In Turkey - World Bank

12-13 October 2010 Ankara
Prof. Dr. Recep AKDAĞ
Human First:
“Let Man Flourish and the State will
also Flourish!"
2
Health Transformation Program
"Mother and Children"
It was included in a governmental emergency
action plan for the first time.
3
Tunceli
Burdur
Artvin
Uşak
Giresun
Isparta
Sinop
Çanakkale
Amasya
Gümüşhane
Erzincan
Muğla
Trabzon
Rize
Bingöl
Kırşehir
Kastamonu
Bolu
Karabük
Balıkesir
Bartın
Ordu
Kırıkkale
Erzurum
Karaman
Denizli
Malatya
Aydın
Tokat
Kütahya
Zonguldak
Niğde
Eskişehir
Edirne
Bitlis
Iğdır
Bayburt
Bilecik
Mersin
Kırklareli
Ankara
Ardahan
Elazığ
Afyon
Çankırı
Osmaniye
Manisa
Samsun
Nevşehir
Sivas
Çorum
Muş
Yozgat
Kars
Bursa
Ağrı
Yalova
Hakkari
Kocaeli
Antalya
TÜRKİYE
Kilis
İzmir
Tekirdağ
Sakarya
Konya
Siirt
Adıyaman
K.Maraş
Kayseri
Aksaray
Diyarbakır
Şırnak
Gaziantep
Hatay
Mardin
Adana
Düzce
Batman
Şanlıurfa
Van
İstanbul
Population per Nurse-Midwife Change by province
2002-2010
2,500
2.090
2,000
1,500
1,000
1.102
500
284
0
December
2002
Aralık
2002
Eylül
20102010
September
4
2,000
Burdur
Karabük
Artvin
Bayburt
Sinop
Aydın
Bolu
Erzurum
Yozgat
İzmir
Bartın
Kırıkkale
Elazığ
Tunceli
Uşak
Isparta
Rize
Kırşehir
Çorum
Nevşehir
Karaman
Bilecik
Balıkesir
Gümüşhane
Amasya
Kırklareli
Eskişehir
Kastamonu
Edirne
Samsun
Çanakkale
Giresun
Denizli
Manisa
Erzincan
Trabzon
Kilis
Yalova
Çankırı
Iğdır
Osmaniye
Malatya
Niğde
Muğla
Konya
Tokat
Düzce
Sivas
Aksaray
Kütahya
Afyon
Adıyaman
Sakarya
Ardahan
Adana
Mersin
Antalya
Bingöl
Bursa
Kayseri
Zonguldak
Hatay
Diyarbakır
TÜRKİYE
Ordu
Tekirdağ
Kocaeli
Gaziantep
Batman
Muş
K.Maraş
Ankara
Kars
Mardin
Siirt
Van
Bitlis
Ağrı
Şırnak
Şanlıurfa
İstanbul
Hakkari
Population per general pratitioner change by province
2002-2010
9,000
8.401
8,000
7,000
6,000
5,000
4.209
4,000
3,000
1.677
1,000
0
December
2002
Aralık
2002
September
Eylül
2010 2010
5
0
Ankara
İzmir
Artvin
Bolu
Isparta
Trabzon
Tunceli
Gümüşhane
Edirne
Sinop
Bayburt
Erzurum
Burdur
Karabük
Kırıkkale
Elazığ
Kilis
Aydın
Çanakkale
Eskişehir
Ardahan
Sivas
Bilecik
Rize
Erzincan
Bartın
TÜRKİYE
Samsun
Kütahya
Kırşehir
Manisa
Zonguldak
Iğdır
Balıkesir
Denizli
Niğde
Çankırı
Giresun
Amasya
Kastamonu
Antalya
Karaman
Nevşehir
Kocaeli
İstanbul
Sakarya
Muğla
Bursa
Uşak
Kırklareli
Yalova
Konya
Ordu
Malatya
Çorum
Hakkari
Aksaray
Yozgat
Mersin
Tekirdağ
Kayseri
Bingöl
Düzce
Adıyaman
Adana
Tokat
K.Maraş
Şırnak
Afyon
Osmaniye
Bitlis
Hatay
Mardin
Gaziantep
Kars
Siirt
Van
Şanlıurfa
Batman
Muş
Diyarbakır
Ağrı
Population per specialist physician change by province
2002-2010
30,000
26.883
25,000
20,000
15,000
10,000
5,000
2.017
4.012
1.342
Aralık 2002
December 2002
Eylül 2010
September 2010
6
5th and 6th Changes in the Number of Healthcare
Personnel Serving in Region Provinces
6000
5190
5000
3951
4000
3107
3000
2000
1764
1000
0
Specialist Physician
2002
General Practitioner
2009
7
5th and 6th Changes in the Number of Healthcare
Personnel Serving in Region Provinces
90000
85579
80000
70000
60000
50000
42725
40000
30000
20000
18418
12847
10000
0
Nurse-Midwife
Total Healthcare Personnel
2002
2009
8
Improvements in the Health Facilities
Number of Active Healthcare Centers and Family
Physician Units
Number of Active Health Houses
6.000
5.268
7.216
7.500
5.000
4.000
5.000
5.055
3.000
2.000
2.500
1.572
1.000
0
0
2002
2009
2002
2009
9
112 Emergency Healthcare Services
x Thousands
2500
2.000
2250
1.800
2000
1,9
Milyon
1.600
1460
1500
1.400
1.200
1.000
1000
800
618
481
500
600
400
0
350 Thousand
200
Number of
Ambulances
2002
Number of Stations
0
Number of 112 Cases
2009
2002
2009
10
112 Emergency Help and Rescue Services
Today...
