 What methods and ways to eliminate and to make the cough
less serious?
BREASTFEEDING. ...............................1
WARM BOILED WATER............2
WARM MINERAL
WATER…....................3
OTHERS________________________ 96
(IDENTIFY)
VN5 What kind of medicines should be taken in order to make the
temperature low?
PARACETAMOL…………… ……1
ASPIRIN……………………… ……2
ANTIBIOTICS………………………..3
INJECTION…….……………… ……4
O DON’T
KNOW……………………….88
OTHERS________________________ 96
(IDENTIFY)
VN6 How much paracetamol do you give to make the temperature
lower?
(evaluate the mother’s answers according to the child’s age)
CORRECT………………………....…1
INCORRECT………………..…………2
I DON’T KNOW …………………….88
If you didn’t enter the section of RI (respiratory infection) ask mother the following questions
VN7 When your child (name) had a cough did you breastfeed
him/her as usual, more or less than usual?
LITTLE....................................................... 1
AS USUAL................................................. 2
MUCH ........................................................ 3
I DON’T BREASTFEED............................ 4
I DON’T KNOW ...................................... 88
VN8 When your child (name) had a cough did you give him/her
liquid as usual, more or less than usual?
LITTLE....................................................... 1
AS USUAL................................................. 2
MUCH ........................................................ 3
I DON’T GIVE LIQUID............................. 4
I DON’T KNOW ...................................... 88
VN9 When your child (name) had a cough did you feed him/her as
usual, more or less than usual?
LITTLE....................................................... 1
AS USUAL................................................. 2
MUCH ........................................................ 3
I DON’T FEED ..............................4
ONLY BREASTFEEDING .......5
I DON’T KNOW...................................88
SECTIOND: DIAREA (D)
CHUND5RI
Project HOPE/CS/Navoi Page 4 of 4
QUESTIONNAIRE FOR MOTHERS
WITH CHILDREN UNDER 5
N. QUESTIONS AND FILTERS CATEGORY CODE PASS
D-1 Have you noticed the symptoms of liquid faeces of your child? YES .........................................................1
NO
I DON’T KNOW...................................88
D-3
D-3
D-2 What did you give from diarrhea?
What else?
CIRCLE ALL ANAMED SYMPTOMS.
NOTHING...............................................1
ORS POCKET LIQUID ..........................2
HOME PREPARED LIQUID .................3
MEDICINE OR SYRUP .........................4
INJECTION ............................................5
INTROVENUES.....................................6
OTHER HOME PREPARED
MEDICINES AND DRUGS………...7
OTHERS_____________________ 96
(IDENTIFY)
D-3 When your child (name) had a diarrhea did you breastfeed him/her
as usual, more or less than usual?
LITTLE .......................................................1
AS USUAL .................................................2
MUCH.........................................................3
I DON’T BREASTFEED............................4
I DON’T KNOW.......................................88
D-4 When your child (name) had a diarrhea did you give him/her liquid
as usual, more or less than usual?
LITTLE .......................................................1
AS USUAL .................................................2
MUCH.........................................................3
I DON’T GIVE LIQUID.............................4
I DON’T KNOW.......................................88
D-5 When your child (name) had a cough did you feed him/her as
usual, more or less than usual?
LITTLE .......................................................1
AS USUAL .................................................2
MUCH.........................................................3
I DON’T FEED ..............................4
ONLY BREASTFEEDING .......5
I DON’T KNOW..........................................88
D-6 Did you ask anybody about the treatment of diarrhea when your
(name) got diarrhea?
YES .........................................................1
NO...........................................................0 D-8
D-7 Where will you go in order to treat or have a consultation about
this disease?
MARK ONLY ONE ANSWER
Oblast hospital........................................ 1
Rayon hospital........................................ 2
Rayon polyclinic .................................... 3
SUB........................................................ 4
SVP ........................................................ 5
SVA........................................................ 6
Feldsher post .......................................... 7
HEALER ................................................ 8
FRIEND/RELATIVE............................. 9
OTHERS________________________ 96
(IDENTIFY)
I DON’T KNOW/DON’T REMEMBER88
D-8
What should be done in order to
prevent diarrhea?
MARK ALL VERSIONS OF
ANSWERS GIVEN TO THE
QUESTION
WASHING HANDS BEFORE HAVING A MEAL .........................….1
WASHING HANDS AFTER TOILET...............................................…2
DRINK BOILED WATER…..................................…………………...3
EAT WASHED FRUIT AND VEGATEBLES.................................….4
BURY A CHILD’S FAECES/OR DROP IN TO THE TOILET………5
STRUGGLE AGAINST INSECTS …………………………………..6
ONLY BREASTFEEDING UNTIL 6 MONTHS…………….….…….7
KEEP CHILD’S THINGS CLEAN………………………………...…..8
GIVING VARIOUS NEW FOOD………………………..….......…….9
WASHING HANDS BEFORE COOKING ...............................……..10
WASHING A CHILD’S HANDS BEFORE FEEDING HIM………...11
OTHERS_________________________________________________96
(IDENTIFY)
I DON’T KNOW……………………………….......................................88
THANK YOU!
Project HOPE/CS/Navoi 1
Evaluation Questions for C-IMCI Program Monitoring for Visiting Nurses
1. How will you act if a mother doesn’t pay much attention while you are talking to
her?
2. How do you have to proceed in order not to loose the contact during conversation?
3. Please, name general danger signs (signs of child illnesses that are risky to a
child’s life)
4. What signs of a child with pneumonia require treatment?
5. What signs a child with pneumonia who has being treated at home should have in
order to re-visit a doctor?
6. What signs of a child with diarrhea require treatment?
7. Identify the correct way of preparing the rehydron solution.
8. How the Rehydrone should be taken?
9. What should be the correct amount of food provided to a child with diarrhea?
10. What much of liquid should be provided to a child with diarrhea?
11. What is the correct action to prevent dehydration in an infant with diarrhea, who
has been under exclusive breast feeding?
12. Please, name signs of dehydration?
13. What actions should be taken in order to prevent diarrhea?
14. Where one has to refer when ones child gets seek?
FPCI home visit
1
Family Planning Consultation Interview
Date of monitoring: Rayon (Каrmana-1, Kiziltepa-2,Konimekh-3, Nurota-4 :
Name of the facility
Interviewer: Respondent name Respondent age:
Instruction for an interviewer:
Family planning consultation interview will be conducted with a woman of fertile age at the place where patronage health
provider (visiting nurse) is working:
Hi. My name is _________________. I’m from project HOPE. We would like to know your (women) opinion on the services
of the facility promoting family planning program and the consultations given to you as well. I have several questions to you
and I’d be very grateful if you share your time for me. I’ll non write your name. the information given by you will be kept in
secret. We don’t mind if you do not want to answer our questions.
№ Questions and filters Answers Skip
1 Have you ever heard about healthy
family planning?
Yes ...............................................................................1
NO..............................................................................0
Tablet /pill ………………………..…………..1
IUD …………………………………………….……2
Injections (Depo Provera)..………………….…3
Norplant ….……………...…………………….…..4
Women sterilization...………………………….…...5
Preservative..……………………………………….6
Spermicides..………………….………………….7
Natural rhythm……….……………….. …………...8
LAM…………….........................................................9
Others (specify)_________________...................96
2 Which of the modern
contraceptive ways or
prevention of undesirable
pregnancy do you know?
Please, count.
YES if more than 2..........................................1
NO if less than two......................................................0
3 Have you used any ways of
contraceptive ways?
Yes ..................................................................... 1
No.................................................................... 0 →9
4 Which contraceptive
ways have you used or are
you using?
MARK ALL
ANSWERED
VERSIONS
Tablet /pill ………………………..…………..1
IUD …………………………………………….……2
Injections (Depo Provera)..………………….…3
Norplant ….……………...…………………….…..4
Women sterilization...………………………….…...5
Preservative ..……………………………………….6
Spermicides ..………………….………………….7
Natural rhythm……….……………….. …………...8
LAM…………….........................................................9
Others (specify)_________________...................96
5 When visiting your place has the medical
provider ever asked you if you face any
problems in using the contraceptive
methods?
Yes ..................................................................... 1
No.................................................................... 0
6 Have you had any problems while using
contraceptive methods Probe: (You were
going to consult with the medical provider)?
Yes ..................................................................... 1
No .................................................................... 0 →11
7 What is the most
problematic when you
used this method?
(mark only one problem)
Acute pain in stomach..................................................1
Acute headache......................................................2
Acute breast pain ……………...........3
Acute bleeding......................................................4
Disorder of menses periods …………….............….5
Rushes ……………….......................................….6
Nausea ......................................................….7
Dizzy ........................................................…8
Indifference to sex...........................9
Getting fat……………............................10
FPCI home visit
2
№ Questions and filters Answers Skip
Others (specify)......................................................96
8 Were you satisfied with the medical
worker’s advice or treatment in order to
solve your problem?
Yes ..................................................................... 1
No.................................................................... 0
9 Has the medical worker recommended you
about some contraceptive methods?
Ҳа, тавсия/маслахат берди…......................…1
Йўқ.....................................................................0 13
10 Which contraceptive method did the medical
worker discussed with you about?
MARK ALL THE ANSWERED
VERSIONS
Tablet /pill ………………………..…………..1
IUD …………………………………………….……2
Injections (Depo Provera)..………………….…3
Norplant ….……………...…………………….…..4
Women sterilization...………………………….…...5
Preservative ..……………………………………….6
Spermicides ..………………….………………….7
Natural rhythm……….……………….. …………...8
LAM…………….........................................................9
Others (specify)_________________...................96
About the above answered methods:
a Did the medical provider show you how to
use the method?
YES…….……….….......1
NO……………..........0
DO NOT KNOW..…..........88
THE QUESTION IS NOT PROPER …….....87
b. Did the medical provider explain the
possibility of side effects ?
YES…….……….….......1
NO…………….….....0
DO NOT KNOW..…..…....88
c. Was it explained what should be done if
the problems occur?
YES…….……….….......1
NO…………….….....0
DO NOT KNOW..…..…....88
11
d. Was it explained that the very method
prevents STDs and AIDS
YES…….……….….......1
NO…………….….....0
DO NOT KNOW..…..…....88
12 Were you warned about the following visit to
your house by the health provider?
YES…….……….….......1
NO…………….….....0
DO NOT KNOW/DO NOT REMEMBER..…..…....88
13 Did you talk with health provider about
STDs and AIDS?
YES…….……….….......1
NO…………….….....0
DO NOT KNOW..…..…....88
Pain in the lower part of stomach...................... .............……1
Dropping secretion from male sexual organ ..........................2
Unpleasant smell of secretion ................................................3
Burning sensation while urination..........................................4
Frequent urination ..................................................................5
Getting reddish or rub of sexual organ...................................6
Pain and oedema around sexual organs or……………..........7
Pain / sores on sexual organs.................................................. 8
Warts on sexual organs .......................................................... 9
Blood in urine....................................................................... 10
Sexual impotence ................................................................. 11
14 How can be identified the
existents of sexual
transmitted diseases of
men?
Any other?
MARK ALL THE
ANSWERED
VERSIONS YES if more than 2……………...............1
NO if less than 2.......................................0
FPCI home visit
3
№ Questions and filters Answers Skip
Pain in the lower part of stomach...................... .............……1
Dropping secretion from male sexual organ ..........................2
Unpleasant smell of secretion ................................................3
Burning sensation while urination..........................................4
Frequent urination ..................................................................5
Getting reddish or rub of sexual organ...................................6
Pain and oedema around sexual organs or……………..........7
Pain / sores on sexual organs.................................................. 8
Warts on sexual organs .......................................................... 9
Blood in urine....................................................................... 10
No symptom...................................................................... 11
Sterility.............................................................................. 12
15 How can be identified the
existents of sexual
transmitted diseases of
women?
Any other?
MARK ALL THE
ANSWERED
VERSIONS YES if more than 2……………...............1
NO if less than 2.......................................0
16
Can the STDs be without any symptoms? YES........................................1
NO/Do not know……...........0
17
Is there any prevention way to avoid both men
and women STDs?
YES........................................1
NO/Do not know……...........0 →20
Keeping himself/herself from sexual contact.. ............ 1
Using preservation ..................................................... 2
Having an only sexual partner ..................................... 3
Limiting the number of sexual partners....................... 4
No contact with prostitutes .......................................... 5
No contact with people who have several sexual partners…6
No exchange with shaving articles.. ............................ 7
18 What must man or woman do to
prevent themselves from STDs?
Any other?
MARK ALL THE ANSWERED
VERSIONS YES if more than 2……………...............1
NO if less than 2.......................................0
In the middle of menses
cycle...................................................1
As soon as the menses cycle is over.................2
Before the beginning of menses cycle...............................3
Do not know /do not remember...........................................88
Others ________________ ________96
19 At whay period of menses cycle there
is more possibility of being a woman
pregnant?
YES if the 2nd version was answered....................1
NO if other versions..............................................0
Months ________
20 How long should a
woman expect the
following pregnancy after
delivery?
YES if the period after delivery is 24
months.........................................................1
NO if other versions.....................................................................0
FPCI home visit
4
Show the book, brochure
QUESTION YES NO DETAILED ANSWERS
1. Have you ever seen the
leaflet “Family Planning”?
STOP if the answer is NO.
2. Do you have this book?
3. Do you like the cover and the
book itself?
Why?
4. Which part do you think is
more interesting for you?
If YES, which one?
5. In your opinion what other
information should be added or
cut?
If YES, which one?
6. For monitors:
According to the above
answers decide if the women
are using the book effectively.
Thank you for your interview!
Evaluation List on monitoring on Reproductive Health of Visiting (Patronage) nurses
Oblast ______________________ Rayon _______________________
Leader _____________________ Medical worker__________________________
Date ______________ Facility name _________________________
№ Indicators
Yes=1, No=0,
inappropriate 
1 Greeted a woman with respect.
Met the patient/Spouses with respect and asked them to have a seat and feel comfortable.
Introduced herself. Kept patience while the talk. Didn’t interrupt the patient?
2 Explained the woman that the information she has given during the interview will be kept
in secret?
3 Had a very briefly talk providing the necessary information for her and asked question
concerning only the topic.
4 Provided about the all methods of contraception, their effect of mechanism. Advantageous
and disadvantageous?
5 Used visual aids, such as posters, pictures, samples of contraceptives, plaster cast and at
the same time was able to make the listener be interested and participate?
6 Explained all necessary information about STDs?
7 Corrected any problems unclear to the patient?
8 Asked the patient if he/she is satisfied with the method she had chosen and continuous
using it? Asked the occurring problems?
9 Asked the patient to show how she uses chosen contraception method and asked to show
again if it was necessary in order to be confirmed in the correct usage.
10 Checked if there is any side effects of the contraception? Recommended to have
necessary procedures or to go to a more qualified specialist in case of necessity?
11 Explained the patient that she/he can stop and if wants not to use that method at any time
again.
12 Explained the patient when to come for the second examination? Asked to go to a
medical provider if some problems and questions occur?
13 Fixed the dates and time of following visits?
14 Saw off the woman politely and asked to come to the physician at any time she needs.
15 FPCEI = №2 Which modern contraceptive ways do you know? Please, count.
16 FPCEI = №5
17 FPCEI = №8
18 FPCEI = №11
19 FPCEI = №14
20 FPCEI = №15
21 FPCEI = №18
22 FPCEI = №19
23 FPCEI = №20
24 Were tested: (0=<55%; 1=55%-69%; 2=70-84%; 3=85-100%)
25 Using the book (item №6)
Total sum of 1 and  /27 and %
TEST QUESTIONS FOR PATRONAGE NURSES
ON REPRODUCTIVE HEALTH
1. What types of contraceptives can be used immediately after delivery?
2. What types of contraceptives can be used after the six-week period after delivery?
3. When should a woman who wants take COC shall start doing it for the first time?
4. Instruction on taking COC :
5. If a woman forgets to take one or two pills then she has to:
6. Which of the followings belongs to side effects of COC?
7. Please, give the correct description of Depo-Provera:
8. DMPA injection is done every:
9. A Copper T 380 type IUD shall be taken out or replaced, according to will of the woman, after the following
period of time
10. 10 . The following types of women may not have IUD:
11. If a woman with IUD can not feel thread of the IUD after a menstrual cycle, she has to:
12. Natural methods include the followings:
13. LAN is effective in the following case:
14. Who may use the Standard Days Method?
15. The advantages of the Standard Days Method does not include:
16. What is the most important feature of condoms?
17. Disadvantages of the spermicides include:
18. The signs of STD in a woman include:
19. Which of the followings is important in providing consultation on sterilization?
20. Sterilization is recommended to the following types of women:
home visit
1
Consulting by the Patronage (Visiting) nurses Family Planning program
Date of monitoring: Oblast Rayon
Name of the facility
Observer: Medical Provider:
Steps\ duties yes/no
General skills of Consulting
1 Greeted a woman with respect. 1 0
Kept patience while talking with a woman, did not interrupt her and listened her attentively. 1 0
2 Showed respect and didn’t criticize her. 1 0
3 Knows all the about contraceptive methods very well. 1 0
4 Explained the woman that the information she has given during the interview will be kept in
secret.
1 0
5 Had a very briefly talk providing the necessary information for her and asked question
concerning only the topic.
1 0
6 Used visual aids, such as posters, pictures, samples of contraceptives, plaster cast and at the same
time was able to make the listener be interested and participate.
1 0
7 Asked open questions. 1 0
8 Sexual transmitted diseases (STDs):
 Symptoms at women
 Symptoms at men
 The evidence of STDs without symptoms
 Where to apply if there are symptoms of STDs
 Ways of prevention
1 0
9 Gave the opportunity to a woman to ask a question, was very laconic while speaking, gave the
correct and proper recommendations.
1 0
10 Explained the information by different ways until she was confirmed that she supplied the woman
with necessary conception.
1 0
11 Asked the women to repeat the given information in order to be confirmed in her strong
knowledge.
1 0
Women using contraceptive methods
1 Has a woman’s life, her mode of life been changed since she had visited the physician. Whether it
was asked the reason of changing the contraception methods or stop using them at all.
1 0
2 Asked the woman whether she is satisfied with the chosen contraception method and whether she
continuous using them.
1 0
3 Asked the woman to show how she uses chosen contraception method and asked to show again if
it was necessary in order to be confirmed in the correct usage.
1 0
4 Identified if here are some problems while using the contraception. Instructed the woman more
deeply if it was necessary.
1 0
5 Helped the woman to be calm in case if she had expected more negative effect from chosen
contraceptive method.
1 0
6 Answered the woman’s questions. 1 0
7 Write necessary prescriptions (and recommendations) for getting more contraceptives. 1 0
8 Fixed the following visiting dates and time. 1 0
9 Left the woman’s place politely and asked to come to the physician at any time she needs. 1 0
10 Used skills communications during the interview: 1 0
Asking and listening?
Encouraging?
Advising / recommending?
Examining?
Evaluation List on Reproductive Health consultation in out-patient health facility
Oblast ______________________ Rayon ______________________________
Monitor ____________________ Medical worker________________________
Date ______________ Facility name _________________________
№ Indicators
Yes=1, No=0,
N/a 
1 Met the patient/Spouses with respect and asked them to have a seat and feel comfortable.
Introduced herself. Kept patience while the talk. Didn’t interrupt the patient?
2 Explained the woman that the information she has given during the interview will be kept in
secret?
3 Had a very briefly talk providing the necessary information for her and asked question
concerning only the topic.
4 Provided information about the all methods of contraception, their effect of mechanism.
Advantageous and disadvantageous?
5 Used visual aids, such as posters, pictures, samples of contraceptives, plaster cast and at the
same time was able to make the listener be interested and participate?
6 Gave an opportunity to the patient to ask questions?
7 Asked the women to repeat the given information in order to be confirmed in her strong
knowledge by giving open questions and showing it in the practice
8 Explained all necessary information about STDs?
9 Corrected any problems unclear or wrong information to the patient?
10 Identified the objective of the reproductive health of the patient, gathered the patient’s general
and reproductive anamnes and identified the accuracy while using contraceptive methods at
the somatic state?
11 Provided the necessary information of chosen contraceptive methods (its advantageous and
disadvantageous, effectiveness, mechanism, using, applying to a specialist in case if some
dangerous symptoms occur.
12 Explained the patient about the effectiveness of chosen contraceptive methods in preventing
or not preventing from STDsand if it is necessary using preservatives additionally.
13 Explained the patient that she /he can stop and if wants not to use that method at any time
again.
14 Explained the patient when to come for the second examination and to ask about the chosen
method? Asked to go to a medical provider if some problems and questions occur?
15 Informed the patient about the getting spare contraceptive method he/she has chosen?
16 Concrete (chosen) method:____________________
Informed and about the qualities of the concrete method?
17 The patient is satisfied with the method chosen and continous using it?Asked if there are any
problems or not?
18 Asked the woman to show how she uses chosen contraception method and asked to show
again if it was necessary in order to be confirmed in the correct usage.
19 Checked if there are any negative sides of the contraception? Recommended to have
necessary procedures or to go to a more qualified specialist in case of necessity?
20 FPCEI = №2 СОШ What kind of modern contraceptive methods do you know? Please, list.
21 FPCEI = №5
22 FPCEI = №8
23 FPCEI = №12
24 FPCEI = №15
25 FPCEI = №16
26 FPCEI = №19
27 FPCEI = №20
28 FPCEI = №21
29 Were tested: (0=<55%; 1=55%-69%; 2=70-84%; 3=85-100%)
30 Using the book (Interview: item №6)
Total sum of 1 and  /32 and %
reception
1
MAIN SKILLS AND STEPS OF THE FAMILY PLANNING CONSULTING
Observation form
Monitoring date: Oblast Rayon
Name of the facility
Observer: Medical worker:
Type of consultation ____________________ Method of contraception___________________
steps\objectives YES/NO
General skills of consulting
1 Kept patience while talking with a patient, did not interrupt her and listened her attentively. 1 0
2 Showed respect and didn’t criticize the patient. 1 0
3 Knows all the about contraceptive methods very well. 1 0
4 Explained the patient that the information she has given during the interview will be kept in
secret.
