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In Uzbekistan, expanding health care to the most vulnerable and hardest-to-reach

By Rob McBride

KARAKALPAKSTAN, Uzbekistan, 20 January 2012 – In the remote Khujayli District of Karakalpakstan, Uzbekistan, the Saparova family can often be found in a traditional yurt at the back of the house, escaping the worst of the summer heat.

VIDEO: UNICEF correspondent Rob McBride reports on Uzbekistan's efforts to expand quality health care to the most vulnerable and hardest-to-reach children.  Watch in RealPlayer


This was where a visiting medical team headed to find Gulmira Uzakova and her 8-month-old daughter, Hurmiza. After removing their shoes and going through the traditional greetings, the visitors were invited inside.

As they weighed and measured Hurmiza, they chatted with her grandmother, Bibizada Saparova. In traditional families, the grandmother is a key decision maker, and the medical team knew that influencing Ms. Saparova would be crucial to promoting positive child-care practices.

Fortunately, Ms. Saparova was impressed by the level of attention her daughter and granddaughter were receiving.

© UNICEF Uzbekistan/2011/Pirozzi
Gulmira Uzakova holds her 8-month-old daughter, Hurmiza, as they are weighed by a nurse in their home in Karakalpakstan, Uzbekistan.

“They measure the growth of the child regularly,” she said approvingly. “And depending on how the child is doing, they give advice on feeding and so on.”

It is a very different level of service than Ms. Saparova is used to.

Expanding quality health care

Karakalpakstan is blighted by the shrinking Aral Sea, which has worsened water quality and food security, and has threatened livelihoods. These conditions are reflected in high rates of pneumonia, diarrhoea, anaemia and malnutrition among children. In fact, child health and nutritional indicators in the western region are among the worst in the country. And given the area’s remoteness, extra effort is required to reach the most vulnerable children here.

Medical visits like those at the Saparova household are part of a new, ambitious, UNICEF-supported government plan to expand quality health care and improve child health.

© UNICEF Uzbekistan/2011/Pirozzi
Dr. Shakhnoza Djumaniyazova, who has received UNICEF-supported training, measures a girl’s height in Taza Baz Village, Uzbekistan.

In a clinic in the rural village of Tara-Baz, Dr. Shakhnoza Djumaniyazova performs similar evaluations on babies brought by their mothers.

“The main problem here has been children who are underweight and below normal height,” she said. “But now, we are taking regular checks on growth development and counselling the mothers on giving proper nutrition.”

Like many other doctors and nurses, Dr. Djumaniyazova has received UNICEF-supported training on improved child health care, making her a more effective physician and counsellor.

“What is important is reaching the household level so that all children benefit,” said Dr. Hari Krishna Banskota, a UNICEF health specialist.

Radical changes in health care quality

In her 29 years as an obstetrician at the District Hospital’s maternity ward, Dr. Bibihadicha Isakova has seen radical changes in the delivery and quality of health care. 

“Our hospital has been through several programmes,” she recalled, “including breastfeeding promotion and a baby-friendly initiative.” As a result, child morbidity has declined.

© UNICEF Uzbekistan/2011/Pirozzi
Jonsulu Shukurbaeva rests with her newborn in a hospital in Karakalpakstan, Uzbekistan.

The hospital also embraced baby- and mother-friendly techniques, such as allowing husbands or other family members to be present during delivery and allowing mothers to hold their babies immediately after birth.

One of Dr. Isakova’s patients, Gulnur Bekbosinova, has seen those changes first-hand, between the delivery of her first baby six years ago and her youngest child the previous day.

“The first time, my child was taken from me straight away,” she said as she nursed day-old Arman. “But this time, they gave the child to me, and I felt much happier.”

Little Arman has been born into a region facing a variety of hardships. But with changes like those he and his mother are experiencing, they, and their community, have cause for hope.



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