11
112 Emergency Help and Rescue Services
Today...
12
Air Ambulance Services
13
Ministry of Health
Newborn Intensive Care Services
Present Status of Newborn Units
Number of Newborn Centers
Number of Newborn Intensive Care
Beds
Number of Portable Incubators
Number of Medical Ventilators
Number of Personnel Who Received
Newborn Resuscitation Training
Number of Newborn Specialist Working
in Newborn Unit
Number of Nurses Working in Newborn
Unit
2.002
2.009
39
116
665
2.140
115
555
406
3.148
4.005
26.572
5
43
654
3.000
14
Changes in General Intensive Care Units
Number of Intensive Care Beds
8000
7351
7000
6000
Ninefold
5000
4000
3000
2000
1000
869
250
0
1993
19 years
2002
7 Years
2009
15
Success=
Determination
Monitoring and Assessment
16
Best Decrease Rates of Last Years
in Maternal and Infant Mortality in
Turkey and in the World
17
Researchs and Records Related to Maternal Mortality
•Turkey Demographic Research (1974-75)
–State Statistical Institute (Dual Record System)
–208 in one hundred thousand live births
•Turkey Demographic Research (1988)
–State Statistical Institute (Sister Method
–132 in one hundred thousand live births
•Maternal Mortality and its Causes (1998)
–Ministry of Health Mother-Child Health and Family Planning (Hospital Records)
–49 in one hundred thousand live births
(projection to the total of births is 70)
•National Maternal Mortality Study (2005)
–Ministry of Health General Directorate of Mother-Child Health and Family Planning-Hacettepe Institute
of Demographic Studies
–29 in one hundred thousand live births
•Ministry of Health Records(Active surveillance is conducted since 2007.)
-2007 21.75 in One Hundred Thousand Births
-2008 21.75 in One Hundred Thousand Births
-2009 21.75 in One Hundred Thousand Births
18
Maternal Mortality by Year
IN HUNDRED THOUSANDS
Maternal Mortality
2015 Target
120
100
100
80
70
60
40
25
28,5
20
19,4
0
1990
1998
2006
2008
18,6
2009
Source: 1990 State Planning Organization Projection, 1998 Hospital Research Projection, 2006 National Maternal
Mortality Study, 2008-2009 Ministerial Records
19
Millennium
Development
Goals in the WHO
European Region
A situational analysis
at the end of the
five-year countdown
20
Trends in maternal mortality:
1990 to 2008
Estimates developed by WHO,
UNICEF, UNFPA and The
World Bank
Authors: World Health
Organization, UNICEF, UNFPA
and The World Bank
Publication date: 2010
Languages: English
ISBN: 978 92 4 150026 5
21
Where is Turkey among the Other Countries
in Maternal Mortality
(World Health Organization Estimates)
World Average (In Hundred Thousand)
Low Income Group
Lower Middle Income Group
Upper Middle Income Group
High Income Group
Turkey
260
580
230
82
15
23
Turkey is in Upper Middle Income Group.