1 0
5 Had a very briefly talk providing the necessary information for her and asked question
concerning only the topic.
1 0
6 Used visual aids, such as posters, pictures, samples of contraceptives, plaster cast and at the same
time was able to make the listener be interested and participate.
1 0
7 Asked open questions. 1 0
8 Sexual transmitted diseases (STDs):
 Symptoms at women
 Symptoms at men
 The evidence of STDs without symptoms
 Where to apply if there are symptoms of STDs
 Ways of prevention
1 0
9 Gave the opportunity to a woman to ask a question, was very laconic while speaking, gave the
correct and proper recommendations.
1 0
10 Explained the information by different ways until she was confirmed that she supplied the woman
with necessary conception.
1 0
11 Asked the women to repeat the given information in order to be confirmed in her strong
knowledge.
1 0
Primary consultation
1 Met the patient/Spouses with respect and asked them to have a seat and feel comfortable. Introduced
herself.
1 0
2 Briefly explained about the influence mechanism of all FP methods 1 0
3 Explained the advantageous and disadvantageous of every method 1 0
4 Identified the patients preference in using the contraceptives and asked if he possess the information of the
method chosen by him.
1 0
5 Corrected any wrong and unclear information 1 0
6 Answered any question if the patient 1 0
Consultation on the method (secondary)
1 Met the patient/Spouses with respect and asked them to have a seat and feel comfortable.
Introduced herself.
1 0
2 Identified the objective of the reproductive health of the patient, gathered the patient’s general and
reproductive anamnesis and identified the accuracy while using contraceptive methods at the somatic
state?
1 0
3 Asked the patient about the knowledge of the chosen contraceptive method, corrected the
wrong information.
1 0
reception
2
4 Briefly explained about the influence mechanism of contraceptive methods:
 Effectiveness
 influence mechanism
 usage
 advantageous and disadvantageous
 negative sides
 Unsafeness from STDs
 Necessity preservative usage additionally
 Apply to the specialist as soon as some dangerous symptoms occur
1 0
5 Emphasized: it’s the patient’s preference in using or not using the contraceptive methods. 1 0
6 The medical worker checked if the patient is confident in using the chosen contraceptive
method.
1 0
7 Instructed the patient about the usage of contraceptive methods by the following questions:
 The rules and techniques of using the method
 Applying the physician as soon as some problems occur.
 The place of getting more contraceptives
 What to do in case not breaking the rules of usage
 Answered the patients questions
1 0
8 Asked the patient to repeat the instruction and answered all the questions. 1 0
tablets:
-measuring blood pressure
-examining for pregnancy
-asking about smoking or
not smoking
-unclear vaginal bleeding
IUD:
- gynecologic examination
-examining for pregnancy
-clarifying the date of the
last pregnancy
- Hb level
- Pap-test
Injections:
-measuring blood pressure
--examining for pregnancy
-unclear vaginal bleeding
- chronic liver failure
9
Preservatives:
- asking about allergy
for latex
Spermicides:
- asking about complications
during last pregnancy
- asking about allergy status
Natural rhythm:
- asking about complications during
last pregnancy
- menses status
Surgery:
-surgery in the part of
stomach
-examining for pregnancy
-identifying chronic
diseases
1 0
10 Explain the patient when to come for the second examination. Recommended to come to the
specialist if there are some problems.
1 0
11 Saw off the patient politely and asked to come at any time. 1 0
Repeated Consultation(tertiary)
1 Met the patient with respect and asked them to have a seat and feel comfortable. 1 0
2 Has a woman’s life, her mode of life been changed since she had visited the physician. Whether it
was asked the reason of changing the contraception methods or stop using them at all.
1 0
3 Asked the woman whether she is satisfied with the chosen contraception method and whether she
continuous using them.
1 0
4 Asked the woman to show how she uses chosen contraception method and asked to show again if
it was necessary in order to be confirmed in the correct usage.
1 0
5 Identified if here are some problems while using the contraception. Instructed the woman more
deeply if it was necessary.
1 0
6 Helped the woman to be calm in case if she had expected more negative effect from chosen
contraceptive method.
1 0
7 Answered the woman’s questions. 1 0
8 Write necessary prescriptions (and recommendations) for getting more contraceptives. 1 0
9 Fixed the following visiting dates and time. 1 0
10 Saw off the patient politely and asked to come at any time. 1 0
Test Questions for Ob-Gyn, GP, and Midwifes
1. What types of contraceptives might be applied right after delivery?
2. What types of contraceptives might be applied in 6-weeks period after delivery?
3. What is the right time to use IUD after giving a birth?
4. The breast feeding may not be considered as an effective contraceptive if:
5. Instructions on using COC:
6. What is the right time for a woman who wants to start taking COC?
7. If a woman forgets to take one or two tablets she has to:
8. Which of the followings is more characteristic to COCs’ side effects?
9. Prior to Depo-Provera injection a doctor has to make sure that a woman does not have:
10. Usage of progestin pills is prohibited if:
11. What is the right description of Depo-Provera?
12. When a woman may get IUD?
13 . The following types of women may not use IOD:
14. If a woman with IUD can not feel its threads after an menstrual cycle she has to:
15. In using IUD the caution is not required if:
16. How may sexually active person protect himself/herself from HIV/AIDS?
17. The followings belong to STD signs in women:
18. In case of unavailability of lab facilities, how can one be checked for STDs?
19. What is the procedure to take low dosage (30-35) AOK for immediate contraception?
20. Which of the followings is important in giving advices on sterilization?
21. Is sterilization advised to the following women?
home visit
Evaluation list on monitoring of out-patient work by the “Safe Motherhood” program
(Postpartum care)
Check-list
Monitoring date: oblast: Rayon:
Medical worker: Facility name:
Monitor: Type of consultation: delivered woman (infant under1,5 months):
For monitoring: the question №24 is not considered at the time of summing and making
percentage.
Post natal period
№ Indicators (source)
Yes=1, No=0,
inappropriate
1. Met the patient/Spouses with respect and asked them to have a seat and feel comfortable.
Introduced herself. Kept patience while the talk. Didn’t interrupt the patient (OPSO1)
2. Asked about the woman’s state. Had a very briefly talk, only necessary information. Asked clear
and proper questions. Asked open questions. Made the woman be interested in giving questions.
(OPSO2-3)
3. Explained the information in different ways. In order to be confirmed in the obtaining the information
asked the woman to repeat the given instructions. (OPSO4)
4. Used visual aids (postures, brochure, books, album) and at the same time made the woman be
interesred and participant. (OPSO5)
5. Fixed the time of the following visit and explained how many times she should visit health facility
after delivery. (OPSO6)
6. Explained the dangerous symptoms for mother and a baby. Used “mother’s home book” for it.
(OPSO7)
7. Explained the importance of breastfeeding. Asked if there are problems of breastfeeding and give
recommendations. (OPSO8)
8. Explained about the nutrition of thepegnant/delivered women. (OPSO9)
9. At this visit all the necessary examinations have been carried out. (OPSO15-17)
10. Explained about the possible dangerous symptoms of post natality. (OPSO11)
11. Explained about the dangerous symptoms during the taking care of the baby. (OPSO12)
12. Informed where to go in case if there are dangerous symptoms. (OPSO13)
13. Informed how to take care of the baby. ( OPSO14)
14. Gave necessary recommendations about the contraception methods after delivery.. (OPSO18)
15. Used communication skills during the interview. (OPSO19)
16. Having a conversation about the differences between deliveries. (OPI 3c)
17. The knowledge of the woman after delivery. (OPI 4)
18. The knowledge of the woman about the possible dangerous symptoms of babies. (OPI 5)
19. Satisfaction of the patient after visiting the specialist. (OPI 7)
20. Test: 55-70%=1 score, 71-85%=2 scores, 86-100%=3 scores
21. Having recommended protocols of postnatal period of ЖССТ (OPSO, OPI 8)
22. The medical workers work and uasage with the “Mother’s home book”. (OPSO7)
23. The objective visits of the pregnant women (more than 3 times) (OPI 20)
24. The gap difference between the previous and a just born baby must be 24 and more months.
(OPI 10)
Total sum of 1 and  is/25 and % %
SM: OUT-PATIENT SERVICE OBSERVATION home visit
1
Observation for consultation by the “Safe Motherhood” program
(delivered woman)
MONITORING DATE: Oblast Rayon:
Medical worker: Facility name:
Monitor: Type of consultation: delivered woman (infant under1,5 months):
The delivered woman should visit the doctor at least once during 1,5 months, or the visiting nurse should
visit her during a week.
steps\objectives practice
yes=1, no=0,
inappropriate 
GENERAL SKILLS OF CONSULTATION
OPSO1 Met the patient/Spouses with respect and asked them to have a seat and feel
comfortable. Introduced herself. Kept patience while the talk. Didn’t interrupt the
patient (OPSO1)
OPSO2 Asked about the woman’s state. Had a very briefly talk, only necessary information.
Asked cleat and proper questions.
OPSO3 Asked clear and proper questions. Asked open questions. Made the woman be
interested in giving questions
OPSO4 Explained the information in different ways. In order to be confirmed in the obtaining the
information asked the woman to repeat the given instructions
OPSO5 Used visual aids (postures, brochure, books, album) and at the same time made the
woman be interesred and participant.
OPSO6 Fixed the time of the following visit and explained how many times she should visit
DPM after delivery.
OPSO7 Explained the dangerous symptoms for mother and a baby. Used “mother’s home
book” for it.
OPSO8 Explained the importance of breastfeeding. Asked if there are problems of breastfeeding
and give recommendations
OPSO9 Explained about the nutrition of thepegnant/delivered women.
(1-if the answers from 9a – 9g, otherwise – 0)
OPSO9a Feeding with bread and bread production, rice, potato, whet products several times a
day.
OPSO9b Feeding with fruits and vegetables, greens which are rich in vitamins several times a
day.
OPSO9c Feeding with dairy products which contain less oil.
OPSO9d Feeding with oily less meat or wheat vegetables.
OPSO9f Feeding with sweets and oily products less than it was asked
OPSO9g Not to drink tea or Coca-Cola after having meal
OPSO10 If there are any dangerous symptoms of the delivered woman or of the baby was sent
to the facility immediately
OPSO11 Explained about the possible dangerous symptoms of post natality
(1- if two answers from 16a to 16c,otherwise– 0)
OPSO11a The temperature is above 38°С, fever
OPSO11b bleeding
OPSO11c Unpleasant smell of excretions
OPSO12 Explained about the dangerous symptoms during the taking care of the baby.
(if 6 from 17a - 17h , otherwise – 0)
OPSO12a Rare breastfeeding
OPSO12b Шайтонлаш
OPSO12c Frequent or difficult breathing
OPSO12d Getting red or pus of the umbilical
OPSO12e Changing the body temperature
OPSO12f Weakness and excitement
OPSO12g Diarrhea or vomiting
SM: OUT-PATIENT SERVICE OBSERVATION home visit
2
OPSO12h Getting blue the palm and foot/around the mouth
OPSO13 Where to go if there are dangerous symptoms
OPSO14 INFORMED THE WOMAN HOW TO TAKE CARE OF THE BABY (SWADDLING, BATHING,
MAKING MASSAGE, WHAT TO DO WHEN THE BABY CRYING)
OPSO15 Checked the breast and its tops
OPSO16 Examined woman’s stomach and measured the uterus height in order tobe confirmed
in shortening if uterus bottom.
OPSO17 Examined secretion
OPSO18 Gave necessary recommendations about the contraception methods after delivery
OPSO18a Asked the patient about the reproductive aim. Identified the somatic state of the
patient in order to be care in using the contraception methods and in collecting the
patient’s general and reproductive anamnesis.
OPSO18b Used visual aids (postures, brochure, books, album) and at the same time made
the woman be interesred and participant.
OPSO18c Informed about STDs
OPSO18d Briefly informed about all methods of FP and their mechanism.
OPSO18e Explained about the advantageous and disadvantageous of each method.
OPSO18f Asked the patient about the method she was interested and asked if she needs the information abot the
method chosen.
OPSO18g Asked the patient about the information of the chosen contraceptive method and
corrected the wrong information.
OPSO18h Asked the patient to repeat the given information and responded all the unclear
questions and misunderstandings.
OPSO18i Explained when to come for the following examination. Emphasized the
necessity of the visit if any problems or questions occur.
OPSO19 Using communication skills during consultation:
Asking and listening?
Encouraging?
Advising?
Checking?
PNC OUT-PATIENT INTERVIEW home visit
1
Interview with mother on the post natal care by the “Safe Motherhood” program monitoring
Monitoring date: oblast: Rayon:
Medical worker:: Facility name:
Monitor: Type of consultation: delivered woman (infant under1,5 months):
OPI 1
When did you deliver?
Write the answer in months. Write «-» if she does not know _________months
OPI 2
When did the medical worker visit you for the first time after delivery? (After you have left the facility?)
Write the answers in days ________ weeks
OPI 3
I’D LIKE TO KNOW ABOUT THE SERVICE TO YOU DURING THAT CHILLA PERIOD.
DID THE MEDICAL WORKERS DO THE FOLLOWING PROCEDURES?
Ask about the each procedure
Mark only one answer for
each procedure
{OPI 3a} WERE Fe AND FOLIC ACID RECOMMENDED 1 YES 0 NO
{OPI 3b} WERE THE INSTRUCTIONS GIVEN ABOUT THE PROPER NUTRITION 1 YES 0 NO
{OPI 3c} HAD THE WOMEN CONVERSATION WITH FAMILY ABOUT THE CHILD SPACE
INTERVAL
1 YES 0 NO
{OPI 3d} WHAT WAS TOLD ABOUT SEXUAL TRANSMITTED DISEASES? 1 YES 0 NO
{OPI 3e} WAS IT EXPLAINED HOW YOU SHOULD GET TO THE FACILITY IN CASE OF THE
EMERGENCY 1 YES 0 NO
{OPI 3f} WERE YOU INFORMED ABOUT ONLY BREASTFEEDING 1 YES 0 NO
{OPI 3j} INFORMED YOU HOW TO TAKE CARE OF THE BABY (SWADDLING, BATHING,
MAKING MASSAGE, WHAT TO DO WHEN THE BABY CRYING)
1 YES 0 NO
FEVER.......................................................................1
BLEEDING................................................................2
UNPLEASANT SMELL EXCRETIONS ..................3
OTHRES_________________________.................96
(specify)
DON’T KNOW 88
OPI 4
AFTER WHAT KIND OF DANGEROUS
SYMPTOMS YOU MUST GO TO THE DOCTOR?
Mark all the answered versions
IF 2 AND MORE CORRECT ANSWERS ...................................1
ON OTHER CASE........................................................................0
RARE BREASTFEEDING......................................................................1
CONVULSIONS......................................................................................2
FREQUENT OR DIFFICULT BRETHING............................................3
GETTING RED OR PUS OF THE UMBILUCAL CORD ...................4
CHANGING OF THE BODY TEMPERATURE..................................5
WEAKNESS OR EXCITEMENT..........................................................6
DIAHHREA OR VOMITTING.............................................................7
GETTING BLUE OF THE PALM AND FOOT OR ARROND THE
MOUTH.................................................................................................8
OPI 5
WHAT KIND OF DANGEROUS SYMPTOMS
SHOW YOU THAT YOU MUST GO TO THE
DOCTOR?
Mark all the answered versions
IF 2 AND MORE CORRECT ANSWERS ...................................1
ON OTHER CASE........................................................................0
OPI 6 DO YOU KNOW WHERE YOU SHOULD GO IFTHE DANGEROOUS SYMPTOMS APPEARА? 1 YES 0 NO
OPI 7 ARE YOU SUTISFIED OF TODAY’S VISIT OF THE MEDICAL WORKER? 1 YES 0 NO
OPI 8
FOR MONITORS:
According to the answers N 3-7 identify if the way of writing protocols based on WHO
is correct during the postnatal period? 1 YES 0 NO
OPI 9 Do you have other children besides this baby? 1 YES 0 NO (OPI 11)
OPI 10 How old is the youngest?
(if it is necessary identify the date of birth)
24 months and more……….. 1
Less than 24
months…………………… 0
It is necessary to check mother’s home book if possible.
PNC OUT-PATIENT INTERVIEW home visit
2
The pregnant woman had to visit the specialist at least 3 times. (order №425 table, according to gestation age).
To examine the last pregnancy correctly
Ҳа=1, Йўқ=0,
inappropriate
OPI 11 At what time of your last pregnancy did you visit the specialist?
Mark 1 if the pregnancy was not more than 12 weeks, otherwise 0
OPI 12 How many times was your blood pressure measured?
(the blood pressure must be measured at each visit)
mark1if 3 and more, otherwise 0
OPI 13 HOW MANY TIMES THE HEART PALPITATION OF YOUR PREGNANCY WAS MEASURED?
(The heart palpitation and the fetus movement is measured after 18-20 weeks)
mark 1 if 3 and more, otherwise 0
OPI 14 Was your weight and height measured / your weight of body index?
mark1 if 3 and more, otherwise 0
OPI 15 How many times was your uterus bottom measured?
mark1 if 3 and more, otherwise 0
OPI 16 How many times did you have analysis for Hb?
mark1 if 3 and more, otherwise 0
OPI 17 Do you know your blood rhesus and blood group?
1 YES 0 NO
OPI 18 Were you told about the results of your HIV, syphilis, gonorrhea, захм, hepatitis В analyses?
1 YES 0 NO
OPI 19 How many times did you have urine analyses?
mark1 if 3 and more, otherwise 0
OPI 20 For monitors:
Considering the above OPI 11-19 and MHB
How many visits were the objective visits of the pregnant woman?
mark1if 3 and more, otherwise 0
THANK YOU FOR YOUR INTERVIEW, IF YOU HAVE ANY QUESTION WE ARE HAPPY TO ANSWER
TEST QUESTIONS FOR OB-GYNS, GPs, AND MIDWIVES ON SAFE MOTHERHOOD
1. Which of the followings is not responsibility of the HP at a Village Health Post (VHP￾SVP)?
2. Which infections do not affect pregnancy?
3. What signs and symptoms may indicate pregnancy?
4. In conduct of routine medical checks of pregnant women with pregnancy for more than
16 weeks what checks should be conducted each time?
5. Which of the following changes do not belong to natural changes that are characteristic to
pregnancy?
6. Which of the followings does not belong to advantages of using the Mother Home Card
7. What criterion is used to diagnose severe pre-eclampsia?
8. The causes of bleeding during the first trimester of pregnancy include:
9. The effective records in medical records (primary health care level) shall be as follows:
10. What danger signs, during pregnancy, imply necessity of seeing a doctor? (name any
six)
11. What danger signs during postpartum period indicate to necessity for immediate
medical assistance? (name any four)
12. What procedures are required to treat anemia?
13. What should a patronage nurse bring with her in her visits to a house of a pregnant
women?
home visit: pregnant woman
Evaluation list on monitoring of out-patient work by the “Safe Motherhood” program
(Pregnant woman)
Check-list
Monitoring date: Oblast : Rayon:
Medical worker: Facility name:
Monitor: Consultation type: first pregnancy
Antenatal/postnatal period
№ indicators (sources)
Yes=1, No=0
inappropriate
1. Met the patient/Spouses with respect and asked them to have a seat and feel comfortable.
Introduced herself. Kept patience while the talk. Didn’t interrupt the patient (OPSO1)
2. Asked about the woman’s state. Had a very briefly talk, only necessary information. Asked
proper and appropriate questions. Made the woman be interested in giving questions (OPSO2-
3)
3. Explained the information in different ways. In order to be confirmed in the obtaining the information
asked the woman to repeat the given instructions.
4. Used visual aids (postures, brochure, books, album) and at the same time made the woman be
interesred and participant.OPSO5)
5. Fixed the time of the following visit and explained how many times she should visit health facility
after delivery.(OPSO6)
6. Explained the role of the woman and mahalla for the safety life of her future baby and used the
“Mother’s home book”. (OPSO7)
7. Explained the importance of breastfeeding. Asked if there are problems of breastfeeding and give
recommendations.(OPSO8)
8. Explained about the nutrition of thepegnant/delivered women. ((OPSO9)
9. Examined all necessary things at the time of the visit. (OPSO11)
10. Explained and advised the woman where to deliver? (OPSO12)
11. Explained about the possible dangers during pregnancy (OPSO14)
12. Explained about the possible dangerswhile delivering. (OPSO15)
13. Explained about the possible dangers after delivery (OPSO16)
14. Explained about the possible dangerswhile taking care of the baby. (OPSO17)
15. Explained where to go if there are dangerous symptoms. (OPSO18)
16. Explained about the advantageous of her partner participance during the delivery. (OPSO19)
17. Gave advice about contraception methods after delivery. (OPSO20)
18. Used communication skills during consultation:(OPSO21)
19. Knowledge of the woman about the dangerous symptoms at the period of pregnancy (OPI 6)
20. Knowledge of the woman about the dangerous symptoms while delivering(OPI 7)
21. Knowledge of the woman about the dangerous symptoms of postnatal period (OPI 8)
22. Knowledge of the woman about the dangerous symptoms at the period of taking care of the
baby (OPI 9)
23. Satisfaction of medical worker’s visit. (OPI 12)
24. Test: 55-70%=1 score, 71-85%=2 scores, 86-100%=3 scores
25. Writing the pregnancy state in the protocol based on ЖССТ recommendation (OPSO 1-20, OPI
13)
26. Using the mother of “mother’s home book” (item #6)
27. Working of the medical worker with “Mother’s home book”
Total sum 1 and  is /29 and % %
OUT-PATIENT INTERVIEW home visit
1
Interview with pregnant women by “Safe Motherhood” program monitoring
Date of monitoring Oblast: Rayon:
Medical worker: Name of the facility
Monitor : Consultation type: pregnant woman
We are studying the service in your facility organized and we’d like you to answer our several questions.
We will not write your name and will keep information given by you in secret.
INTERVIEW WITH PREGNANT WOMAN
OPI 1
HOW LONG ARE YOU PREGNANT?
WRITE THE ANSWER IN MONTHS. write «-» if doesn’t know _________MONTH
OPI 2
At what time of your pregnancy week did you visit the facility for the first?
Write the answers in weeks ________ WEEK
OPI 3 WERE YOU INFORMED THAT YOUR PATNER CAN PARTICIPATE IN YOUR DELIVERY? 1 YES 0 NO
OPI 4
PLEASE, COUNT THE
ADVANTAGEOUS THE PARNER
PARTICIPANCE IN THE
DELIVERING
MARK “1” IF THE ANSWER IS 2 AND
MORE, OTHERWISE «0»
1. the process of delivery will take less time
2.less opportunities in using anesthetic means
3. less necessity in using
4. less necessity in using delivery procedures
5. less necessity surgery involvement
1 YES 0 NO
I’D LIKE TO KNOW ABOUT ALL THE MEDICAL SERVICES OF THIS FACILITY
DURING YOUR BEFORE AND AFTER PREGNANCY.
DID THE PATIENTS HAVE THE FOLLOWING PROCEDURES?
ASK ABOUT EACH PROCEDURE
Mark only one answer for
each procedure
{OPI 5a} WERE Fe AND FOLIC ACID RECOMMENDED 1 YES 0 NO
{OPI 5b} WERE THE INSTRUCTIONS GIVEN ABOUT THE PROPER NUTRITION 1 YES 0 NO
{OPI 5c} DID YOU HAVE A TALK ABOUT THE DELIVERING PLACE 1 YES 0 NO
{OPI 5d} EXPLAINED THE ADVANTAGEOUS OF THE DELIVERING IN THE FACILITY 1 YES 0 NO
{OPI 5e} Informed you about the role of the woman and mahalla for your baby’s health? 1 YES 0 NO
{OPI 5f} HAD THE WOMEN CONVERSATION ABOUT THE GAP DIFFERENCES BETWEEN
DELIVERIES AND FAMILY
1 YES 0 NO
{OPI 5g} WHAT WAS TOLD ABOUT SEXUAL TRANSMITTED DISEASES? 1 YES 0 NO
{OPI 5h} Explained you how to get to the facility in case of emergency 1 ҲА 0 ЙЎҚ
{OPI 5i} Explained you about breastfeeding advantageous 1 YES 0 NO
CONVULSIONS....................................................................1
EYESIGHT DESTROY.........................................................2
BLEEDING............................................................................3
DIFFICULT BREATHING ...................................................4
HEADACHE .........................................................................5
FREQUENT APPEARING AND DISAPPEARING OEDEMA 6
FEVER...................................................................................7
STRONG PAIN IN STOMACH ............................................8
CHANGING THE FOETUS MOVEMENT ..........................9
CONSCIOUSNESS ............................................................10
ANY HURTS WHILE FELLING OR BEATING ...............11
OTHERS_________________________.................96
(SPECIFY)
DO NOT KNOW .................................................................88
OPI 6
At what kind of dangerous symptoms in the period of
pregnancy you should see a specialist?
Mark all versions of the answers
IF THREE AND MORE ANSWERS.............1
OTHERWISE........................................................................0
OUT-PATIENT INTERVIEW home visit
2
CONVULSIONS........................................................................1
FEVER...................................................................................... 2
BLEEDING............................................................................... 3
UNPLEASANT SMELL OF SECRETIONS..............................4
DELIVERING MORE THAN 12 HOURS ............................... 5
IF PLACENTA ARE NOT SEPARATES IN 30 MINUTES.... 6
OTHERS_________________________................................ 96
(IDENTIFY)
DO NOT KNOW .................................................................... 88
OPI 7
WHAT KIND OF DANGEROUS SYMPTOMS MAY
OCCUR WHILE DELIVERING?
Mark all versions of the answers
IF 2 AND MORE ANSWERS.............1
OTHERWISE........................................................................0
FEVER.......................................................................1
BLEEDING................................................................2
UNPLEASANT SMELL OF SECRETIONS............ .3
OTHERS_____________________..........................96
(IDENTIFY)
DO NOT KNOW 88
OPI 8
What kind of dangerous symptoms make you go to a
specialist after delivery?
Mark all versions of the answers
IF 2 AND MORE ANSWERS.............1
OTHERWISE........................................................................0
RARE BREASTFEEDING..............................................................1
CONVULSIONS.............................................................................2
FREQUENT/DIFFICULT BREATHING.......................................3
GETTING RED OR PUS OF THE UMBILUCAL CORD............4
CHANGING OF THE BODY TEMPERATURE..........................5
WEAKNESS OR EXCITEMENT..................................................6
DIAHHREA OR VOMITING........................................................7
GETTING BLUE OF PALMS, FEET, AND AROUN MOUTH...8
OPI 9
What kind of dangerous symptoms of baby show that
you must go to a specialist?
Mark all versions of the answers
IF 2 AND MORE ANSWERS...............................................1
OTHERWISE........................................................................0
OPI 10
IF THERE ARE DANGEROUS SYMPTOMS WHERE YOU SHOUL GO?
1 YES 0 NO
OPI 11
WERE YOU INFORMED ABOUT CONTRACEPTION METHODS AFTER DELIVERING?
1 YES 0 NO
OPI 12
ARE YOU SATISFIED WITH TODAY’S MEDICAL WORKER’S VISIT?
1 YES 0 NO
OPI 13
FOR MONITORS:
According to № OPI 1-4, 7, 8, 10-12 woman’s answers find out if the woman’s pregnancy
written in protocol based on WHO?
1 YES 0 NO
SHOW THE BOOK, BROCHURE
OUT-PATIENT INTERVIEW home visit
3
QUESTION YES NO DETAILED ANSWERS
1. Have you ever seen “mother’s
home book”?
Stop if the answer is no
2. Do you have the same note book?
3. Do you like the cover and the note
book itself?
Why?
4.Which part do you consider is the
most interesting for you?
If ‘yes” which one?
5.In your opinion what kind of
information should added or cut?
If ‘yes” which one?
6.For monitors:
According to the above answers
identify how efficient the women use
the note book?
7.for monitors:
Check the women’s note books and
evaluate the medical worker’s work.
Thank you for your interview with us. If you have any questions we are happy to answer!
SM: OUT-PATIENT SERVICE OBSERVATION home visit
1
Observation form for health providers’ consulting skills for pregnant women by the “Safe Motherhood”
program.
Monitoring date: oblast: Rayon:
Medical worker: Facility name:
Monitor: Type of consultation: pregnant woman
The objective visits of the pregnant woman must be at least 3 times
Steps \Objectives Practice
yes=1, no=0,
inappropriate 
General skills of consultation
OPSO1 Met the patient/Spouses with respect and asked them to have a seat and feel
comfortable. Introduced herself. Kept patience while the talk. Didn’t interrupt
the patient
OPSO2 Asked about the woman’s state. Had a very briefly talk, only necessary information.
OPSO3 Asked proper and appropriate questions. Made the woman be interested in giving
questions
OPSO4 Explained the information in different ways. In order to be confirmed in the obtaining the
information asked the woman to repeat the given instructions.
OPSO5 Used visual aids (postures, brochure, books, album) and at the same time made the
woman be interesred and participant.
OPSO6 Fixed the time of the following visit and explained how many times she should visit
DPM after delivery.
OPSO7 Explained the role of the woman and mahalla for the safety life of her future baby and
used the “Mother’s home- book”.
OPSO8 Explained the importance of breastfeeding. Asked if there are problems of breastfeeding
and give recommendations.
OPSO9 Explained about the nutrition of thepegnant women. (mark 1if answered from 9a-9g,
otherwise – 0)
OPSO9a Feeding with bread and bread production, rice, potato, whet products several times a
day.
OPSO9b Feeding with fruits and vegetables, greens which are rich in vitamins several times a
day.
OPSO9c Feeding with dairy products which contain less oil.
OPSO9d Feeding with oily less meat or wheat vegetables.
OPSO9f Feeding with sweets and oily products less than it was asked above
OPSO9g Not to drink tea or Coca-Cola after having meal
OPSO10 If there are any dangerous symptoms of the delivered woman or of the baby was sent
to the facility immediately
Consulting on the pregnancy conduction
For monitors:
to conduct this type of consultation the medical worker should examine a pregnant woman
OPSO11 Were all necessary examinations and analyses carried out at this time of the
woman’s visit? (summarize considering the pregnancy period and other factors) (11a –
11d)
OPSO11a Examined the woman’s blood pressure
OPSO11b Examined woman’s stomach and measured the bottom of uterus height (beginning
from the 24 week the bottom of uterus height must be equal to the bottom of uterus
height of gestation period (in cm)
OPSO11c Identified the state of pregnancy. 9it is done at each visit after second part period of
pregnancy) and beginning from the 36 week identified entrance baby’s head into small
pelvis minor.
OPSO11d Examined the heart palpitation of the pregnancy (the period is more than 18 weeks)
SM: OUT-PATIENT SERVICE OBSERVATION home visit
2
OPSO12 The medical worker recommended the woman about the place of the delivery and
explained how to deliver in the
OPSO13
Informed the woman about the physiological
(mark 1 if 5 answered from13a-13j 5, otherwise – 0)
OPSO13a Feeling sickness at the beginning period of the pregnancy
OPSO13b Felling pain in the tops of breast and leaking milk at the end period of pregnancy.
OPSO13c No menses
OPSO13d Getting dark of pigment spots on the skin
OPSO13e Overweighting to 10-12 kg
OPSO13f Getting tired at the end of pregnancy.
OPSO13g Constipation
OPSO13h Frequent urination
OPSO13i Getting the uterus bigger (growing)
OPSO13j Pains in the small of the back
OPSO14 Explained about the possible dangers of the pregnancy period.
(mark I if 8 answered from 14a-14j, otherwise – 0)
OPSO14a Having secretion (blood, having amniotic water before the time )
OPSO14b Changing the movement of the foetus (more or less often than usual)
OPSO14c Constant headache, poor eyesight, getting dark before eyes, the dark spots becoming
bright
OPSO14d Having fever and if the temperature is 38°С or above
OPSO14e Falling down and having any types of hurts in the part of stomach
OPSO14f Strong pains in the stomach
OPSO14g Sudden appearing and disappearing oedema.
OPSO14h Unconscious
OPSO14i Convulsions
OPSO14j Difficult breathing
OPSO15 Explained dangerous symptoms during having delivery
(if the period of pregnancy is more thаn 32 weeks)
(if 5 answered from15a –15f– 1, otherwise – 0)
OPSO15a Convulsions
OPSO15b if the temperature is 38°С or above
OPSO15c Bleeding
OPSO15d Having deliveries more than 12 hours
OPSO15e NO separation of placenta during 30 minutes
OPSO15f Having unpleasant smell or pus of secretions
OPSO16 Explained about the possible post natal dangerous symptoms
(mark 1 if 2 answered from 16a - 16c,otherwise – 0)
OPSO16a if the temperature is 38°С or above, fever
OPSO16b Bleeding a lot
OPSO16c Having unpleasant smell or pus of secretions
OPSO17 Explained how to take care of the baby and possible dangerous symptoms.
(mark 1 if 6 answered from 17a - 17h, otherwise – 0)
OPSO17a Rare breastfeeding
OPSO17b Convulsions
OPSO17c Frequent or difficult breathing
OPSO17d Getting red or pus of the umbilical cord
OPSO17e Changing of body temperature
OPSO17f Weakness and excitement
OPSO17g Diarrhea and vomiting
OPSO17h Getting blue of the palm, foot, and around mouth
OPSO18 Explained where to go if there are dangerous symptoms.
OPSO19 Explained about the advantageous of her partner participance during the
delivery.
OPSO20 Gave advice about contraception methods after delivery.
SM: OUT-PATIENT SERVICE OBSERVATION home visit
3
OPSO21 Used communication skills during consultation:
Asking and listening?
Encouraging?
Advising?
Checking?
TEST QUESTIONS FOR OB-GYNS, GPs, AND MIDWIVES ON SAFE MOTHERHOOD
1. Which of the followings is not responsibility of the HP at a Village Health Post (VHP￾SVP)?
2. Which infections do not affect pregnancy?
3. What signs and symptoms may indicate pregnancy?
4. In conduct of routine medical checks of pregnant women with pregnancy for more than
16 weeks what checks should be conducted each time?
5. Which of the following changes do not belong to natural changes that are characteristic to
pregnancy?
6. Which of the followings does not belong to advantages of using the Mother Home Card
7. What criterion is used to diagnose severe pre-eclampsia?
8. The causes of bleeding during the first trimester of pregnancy include:
9. The effective records in medical records (primary health care level) shall be as follows:
10. What danger signs, during pregnancy, imply necessity of seeing a doctor? (name any
six)
11. What danger signs during postpartum period indicate to necessity for immediate
medical assistance? (name any four)
12. What procedures are required to treat anemia?
13. What should a patronage nurse bring with her in her visits to a house of a pregnant
women?
reception
Evaluation list on the monitoring of trained health providers by “Safety Motherhood” program
(In-patient part of the post natal care)
Check-list
Monitoring date: Oblast: Rayon:
Medical worker: Facility name:
Monitor: Consultation type: pregnant woman
Antenatal/ Postnatal period
№ Indicators
(source)
Yes=1, No=0
Inappropriate

1. Met the patient/Spouses with respect and asked them to have a seat and feel comfortable.
Introduced herself. Kept patience while the talk. Didn’t interrupt the patient (OPSO1)
2. Asked about the woman’s state. Had a very briefly talk, only necessary information. Asked
clear and proper questions. Asked open questions. Made the woman be interested in giving
questions. (OPSO2-3)
3. Explained the information in different ways. In order to be confirmed in the obtaining the
information asked the woman to repeat the given instructions. (OPSO4)
4. Used visual aids (postures, brochure, books, album) and at the same time made the woman
be interesred and participant. (OPSO5)
5. Fixed the time of the following visit and explained how many times she should visit facility
after delivery. (OPSO6)
6. Explained the role of woman and mahalla for her baby’s health. Used “Mother’s home book”
(OPSO7)
7. Explained the importance of breastfeeding. Asked if there are problems of breastfeeding and
give recommendations. (OPSO8)
8. Explained about the nutrition of thepegnant/delivered women. (OPSO9)
9. At this visit all the necessary examinations have been carried out.
10. Explained the woman where to deliver and recommended to deliver in the facility и.
(OPSO12)
11. Explained about physiological changes during pregnancy (OPSO13)
12. Explained about the possible dangerous symptoms during pregnancy. (OPSO14)
13. Explained about the possible dangerous symptoms while delivering. (OPSO15)
14. Explained about the possible postnatal dangerous symptoms (OPSO16)
15. Informed where to go in case if there are dangerous symptoms. (OPSO13)
16. Explained about the advantageous of the partner presence while delivering (OPSO18)
17. The focus visits of the pregnant woman should be more than 3 times (PPR 2)
18. The postnatal period is being carried out correctly (PPR 15)
19. Knowledge of the woman about postnatal period (OPI 6)
20. Knowledge of the woman about the dangerous symptoms of the baby (OPI 7)
21. Knowledge of the woman about pregnancy period. (OPI 8)
22. Knowledge of the woman about dangers while delivering (OPI 9)
23. Satisfaction of the medical worker’s visit. (OPI 12)
24. Test: 55-70%=1score, 71-85%=2 scores , 86-100%=3 scores
25. The pregnancy situation of the woman is written according to the ЖССТ recommendation
(OPSO 1-18, PPR1-14, OPI 13)
26. Using the “Mother’s home book” (item №6)
Total sum of 1 and  is /28 and % %
SM: OUT-PATIENT SERVICE OBSERVATION reception
1
Evaluation consultation skills list on the program “Safety Motherhood” (In-patient part of the post natal care)
Monitoring date: Oblast: Rayon:
Тиббиёт ходими: Facility name:
Monitor: Consultation type: 1st pregnancy/ 2nd pregnancy (infant under 1,5 months)
The delivered woman should visit the doctor at least three times during her pregnancy.
The delivered woman should visit the facility at least once within 1,5 month or the visiting nurse should
visit her during a week.
steps\objectives Yes=1, No=0,
N/a 
GENERAL SKILLS OF CONSULTATION
OPSO1 Met the patient/Spouses with respect and asked them to have a seat and feel
comfortable. Introduced herself. Kept patience while the talk. Didn’t interrupt
the patient?
OPSO2 Asked about the woman’s state. Had a very briefly talk, only necessary information.
OPSO3 Asked clear and proper questions. Asked open questions. Made the woman be
interested in giving questions
OPSO4 Explained the information in different ways. In order to be confirmed in the obtaining the
information asked the woman to repeat the given instructions
OPSO5 Used visual aids (postures, brochure, books, album) and at the same time made the
woman be interesred and participant.
OPSO6 Fixed the time of the following visit and explained how many times she should visit
DPM after delivery
OPSO7 Used the “mother’s home book” and explained the role of the woman and mahalla
OPSO8 Explained the importance of breastfeeding.
OPSO9 Explained about the nutrition of thepegnant/delivered women.
(1-if the answers from 9a – 9g, otherwise – 0)
OPSO9a Feeding with bread and bread production, rice, potato, whet products several times a
day.
OPSO9b Feeding with fruits and vegetables, greens which are rich in vitamins several times a
day.
OPSO9c Feeding with dairy products which contain less oil.
OPSO9d Feeding with oily less meat or wheat vegetables
OPSO9f Feeding with sweets and oily products less than it was mentioned above
OPSO9g Not to drink tea or Coca-Cola after having meal
OPSO10 If there are any dangerous symptoms of the delivered woman or of the baby was sent
to the facility immediately
CONSULTATION ON CONDUCTIONG PREGNANCY
OPSO11 Were all necessary examinations and analyses carried out at this time of the
woman’s visit? summarize considering the pregnancy period and other factors) (11a –
11e)
OPSO11a Examined the woman’s blood pressure
OPSO11b Examined woman’s stomach and measured the bottom of uterus height (beginning
from the 24 week the bottom of uterus height must be equal to the bottom of uterus
height of gestation period
OPSO11c Identified the state of pregnancy. 9it is done at each visit after second part period of
pregnancy) and beginning from the 36 week identified entrance baby’s head into small
pelvis minor.
OPSO11d Examined the heart palpitation of the pregnancy (the period is more than 18 weeks)
OPSO11e Measured the woman’s weight and observed her dynamics (the weight should be to
10-12 more than her own weight)
OPSO12 The medical worker asked the woman to find out the place to deliver and advised
to deliver in the facility (in 36 weeks)
OPSO13 Gave the woman information on the physiological changes (1 score if answered 5
SM: OUT-PATIENT SERVICE OBSERVATION reception
2
from 13a-to13j – 1,otherwise– 0)
OPSO13a Feeling sickness at the beginning period of the pregnancy
OPSO13b Feeling sickness at the beginning period of the pregnancy
OPSO13c No menses
OPSO13d Getting dark of pigment spots on the skin
OPSO13e Overweighting to 10-12 kg
OPSO13f Getting tired at the end of pregnancy.
OPSO13g Constipation
OPSO13h Frequent urination
OPSO13i Getting the uterus bigger (growing)
OPSO13j Pains in the small of the back
OPSO14 Explained about the possible dangers of the pregnancy period.
(mark I if 8 answered from 14a-14j, otherwise – 0)
OPSO14a Having secretion (blood, entrance baby’s head into small pelvis minor.)
OPSO14b Changing the movement of the foetus (more or less often than usual)
OPSO14c Constant headache, poor eyesight, getting dark before eyes, the dark spots becoming
bright
OPSO14d Having fever and if the temperature is 38°С or above
OPSO14e Falling down and having any types of hurts in the part of stomach
OPSO14f Strong pains in the stomach
OPSO14g Sudden appearing and disappearing oedema.
OPSO14h Unconscious
OPSO14i Convulsions
OPSO14j Difficult breathing
OPSO15 Explained about the possible post natal dangerous symptoms (if the pregnancy is
more than 32 weeks)
(mark 1 if 2 answered from 16a - 16c,otherwise – 0)
OPSO15a entrance baby’s head into small pelvis minor.
OPSO15b if the temperature is 38°С or above
OPSO15c Bleeding a lot
OPSO15d Having delivery more than 12 hours
OPSO15e NO separation of placenta during 30 minutes
OPSO15f Having unpleasant smell or pus of secretions
OPSO16 Explained about the possible post natal dangerous symptoms
(mark 1 if 2 answered from 16a - 16c,otherwise – 0)
OPSO16a if the temperature is 38°С or above, fever
OPSO16b Bleeding a lot
OPSO16c Having unpleasant smell or pus of secretions
OPSO17 Explained where to go if there are dangerous symptoms.
OPSO18 Explained about the advantageous of her partner participance during the delivery.
OUT-PATIENT INTERVIEW reception
Interview with out-patient pregnant/delivered women on “Safe Motherhood” program
Monitoring date: Oblast: Rayon:
Medical worker: Facility name:
Monitor: Consultation type: pregnant woman
We are studying the service in your facility organized and we’d like you to answer our several questions.
We will not write your name and will keep information given by you in secret.
INTERVIEW WITH PREGNANT WOMAN
OPI 1
HOW LONG ARE YOU PREGNANT?
WRITE THE ANSWER IN MONTHS. write «-» if doesn’t know _________months
OPI 2
At what time of your pregnancy week did you visit the facility for the first?
Write the answers in weeks ________ weeks
OPI 3 WERE YOU INFORMED THAT YOUR PATNER CAN PARTICIPATE IN YOUR DELIVERY? 1 YES 0 NO
OPI 4
PLEASE, COUNT THE
ADVANTAGEOUS THE PARNER
PARTICIPANCE IN THE
DELIVERING
MARK “1” IF THE ANSWER IS 2 AND
MORE, OTHERWISE «0»»
1. the process of delivery will take less time
2.less opportunities in using anesthetic means
3. less necessity in using
4. less necessity in using delivery procedures
5. less necessity surgery involvement
1 YES 0 NO
OPI 5
I’D LIKE TO KNOW ABOUT ALL THE MEDICAL SERVICES OF THIS FACILITY
DURING YOUR BEFORE AND AFTER PREGNANCY.