Source: WHO Trends in MM 1990 to 2008
22
1990-2008 Maternal Mortality Rates
(First 10 Countries with Most Decreasing)
Country
Maldives
Romania
Iran
Bhutan
1990
2008
310
170
150
37
27
30
940
48
1,000
200
12
280
Poland
China
930
17
110
280
6
38
Turkey
68
23
Estonia
Equatorial Guinea
Eritrea
Source: WHO Trends in MM 1990 to 2008
Change Rate (%)
-93
-84
-80
-79
-76
-73
-69
-67
-66
-66
23
Under Five Mortality Rates by Year
IN THOUSANDS
80
60
40
Infant Mortality
61
2015 Target
52
37
20
22
20
17
0
1993
1998
2003
2008
2009
Source: 1993, 1998, 2003, 2008 Turkey Demographic and Health Survey Results; 2009 Ministerial
24
Records
Under Five Mortality Rates 2007
(First 10 Countries by Annual Decrease Rates)
Countries
Thailand
Peru
Maldives
Portugal
Vietnam
Turkey
Lichtenstein
San Marino
Luxembourg
Estonia
Under Five
Under Five
Mortality Rate Mortality Rate
1990
2007
Average Annual
Decrease Rate
1990-2007
Improvement
with Respect to
1990 (%)
31
78
111
15
56
7
20
30
4
15
8.8
8.0
7.7
7.8
7.7
77
74
73
73
73
82
23
7.5
72
10
13
23
18
3
4
9
6
7.1
6.9
6.5
6.5
70
69
67
67
Source: 2009 The State of the World's Children UNICEF
25
Infant Mortality Rates by Year
IN THOUSAND
80
0-11 Months Infant…
77
53
60
43
40
29
17
20
13
10
0
1988
1993
1998
2003
2008
2009
2010 *
Source: 1993, 1998, 2003, 2008 Turkey Demographic and Health Survey Results; 2009 Ministerial
26
Records, 2010 Ministerial Records for the First Eight Months
Turkey among the Other Countries
in Maternal Mortality in 2009
World Average (In Hundred Thousand)
Low Income Group
Lower Middle Income Group
Upper Middle Income Group
High Income Group
Turkey
45
76
44
19
6
13
Turkey is in Upper Middle Income Group.
Source: 2010 WHO Statistics
27
Improvements in Infant Mortality Rate
Decrease rate of Infant Mortality Rate in 1988-1993: 31.2%
Decrease rate of Infant Mortality Rate in 1993-1998: 18.9%
Decrease rate of Infant Mortality Rate in 1998-2003: 32.6%
Decrease rate of Infant Mortality Rate in 2003-2008: 37.9%
Decrease rate of Infant Mortality Rate in 2008-2010: 41.2%
As maternal and infant mortality rate decrease, it is
difficult to decrease it more.
Nevertheless, our success is very important.
We want to sustain this success with you.
28
Decreasing the Maternal and Infant Mortality
• Our aim for the end of 2010 to decrease
the Maternal Mortality under 16/100,000
the Infant Mortality under 10/1,000
• Our ultimate aim is
not to lose any mother or infant because of
reasons that can be prevented.
29
In Turkey,
health system is the only system that
provides services for diagnosis, treatment
and rehabilitation of biological,
psycho-social
and developmental problems
and
through which every child is monitored in
the pre-school period.
30
We monitor Every Infant
9 times until the first year,
and 7 times after the first year,
16 times in total.
31
Monitoring Protocols
Flowchart 5a (FC 5a)
ASK AND CHECK
THE RECORDS
Ask the mother:
 How is the
breastfeeding going?
 Was the baby
breastfed in the
previous hour?
 Is the baby happ
with breastfeeding?
 Did you give any
other type of nutrition
to the baby?
 Do you have any
problem with your
breasts?
 Do you have any
concerns?
If the baby is more
than one day old:
 How many times
was the baby breastfed
in the last 24 hours?
INDICATIONS
Monitor
thebreastfeeding:
 If the baby wasn’t
breastfed in the last
hour, make the
mother breastfeed the
baby and watch for 5
minutes.
Watch:
 Does the baby
grip the breast well?
 Is the baby in the
right position?
 Does the baby
suck well?
 If the baby was
breastfed in the last
hour, tell the mother
to wait for the baby
to wake up for
breastfeeding.
CLASSIFICATION
TREATMENT AND ADVICES
 Nurses well.
 Nurses 8 times a day,
WELL-FEEDING
day and night.
BABY
 More than one day old
baby urinates six or
more times a day.
 Courage the mother to breastfeed the baby
when the baby wants (P1-FC 5b)
 Hasn’t nursed yet.
(in first hours of the
baby’s life)
 Doesn’t grip well.
 Doesn’t nurse well.
 Nurses less than
8 times a day.