DID THE PATIENTS HAVE THE FOLLOWING PROCEDURES?
ASK ABOUT EACH PROCEDURE
Mark only one answer for
each procedure
{OPI 5a} WERE Fe AND FOLIC ACID RECOMMENDED 1 YES 0 NO
{OPI 5b} WERE THE INSTRUCTIONS GIVEN ABOUT THE PROPER NUTRITION 1 YES 0 NO
{OPI 5c} DID YOU HAVE A TALK ABOUT THE DELIVERING PLACE 1 YES 0 NO
{OPI 5d} EXPLAINED THE ADVANTAGEOUS OF THE DELIVERING IN THE FACILITY 1 YES 0 NO
{OPI 5e} Informed you about the role of the woman and mahalla for your baby’s health? 1 YES 0 NO
{OPI 5f} HAD THE WOMEN CONVERSATION ABOUT THE GAP DIFFERENCES BETWEEN
DELIVERIES AND FAMILY
1 YES 0 NO
{OPI 5g} WHAT WAS TOLD ABOUT SEXUAL TRANSMITTED DISEASES? 1 YES 0 NO
{OPI 5h} Explained you how to get to the facility in case of emergency 1 YES 0 NO
{OPI 5i} Explained you about breastfeeding advantageous 1 YES 0 NO
CONVULSIONS ...................................................................1
EYESIGHT DESTROY.........................................................2
BLEEDING ...........................................................................3
DIFFICULT BREATHING ...................................................4
HEADACHE .........................................................................5
FREQUENT APPEARING AND DISAPPEARING OEDEMA 6
FEVER...................................................................................7
STRONG PAIN IN STOMACH............................................8
CHANGING THE FOETUS MOVEMENT ..........................9
CONSCIOUSNESS ............................................................10
ANY HURTS WHILE FELLING OR BEATING ...............11
OTHERS_________________________.................96
(SPECIFY)
DO NOT KNOW .................................................................88
OPI 6
At what kind of dangerous symptoms you should see a
specialist?
Mark all versions of the answers
IF THREE AND MORE ANSWERS.............1
OTHERWISE........................................................................0
OUT-PATIENT INTERVIEW reception
RARE BREASTFEEDING........................................................................1
CONVULSIONS........................................................................................2
FREQUENT/DIFFICULT BREATHING..................................................3
GETTING RED OR PUS OF THE UMBILUCAL CORD.......................4
CHANGING OF THE BODY TEMPERATURE......................................5
WEAKNESS OR EXCITEMENT.............................................................6
DIAHHREA OR VOMITING....................................................................7
GETTING BLUE OF PALMS, FEET, AND AROUN MOUTH...............8
OPI 7
What kind of dangerous symptoms of baby show that
you must go to a specialist?
Mark all versions of the answers
IF 2 AND MORE ANSWERS.............1
OTHERWISE........................................................................0
CONVULSIONS ...................................................................1
EYESIGHT DESTROY.........................................................2
BLEEDING ...........................................................................3
DIFFICULT BREATHING ...................................................4
HEADACHE .........................................................................5
FREQUENT APPEARING AND DISAPPEARING OEDEMA 6
FEVER...................................................................................7
STRONG PAIN IN STOMACH............................................8
CHANGING THE FOETUS MOVEMENT ..........................9
CONSCIOUSNESS ............................................................10
ANY HURTS WHILE FELLING OR BEATING ...............11
OTHERS_________________________.................96
(SPECIFY)
DO NOT KNOW .................................................................88
OPI 8
At what kind of dangerous symptoms in the period of
pregnancy you should see a specialist?
Mark all versions of the answers
IF THREE AND MORE ANSWERS.....................................1
OTHERWISE........................................................................0
CONVULSIONS .......................................................................1
FEVER...................................................................................... 2
BLEEDING .............................................................................. 3
UNPLEASANT SMELL OF SECRETIONS...............................4
DELIVERING MORE THAN 12 HOURS............................... 5
IF PLACENTA ARE NOT SEPARATES IN 30 MINUTES.... 6
OTHERS_________________________................................ 96
(IDENTIFY)
DO NOT KNOW .................................................................... 88
OPI 9
WHAT KIND OF DANGEROUS SYMPTOMS MAY
OCCUR WHILE DELIVERING?
Mark all versions of the answers
IF 2 AND MORE ANSWERS................................................1
OTHERWISE........................................................................0
OPI 10
IF THERE ARE DANGEROUS SYMPTOMS WHERE YOU SHOUL GO? 1 YES 0 NO
OPI 11 WERE YOU INFORMED ABOUT CONTRACEPTION METHODS AFTER DELIVERING? 1 YES 0 NO
OPI 12 ARE YOU SATISFIED WITH TODAY’S MEDICAL WORKER’S VISIT? 1 YES 0 NO
OPI 13 WERE YOU INFORMED ABOUT CONTRACEPTION METHODS AFTER DELIVERING? 1 YES 0 NO
ARE YOU SATISFIED WITH TODAY’S MEDICAL WORKER’S VISIT?
Show the book, brochure
QUESTION YES NO DETAILED ANSWERS
1. Have you ever seen “mother’s
home book”?
Stop if the answer is no
2. Do you have the same note book?
3. Do you like the cover and the note
book itself?
Why?
4.Which part do you consider is the
most interesting for you?
If ‘yes” which one?
OUT-PATIENT INTERVIEW reception
5.In your opinion what kind of
information should added or cut?
If ‘yes” which one?
6.For monitors:
According to the above answers
identify how efficient the women use
the note book?
Thank you for your interview with us. If you have any questions we are happy to answer!
PRENATAL/POSTNATAL RECORDS reception
Monitoring date: Oblast: Rayon:
Medical worker: Facility name:
Monitor: Consultation type: 1st pregnancy/ 2nd pregnancy (infant under 1,5
бор):
EVALUATION WOMAN’S MAP OF PREGNANCY AND “MOTHER’S HOME BOOK” (MHB)
THE PREGNANT SHOULD HAVE THREE OBJECTIVE VISITS. (MOH ORDER №425 of the table, according to gestation
age). The delivered woman should visit the facility at least once within 1,5 months after delivery or the patronage nurse should
visit her.
Protocols on the conduction of the pregnancy Yes=1, no=0,
inappropriate
PPR 1 Do you have information on each visit of the woman?
PPR 2 How many times the objective visits of the pregnant woman were mentioned on the pregnancy map?
Mark 1 if more than 3 times, otherwise 0 (if the gestation period is appropriate)
PPR 3 On the individual map of the pregnancy visit what initial periods were shown according to the MHB ?
Mark1 if the pregnancy period is until 12 weeks, otherwise 0
PPR 4 How many times was the blood pressure measured and was it written in MNB?
(The blood pressure should be measured at each visit)
Mark 1 if three and more times, otherwise 0
PPR 5 How many times the heart palpitation was checked?
(the palpitation and movement are identified at the 12-18 week)
Mark 1 if three and more times, otherwise 0
PPR 6 How many times was the weight measured?
Mark 1 if three and more times, otherwise 0
PPR 7 Was the woman’s height measured/was the weight calculated in index?
Mark 1 if one and more times, otherwise 0
PPR 8 How many times the height if the uterus bottom was measured?
(after 24 weeks the height of the uterus bottom must be equal to the period of pregnancy. It must identified
only by one person )
Mark 1 if three and more times, otherwise 0
PPR 9 How many times the position of the foetus and the previous part of the foetus was examined and written in?
PPR 10 Was the results of Hb mentioned?
(the analusis for Hb must be taken at the 1st and 4th visit. In necessary cases it can be taken repeatedly?
PPR 11 Is the rhesus of blood and the group of the blood clear?
PPR 12 Was the result of syphilis analysis mentioned?
(must be mentioned at the first visit)
PPR 13 How many times the urine analysis taken?
Mark 1 if three and more times, otherwise 0
PPR 14 Was the treatment duration from anemia with Fe and Folic acid prescribed correctly?
( Fe must be 120 мg and folic acid must be 0,4 мg per a day and this treatment procedure must last 3
months)
Protocols of the postnatal period
(for monitors: summarize after considering 5 protocols)
PPR 15 Was the protocols of postnatal period conducted correctly?
(give the correct summary after considering items “a-i”)
a. Is there information about the state of the woman in the protocol, any complains
b. Is there any problems of breastfeeding mentioned?
c. Was the blood pressure measured?
d. The in formation about breast?
e. While examining the part of the stomach is there notice about the shortanage of the uterus height of the
bottom?
f. Information about bleeding?
g. Notices about postnatal contraception?
h. Notice about the process of the implementation if the woman chose BIV method?
i. Was the time of the following visit fixed?
TEST QUESTIONS FOR OB-GYNS, GPs, AND MIDWIVES ON SAFE MOTHERHOOD
1. Which of the followings is not responsibility of the HP at a Village Health Post (VHP￾SVP)?
2. Which infections do not affect pregnancy?
3. What signs and symptoms may indicate pregnancy?
4. In conduct of routine medical checks of pregnant women with pregnancy for more than
16 weeks what checks should be conducted each time?
5. Which of the following changes do not belong to natural changes that are characteristic to
pregnancy?
6. Which of the followings does not belong to advantages of using the Mother Home Card
7. What criterion is used to diagnose severe pre-eclampsia?
8. The causes of bleeding during the first trimester of pregnancy include:
9. The effective records in medical records (primary health care level) shall be as follows:
10. What danger signs, during pregnancy, imply necessity of seeing a doctor? (name any
six)
11. What danger signs during postpartum period indicate to necessity for immediate
medical assistance? (name any four)
12. What procedures are required to treat anemia?
13. What should a patronage nurse bring with her in her visits to a house of a pregnant
women?
Project HOPE, Navoi, Uzbekistan
Monitoring and evaluation/school level
“Adolescents reproductive and sexual health”
Checklist
Oblast:______________________________ Rayon/city:_____________________________
Date:______________________ Name of educational department (sch.
number):__________________________________
№
Checklist for “ARH” educational services Characteristics «Yes» «No»
1 0
Educational Institution Administration support in program implementing
1 Realization of ARH classes at the educational institution (DIR – 1)
2 Knowledge about governmental degree/local administration orders depending on ARH classes
realization (make a conclusion relying on DIR – 2, 3)
3 Adequate usage of specialists (make a conclusion relying on DIR – 5, 15)
4 Realization of parents’ meeting devoted to “Reproductive health and healthy family creation”
educational program importance (make a conclusion relying on DIR – 13, 14)
5
HPs involvement in ARH classes realization (make a conclusion relying on ADOL – 9, 9; DIR – 5)
6 “Adolescents reproductive and sexual health” participant’s manual availability at educational
institution library (make a conclusion relying on ADOL – 7; DIR - 7)
7 “Adolescents reproductive and sexual health” participant’s manual usage during ARH classes (make
a conclusion relying on ADOL –5, 6; TEACH - 7)
8 Possibility in taking home “Adolescents reproductive and sexual health” participant’s manual for
home reading (make a conclusion relying on DIR – 11, ADOL- 8)
“ARH” classes’ provider’s qualification
9 Participated in special “Adolescents reproductive and sexual health” course
(TEACH –2)
10 Knowledge about governmental degree/local administration orders depending on ARH classes
realization
(make a conclusion relying on TEACH – 3, 4, 5)
11 “Adolescents reproductive and sexual health” manuals usage in making ARH classes plan (make a
conclusion relying on TEACH – 6)
12 Knowledge about interactive teaching methods (TEACH – 9)
13 Interactive teaching methods usage during the classes (make a conclusion relying on OBS Part -
1, TEACH – 10)
14 “Reproductive health” term understanding (TEACH – 12)
15 Knowledge about consequences of adolescents pregnancy (TEACH – 14)
16 Knowledge about consequences of abortion (TEACH – 15)
17 Knowledge about modern contraceptive methods (make a conclusion relying on TEACH – 16, 17,
18, 19)
18 Knowledge about STI signs (TEACH – 20)
19 Knowledge about ways of STI prevention (TEACH – 21)
20 Knowledge about ways of HIV/AID transmission (make a conclusion relying on TEACH – 22, 23)
21
Knowledge about ways of HIV/AID prevention (TEACH – 24)
Adolescents knowledge
22 “Reproductive health” term understanding (ADOL – 11)
23 Knowledge about modern contraceptive methods (ADOL – 15)
24 Knowledge about STI signs (ADOL – 16)
25 Knowledge about ways of STI prevention (ADOL – 17)
26 Knowledge about ways of HIV/AID transmission (ADOL – 18)
27 Knowledge about ways of HIV/AID prevention (ADOL – 19)
Total mark %
Monitors:_________________________________________________________________________________
Project HOPE, Navoi, Uzbekistan
Monitoring and evaluation/school level
Instrument 1: “Adolescents reproductive and sexual health”
All questions are to be addressed to educational institution administration.
Oblast:______________________________ Rayon/city:_________________________
date:_____/____________/_____
Name of educational
department:_____________________________
Interviewer:___________________________ Respondent: ___________________________
Informed Consent
Hello, my name is ______________ and I am working with Oblast Health Department/Oblast Public Education
Department/Oblast Colleges Department. Oblast Health Department/Oblast Public Education Department/Oblast
Colleges Department jointly are going to monitor quality of measures taken due to “Reproductive health and healthy
family creation” educational program at your educational institution. Within the aim we need to carry out a survey with
you. The survey is going to take us 20 minutes to complete.
Information related to “Adolescents Reproductive Health” classes
№ QUESTIONS AND FILTERS CODING CATEGORIES SKIP
1 Do you have any classes on reproductive health for
10 -11 class formers (first, second year
students) at your educational institution?
a) Yes
b) No
(а – 1 point)
2 Do you know about governmental degree/local
administration orders depending on which
“Reproductive health and healthy family creation”
educational program was entered on 10 -11 class
formers (second, third year
students) educational program?
(identify if the administration have known about
governmental degree/local administration
orders )
a) Yes
b) No
(а – 1 point)
3 How many hours devoted for “Reproductive health
and healthy family creation” educational program
annually?
a) 16, 17 hours
b) don’t know/don’t remember
c) other (identify)___________________
________________________________________
4 How the provision of reproductive health classes is
registered at your educational institution?
a) In class journal
b) Don’t know/don’t remember
c) Other (identify)___________________
5 What is the trade of person provided ARH classes
at your educational institution?
a) Psychologist
b) Biology teacher
c) HP
d) Other:______________________________
(c– 1 point)
6
Has the person any certificate or another document
which can testify his (her) participation in special
“Adolescents reproductive health” course?
a) Yes, certificate given in “Adolescents
reproductive and sexual health” seminar
organized by OHD, OPED and Project HOPE
b) No
c) Don’t know/don’t remember
d) Other (identify)___________________
________________________________________
7 Is there any manual on adolescents reproductive
health available at your educational institution
library?
(make sure that any manual is available in the
a) Yes
b) No
(а – 1 point)
10
Identify the following information
library)
8 Can you tell the name of the manual on
adolescents reproductive health available at your
educational institution library?
(identify the name of available manual)
a) “Adolescents reproductive and sexual health”
participants manual
b) Other:_________________________________
_____________________________
9 Is the quantity of the available manual enough for
your educational institution?
a) Yes
b) No
c) Don’t know/don’t remember
10 What is the total number of 10 - 11 class
formers (second, third year students) at your
educational institution?
(identify the correct number)
a) Identify ______________________________
11 Have the students of the educational
institution possibility to take the manual home
for reading?
a) Yes
b) No
(а – 1 point)
12 Do you provide meetings for 10-11 class
formers (second, third year students) at your
educational institution?
a) Yes
b) No
13 Has the parents’ meeting devoted to
“Reproductive health and healthy family creation”
educational program importance been provided at
your educational institution?
a) Yes
b) No
(а – 1 point)
15
14 Have you got any written guideline or protocol
which can testify the provision of
parents’ meeting devoted to “Reproductive health
and healthy family creation” educational program
importance?
(If the answer is “Yes” look through the
protocol)
a) Yes
b) No
(а – 1 point)
Staff Positions Person’s full name
Taught on
«Adolescents
reproductive and
sexual health»
course
(put the mark «√»)
Haven’t been taught
on «Adolescents
reproductive and
sexual health» course
(put the mark «√»)
Psychologist
Health provider
15
“Reproductive health and
healthy family creation”
lessons providing teacher
(ADOL) Мониторинг ва баҳолаш.
1
Project HOPE, Navoi, Uzbekistan
Monitoring and evaluation/school level
Instrument 3: “Adolescents reproductive and sexual health”
All questions are to be addressed to adolescents 16-18 years of age
Oblast:______________________________ Rayon/city:_________________________
Date:_____/____________/_____
Name of educational
department:_____________________________
Interviewer: ______________________ Respondent: _________________________
Informed Consent
Hello, my name is ______________ and I am working with Oblast Health Department/Oblast Public Education
Department/Oblast Colleges Department. We are going to monitor quality of “Reproductive health” classes providing at
your educational institution. Within the aim we need to carry out a survey with you. The survey is going to take us 20
minutes to complete.
Information related to “Adolescents Reproductive Health” classes
№ QUESTIONS AND FILTERS CODING CATEGORIES SKIP
1 How old were you at your last birthday? AGE IN COMPLETED YEARS ……………………[ / ]
2
What form (course) are you in?
a) Form 10
b) Form 11
c) Third year student
d) Second year student
3 Did you have any classes on reproductive health
at your educational institution? (If the answer is
“Yes” define the name of the classes provider)
a) Yes
b) No
c) Don’t know
10
10
4
What topics did you discussed
during the classes?
(Read the topics and mark the
discussed ones)
a) Reproductive and sexual health
b) Anatomy and physiology
c) Body changes
d) Friendship. Love. Relationship with boyfriend/girlfriend.
e) Consequences of adolescent pregnancy
f) Abortion consequences
g) Contraceptive methods
h) STI
i) HIV/AID and its prevention
j) Violence. Violence prophylactics.
k) Risky behavior (alcoholism, smoking, drug addiction)
l) Don’t remember
m) Other (identify)_________________________________
______________________________________________________
5 Do you use any manual on reproductive health
during the classes?
a) Yes
b) No
(а – 1 point)
7
6 Can you name the manual? (identify the name
of manual)
a) “Adolescents reproductive and sexual health”
b) Don’t remember
c) Other (identify the name)__________________
____________________________________________
(а – 1 point)
7 Have you seen any manual on adolescents
reproductive health at the library of your
educational institution? ( If the answer is “Yes”
identify the name of manual)
a) Yes, “Adolescent reproductive and sexual health”
b) No
(а – 1 point)
9
8 Can you take the manual home to read? a) Yes
b) No
c) Don’t know
(а – 1 point)
9 Have the health provider ever attendee your
reproductive health classes?
a) Yes
b) No
c) Don’t know
(а – 1 point)
(ADOL) Мониторинг ва баҳолаш.
2
10 Have you ever attended health facility during the
classes?
a) Yes
b) No
(а – 1 point)
Knowledge on reproductive health
№ QUESTIONS AND FILTERS CODING CATEGORIES SKIP
11 (Now I want to ask you some questions about
topics you studied during reproductive health
classes)
How do you understand the “reproductive
health” term?
a) Reproductive health is not only the absence of
reproductive system diseases; it is total physical,
mental and social development.
b) Other: (identify)_______________________
__________________________________________
__________________________________________
(а – 1 point )
12
Please can you name the
reproductive and sexual
rights?
a) THE RIGHT FOR LIFE
b) THE RIGHT FOR INDIVIDUAL SAFETY
AND LIBERTY
c) THE RIGHT ON EQUALITY
d) THE RIGHT ON INDIVIDUAL LIFE AND CONFIDENTIALITY
e) RIGHT ON FREEDOM WORLD VIEW
f) THE RIGHT ON RECEPTION OF
INFORMATION AND KNOWLEDGE
g) THE RIGHT OF FAMILY PLANNING
h) THE RIGHT TO HAVE A CHILD
i) THE RIGHT ON RESEPTION HEALTH SERVICES
j) THE RIGHT ON SCIENTIFIC ACHIVEMENTS USE
k) THE RIGHT ON PARTICIPATION IN SOCIAL MEETINGS
l) THE RIGHT ON PROTECTION
FROM VIOLENCE
m) Don’t know
(3 right answers – 1 point )
13
Can you name consequences of adolescents’
pregnancy?
(the question is non applicable for 10
formers)
a) Blood pressure increasing
b) Hypostasis
c) Fetus hypoplasia
d) Premature birth
e) Miscarriage
f) Mother and child anemia
g) Handicapped child birth
h) Difficult confinement can lead to mother’s mortality
i) Don’t know
j) Other (identify)__________________________
______________________________________________
______________________________________________
(3 right answers – 1 point )
14
Can you name consequences of adolescents’
abortion?
(the question is non applicable for 10
formers)
a) Menstrual irregularities
b) Reproductive organs diseases
c) Bleeding
d) Injuries to uterus
e) Contamination
f) Sterility
g) Mortality
h) Don’t know/don’t remember
i) Other(identify)___________________
________________________________________
(3 right answers – 1 point )
15
Can you name contraceptive methods?
(the question is non applicable for 10
formers)
a) Oral contraceptives
b) Injectable
c) Emergency contraceptives
d) Spermicides
e) Natural family planning
f) Condom
g) IUD
h) Don’t know/don’t remember
i) Other (identify)___________________
________________________________________
(ADOL) Мониторинг ва баҳолаш.
3
(3 right answers – 1 point )
16
Can you name the signs or symptoms suggest that a
person has sexually transmitted infection?
(Probe by asking “Anything else?” and circle all
that apply.)
a) Discharge from penis/vagina
b) Burning pain or itching in penis/vagina
c) Sores or warts on penis/vagina
d) Swelling in groin region
e) Reddening in penis/vagina
f) Rapid urination
g) Painful urination
h) Low part abdominal pain
i) Don’t know/don’t remember
j) Other (identify)___________________
________________________________________
(3 right answers – 1 point )
17 Can you say what should one do to avoid getting
STI’s?