 Takes additional food.
 Several days old and
took insufficient weight.
 Support the breastfeeding.
 Help the mother for the first breastfeeding.
 Teach the mother how to put the baby into the
right position and how to make the baby grab.
 Advise her to breastfeed more frequently
day and night. Convince her that she has enough
milk.
 Advise the mother to cut the additional foods.
 Assess the case again at the next breastfeeding
or the monitoring examination.
 Doesn’t nurse (less
than 6 times a day)
 Doesn’t nurse at all.
FEEDING
DIFFICULTY
UNNOURISHED
 Transfer the baby and the mother to a hospital
İmmediately.
32
Monitoring Protocols
Flowchart 5a (FC 5a)
Birth Trauma and Congenital Anomalies
INDICATIONS
 Swelling and cyanosis on the thighs.
 Swelling on the head at one side or both
Sides
 Abnormal positioning of the legs (after a
breech birth)
 Asymmetrical arm movements, arm(s)
not moving
CLASSIFICATION
BIRTH TRAUMA
 Pes equinovarus
 Cleft palate-cleft lip
MALFORMATION
 Distinguishing features, abnormal
Appearance
 Tissues on the head, abdomen or back
not covered with skin.
 Additional anomalies
TREATMENT AND ADVICES
 Tell the mother and the father that these
will not harm the baby and will get better in 1-2
weeks
 Don’t try to get the legs into a different
position BY FORCE.
 Hold the immobile extremity gently, don’t pull
 Transfer the baby to the hospital
 Help the mother to breastfeed the baby,
if the baby don’t nurse, teach her alternative
feeding methods
 Direct the baby to surgical correction when
the baby is a few months old
 Direct the baby to the institution specialized
in the related field
 Befor the transfer, cover the open tissues
with strerile dressings saturated with normal
saline
 Transfer the baby to the hospital
SEVERE MALFORMATION
33
Flowchart 1(FC1)
Examine infants of 1 week to 2 months of age according to the diagram below:
EVALUATION
ASK THE MOTHER ABOUT THE BABY’S PROBLEMS
• Define if this is the first examination for the problem or they come for control
− If they come for control, apply the instructions
at the bottom of this chart
− If it is the first examination, examine the baby according to the
instructions below
LOOK FOR THE POSSIBLE BACTERIAL INFECTION
ASK:
• Have the baby
had a convulsion?
WATCH, LISTEN; FEEL:
• Measure the respiration rate.
If it is too high, measure again.
• Check if the baby has chest
shrinkage.
• Check if there is nose wing
respiration
• Check for any groaning.
• Check for any fontanel bulging.
• Check if there is any pus leaking
from the ears.
• Check if there is any pus leaking
from the eyes.
• Examine the navel. Is there any
Rubescence or any pus leaking?
Does the rubescence expanding to the
skin around the navel?
• Measure the body temperature (or
check with your hand). Is it high or low?
• Check for any pustule on the skin. Are
they more than 5 or heavy?
• Check for any candidiasis or diaper
dermatitis
• Check if the baby is lethargic or
unconscious
• Examine the baby’s movements. Are
they less than normal?
CLASSIFY
BABY
ALL THE INFANTS
SHOULD
BE CALM
WHEN
CHECKING
FOR THESE
CLASSIFICATION
CLASSIFY THE BABY’S DISEASE
BY USING ALL THE BOXES RELATED
TO THE BABY’S PROBLEMS AND INDICATIONS
INDICATIONS
CLASSIFICATION
• Convulsion or
• Rapid respiration (60/min or higher)
or
•Heavy chest shrinkage or
• Nose wing respiration or
• Groaning or
• Fontanel bulgingor
• Pus leakage from the ears or
• Rubescence expanding over the skin
around the navel or
• Fever (at 37.5°C or higher or feels
hot) or low body temperature (under
35.5°C or lower or feels cold) or
• Heavy or more than 5 pustules or
• Lethargic or unconscious or
• Movements less than normal.
• Reddened or inflamed navel or
• Less than five pustules or
• Pus leakage from the eyes.
• Candidiasis or diaper dermatitis.
•None of the above.
POSSIBLE
SEVERE
BACTERIAL
INFECTION
OR
SERIOUS
DISEASE
LOCAL
BACTERIAL
INFECTION
LOCAL
FUNGAL
INFECTION
PROBABLY
NO
INFECTION
DETERMINING
THE TREATMENT
TREATMENT
(Emergency treatments before
the transfer are in bold.)
 Treat the baby if it is having a
convulsion.
 Give the baby the first dose of
intramuscular antibiotic.
 Take precautions against the
hypoglycemia.
 Inform the mother on how to
keep the baby warm on the road to
the hospital.
 TRANSFER the baby immediately
to a hospital.**
 Teach the mother how to treat local infections at
home.
 Teach the mother how to care for the baby at
home.
 Tell the mother to come again for control 2 days
later.
 Give the baby local antifungal.
 Teach the mother how to treat local infections at
home.
Teach the mother how to care for the baby at home.
 Tell the mother to come again for control 2 days
later.
Teach the mother how to care for the baby at home.
34
Gelişimi İzleme Rehberi
QUESTIONS
2 MONTH
4 MONTH
6 MONTH
9 MONTH
12 MONTH
15 MONTH
18 MONTH
1. “Ali’nin gelişmesi, öğrenmesi yani konuşması, sesler çıkarması, duyması, dinlemesi, başkaları ile ilişkisi, anlaşması, isteklerini anlatması, ellerini, parmaklarını, kollarını, bacaklarını
kullanması, oyun oynaması gibi konularda sizi düşündüren neler var?.
2.”______şimdi
istediklerini size
nasıl anlatır?”
Kucaklandığında
rahatlar, mutluluk,
açlık, huzursuzluk
durumunda farklı
sesler çıkarır.
Mutluluk, üzüntü
gibi duygularını
gösterir, kahkaha
atar, “aa,uu” sesleri
çıkarır.
“Agu”lar, sesli
harfler ile sessizleri
birleştirir.
“Ga-ga”“Da-da”
gibi heceleri
birleştirir. İşaret
eder, gösterir.
Başını sallar.
Değişik heceleri
birleştirir, işaretlerle
anlatır. Bir anlamlı
sözcük söyler (anne,
baba, mama, su).
“Anne, baba,
mama”dan başka bir
anlamlı sözcük,
işaretle istediklerini
gösterir.
3. “______ şimdi
neleri
anlayabiliyor?”
Konuşulduğunda,
gülündüğünde yüzü
değişir, dinler,
ilgilenir.
Konuşulduğunda
ağıza bakar, “anne”
nin sesini tanır
Kendi adını tanır,
bakar, sese döner,
konuşulduğunda
seslerle yanıt verir.
“Mama”,”hayır”
gibi sık tekrarlanan
basit sözcükleri
anlar.
Tanıdığı kişi ve
nesnelerin adını,
”ver, gitti, al” gibi
komutları anlar.
“Git ayakkabılarını getir” gibi basit
komutları “Anne nerde?” gibi basit soruları
anlar. Veda eder, el sallar.
Yüzüstüyken başını
kaldırır, çevirir, kol
bacaklarını oynatır,
yandan sırta döner,
ellerini genelde açık
tutar.
Başını dik tutar,
yüzüstüyken başını
90 derece kaldırır,
ellerini açık tutar,
birleştirir.
Destekle oturur,
önden arkaya,
arkadan öne döner,
elleriyle uzanır,
tutar, bacaklarına
ağırlık verir basar.
Desteksiz oturur
Elden ele geçirir,
üzüm gibi küçük
taneleri yerden alır.
Elleriyle tutunup
ayağa kalkar, “taytay” durur, tutarak
adımlar, işaret
parmağını kullanır.
Yardımsız yürür.
Yüze bakar, izler,
ağlarken kucaklansa
kucağa yerleşir,
susar, konuşulsa
dikkat verir, dinler,
ilgilenir, karşılıklı
gülümser.
Onunla oynanırsa
dikkatli, canlı bakar,
“anne”sine döner,
güler.
“Anne” si ve yakın
bakım veren diğer
kişileri tanır, kendisi
onlara uzanır, güler,
yüzlerini inceler
agular, heyecanını,
öfkesini belirtebilir.
İstemli, amaçlı ilişki
kurar. Oyuncu yüz
takınır, “anne”nin
yüzüne uzanır, bu
sırada güler, öfkeli
ifadeyle yemeğini
dökebilir, korkmuş
ifadeyle yabancıdan
uzaklaşabilir.
Yakınlık, sıcaklık, mutluluk, kendini
gösterme, araştırma, karşı gelme, öfke,
korku, çekinme gibi birçok duygusunu
düzenleyebilir, davranışları ile gösterebilir.
Örn: Anneye sarılır, öper, yeni bir oyuncağı
birlikte araştırır, yabancı ortamda sokulup
arkasına saklanabilir, annenin kızgınlığına
protesto ederek, öfke ile karşılık verebilir.