(Probe by asking “Anything else?” and circle all
that apply.)
a) Abstinence
b) Using condom
c) To have one partner
d) Avoiding multiple sex partners
e) Avoiding sexual intercourse with prostitutes
f) Avoiding occasional sexual intercourse
g) Don’t know/don’t remember
h) Other (identify)
(3 right answers – 1 point )
18
Please can you mention all the ways in which a
person can get HIV/AIDs?
(Probe by asking “Anything else?” and circle all
that apply.)
a) Sexual intercourse
b) From a mother to a child
c) Blood transfusion
d) Don’t know/don’t remember
e) Other (identify)___________________
________________________________________
(a, b, c – 1 point )
19
Can you say what should one do to avoid getting
HIV/AID?
(Probe by asking “Anything else?” and circle all
that apply.)
a) Abstinence
b) Using condom
c) Avoiding multiple sex partners
d) Avoiding sexual intercourse with prostitutes
e) Avoiding use of unsterile
needles
f) To have individual instruments
of manicure,
pedicure and hygiene
g) Don’t know/don’t remember
h) Other (identify)___________________
________________________________________
(3 right answers – 1 point )
20 What does “safe-sex” mean to you?
(Don’t read. Probe by asking “Anything else?”
and circle all that apply.)
a) STIs prophylaxis
b) Avoiding unwanted pregnancy
c) Don’t know/don’t remember
d) Other (identify)___________________
________________________________________
(а, b – 1 point )
21 Have you heard your peers conducting
classes/meetings or seminars on reproductive
health at your educational institution?
a) Yes
b) No
c) Don’t know
d) Other (identify)___________________
22 Would you like to participate in а special
training on training peer educators on
adolescents’ reproductive health?
a) Yes
b) No
c) Don’t know/don’t remember
d) Other (identify)___________________
23 Could you tell the reason? Identify:
______________________________________________
______________________________________________
_____________________________________________
(ADOL) Мониторинг ва баҳолаш.
4
Show the brochure
Question Yes No Full answers
1. Have you ever seen the
brochure “Answers for some
interesting to adolescents’
questions”?
If the answer is “No” end the interview
2. Do you have the kind of
brochure?
3. Do you like the brochure’s
design?
What for?
4. What topic seems most
interesting to you?
Identify?
5. What topics should be
added to the brochure to your
opinion? What topics should
be deleted from the brochure
to your opinion?
Identify?
6. for monitors:
Relying on answers make a
conclusion about brochure’s
adecuate usage.
THANK YOU FOR PARTICIPATING!
Rayon/city:______________________________
_______________________________________
Name of the educational institution
____________________________________________
(TEACH) Мониторинг ва баҳолаш.
1
Project HOPE, Navoi, Uzbekistan
Monitoring and evaluation/school level
Instrument 2: “Adolescents reproductive and sexual health”
All questions are to be addressed to the ARH classes’ provider.
Oblast:______________________________ Rayon/city:_________________________
date:_____/____________/_____
Name of educational
department:_____________________________
Interviewer:___________________________ Respondent: ___________________________
Informed Consent
Hello, my name is ______________ and I am working with Oblast Health Department/Oblast Public Education
Department/Oblast Colleges Department. Oblast Health Department/Oblast Public Education Department/Oblast
Colleges Department jointly are going to monitor quality of measures taken due to “Reproductive health and healthy
family creation” educational program at your educational institution. Within the aim we need to carry out a survey with
you. The survey is going to take us 20 minutes to complete.
Common information related to “Adolescents Reproductive Health” classes
Now I want to ask you about ARH classes you provide at the educational institution
№ QUESTIONS AND FILTERS CODING CATEGORIES SKIP
3 Do you know about governmental degree/local
administration orders depending on which
“Reproductive health and healthy family creation”
educational program was entered on 10 -11
class formers (second, third year
students) educational program?
(identify if the person have known about
governmental degree/local administration
orders )
a) Yes
b) No
(а – 1 point)
4 How many hours devoted for “Reproductive
health and healthy family creation” educational
program annually?
a) 16, 17 hours
b) don’t know/don’t remember
c) other (identify)___________________
________________________________________
(а – 1 point)
№ QUESTIONS AND FILTERS CODING CATEGORIES SKIP
1
What is the trade of person provided ARH
classes at the educational institution
a) HP
b) Psychologist
c) Biology teacher
d) Other: (identify)___________________
2
Did you participate in any course or seminar
devoted to adolescents reproductive health?
a) Yes
b) No
c) Don’t remember
d) Other (identify)___________________
(а – 1 point)
(TEACH) Мониторинг ва баҳолаш.
2
5 What topics should be discussed during ARH
classes due to your work plan? (Look through
the work plan and 10-11 form (second, third
year students) journals and compare the
topics with the ones given in governmental
degree - 32)
10 – form program:
a) “Reproductive health”. “Adolescence”
b) “Parents’ health is a future child health”
c) “Anatomy and physiology”
d) “STI”, “HIV/AID”
e) “Drug addiction and its influence on human
health”
f) “Luck of iodine”
g) “tuberculosis”
h) “Risky behavior”
i) Don’t remember
j) Other (identify)___________________
11 – form program:
a) “Citizens’ health protection” governmental
degree of Republic of Uzbekistan
b) “Healthy marriage is a foundation of healthy
generation”
c) “Human’s body immunity”
d) “Mother and child health protection is national
policy of Republic of Uzbekistan”
e) “extragenital diseases”
f) “Contraceptive methods usage technology”
g) “Pregnancy and pathological pregnancy”
h) “Breastfeeding advantages”
i) don’t remember
j) Other (identify)___________________
6 What manuals or guidelines do you use in
making lesson plan?
(make sure in manuals or guidelines
availability)
a) “Adolescents reproductive and sexual health”
– trainers’ manual
b) “Adolescents reproductive and sexual health”
– informational source for trainers
c) “Adolescents reproductive and sexual health”
– participants manual
d) None
e) Other (identify)___________________
________________________________________
(a, b, c – 1 point)
7 Do the students use “Adolescents reproductive
and sexual health” – participants manual during
the classes?
a) Yes
b) No
(а – 1 point)
9
8 Identify the reason
________________________________________
________________________________________
9 What interactive teaching methods do you use
during the classes?
a) “Energizers”
b) Role playing
c) “Brainstorming”
d) Group discussion
e) Small group work
f) Demonstration
g) Mini lection
h) Real life story study
i) Don’t know/don’t remember
j) Other(identify)________________________
(5 right answers – 1 point )
10
How do you build up the friendly creative
atmosphere during the classes?
a) Listen to the speaker attentively
b) Do not criticize the speaker whatever he (she)
says
c) Gve free rein in communication to everyone
d) Motivate participants
e) Setle down disagreements in friendly manner
f) Don’t know/don’t remember
g) Other (identify)________________________
(3 right answers – 1 point )
(TEACH) Мониторинг ва баҳолаш.
3
Knowledge on Reproductive health issues
№ QUESTIONS AND FILTERS CODING CATEGORIES SKIP
11 In your opinion, what can we have as the result
of sexual education?
a) Sexual education leads to adolescents’ sexual
activity; they try practice the knowledge they got.
b) Sexual education is a part of moral education; it
helps to develop responsibility in adolescents for their
own health and actions.
c) Don’t know/don’t remember
d) Other (identify)____________________________
12 How do you understand the “reproductive
health” term?
a) Reproductive health is not only the absence of
reproductive system diseases; it is total physical,
mental and social development.
b) Other: (identify)_______________________
__________________________________________
__________________________________________
(а – 1 point )
13 Please can you name the reproductive
and sexual rights?
a) THE RIGHT FOR LIFE
b) THE RIGHT FOR INDIVIDUAL SAFETY
AND LIBERTY
c) THE RIGHT ON EQUALITY
d) THE RIGHT ON INDIVIDUAL LIFE AND CONFIDENTIALITY
e) RIGHT ON FREEDOM WORLD VIEW
f) THE RIGHT ON RECEPTION OF
INFORMATION AND KNOWLEDGE
g) THE RIGHT OF FAMILY PLANNING
h) THE RIGHT TO HAVE A CHILD
i) THE RIGHT ON RESEPTION HEALTH SERVICES
j) THE RIGHT ON SCIENTIFIC ACHIVEMENTS USE
k) THE RIGHT ON PARTICIPATION IN SOCIAL MEETINGS
l) THE RIGHT ON PROTECTION
FROM VIOLENCE
m) Don’t know/don’t remember
(5right answers – 1 point )
14 Can you name consequences of adolescents’
pregnancy?
a) Blood pressure increasing
b) Hypostasis
c) Fetus hypoplasia
d) Premature birth
e) Miscarriage
f) Mother and child anemia
g) Handicapped child birth
h) Difficult confinement can lead to mother’s mortality
i) Don’t know
j) Other (identify)__________________________
_________________________________________
(4right answers – 1 point )
15
Can you name consequences of adolescents’
abortion?
a) Menstrual irregularities
b) Reproductive organs diseases
c) Bleeding
d) Injuries to uterus
e) Contamination
f) Sterility
g) Mortality
h) Don’t know/don’t remember
i) Other(identify)___________________
________________________________________
(4right answers – 1 point )
16 Can you name contraceptive methods? a) Oral contraceptives
b) Injectable
c) Emergency contraceptives
d) Spermicides
e) Natural family planning
f) Condom
g) IUD
(TEACH) Мониторинг ва баҳолаш.
4
h) Don’t know/don’t remember
i) Other (identify)___________________
________________________________________
(3 right answers – 1 point )
17 Can you name advantages of contraceptives? a) Condom protects from pregnancy and STIs
b) Condom protects from HIV/AID
c) ОC protect from pregnancy and abate
pain during m-cycle
d) Emergency contraception protects from
pregnancy after unsafe sexual intercourse
e) Don’t know/don’t remember
f) Other (identify)___________________
________________________________________
(3 right answers – 1 point )
18 Can you name disadvantages of
contraceptives?
a) Condoms incorrect usage leads
to their quality fall-off
b) None of contraceptive methods protects from STIs
except condom
c) OC can lead to nausea
and headache
d) You can forget to take pill in time
e) IUD doesn’t protect from STIs
f) Some of contraceptive methods can influence on m￾cycle
g) Don’t know/don’t remember
h) Other (identify)__________________________
(4 right answers – 1 point )
19 Can you give the information about emergency
contraception?
a) The method can protect from unwanted pregnancy
after unprotected sexual intercourse and violence
b) Emergency method do not protect from STIs
c) Pills can be taken in 72 hours after unprotected
sexual intercourse
d) The total doze of ethinyl estradiol in taken pills
shouldn’t be less than 100 microgram
e) IUD can be used in 5 days after unprotected sexual
intercourse
f) Don’t know/don’t remember
g) Other (identify)___________________
________________________________________
(3 right answers – 1 point )
20
Can you name the signs or symptoms suggest
that a person has sexually transmitted
infection?
(Probe by asking “Anything else?” and
circle all that apply.)
a) Discharge from penis/vagina
b) Burning pain or itching in penis/vagina
c) Sores or warts on penis/vagina
d) Swelling in groin region
e) Reddening in penis/vagina
f) Rapid urination
g) Painful urination
h) Low part abdominal pain
i) Don’t know/don’t remember
j) Other (identify)___________________
________________________________________
(4right answers – 1 point )
21 Can you say what should one do to avoid
getting STI’s?
(Probe by asking “Anything else?” and
circle all that apply.)
a) Abstinence
b) Using condom
c) To have one partner
d) Avoiding multiple sex partners
e) Avoiding sexual intercourse with prostitutes
f) Avoiding occasional sexual intercourse
g) Don’t know/don’t remember
h) Other (identify)
(3right answers – 1 point )
22 Please can you mention all the ways in which a
person can get HIV/AIDs?
(Probe by asking “Anything else?” and
a) Sexual intercourse
b) From a mother to a child
c) Blood transfusion
(TEACH) Мониторинг ва баҳолаш.
5
THANK YOU FOR PARTICIPATING!
circle all that apply.) d) Don’t know/don’t remember
e) Other (identify)___________________
________________________________________
________________________________________
(a, b, c – 1 point)
23 Can you name the situations when HIV/AIDs
can be transmitted from a mother to a child?
(Probe by asking “Anything else?” and
circle all that apply.)
a) Pregnancy
b) Delivery
c) Breastfeeding
d) Don’t know/don’t remember
e) Other (identify)___________________
________________________________________
(a, b, c – 1 point)
24 Please can you mention all the ways in which a
person can get HIV/AIDs?
(Probe by asking “Anything else?” and
circle all that apply.)
a) Abstinence
b) Using condom
c) Avoiding multiple sex partners
d) Avoiding sexual intercourse with prostitutes
e) Avoiding use of unsterile
needles
f) To have individual instruments
of manicure,
pedicure and hygiene
g) Don’t know/don’t remember
h) Other (identify)___________________
________________________________________
(3 right answers – 1 point )
25 What does “safe-sex” mean?
(Don’t read. Probe by asking “Anything
else?” and circle all that apply.)
a) STIs prophylaxis
b) Avoiding unwanted pregnancy
c) Don’t know/don’t remember
d) Other (identify)___________________
________________________________________
(а, b – 1 point )
Project HOPE, Navoi, Uzbekistan
Monitoring and evaluation/school level
Instrument 4: “Adolescents reproductive and sexual health”
The form is used as a part of ARH classes’ provider skills evaluation
Oblast:______________________________ Rayon/city:_________________________
date:_____/____________/_____
Name of educational
department:_____________________________
Interviewer:___________________________ Respondent: ___________________________
Evaluate ARH classes provider skills due to the criteria:
Interactive teaching methods usage skills
Yes / NA
“1” “①”
No
“0”
Part 1 – Interactive teaching methods usage
Energizers (limbering-up)
Mini lection
Small group work
«Brainstorming»
Demonstration
a)Practical exercises
Real life story study
Role playing
Group discussion
Visual aids usage
Flips and markers usage
Summing-up
Reminding: at least 3 kinds of interactive teaching methods
should be used during a lesson
3 and more methods– “1” point
Otherwise – “0” point
Part 2 – New information explanation
Fully understand the purpose of giving information
Give questions to identify the level of adolescents’ existing
knowledge on new theme before the explanation
Explain new information in simple and clear way
Pay special attention to main points of new theme
Write main points of new theme on the blackboard
Suggest adolescents to record main points of new theme in their
note-books
Give simple and clear answers on adolescents questions
Give adolescents questions to identify the level of new theme
understanding
Give adolescents clear tasks
Use practical tasks on strengthening new information
Make a conclusion in the end of the lesson
Reminding: at least 6 kinds of criteria should be used during a
lesson 6 and more methods– “1” point
Otherwise – “0” point
Part 3 – Trainer’s skill
Communication with the audience
Eye contact usage
Energy
Mimicry usage
Listening skills
Appropriate level of voice
Appropriate level of intonation
Dramatic skills
Adolescents’ activation
Work with “difficult” adolescents
Solution of boredom problem
Building up friendly creative atmosphere
Preparing program for adolescents’ presentations
Supporting adolescents’ during small group work
Supporting adolescents’ during presentations
Motivation of the small groups’ members
Creation of harmonious working posses
Reminding: at least 10 kinds of criteria should be used during a
lesson 10 and more methods– “1” point
Otherwise – “0” point
Increasing the Quality of Child Survival and Maternal
Care Services in the Navoi Oblast of Uzbekistan
Cooperative Agreement No. FAO-A-00-99-00026-00
Flexible Fund Final Report
Project Duration: October 1, 2003 – September 29, 2007
Submitted to:
USAID/GH/HIDN/NUT/CSHGP
Child Survival and Health Grants Program
Room 3.7-74, Ronald Reagan Building
1300 Pennsylvania Avenue
Washington, DC 20523-3700
Janet Meyers
FP/RH Technical Advisor to the Flexible Fund
CSTS+
Macro International
11785 Beltsville Drive
Calverton, MD 20705-3119
Submitted by:
Project HOPE – The People-to-People Health Foundation, Inc.
Millwood, Virginia 22646
Tel: (540) 837-2100
Fax: (540) 837-1813
December 2007
HQ Contact person: Field Contact Person:
Ruth Madison, MPH Abdunabi Kuchimov, Program Manager
Tech Advisor, HWC Unit Project HOPE Uzbekistan
ACRONYMS
AIDS Acquired Immune Deficiency Syndrome
ARH Adolescent Reproductive Health
ARSH Adolescent Reproductive and Sexual Health
ADB Asian Development Bank
BCC Behavioral Change and Communication
BF Breast Feeding
CI Confidence Interval
CS Child Survival
CSHGP Child Survival and Health Grant Program
DIP Detailed Implementation Plan
FGD Focus Group Discussions
FP Family Planning
GP General Practitioner
HD Health Department
HF Healthy Family
HP Health Provider
HIV Human Immunodeficiency Virus
HOPE Health Opportunities for People Everywhere
IMCI Integrated Management of Childhood Illness
INGOs International non governmental organizations
IUD Intrauterine Device
KPC Knowledge, Practice, Coverage
LAM Lactational Amenorrhea Method
MOE Ministry of Education
MOH Ministry of Health
MOHSSE Ministry of Higher and Secondary Special Education
MPS Making Pregnancy Safer
MTE Mid Term Evaluation
NGO Non-Governmental Organization
OHD Oblast Health Department
PEPC Promoting Effective Perinatal Care
PHC Primary Health Care
Prikaz Official (Government) order or decree
RDH Rayon Health Department
RH Reproductive Health
STIs Sexually Transmitted Infections
STD Sexually Transmitted Disease
SVP Rural physician post
TWG Technical Working Group
TOT Training of Trainers
USAID United States Agency for International Development
WHO World Health Organization
WRA Women of Reproductive Age
1
Introduction
Project HOPE’s child survival project, Increasing the Quality of Child Survival and Maternal
Care Services in the Navoi Oblast of Uzbekistan, was an extension of a previous child survival
project that began in 1999. The current project continued activities from October 2003 to
September 2007. The purpose of the HOPE CS project in Uzbekistan was to: (a) reduce the
mortality and morbidity in children under five and women of reproductive ages and (b) increase
adolescents’ knowledge about reproductive and sexual health. The CS project directly targets an
estimated 36,716 children ages 0-5 years; 77,479 women of reproductive age (15-49 years old),
and 25,505 adolescents (16-18 years of age). The Project has introduced and expanded the use
of standard case management protocols in IMCI, Making Pregnancy Safer and Family Planning
interventions.
Based on qualitative and quantitative assessments conducted as part of the final evaluation, it can
be said that the CS project has been quite successful. As the Table in the following section
shows, many of the objectives have either been achieved or surpassed. Furthermore, and perhaps
more importantly, the project has successfully influenced the Oblast Health Department (OHD)
and Rayon Health Departments (RHD) to adopt such programs as IMCI and Making Pregnancy
Safer, as their own and these health departments are implementing those programs in other parts
of the country. Additionally, some of the materials developed by the project are now being used
by UNICEF and other INGOs in other areas of the nation.
The partnership between the project staff and the OHD and the RHDs is very strong and the
project has made tremendous strides in building the capacity of the health department staff on a
myriad of technical issues, which is one of the cardinal achievements of the project.
Additionally, the project has been in the vanguard in training community leaders, teachers, and
peers on adolescent reproductive health issues. The strategy of working with vocational schools
as well as high schools was commended by the Ministry of Education in Navoi as an innovative
strategy to reach adolescents not attending traditional high schools.
The following adolescent reproductive health (ARH) achievements are most noteworthy:
 Organization and support of four ARH courses,
 Training of 475 health professionals in family planning,
 1811 adolescents directly exposed to reproductive health information,
 Development and support of several training centers,
 Development of protocols at local and national levels in support of family planning,
 Joint prikaz (government directive) between MOH and MOE (Ministry of Education) to
support adolescent reproductive health facilities supported by the project, and
 ARH Guidelines developed by CS project and local partners (MOH and MOE) accepted
at national level and recommended to other regions.
Many of the programs initiated by this project have already been “sustained” by the MOH and
are being scaled up in other parts of the Oblast and to other parts of the country as a direct result
of this project. In addition, there have been requests to extend the ARH training to schools in the
non-pilot rayons.
2
Main Strategies and Activities: (1) Implement TOTs and train health staff in family planning;
(2) explore the possibility of continuing surgical contraception (minilap) training for health
providers; (3) BCC and makhalla/community-based work focused on WRA and their partners by
initiating sessions to orient makhalla committees and leaders in reproductive health and family
planning; (4) Adolescents Reproductive and Sexual Health (ARSH) to increase adolescents’
knowledge about sexuality and reproductive health and to develop an adolescent-friendly health
services strategy; (5) BCC and makhalla/community-based work to increase knowledge of
reproductive health and sexuality; and (6) focus on improving the quality of FP service delivery
through training, community education and close monitoring and supervision.
Family Planning and Child Spacing
The overall objectives of the program as relates to family planning, child spacing, and
knowledge on reproductive health issues are detailed below:
Objectives: (1) Increase the number of women/couples with a birth interval at least 24 months
after the previous surviving child; (2) Increase the number of women/ adolescent/ couples’
knowledge of the reproductive cycle; (3) Increase the number of non-pregnant women who
desire no more children to space births and are using a modern method of FP; and (4) Increase
the number of family planning clients who received counseling on contraceptive choices,
common side effects, and when to return for follow-up. The level of effort the CS project
dedicated to FP and child spacing was 30%.
KPC Statistics on FP and child spacing
Baseline (Feb 2004) MTE
(May 2005)
KPC FE*
Indicators June 2007
% CI % CI % CI
Adequate Birth Interval Between Youngest
Surviving Children: Percent of children aged 0-23
months who were born at least 24 months after the
previous surviving child.
48.3% ±18.2 86.9% ±6.13 84.7% ±5.8
Percent of women of RA who report that women are
likely to get pregnant halfway between two
menstrual periods.