Yakınlarının
davranışlarını taklit
eder (babasının
şapkasını giyip
gururla baba gibi
yürümek gibi), söz
ve işaret kullanarak
istediklerinin
çoğunu ailesine
anlatır.
Gözleri ile her yönü
izler, birçok sese
cevap verir, dinler,
kucaklanınca
rahatlar, oyunlara
gülümser.
Onunla oynandığında
sesler çıkarır,
oyuncağı, elini,
ağzına götürür,
sesleri taklit eder,
oyuncaklara uzanır,
çıngırağı yakalar.
Ağzına götürür,
ellerine bakar,
oyuncakları sallar,
“cee” oyununa
şaşkınlıkla tepki
verir, aynada
yüzüne bakar, güler.
Ağzına götürür,
yeni oyuncağı
merakla araştırır,
atar, vurur, arar, “tel
sarar, cee” oynar,
taklit eder.
Ağzına götürür, atar, vurur, kap-kacak
doldurur boşaltır, çeker, sürür, araba sürer,
oyuncak nasıl işliyor araştırır, çizgi çizmeyi
taklit eder.
Telefonla konuşma,
tarakla tarama,
bebeği besleme,
uyutma gibi çok
basit hayali oyunlar
kurar, öykü dinler.
4.”______ şimdi
bedenini nasıl
hareket ettiriyor?”
5. “_______şimdi
sizinle, aile
bireyleri ile nasıl
ilişki kuruyor?”
6. “________nin
şimdiki oyunlarını
bana anlatır
mısınız?”
En az 3 anlamlı
sözcük kullanır.
Ailesi onu
anlayabilir.
İleri ve geri-geri
yürür, yürürken topu
atabilir, kalem tutar,
çizgi çizer.
35
Supporting of the Psycho-social
Development of the Child (SPDC)
• First step healthcare facilities and family physicians,
• Regular monitoring of the psycho-social development
of the expecting mother and children of 0-6 years of
age,
• Supporting of healthy development,
• Early determining of the risk factors/pathologies that
can prevent the healthy development of the child,
• Early intervention to the risk factors/pathologies,
The Psycho-social Development Support Program
is started to be expanded nationwide in 2005.
36
Why SPDC?
• The structuring of first step
healthcare services is a
structuring that enables
access to the expecting
mothers and children of 0-6
years of age in a wide and
regular way.
• Midwives and nurses monitor
the physical development of
the expecting mothers and
children of 0-6 years of age
and also their psycho-social
development.
37
Monitored Risk Factors
• Poverty in a level of malnutrition,
• Developmental delays depending on the
environmental factors,
• Maternal/paternal mental disorders,
• Violence,
• Abuse/Neglect,
38
In the cases the risk is detected,
• Midwife and physician handles the case together.
• Family is guided to the institutions where they can
receive support if needed. These institutions are as
follows
• Social Assistance and Solidarity Foundations
• Social Services and Child Protection Agency
• Turkish Employment Organization
• Metropolitan and District Municipalities
• Governorate Women's Status Unit
• Directorate of National Education
• Turkish Red Crescent Society
39
Interviews with Fathers
In Turkey, interviews with fathers are first started to
be follows thanks to the SPDC program.
Information on the expecting mother/mother
support,
Alcohol and tobacco use,
Healthy diet and family planning
is given to the fathers and factors seen as risk factors to
the violence are examined.
Cases considered necessary are closely monitored.
40
• Trained Personnel
Number of Physicians
8,374
Number of Midwifes/nurses 22,023
• Within the scope of the program in the first six
months of 2010, the following is monitored:
Pregnant:
296,029*
Infant:
332,393*
Child:
275,055*
Father:
76,441*
• The coverage of the Program will be expanded to all
provinces in 2011.
* January-July 2010 (data from 68 provinces)
41
Independent Effectiveness Survey
(UNICEF)
• Raising the understanding of healthcare personnel
and mothers about child's development,
• Increasing the number of early interventions by
detecting the risks earlier,
are the strong aspects of the Program.
• The expansion of the Program will contribute greatly
to the health and development of our children.
42
United Nations General Assembly 1959
Declaration
Every child has the right to reach its full
potential.
Principle 2: The child shall enjoy special protection,
and shall be given opportunities and facilities, by law
and by other means, to enable him to develop
physically, mentally, morally, spiritually and socially in
a healthy and normal manner and in conditions of
freedom and dignity.
43