9.3% ±2.8 72.8% ±8.21 45.7% ±5.6
Percent of non-pregnant women who desire no more
children in the next two years, or are not sure, who
are using a modern method of child spacing.
72.6% ±4.6 91.5% ±5.67 72.8% ±9.3
Percentage of respondents who report discussing FP
issues with somebody in the past 12 months. 56.2% ±4.7 82.5% ±5.71 65.7% ±5.4
Counseling: Percentage of family planning clients
who receive counseling on contraceptive choices,
common side effects, and when to return for follow￾up.
62.7% ±5.8 77.2% ±5.86 86.6% ±6.8
Project HOPE successfully worked with several members of technical working groups (TWGs),
Oblast and Rayon Health Departments and PHC services to provide family planning training
courses and to implement 6-8 month monitoring visits. The RH training courses conducted by
the project are shown below. In total, 475 health providers were trained in Reproductive Health.
3
Type of Training Numbers and Types
of Participants
Training Topics
3-day TOT 16 Ob-Gyns, midwives, and
GPs
Improved skills on RH and
teaching/adult education skills
4-day training on RH and
counseling (Note that in the
DIP this was anticipated to be
a 5-day course)
221 Ob-Gyns, GPs, midwives,
and feldshers
General counseling skills and
informed consent, screening tests,
provision of contraceptive
methods, including method
delivery and follow-up;
management of secondary effects;
health information system and
information management.
4-day RH course 238 Patronage nurses Content MPS and RH includes
above plus antenatal and
postpartum skills.
In the DIP, reproductive health trainings for the patronage nurses were planned to be conducted
separate from the maternal health care course; however as great as the need was to train
patronage nurses, this methodology has been fused with basic outreach antenatal and postpartum
care topics.
The results of the baseline and final data surveys are not legitimately comparable with those of
the MTE survey because the profiles of the respondents were not the same. In the baseline and
final surveys, the respondents were women of child bearing age, while the mid-term evaluation
interviewed mothers of children under two years of age. Hence, the higher MTE results might
simply reflect differences in the surveyed populations. In any case, the final results, though
generally not as high as the MTE show definite gains in FP knowledge and behaviors. Although
the percent of women using modern methods did not change much from the baseline (72
percent), the percent of women who reported receiving counseling on contraceptive choices (and
associated side effects) and when to return for a follow-up visit increased by more than 25
percent. This is a strong indication that the percentage of women informed about contraceptive
choice rose significantly during the project. The team also pointed out that there has been
substantial progress in the area of informed choice. Before the project, women used
contraception because they were pushed to use it but women now report they have information
about the different methods. Progress of informed choice is evidenced by the fact that women
can now list the advantages and disadvantages of the different methods. As a result of the
project, if women are asked why they use the IUD, they can now discuss the disadvantages of the
other methods for them and the advantages of the IUD. Additionally, women now know when
they should come to have it checked. Before the project and the project interventions, many
women could not provide this level of detailed information regarding the IUD. The project staff
also believe that the HPs have improved their communication skills and are doing a better job of
discussing contraceptives with patients. The staff noted that before the project, in many cases,
the HPs themselves were a real barrier to providing informed choice. The pre and post tests from
the training courses evidence this, showing that many HPs believed the myths about the different
methods and shared their prejudices about different methods with their clients.
The project and HD staff have also indicated thanks to the trainings provided by the project, the
quality of care improved. Counseling of clients has also improved through the provision of
educational materials and improved counseling skills delivered by trained HPs. Counseling
4
skills were greatly improved through the monitoring and supervision visits provided by project
staff. Having standards and protocols for new acceptors and continuing users has also helped
improve care. The project also developed posters on counseling steps that are clear and easy to
follow and assist HPs in providing care. From the monitoring visits, it has been found that
clients are more satisfied with services, that there are fewer stock outs of contraceptives, and that
there is improved counseling by visiting nurses for both FP and antenatal care (before they did
not provide this counseling). Also, 91.4% of all 83 SVPs (rural physician posts) offer mothers
classes for antenatal care, which includes information about FP.
The project and HD staff believe that FP access has improved because of improvements in the
supply system and informed choice. Before this project, health departments had supplies of
contraceptives but less access because women weren’t informed of all the choices available and
practitioners did not counsel them adequately. Additionally, thanks to the World Bank and ADB
primary care program, there are more local level SVPs in the oblast providing primary care.
The most preferred FP method in Uzbekistan is still the IUD. The following table depicts the
distribution of FP method utilization in Navoi.
Which of FP methods do you use or used
before Baseline (Feb 2004) MTE (May 2005) KPC FE* June 2007
Pill 15.7% 11.11% 14.4%
IUD 86.3% 64.33% 70.8%
Injection (DepoProvera) 13.2% 21.05% 16.8%
Norplant n/a 1.17% n/a
Sterilization 4.4% 2.34% 5.6%
Condom 12.9% 1.75% 13.6%
Spermicides 0.3% 0.00% 1.2%
Calendar method 13.5% 1.17% 17.2%
LAM 59.6% 5.85% 38.0%
While the use of IUDs has decreased a bit since the baseline, it is still the preferred family
planning method. There is a small increase in the use of injectables but the other methods are
more or less at the same levels of use. When interviewed by the FE team, women stated that
while they had been informed about other methods they preferred the IUD because they believed
it to be effective and convenient, i.e., they did not have to be reminded every day to use it. The
additional questions added to the final KPC also showed that 99 percent of women of
reproductive age knew of three or more modern methods of contraception. Interviews also
showed that women who were using other methods were using them because they had had
problems with the IUD. In other words their first choice was still the IUD. Because the FE team
was concerned that the bias for the IUD might be coming from the providers, we asked about this
and the GPs admitted that they had more faith in the IUDs and did not fully trust the other
methods. Project staff and some health department staff indicated that they thought there was
informal pressure coming from higher levels of the government to encourage use of sterilizations
and IUDs. However the FE team was unable to verify further details. While not common place,
at the start of the project, there had been instances where women were found to have as many as
three IUDs inserted at one time. The project staff surmise that this was because there was a
requirement that all women who delivered at Maternity Houses should have an IUD inserted
within five days. Later, when women returned to the PHC for follow-up care, HPs would insert
another one or two IUDs – depending on the number of visits! Fortunately, the project was
5
instrumental in correcting this situation in Navoi by asking that the Maternity Houses not stock
IUDs but to provide them to the PHCs. Health workers at PHC would ascertain that there are no
IUDs in a client before inserting one during post partum visits.
The MTE evaluation noted that there had been shortages of contraceptives, particularly condoms
at the health facilities. However, this situation improved with increased monitoring and the
project and HD staff worked with SVP facilities to train a staff member in logistics management.
The oblast RH center staff have developed a table for calculating stocks for the rayons. The FE
team found during field visits that there were adequate contraceptives at the health facilities
visited. According to project and HD staff, contraceptive supplies are monitored and maintained
by the MOH and HDs. Contraceptives are provided free of charge, because they are donated by
UNFPA. Due to the regular monitoring of services, the primary care facilities have been able to
plan and program adequate supplies. Despite this, the project staff still has concerns about
stockouts because they think the people responsible for logistics at rayon and oblast levels are
not calculating supply needs correctly. Some providers base their estimates of the needs at each
SVP on the numbers of WRA in each makhalla without taking into account actual demand levels
that are calculated at the SVPs. One concern raised by this situation is that some of the remote
rural clinics have had problems maintaining condom stocks. There appears to be an increasing
demand for condoms.
The project realizes that free supplies of contraceptives will not always be available and worries
that the heavy reliance on the IUD method may impede donations of other types of
contraceptives.
The project complied with the Mexico City Policy by not funding any abortion services or
providing any training related to abortion. Also as discussed above there was extensive attention
paid to and training about informed consent. In addition, the FE team observed numerous
posters about the advantages and disadvantages of different FP methods at all facilities visited
(Tiahrt Amendment).
A huge lesson learned by the project was the importance of training the visiting nurses to take a
more active role in home based preventive health care. These nurses, also known as patronage
nurses, have proved to be a key link between the communities and the health services.
Lastly, the new Parents’ Schools also serve to educate recent parents on LAM and modern
family planning methods.
Adolescents Reproductive and Sexual Health (ARSH):
The Adolescent Reproductive and Sexual Health component had two primary purposes: (1) to
increase adolescents’ knowledge about sexuality and reproductive health and (2) to develop
adolescent-friendly health services. The strategies and main activities of the project as relates to
ARH were to:
 Improve the knowledge, practice, and behavior of healthcare providers and teachers by
preparing and implementing training curricula for school health providers and teachers;
training of school health providers and teachers how to conduct adolescent RH classes in
the schools; conduct regular and routine follow up and monitoring visits to ARH centers.
6
 Improve access to Youth Friendly Health Service of target population by establishing
Youth Friendly Health Services; training health providers in the principles of providing
Youth Friendly Health Services; conducting follow up and monitoring visits.
 Improve health, knowledge, practice, and behavior of adolescents aged 16-18 years old
by conducting peer-to-peer training; developing and disseminating booklets and posters
on ARH topics; broadcasting of short films on adolescent RH key messages.
 Create a supportive environment for improved health of target population (by influencing
policy, local and social norms) by conducting orientation meetings with Oblast
Educational Department teams and with vocational education department; train
community/makhalla leaders on adolescent RH key messages and health promotion
skills; provide follow up and monitoring of trained community leaders; develop and
disseminate booklets for parents on adolescent RH key messages.
Part of the ARH activities have been funded by the Swiss donor associated with Project HOPE,
the Foundation for Partnerships in Health. The CS project has partnered with the MOH, MOE,
MOHSSE, the Oblast Health Department, Oblast Public Education and OSSPED, the Healthy
Family Project, HOPE/ Tashkent and other NGOs in implementing ARH activities.
In order to adequately identify the situation of adolescent reproductive health in Navoi,
Uzbekistan, the project conducted a baseline survey for CS activities and also included questions
for adolescents. The objective of the survey conducted among adolescents was to assess their
knowledge on reproductive health issues and HIV/AIDS prevention. The relevant results of the
baseline appear in the table below:
Percent of targeted adolescent population (16-18) who can state that women
are likely to get pregnant halfway between two menstrual periods. 1.3%
Percent of targeted adolescent population who can name at least three
methods of contraceptive methods. 29.8%
Percent of targeted adolescent population can name at least 2 mechanisms
of HIV transmission. 44.2%
Percent of targeted adolescent population who can name at least 2 means of
protecting themselves against contracting STIs. 16.7%
Source: Baseline Survey of CS Program, Navoi, February 2004
The objectives of the ARH activities were to: 1) increase the knowledge about reproductive and
sexual health among targeted adolescents, 2) decrease the percent of targeted adolescents having
unprotected sex, and 3) increase knowledge among targeted adolescents who know how to
correctly use a condom.
The project worked to support the following program components:
1) support the Educational Sector in implementation of ARH education activities,
2) support the Health Sector in establishment of adolescent friendly health services,
3) support creation of a network of all sectors involved into ARH promotion, and
4) increase community awareness of ARH.
7
During the CS project, Project HOPE educated a large number of adolescents through formal
school classes and peer educators. The Adolescent Health Center at the Oblast level and centers
at the four rayons now offer services as a result of the Youth Friendly Initiative. The work also
involved school teachers and almost all community leaders. To accomplish those activities,
Project HOPE has developed and offered four types of training events for adolescents and peer
educators. These activities included:
Type of Course Participants Objectives
A five-day TOT
course on ‘adolescent
reproductive and
sexual health’
394 health providers and
school teachers
responsible for ‘ARH’
classes and counseling
To improve the health providers’ and
teachers’ knowledge about adolescent
reproductive health topics and to develop
their skills in providing classes about ARH;
to inform health providers about youth
friendly service requirements; and to teach
health providers to provide youth friendly
counseling on reproductive measures.
Four-day ‘peer-to￾peer’ course on peer
education
405 Peer educators To provide correct adolescent reproductive
health information through peer educators.
Includes counseling skills.
Two-day course on
ARH
1,012 students and youth Taught principals of ARH including
physiology of RH system, consequences of
early marriage, advantages and
disadvantages of modern contraceptives,
prevention of STI/HIV and safe sex
practices.
Three-day course for
establishing youth
friendly services
17 Ob-Gyns and youth
health providers
Taught principals of youth friendly
services and youth counseling skills.
Summer camp 140 adolescents
In summary a total of 394 adult trainers, 405 peer educators and 1,527 adolescents have been
trained.
In general, adolescents do not have the opportunity and/or willingness to discuss their
reproductive health problems with adults. The project identified two types of adolescents; those
who just feel shy about talking about ‘ARH’ with adults, and those who do not believe adults can
help them. The Project HOPE team believes that boys and girls prefer to get information on
reproductive and sexual health from their peers, so would feel more confident to talk with them
about intimate issues. This belief was confirmed by the FE team when the interviewed
adolescents, community leaders and teachers. The evaluation’s focus group discussions with
adolescent boys and girls demonstrated that boys do talk about RH with their peers, while girls
talk with peer-educators, except when they have a problem; they go to a health provider or
discuss the issues with a relative. Although providers and adolescents stated that numbers of
youth are sexually active, it is difficult to verify this through the surveys. It is a difficult
situation for youth because they are expected to be virgins before marriage but at the same time
boys are expected to be experienced. Therefore boys go to prostitutes and often contract STIs.
The project developed instruments for monitoring youth friendly services (YFS). The
monitoring helped evaluate effectiveness, friendliness, accessibility and the quality of YFS
8
services; define if the service management is adequate; define the work of health providers;
define service conditions; identify the clients’ opinions of the quality of services; and elucidate
the weaknesses and strengths of the services.
Project HOPE has used the following materials for training of trainers, and for educating
adolescents:
 ‘Adolescents reproductive and sexual health’ – training manual, school book and
informational source for health providers and school teachers responsible for providing ARH
classes and counseling (developed by Project HOPE/CS/USAID/Navoi, Project
HOPE/HF/USAID/Tashkent, Oblast Reproductive Health Center, Oblast Adolescents
Reproductive Health Polyclinic staff, approved by Uzbekistan MOH Deputy Chief)
 Short films: ‘Abortion prevention’, ‘Menace of early marriage’, ‘STI prevention’, and ‘Drug
addiction prevention’ (developed by Project HOPE/CS/USAID/Navoi and City
administration).
 ‘Peer-to-Peer’ – guideline for peer educators (developed by Project HOPE/CS/USAID/Navoi
staff).
 Short films on: ‘Modern contraception methods,’ the cartoons ‘Karate Kids – HIV/AID
prevention’, and ‘Karate Kids – drug addiction prevention’ (borrowed from ‘Rainbow’,
Kyrgyz Project working with adolescents).
 An adaptation of the ARH booklet ‘Me and my world’ after conducting FGDs with rural
parents and teenagers.
 ‘Answers on some interesting adolescents’ questions - adolescents brochure is developed by
National ‘Health’ Institute, ‘Navoi Oblast Reproductive Health Center’, Project
HOPE/CS/Navoi.
 Short films developed by peer educators through competitions. Used peer educators as actors.
Project HOPE has distributed all educational and reference materials to the school libraries, so
that there will be permanent resources available at the schools. The Administrators interviewed
talked about the importance of the materials in providing information to teens who may not want
to talk to adults about RH but will read the materials.
Youths interviewed for the final evaluation stated that they like the ARH centers for services and
counseling. They use the counseling services, the library and they acquire contraceptives for
themselves and friends. They stated that they often get contraceptives or counseling for friends
who are too embarrassed to come for services. Some youth still have problems asking for
services as they feel there is a stigma. The adolescents stated that they had complete confidence
in the health providers at the ARH Center and had even tested them for confidentiality. The peer
counselors said they felt comfortable counseling peers themselves and when they had questions
they consulted the HPs at the center. They said they would also go to the SVPs for general
health consultation but preferred the youth centers.
Rayon and Navoi city youth said they liked all the ARH instruction and that it was the first time
that anyone had openly talked to them about puberty and sexuality. They particularly liked the
sessions about ‘physiology and the RH cycle,’ ‘creating a healthy family,’ ‘contraception,’
‘advantages of delaying sexual debut and abstinence’ and ‘how to prevent STIs and HIV.’ Both
the students and the teachers commented that before having these classes boys and girls did not
communicate very well. Now that they have had the ARH classes together and learned to
9
discuss among themselves, they have a better understanding of what it means to be male and
female. The teacher administrators also noted that now if they organize an event about early
marriage all students are interested and come to discuss it openly. They are not shy and ask
questions easily. They also noticed that after the ARH classes the boys were more respectful of
the girls. When asked what changes they would like in the ARH classes, the students responded
that they would like for the trained teachers to have more leeway to teach ARH classes. They
indicated that untrained teachers who did not understand the purpose of ARH often put up
barriers to the classes or did not let them or the peer educators distribute materials. Since the
ARH classes are not required classes it is more difficult to insist on having the classes
particularly if parents object. Students wanted to have more information about sexual organs,
fertile cycle, anti-retrovirus therapy, oncological diseases and how to behave during the
honeymoon. They also said wanted to know more about contraceptives.
The FE team found that in the rayons, the administrators of the health facilities do not support
the ARH trained HPs in providing youth friendly services, since it’s not a focus area for them,
and although they provide counseling, they don’t stock contraceptives. They do have a hotline
and provide check-ups. This conflict arises because in the rayon polyclinics, only the Ob-Gyns
provide contraceptives but the ARH specialists are pediatricians. The pediatricians refer
adolescents to the Ob-Gyns for contraceptive but because the OBs are not trained to be youth
friendly, most of the adolescents do not go. The project has brought the issue of pediatricians
being providers for the adolescents and the Ob-Gyn providing contraceptives to the Steering
Committee meeting for discussion and it was decided that each of the PHC level health facilities
and ARH centers/rooms should have three to four kinds of contraceptives available.
The project only began talking to parents about sex education when the community health
component began in 2006. By then, the project staff recognized the religious and cultural
barriers to talking to youth about ARH. The administrators indicated that about half of their
vocational students come from rural areas that tend to be more traditional and do not understand
the purpose of ARH. They and the students believe that there is a need to convince parents to let
teachers and providers talk to the students. They believe that the women leaders cannot really do
this as they are too old to reach the adolescents and do not seem real comfortable talking to the
parents about ARH. When the FE team asked them about educating the parents on ARH, the
leaders responded that they gave them the parents’ brochure to read and seemed to think that was
enough.1
The Director of the ARH center reported that the number of adolescents seeking services at the
ARH center is increasing, and that confidentially on the part of providers is being stressed.
Providers also stated that they enjoyed the training and that before the training, it had been hard
to talk to the adolescents. Now with their counseling skills, the youths come easily. Also waiting
times are shorter and they appreciate the anonymity as the MDs don’t discuss the visits with
parents or ask for their names. Before, boys did not come to the center, but how they have a large
number who come with friends. Also before they did not have a center but the Oblast renovated
the current facility they are in and HOPE provided furniture, computers and materials.
1
Parents brochure for city and pilot rayons was entitled “If there is a teenager in your house”. It was developed by
Republic “Health” Institute, Navoi Oblast ARH Center and Project HOPE/CS/USAID/Navoi staff). 20, 000 copies
were printed of which 19, 900 copies were disseminated.
10
Sustainability is a key component of the ARH activities and the project has worked on
improving the capacity of existing governmental structure for ARH activities, which is already
staffed and partially funded by the government. The project was responsible for creating two
Youth Friendly Centers and three Youth Friendly Rooms in the targeted area. Two to three
health providers and/or teachers from each school and vocational school were trained on how to
conduct adolescents RH classes in the schools. A set of adolescents RH books were provided to
the library of each school and vocational schools. The project has left each of the ARH facilities
with trained health providers or/and teachers in each school and vocational schools and enough
copies of training materials to sustain training activities in the schools. Almost all health
facilities of the four pilot rayons were involved in adolescent RH trainings. There are 83 PHC
level health facilities in the four rayons and Youth Friendly Health Center of Navoi city. In total,
there are two Centers (Navoi city and Nurota rayon) and three rooms (in Karmana, Kiziltepa and
Konimeh rayons) created by with assistance from the project. The MOH will assume
responsibility for sustaining project activities and the Oblast ARH center in Navoi city will
coordinate other ARH center/rooms activities under the supervision of the Oblast Health
Department. The government has issued Prikazes (decrees) #242 and #32 which stipulate that
16-17 hours of ARH classes will be provided in the schools and vocational schools. According
to these directives, OHD and Oblast Educational Departments will continue to support training
and follow up activities. Additionally, the MOH recently issued a prikaz establishing youth
friendly health services in the country and approved ARH standards. The Youth Friendly
Initiative introduced by the CS Navoi project will be sustained by the MOH and OHD according
to the aforementioned prikazes.
The project had requested that maternity houses not stock IUDs as there were reports in the
project area that women were found to have more than one IUD inserted after delivery. Health
workers were adamant in ensuring that that soon after delivery, a woman had an IUD inserted
before leaving the maternity house. It was not clear how a woman could have more than one
IUD inserted after a pregnancy, but the project wanted to reduce the risk of this occurring again
by suggesting that IUDs only be stocked in the health facilities. The important issue to highlight
is that thanks to the CS Navoi project, IUD use has decreased from 82.7% at baseline to 70.8% at
the final evaluation, indicating that women are using other methods of contraceptive, thanks to
the project’s training on informed choice.
Please see the next page for the Core Indicators for Flexible Funding.
11
USAID Office of Population/Reproductive Health
PVO/NGO Flexible Fund
Core Indicators
Project HOPE
Increasing the Quality of Child Survival and Maternal Care Services
in Navoi Oblast of Uzbekistan
Key Result (KR) (or Objective): Increased FP Use and Improved FP/RH Practices
Indicators Result Source/Date
KR1: Couple Years of
Protection
8,564 Final KPC, July 2007
KR2: Number of New
Users of Modern
Contraception
5,231 Project Monitoring Data,
April 2007
KR3: Contraceptive Use
(prevalence rate)
72.8% Final KPC, July 2007
KR4: Unmet Need for
Family Planning
13.8% Final KPC, July 2007
KR5: Adequate Birth
Spacing
84.4% Final KPC, July 2007
Result 1: Increased Knowledge and Interest (R1)
R1.1 Percent of respondents
who know at least three
methods of family planning
98.7% Final KPC, July 2007
R1.2 Percent of women
with a child <12 months
who received counseling
about birth spacing
80.3% Final KPC, July 2007
R1.3 Percent of respondents
who report discussing
family planning with their
partner in the past 12
months
82.7% Final KPC, July 2007
Result 2: Improved Quality of FP Services (R2)
R2.1 Percent of family
planning clients who
receive adequate counseling
86.6% Project Monitoring Data,
April 2007
R2.2 Percent of facilities
offering three or more
modern family planning
methods
75.9% Project Monitoring Data,
April 2007
Result 3: Increased Access (R3)
R3.1 Precent of
beneficiaries that live
within 5 km of a FP service
delivery point
91.3% Final KPC, July 2007
12
R3.2 Percent of facilities
reporting no stockouts in
the last quarter
100% Project Monitoring Data,
April 2007
R3.3 Percent of respondents
who report discussing FP
with a health worker or
promoter in the past 12
months
89% Final KPC, July 2007
Result 4: Improved Social and Policy Environment for FP Services (R4)
R4.1 Program Sustainability
in Place
Flexible Fund Program Cross- Cutting Indicator
Number of beneficiaries Infant <12months: 8,101
Children 12-23 months: 5,921
Children 24-59 months: 24,990
Women 15-49 years: 86,636
Population of Target Area:
315,962
SUMMARY NOTES OF QUALITATIVE RESEARCH
CONDUCTED AS PART OF FINAL EVALUATION OF PROJECT
HOPE’S CS NAVOI, UZBEKISTAN
JULY 2007
AREA STRENGTHS CHALLENGES ADDITIONAL
COMMENTS
IMCI -B4 did not know how
to treat children<5.
-now more comfortable
with treating children
and feel
communication skills
are better
- improved ability to
work wth community
- seen reduction in IMR
since IMCI
In pilot rayons where
IMCI is implemented
docs say they prefer it –
Even though MOH
inspectors use the old
style approach – they
still don’t prohibit use
of IMCI
- thinks the 11 day trg
is right – people don’t
get exhausted and has
varied methods – as a tr
organizer – timing was
right.
- less antibiotics
prescribed – more
economical and better
care (though mothers
don’t believe its good
care- also untrained
HPs who provide long
list of meds and when
return home the SVP
doc has – nuradeen –
but mother goes to tk
-IMCI started in
2001-getting other
docs to accept IMCI
strategy – not all are
trained (only 2-3 in
Rayon are trained –
after added hosp
IMCI in 2006 it
improved at Oblast
and Rayon in patient.
(b4 had trained
primary and some
peds of rayon
- since all docs don’t
use IMCI – challenge
bec pts get some
treatment from IMCI
docs but not in
others.
-ped research
institute does IMCI
coordination but
doesn’t do tr and
monitoring – other
MOH reps came to
do a review and
weren’t IMCI trained
– so difficult-
- would have liked to
have trained
providers all at once
but HOPE couldn’t
do that. – costly
- some think should
have longer training
days – others 11 is
too long – want
diverse tr methods –
more practicums
- if there is to be
more IMCI tr. –
would recommend
tr of providers
within a short
period –so there is
not a 2 yr gap
btwn docs and
nurses.(delayed
because gov not
ready for c-imci –
so took a while to
adopt – needed
time to adapt for
patronage nurses)-
also there were no
guidelines from
WHO for c-imci –
so developed from
8 of the IMCI 16
key messages –
hard because c￾imci targets
CHWs not
patronage nurses –
so needed to target
them. (judy
aubel’s research
showed they could
work with existing
resources and their
strengths.)
-Would like a
standard refresher
course, now proj
does based on
monitoring.
-IMCI is working
well where HPs
2
once a yr and phc docs
all yr so mother trusts
phc doc more.- at hosp
level docs also given tr
at pilot rayons and
oblast so this conflict is
better)
with patients.
- moms suspicious of
IMCI because docs
gave less meds.
- conflicting
messages as see BF
advertsing and no
nat’l policy for BF.
-lack of essential
meds at the phc level
observed but project
says at all levels.
are trained – esp
in remote areas.
-prikaz 537, 538
for pHC and Hosp
care includes
IMCI- before not
included in these
child health
prikazes for
services and care.
One prikaz existed
before, now
approved and
signed 538 (org of
inpt ch care
services) and
changed to include
hosp IMCI – 537
not – is out pat no
t approved .- will
include 11 day tr
of IMCI. – but
will still be
limited re funding
even with MOH
order but will at
least get correct
supervision from
MOH.
SAFE
MOTHERHOOD
/ RH
EBF – big strength –
mothers and babies
healthier – see fewer
infections
-sm training good as
b4 had more c-sections￾more knowledge of
how to handle
complicated
pregnancies-better pp
and antenatal care.
-increased role of
midwives after training
(b4 all normal del were
managed by ob-gyns –
now after by using
partgraphs have
increased normal
-in future the challenge
will be having a strong
supervision by oblast
HD.
-infection prevention
training –also need tr for
H/A+ mothers.
-most women still prefer
IUD – easier, won’t
forget as with pill. Also
GPs said they ahv e
more faith in IUD than
other methods.
-IUD and sterilization
use- first method offered
isIUD and if
comploications then
offer other. COMMENT
Encourage MOH
to conduct survey
of anemia and
IUD use. (problem
in hosps have old
equipment for
measuring
hemoglobin- so
unsure if measures
are correct)
Continued training
on informrd
choice and
counseling on
methods.
-encourage MOH
3
deliveries – by using
partogr can recognize
earlier the
complications of
deliveries.
-less morbidity and
mortality of newborns
(makhalla leaders also
said fewer infant
deaths)
-increased presence of
partners in delivery
process reduces
complaints about
service – also less meds
used in delivery￾improved quality of
ANC due to standards￾b4 there were no
standards of care but
now have- makes work
easier to follow. At
beginning of proj hard
to implement SM
because no nat’l
support but in 2003 it
improved – because
HOPE encouraged
MOH to change pricazs
for newborn, bf,
delivery management
in hospital. In 2005
MOH also dev’d
antenatl standards
according to WHO –
easier for project to
implement SM in
hospitals.
-at beginning of proj
did bf first because
prikaz for EBF already
existed (1999) in 2000
only had 5 baby
friendly clinics in
Uzbekistan. In collab
with Ped Institute
started more. So after
this easier since half of
world experience shows
that some HPs push IUD
but its not so good for
client- pushing IUD is
not good.
-in some of the rural
areas there’s a high
demand for condoms but
there’s a lack of spply.
-some docs said they
don’t trust that the
women will understand
all the FP methods
available so don’t want
to counsel about them￾esp in rural area – too
much information￾communication problem.
-one woman said anemia
increased-could be due
to IUD.
to approve
protocols and
standards for
emergency
obstetric care.
They have 2
protocols:
eclampsia and pp
hemorrhage.
Waiting for 10
more
-MOH does not
encourage
devlmnt of local
level protocols all
devlpd at central
moh level so
waiting for 10
years are waiting
for protocols –
good the project
conducted training
and used WHO
protocols￾dangerous for HPs
to use not
approved
protocols –if
there’s a death
can’t defend.
-need to move to a
new live birth
definition
consistent with
international
standards.
Currently live
birth starts at 28
weeks.1000
grams. ICD 10
definition is 22
weeks gestation
and more than 500
grams and larger
than 25 cms head
circumference.
4
SM strategy based on
EBF.
- monitoring is very
helpful as able to
correct any weaknesses
and implement
knowledge and
practice. Said will
continue monitoring.
–are leaving a strong
monitoring team in
place.
–have enough
resources to continue
all inpt and out pt to
continue training. Have
materials and trainers.
-B4 SM tr did a lot of
interventions that may
have caused infections
(frequent invasive
vaginal tests)
- pleased with tr as
moms can deliver with
more positions and
vaginally encouraged.
-use of FP: was
encouraged early in
pregnancy and during
hosp stay and pp and
lead to improved birth
intervals
- HP also trained on
informed choice
counseling-most moms
interviewed believe
birth spacing should be
3 yrs
.-most moms know
LAM conditions.
-all facilities have
posters of different
methods and child care.
Now Under 28
weeks gestation is
listed as stillbirth
abortion.
HOPE printed
ICD guidelines for
each HF at request
of MOH. From
2008 will use the
new live birth
definition. ADB
and UNICEF have
agreed to equip all
mat hosps with
equipment for
premature births.
Now don’t have
equipment and
this is concern.
-if could make
monitoring
sustainable- not
sure if oblast
could do the
monitoring but
could maybe do it
from the rayon
level to look at
key staff-only sm
and rh takes 20
days – not sure
MOH will
continue.for time.
mat house level
not a problem but
for phc could be
problem for moh.
– Nursing
association will do
the monitoring for
visiting nurses and
midwives.
-ask chief of mat h
about monitoring
tools-ask if they’re
ready to use at
national level. –
5
Need to reduce the
number of
monitoring items
and reduce the
time.
ADOLESCENT
RH
-Like the training. Ob￾gyns at center said it
was hard to talk to
adolescents before the
training
– hard to get them to
come to center. Now
with counseling skills –
adols come, also
waiting time is shorter.
Appreciate anonymity
(don’t discuss with
parents don’t give
name). Teens can see
whoever they want
midwife or dr.
- B4 boys didn’t come
but now have a lot and
bring friends.
B4 didn’t have such a
center but then Oblast
renovated building and
PH provided furniture
and supplies and
materials.
SchoolAdministrators
think the teacher
training was useful.
-peer educators very
useful for reaching
adolescents
–hard to get students to
talk to adults and vice
versa. want more
training as adolescents
graduate.
-peer educators like
healthy lifestyle,
contraception,
physiology & RH
cycle, sti/hiv because
have learned about
-teachers: Voc schools
don’t use trained
teachers all the time and
HPs adequately. Don’t
allow them to teach RH
as admin doesn’t
understand the purpose
of the classes since they
are not required classes.
-peer educators are
graduating and there is a
need to train more.
Concern re whether they
wil do it without
resources from Hope.
-In rayons Admin of
health facilities do not
support trained HPs in
providing friendkly
services for adolescents.
Not a focus area and
may be uncomfortable.
Don’t have
contraceptives for
adolescents and do’t
think they need – only
provide counseling and
have hotline and
p;rovide checkups but
there are still problems
in offering services bcuz
h facilites don’t support.
In rayon polyclinics only
the ob-gyns can provide
contraceptive supplies
and ARH specialists are
pediatricians. They refer
to ob-gyn and adol don’t
go and don’t come back.
Doctors and youth
-Need to give
ARH as a credited
class so that it will
be given regularly.
-continue peer
education classes￾PH should try to
organize a PE
training plan with
MOE and RH
center. (have
trainers, PEs,
volunteers and
center).
-involve
administrators in
ARH promotion
to get them more
involved in
promoting ARH
teaching.
-pay more attn to
adolescent
services and
support youth
friendly services
in rayon
polyclinic.
-need to advertise
youth
services(have
done with
brochure with
hotline and
address) at rayons
the way they did
at center in Navoi
– but aside from
lack of ads there
6
prevention also learned
the importance of
abstinence.
-teachers see a
difference in students￾now more open to
discuss issues of early
marriage, RH not afraid
to discuss. Also trained
students communicate
more easily between
boys and girls
- before were separate
and they have become
friends.
-really like the
providers at the ARH
center, use counseling,
library, contraceptives
for selves and friends.
-the confidentiality
practiced at ARH
center has had a
positive impact and
increased use of
services. Also like
location of center as
not too many people
around.
-after training gained
more counseling skills
and became more
knowledgable than the
teachers.
-The ARH curriculum
dev by PHope is the
only one used at the
national level
(approved by MOH and
suggested to other
Oblasts that they use
it).
-PHope model of user
friendly clinic was
sustainable –knows
UNFPA tried to use
another model at
University but didn’t
expressed a need for
more psychologists
services specialized in
adolescent issues.
-started to work with
parents only when
community health
promotion program
started in 2006.
Recogmnized religious
and cultural brriers to
talk about RH. Need to
convince parent s to let
teachers and providers
talk to kids. Can’t do it
with the women leaders
as too old to reach
adolescents.
are services
problems:
recommend that
Oblast ARH staff
should support
rayon youth
friendly room
services in
advertising and
improving
services. (began
oblast center in
2004 and rayon in
2005.) Oblast
should arrange
regular meeting
with rayon RH
specialist on the
provision of youth
friendly services.
-teachers want
help to implement
the ARH program
in other rayons. –
could do through
ARH center and
Oblast ed center.
PH can help
coordinate a
meeting between
the oblast
education and
health department
to plan such
activity.
-need tt create a
network btwn
health center,
education and
makhalla sectors –
organize meetings
with parents and
ask ARH health
specialists to meet
with parents and
involve ed sector
as well. May need
7
work. Also tried to use
in students club but it
wasn’t integrated into
existing structure but
PHope model was
integrated with MOH
system.
-deputy of education
and Hakim womens
director really like the
materials.
-adolescent book “Me
and my World” is very
popular and is being
sold in Tashkent and
other places.
-like films and show on
abortion consequences
and stis.
-this was first project to
work on this issue –
gov’t decree in 2002-
PH started in 2003.
First who weren’t
afraid, first to get
health and ed sectors
together to address
problem.
to offer the
opportunity to
allow students to
opt out of RH if
parents are
opposed or similar
strategies. –
provide regular
meetings for
parents and
involve in the
triple party
meeting above.
PH can help the ed
sector make an
agenda for parents
meeting and how
to do it.
COMMUNITY- Started in 2006.
-set up to strengthen
existing community
health structure –
trained existing nurses
and community women
leaders.
-community leaders are
located in community
Therefore more
sustainable
Advantage of using
leaders is that they
know the community
but HPs don’s.
-Women leaders at
rayon level supervise
work at many
communities so built in
-women leaders are great
for working with
mothers
-selection ofnon formal
leaders for training was
difficult – did not
understand purpose and
sent older individuals
who couldn’t read, sit
etc. – therefore in the
future could improve
selection method – did
this after 3 out of 24
seminards changed the
strategy.
- in distinction with HPs
it is difficult to organize
- therefore
important during
training to teach
theme during
training to
integrate activities
into seasonal
activities (trad
weddings as was
done in Nurata)
-gov’t and oblast
HD should create
a team for future
trainings of new
formal leaders in
community
methods.
-this working
8
supervision system.
-in other regions of
Uzbek ths training
doesn’t exist for
community leaders.
-big advantage of using
the women leaders is
that they are older and
have a good in with
othr Mother in laws
and GMs.
-Visiting nurses are key
for linking health
system with the
community. Str of PH
to create training
curricula on MCH.
Improved counseling
skills of visiting nurses
which allowed them to
do more antenatal care
and pp care bf, FP
which brought more
family involvement in
HC system.
-6 monthly activity
plan of planned and
completed activities in
place. Observed that
they are being used at
community .Developed
by Hope staff-useful
for monitoring and
supervision.
-leaders noticed
differences in use of FP
use, birth spacing,
recognizing preg
danger signs, child
danger signs. Leaders
and mothers said do no
t have severe diarrhea
now. No deaths this
year in community
either IMR or MMR.
-leaders said they have
activites by the trained
people right after
training as depends on
other community
commitments (seasonal
agricultural campaigns)-
therefore important
during training to teach
thme during training to
integrate activities into
seasonal activities.
-challenge that couldn’t
involve more men in the
activities. Have a small
number but not enough.
-ARH issue –
community leaders have
problem working with
ARH.and convincing
parents to permit it.
-continuous refresher
training of mahalla
leaders- how will it be
done?
-need to plan updates of
training tools – stories,
pictures, videos etc. as
will need later.
- age of formal
community leaders is
sometimes a challenge.
They understand the key
messages but teaching
skills are an issur.
First monitoring showed
knowkedge was low –so
encouraged them to read
more and knowledge
was better.
group team should
also take
responsibility for
updating
community
teaching materials
and tools.
-monitoring helps
reinforce
education of
leaders- purpose
of leaders is to
generate
awareness and get
people to services
for problems – not
educate in depth.
-to strengthen link
btwn HP and
community
leaders would be
good to involve
health institute
staff (in oblast and
rayon) to do this.
Until now Hope
has done this.
9
good training and
education materials.
-women leaders
manage activities
-monitoring is in place.
Other project in a
healthy family region
was conducted by paid
volunteers so not
sustainable.
-used interactive
methodologies , stories
without end –first used
–all activities are based
on uzbek traditions –
asked people what they
wanted told to use
stories, films.
-this activity was
developed in accord
with the governors
decree 242-(community
health promotion.
-materials are useful,
user friendly. Mother
home card accepted by
MOh as national
appendix of order for
antenatal care. Have
materials for every
intervention area,
brochures, leaflets
posters. All project
activities were
substantiated with IEC
materials.
-Be able to implement
community strategy
able to build link
between health and
community sector.
-in all 4 rayons have
community health
promotion trainers who
know adult ed methods.
(16 trainers trained 391
leaders).
10
-eductional methods
are tools that can be
applied to other sectors
of work besides health
– examples stories,
video discussion, role
play, choosing target
groups.
- involvement of the
nurses assoc is key
strength as they will
continue training
nurses and monitoring.
- used women’s
tendency to
communicate and gave
them something else to
talk about !!
Increasing the Quality of Child Survival and Maternal
Care Services in the Navoi Oblast of Uzbekistan
Cooperative Agreement No.: FAO-A-00-99-00026-00
Flexible Fund Case Study
Project Duration: October 1, 2002 – September 30, 2007
Submitted to:
USAID/GH/HIDN/NUT/CSHGP
Child Survival and Health Grants Program
Room 3.7-74, Ronald Reagan Building
1300 Pennsylvania Avenue
Washington, DC 20523-3700
Janet Meyers
FP/RH Technical Advisor to the Flexible Fund
CSTS+
Macro International
11785 Beltsville Drive
Calverton, MD 20705-3119
Submitted by:
Project HOPE – The People-to-People Health Foundation, Inc.
Millwood, Virginia 22646
Tel: (540) 837-2100
Fax: (540) 837-1813
December 2007
HQ Contact person: Field Contact Person:
Ruth Madison, MPH Abdunabi Kuchimov, Program Manager
Tech Advisor, HWC Unit Project HOPE Uzbekistan
ACRONYMS
AFRH Adolescent Friendly Reproductive Health
AFRHS Adolescent Friendly Reproductive Health Service
AIDS Acquired Immune Deficiency Syndrome
ARH Adolescent Reproductive Health
CHP Community Health Promotion
CS Child Survival
CSHGP Child Survival and Health Grant Program
CSTS Child Survival Technical Support
HF Healthy Family
HIV Human Immunodeficiency Virus
HOPE Health Opportunities for People Everywhere
IEC Information, Education, Communication
IUD Intrauterine Device
KPC Knowledge, Practice, Coverage
MOE Ministry of Education
MOH Ministry of Health
M&E Monitoring and Evaluation
NGO Non-Governmental Organization
OHD Oblast Health Department
PHC Primary Health Care
Prikaz Official (Government) order or decree
PTP Peer to Peer Counseling
RDH Rayon Health Department
RH Reproductive Health
STIs Sexually Transmitted Infections
STD Sexually Transmitted Disease
TOT Training of Trainers
USAID United States Agency for International Development
VC Venerealogical Center
WHO World Health Organization
YF Youth Friendly
YFRHS Youth Friendly Reproductive Health Services
1
Project HOPE CS Navoi Project - Flexible Fund Case Study
Background and Overview of Project Area
Uzbekistan lies in the middle of central Asia, sharing borders with Kazakhstan to the north,
Kyrgyzstan and Tajikistan to the east, Afghanistan to the south, and Turkmenistan to the west.
With a population of over 25 million, it is one of the most densely populated of the Central Asian
Republics. Almost 2/3 of the population lives in rural areas, and over 36% of its population is
younger than 15 years1
.
Despite having a relatively equitable health care system and being considered a mid-level
country in terms of national income, Uzbekistan has excessively high infant, child and maternal
mortality rates as compared with other countries in the region. Infant mortality rates are reported
to be 62 per 1000, while maternal mortality registers 55 per 1000 live births (UHES, 2002). The
total fertility rate of women in Uzbekistan is 2.9 children and CPR, registers at 24.4 per 1000
population2
.
Birth and death rates per 1000 population are 19.5 and 5.0 respectively in Navoi Oblast, 16.3 and
5.7 in Navoi city. There are 191,511 (23.7 %) women of reproductive age in the oblast and
20,175 in Navoi city. The Maternal Mortality Rate (MMR) is 63.9 per 100,000 live birth in the
oblast and 66.6 per 100,000 in Navoi city3
.
The country describes itself as Muslim country but is not extremist. Traditional values are very
important and family is the cornerstone of culture. It is not unusual to have a paternal or maternal
grandmother living with the family. Grandmothers are one of the primary decision makers
regarding child rearing. Cultural issues include women customarily having children early and
the most popular family planning method in Uzbekistan is the IUD.
Navoi Oblast reflects the general characteristics of the population in Uzbekistan. Gender
distribution is almost even with 0.3 % more males than females. Navoi city has a population of
about 144,208, of whom approximately 10% (11,000) are adolescents between the ages of 15
and 17 years of age. 4
Most people work at government establishments such as schools, hospitals, polyclinics, and
banks. Apart from the government in the Navoi region, there are mining, chemical and cement
industries that employ about 55,000 people. The literacy rate in the region is high, with 97% of
children under 16 going to school.
1 CIA Factbook, Uzbekistan, 2001
2 www.indexmundi.com
3
Project HOPE, Final Evaluation CS Navoi, Uzbekistan, July 2007
4
Ibid.
2
The Problem
In order to adequately identify the situation of adolescent reproductive health in Navoi,
Uzbekistan, the project conducted a baseline survey for child survival (CS) activities and also
included questions for adolescents. The objective of the survey conducted among adolescents
was to assess their knowledge on reproductive health issues and HIV/AIDS prevention. The
relevant results are of the baseline appear in the table below:
Percent of targeted adolescent population (16-18) who can state that women
are likely to get pregnant halfway between two menstrual periods 1.3%
Percent of targeted adolescent population who can name at least three
methods of contraceptive methods
29.8%
Percent of targeted adolescent population can name at least two
mechanisms of HIV transmission
44.2%
Percent of targeted adolescent population who can name at least two means
of protecting themselves against contracting STIs
16.7%
Source: Baseline Survey of CS Program, Navoi, February 2004
These precarious statistics stem partially from the fact that more than 25% of the women bearing
children are under the age of 20. Classified as adolescents, this time of life is characterized for
many by tremendous physical and emotional changes as well as heightened vulnerabilities,
reflected partly in the rapidly increasing number of pregnancies and abortions in girls under 18
years of age. Adolescents in Uzbekistan often do not seek reproductive health services, fearing
reprisals from family and community members. Discussion of adolescent reproductive health is
taboo for teens, their parents and, oftentimes, health providers.
Project HOPE’s studies on adolescent reproductive health issues illustrated that a low percentage
of adolescents turn to health providers when they need advice and counseling on reproductive
and sexual health. Focus group discussions further illuminated the adolescents’ poor impressions
of health care providers as ‘inept’ at providing quality Adolescent Reproductive Health (ARH)
services, ‘rude’ to their patients, and potential ‘threats’ for leaking sensitive information to
adults. Adolescents do not seek reproductive health services because customs and traditional
views on child rearing do not facilitate open dialogue between adults and youth about sexual
issues. These views are strong and many service providers hold similar opinions. Community
leaders have lack of information and skills to give information regarding reproductive health to
adolescents and their parents in a correct and straightforward manner. Relations concerning this
issue are not established among education and health care workers, makhalla and Department of
Internal Affairs. Parents are not sufficiently involved in sexual education of youth.
Of those adolescents brave enough to access reproductive health services, many are treated
poorly and disrespected by health providers. With over 36% of the Uzbek population under 15
years old, adolescent reproductive health is an increasingly important component in the health
3
care system. Young women face risks of dying during pregnancy and giving birth that is up to
five times higher than in women between ages 18 to 25.5 As a result, the development of life
skills is crucial to the future of this age group as well as training health providers, parents and
teachers on adolescent reproductive health issues.
Steps Undertaken to Address the Problem
Following an assessment of health facilities, it was discovered that the need for Adolescent
Friendly Reproductive Health (AFRH) services was great in Uzbekistan. Over a third of the
population was not being adequately served by the health structure because of new approaches
in the PHC reform where services by GPs and patronage nurses were organized but there were
no established standards for providing RH services.
As part of the Child Survival Navoi project, in September 2003, Project HOPE expanded its
activities in Navoi, Uzbekistan to include a focus on adolescent reproductive health (ARH).
Project HOPE’s Child Survival Project has successfully strengthened maternal and child health
services and community health knowledge in Navoi over the past four years and the ARH
activities focused on establishing youth friendly clinics in the pilot regions used as a “test case”
for expanding adolescent health activities in the Navoi region as well as in other regions of
Uzbekistan.
Project HOPE’s contributions to the Uzbekistan Ministry of Health are timely, as a recent
government prikaz, or decree (#32 and #242), has ordered a Reproductive and Sexual Heath
component to be developed and standardized in all schools in the Republic. AFRH services
were implemented in Navoi city and in four rayons: a) Oblast ARH center, Navoi city; b)
Children Polyclinic, Karmana rayon; c) Adult Polyclinic, Kiziltepa rayon; d) Adolescents,
students and youth at call-up age, City Center, Nurota rayon; e) Central Rayon Hospital,
Konimekh rayon.
At the beginning of the ARH program, project staff began a search for national policies and
standards regarding ARH provision. The MOH informed the project team that there were no
national policies, standards, or protocols for ARH. Due to lack of national policies and standards
for AFRH services, the project adapted international guidelines which were used for the
implementation of services. Inputs were provided from the Republic ARH Center.
The activities on establishing Youth Friendly Reproductive Health Services (YFRHS) were
implemented in collaboration with the MOH, especially under the supervision and in
collaboration with the National ARH center staff. This arrangement allowed the project team to
pilot the appropriateness of the 11 characteristics for YFRHS suggested by WHO Global
Consultation in 2001 and discussed by the WHO experts group in Geneva in 2002. After these
activities, the MОН instituted prikaz #562, entitled, “About the Implementation of Youth
Friendly Initiative to the System of Health services” in December 2006, which established
policies and standards for ARH provision.
5 WHO fact sheet No 186 Dec. 1997
4
While training activities at the oblast level started in July 2004, Youth Friendly (YF) services at
the rayon level began after the HPs training on ARH at the end of 2005, following an evaluation
of the services done by Project HOPE in November 2005. Rooms were fully furnished and staff
was trained on AFRH service management at the end of March 2006; IEC materials were
distributed to the clinics by June 2006.
As with other Project HOPE activities, the ARH activities were designed to take a more
preventive, public health approach rather than a mere clinical focus approach. The project
worked to support the following program components:
1) Support the Educational Sector in implementation of ARH education activities.
2) Support the Health Sector in establishment of Adolescent friendly health services.
3) Support creation of a network of all sectors involved into ARH promotion.
4) Increase community awareness of ARH.
Activities involved in achieving the aforementioned components took place from August 2003 to
May 2007, in collaboration with the MOH and Oblast Public Education Department, the Health
Republic Institute and “Tarikat”, the Children and Adolescents’ Reproductive Health Republic
Center, Navoi oblast Khokimiyat, Oblast Health Department, Oblast Public Education
Department and Navoi Oblast Secondary – Special Professional Education Department.
One hundred and twenty nine (129) educational institutions and 126 makhallas throughout the
four rayons were involved in the ARH program. Two centers and three YFRHS cabinets were
created. Trainings included ‘Adolescents reproductive and sexual health’ for teachers and health
providers (trained 525 specialists); ‘Community health promotion’ (trained 391 specialists);
‘Peer-to-peer’ (trained 405 peer educators) and others.
While activities at the oblast level started in July 2004 during Phase I of ARH program
implementation, youth friendly services at the rayon level began at the end of 2005 during Phase
II. The work on establishing AFRH service rooms in rayons started in November 2005 from the
evaluation of reproductive health services which had been offered to adolescents at that time.
The evaluation was conducted by Project HOPE and the Navoi Oblast Health Department
(OHD) specialists. The results of the evaluation provided useful information in creating the steps
needed to establish AFRH service rooms in rayons. AFRH service rooms in the following rayon
HFs:
 Adult Polyclinic, Children Polyclinic, Kiziltepa rayon;
 Adult Polyclinic, Konimekh rayon;
 Adolescents, students and youth, City Center, Nurata rayon;
 Adult Polyclinic, Children Polyclinics, Karmana rayon.
The first AFRH clinic monitoring was conducted in Navoi city at the ‘Children and Adolescents’
Reproductive Health’ Center in September 2005. The Center was established in July 2004
during the first phase of ARH program implementation.
5
Furthermore, the specialists of the facilities were trained and the rooms the specialists were using
were refurbished and equipped. All Centers and rayon AFRH service cabinet HPs were
recipients of trainings such as ‘Adolescents reproductive and sexual health’ which was a five-day
TOT that took place in 2004 for Navoi Center HPs and in 2005 for rayon HPs; ‘Organizing
AFRHS’ which was a three-day training that took place in 2006; and ‘Developing AFRHS
protocols’ which was a three-day training that occurred in 2007.
To increase the quality of AFRH services in the selected facilities in the four rayons and in
Navoi city, to motivate HPs to offer quality services, and to introduce them to international
standards for YF facilities, a three-day training on AFRH services management was conducted
in Navoi, for 15 HPs of the selected facilities, from March 30 to April 1, 2006.
During the CS project, Project HOPE educated a large number of adolescents through formal
school classes and peer educators and also created a clinic for the youth population. The work
also involved school teachers and some community leaders. To accomplish project objectives,
Project HOPE developed and offered four types of training events for adolescents and peer
educators. These activities included:
Type of Course Participants Objectives
A five-day TOT course
on ‘adolescent
reproductive and sexual
health’
394 health providers and
school teachers
responsible for ‘ARH’
classes and counseling
To improve the health providers’ knowledge
about adolescent reproductive health topics and
to develop their skills in providing classes about
ARH; to inform health providers about youth
friendly service requirements; and to teach
health providers to provide youth friendly
counseling on reproductive measures.
Two-day courses at
schools on ‘adolescents
reproductive and sexual
health’
339 school teachers and
health providers
To practice conducting ‘ARH’ classes; select
the most active pupils to be trained as peer
educators; to inform adolescents about
reproductive organs physiology, including
function of the organs; to educate of healthy
lifestyle; to explain the importance of
abstinence; to inform about consequences of
initiating sexual activities early in life; to inform
adolescents about the effects early marriage,
pregnancy and abortion can have on their own
life; to inform adolescents about modern
contraceptive methods, advantages and
disadvantages; to inform adolescents about STI
and HIV/AID transmission and prevention; to
educate adolescents on ‘safe-sex’ practices;
about reproductive health rights; and to provide
adolescents with information courses on
reproductive health.
Four-day ‘peer-to-peer’
course on peer education
405 Peer educators To provide correct adolescent reproductive
health information through peer educators.
6
Includes counseling skills.
Five-day monitoring
courses for the
adolescent education
component.
specialist to monitor
teachers, adolescents and
peer educators
to develop/adapt monitoring tools; to define
weakness and strengthening in program
education; and to help teachers and peer
educators to improve their work. All 105
schools in the project area were monitored.
Two-day course on ARH 1,012 students and youth Taught principals of ARH includes physiology
of RH system, consequences of early marriage,
advantages and disadvantages of modern
contraceptives, prevention of STI/HIV and safe
sex practices.
Tow-day course for
establishing youth
friendly services
30 ob-gyns and midwives Taught principals of youth friendly services and
youth counseling skills.
Summer camp 140 adolescents
In summary, a total of 733 adult trainers, 405 peer educators and 1,152 adolescents have been
trained, thanks to the project.
The training was organized in agreement with the Republic ARH Center of Tashkent and the
curriculum developed in strict cooperation with this institution.
During the field visits, all HPs interviewed showed their great appreciation for this training
course, generally defined as essential for their practice within the AFRH clinic as evidenced
below:
“After the training, we started to reorganize our medical service. We dedicated a
room specifically for adolescents, we put a sign outside the door with the list of
services provided to them, we gathered here all the IEC ARH materials that we had
in different places, but most important we have learned to help adolescents who
come here with STIs or who are pregnant before marriage or just come around to
know more about sexual life, instead of condemning them… one of us is always
available for our young clients…”.
Health provider at Karmana AFRH service
Project Results:
 All the facilities offer medical and information services for youth only and are staffed by
YF trained personnel.
 The oblast ARH Center and one of the rayon level Centers in Nurata are physically
independent from other health services (located behind the adolescent polyclinic) while
7
the other four facilities offer a separate room for providing youth services within the
polyclinic.
 All the facilities offer medical services, psychological counseling and educational
materials; the Oblast AFRH service is equipped with a library, a computer with internet
connection, and a photocopy machine.
 Peer educators are actively involved in the Navoi YF clinic: about 15-20 peer educators
are regularly present on Mondays and actively support different educational activities
carried out by the center in different locations.
 ARH promoters of the Oblast center cooperate with school ARH promoters, conducting
ARH classes in different schools and with Makhalla leaders, facilitating community
events in the nearest Makhalla. Kamolot, a local NGO, involves the YF promoters for
different educational events.
 A telephone in the all but one AFRH facilities (a teen ‘Hotline’) is used to provide phone
consultations and information to interested teens, while maintaining the anonymity of the
caller.
 The Navoi AFRH center is well advertised in leaflets and T shirts.
 Navoi YF clinic satisfies the international criteria6
of AFRH service clinic up to 95.4% 7
.
 Technical support is provided to the AFRH services during monitoring and occasional
visits to the center during other activities. The Oblast AFRH center is in charge of the
implementation of the services in the rayons, but lack of transport is negatively
impacting on the activity8
.
During the final evaluation of the CS Navoi project, several health providers openly shared their
views on ARH in their facilities:
“The adolescent polyclinic has always had 10 counsellors on staff, but the [CS Navoi] project has introduced
a new approach that makes ARH a normal issue that can be discussed and talked about… Things have
changed in the last 10 years, and adolescents need and want to talk about sex, STIs and HI/AIDS. The project
has just come on time and has been implemented in time, helping us to update our knowledge, our
methodology and our views, in order to help our adolescents.”
Director, Oblast AFRH center
“When we started, we had 1 adolescent per week coming at the clinic. Now we may see more than 10 clients
per day, who ask questions on STIs, pregnancy, contraception. Susie9 who is a 20 year old girl, has been one
of our first clients, and she is still using the services…”
Director, Oblast AFRH center
6 WHO, YFRHS Consultation, 2001
7 CS Navoi project monitoring data, July 2006
8
The Oblast ARH Center does not have their own transport or transport expenses in the budget to regularly visit
rayons. The OHD also do not have enough money to provide to Oblast ARH Center specialists to visit rayons.
9 Not her real name
8
Challenges
As can be imagined with a project seeking to increase adolescent reproductive health services in
a traditional setting, there were challenges at various levels of program implementation.
Challenges in Health Sector:
 Non-existence of MOH polices or standards regarding AFRH services.
 Health care workers are not comfortable working with youth on issue of ARH.
 Health care workers are not sufficiently trained in adolescents’ reproductive health issues.
 No systemized approach to adolescent service organization.
 Distrust on part of young people toward health care workers.
 Weak network of health facilities and international organizations working on adolescent
reproductive health issues.
 Inability of health care workers to establish contact with youth outside health facility
 Problems with confidentiality.
 Problems with maintaining clients’ anonymity.
Challenges in Education Sector:
 Lack of empathy for youth.
 Insufficient use of effective technologies to work with youth.
 Improper allocation of staff.
 Lack of resources.
Challenges in Community Sector:
 Customs and traditional views on bringing up of youth do not welcome open dialogue
between adults and youth about sexual issues. These views are held both at the
community level as well as at the facility level.
 Community leaders have lack of information and skills to provide information regarding
reproductive health to adolescents and their parents in correct and straight forward
manner.
 Working relationships regarding ARH were not previously established among education
and health care workers, makhalla and Department of Internal Affairs.
 Parents are very uncomfortable speaking with their children about sex.
To overcome the above listed challenges, Project HOPE developed programs (in the form of
meetings and trainings) for each sector to:
 Increase awareness of each sector in ARH issue,
 Increase knowledge and skills of providers in each sector,
 Develop educational and informational materials for educational process for HPs,
teachers, adolescents, makhalla leaders and parents,
 Increase access to ARH health and education services by adolescents, and
 Create a network of all sectors and organizations deal to ARH services.
9
M&E System used to Monitor Results of Approaches
Project staff conducted qualitative monitoring of AFRH services bi-yearly in cooperation with
OHD and the Oblast AFRH center. The draft version of AFRH service monitoring instruments
was developed on August 22–30, 2005 by the children and adolescents reproductive health
specialist at the Navoi oblast Center and CS Navoi staff. As it was the first time to conduct
ARHS monitoring, the team decided to use the instruments as a pilot version and to continue
revising the instrument after using the tool during monitoring visits. The questionnaires were
then customized incorporating feedback from piloting the questionnaires. The following
questionnaires or monitoring tools were developed:
1. Questionnaire for interview with the person responsible for quality services to
adolescents on reproductive health and presence of necessary inventory at ‘Youth
friendly facility service’ /Instrument 1 {See final KPC report annexes for all project
monitoring tools.}
2. Questionnaire for HP of ‘Youth friendly facility service’ /Instrument 2
3. Questionnaire for interview with clients of ‘Youth friendly facility service’
/Instrument 3
4. Questionnaire for observation of visiting client of ‘Youth friendly facility service’
/Instrument 4
5. Checklist
The following materials were used to develop the questionnaires: A guide to Monitoring and
Evaluating Adolescents Reproductive Health Programs/Tool Series 5, June 2000; Monitoring
and Evaluation Plan/AYA June 2004; and Youth Friendly Facility Service -Guideline for
Trainers, UNICEF, 2002.
Statistical data on service utilization and events organization are routinely collected by the OHD.
OHD monitors activities related to improved ARH educational and medical services as this is
now a national priority, being implemented under Goverment decree #242. All information is
collected quarterly on activities which OHD reported to the MOH and Oblast Government. The
project assisted on collecting information by providing technical support on conducting school￾based, makhalla-based and health facility-based monitoring.
Project monitorings gathered mostly qualitative data but the project tracked some quantitative
data, including number of trained students and number of conducted events in makhalla or
schools by trained people. The table below shows the selected indicators for the different
services provided by the AFRH centers, since the beginning of the programme 2004:
Navoi Youth Friendly Service – July 2004 to November 2006:
Services Jul 2004-
Dec 2004
Jan 2005-
Dec 2005
Jan 2006-
Nov 2006
Total
No. of youth using the
facilities 900 4300 3500 8,700
No. of youth counseled 280 1400 1300 2,980
No. of youth medically
checked up 620 2900 2200 5,720
10
No. of diagnosis 300 1700 1600 3,600
No. of STIs diagnosed 0 2 4 6
No. of youth requesting
contraceptives 38 66 36 140
Oral contraceptive 10 11 7 28
Injectable contraceptive 6 11 9 26
Intrauterine device 1 12 8 21
Condom 21 32 12 65
No. of youth using the Hot
line 65 248 262 575
Rayons Youth Friendly
services
Karmana
Jun 2006- Nov 2006
Kiziltepa
Jun 2006- Nov 2006
No. of youth using the
facilities
5517 5436
No. of youth counseled on
contraceptive methods
3528 432
No. of check-ups 1499 5004
No. of diagnosis 1387 287
No. of STIs diagnosed e e
No. of Hotline calls 375 18 f
e
STIs diagnosis is not done at the center because none of the centers has their own test laboratory and needed
reagents. Clients are referred to vinearologic specialists for lab tests. In the case of STI suspicion, adolescents are
referred to Venerealogical Center (VC), which is located in the center of Navoi city, not that far from the ARH
center in Navoi city. VCs are also located in rayons too.
f
Telephone hotline activated in September 2006.
11
Key Findings
Indicators
KPC
Baseline
(Feb 2004)
KPC FE
(June 2007) Target
Percent of targeted adolescent population (16-18) who
can state that women are likely to get pregnant
halfway between two menstrual periods. 10
1.3% 35.3 % 40%
Percent of targeted adolescent population who can
name at least three methods of contraceptive methods.
29.8% 82.7% 70%
Percent of targeted adolescent population can name at
least two mechanisms of HIV transmission. 44.2% 90.7% 75%
Percent of targeted adolescent population who can
name at least two means of protecting themselves
against contracting STIs.
16.7% 80.3% 50%
Percent of targeted adolescent population report
having used (or whose sexual partner used) a condom
during last sexual intercourse.
55.6% 50%
Percent of targeted adolescents who can correctly
name at least six steps associated with correct use of a
condom.
16.7% 15%
Supporting Data
Footnotes throughout the report have indicated sources of data. The primary sources of
information were used in the writing of this case study: the KPC baseline survey based on the 30
cluster methodology recommended by CSTS and the final evaluation, which included both
qualitative and quantitative methodologies. Information from the project monitorings was also
used for the case study.
Lessons Learned
 Beliefs, local traditions and customs need to be considered before designing ARH
educational and informational materials.
10 The project team discussed this indicator with the technical working group after conducting a school based
monitoring. In the opinion of HPs, teachers and peer educators, the menstrual cycle is the most difficult concept to
grasp. As most adolescent girls do not have a regular menstrual cycle at this age, it is difficult for them to count the
time of halfway between two menstrual periods. This explains why most of adolescent girls do not pay much
attention to this issue. Additionally, peer educators and AFRHS HPs felt that for adolescent girls who are not
sexually active, they need not worry about when woman is more likely to get pregnant. These same individuals felt
that those adolescents who are sexually active should use more effective contraceptive methods such as condoms.
12
 It is advisable to begin work with MOH, MOE, Public Prosecutor, Community,
Youth organizations in rolling out ARH services.
 Ensure parents involvement through CHP strategy and the education sector.
 Include needed financial resources to improve AFRH service access, HPs
performance and monitoring.
 Involve peer educators in AFRH service provision and monitoring.
Recommendations/Future Steps
 To increase acceptance of ARH in the schools, it would be important to have the subject
offered as a required credited class so that it will be offered regularly.
 There is a demand and need for additional peer education training as there is high
turnover in the schools. It would be advisable for Project HOPE to organize a peer
education training plan with the MOE and the RH Center. Trainers, peer educators,
volunteers and a training center already exist, so this recommendation would be easy to
implement.
 It would be useful to involve the school administrators in ARH promotion and teaching.
 Pay more attention to adolescent services in the rayon polyclinics. Try to encourage the
Ob-Gyns to work better with the youth friendly practitioners. Also recommended is that
the Oblast ARH staff support the rayon youth centers. It would help if the Oblast
arranged regular meetings with rayon RH specialists on the provision of youth services. It
would also be useful to advertise the youth services in the rayons as they did at the Navoi
Center by providing the center addresses and hotline numbers on the brochures.
 At the request of many, the teachers want to implement the ARH program in the non￾pilot rayons. This could be done through the AFRH center in Navoi together with the
Oblast education center. It is recommended that Project HOPE coordinate a meeting
between the Oblast education and Health departments to plan for such an activity.
 There is also a continuing need to educate parents about ARH. It would be useful to
organize meetings between parents, the health center staff, the education sector and
makhalla sectors. Project HOPE can help the education sector organize an agenda and
plan for such a meeting.