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Home Visiting

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PRACTICE OF HOME VISITING TO IMPROVE CHILD HEALTH AND WELL-BEING OF AT RISK CHILDREN


The Ministry of Health (MOH) and UNICEF have jointly introduced home visiting in six municipalities as an approach to further improve health and well-being of at risk children and the most vulnerable families, to build trust between nurses/social workers and communities and to strengthen municipal family medicine systems.

In other words, the value of the home visiting program is to bring services into the home rather than requiring families to seek out services within health facilities. Home visiting was also triggered by the recommendations of a regional initiative called Regional Knowledge and Leadership Agendas on child survival and young child wellbeing. Regional Experts in Health sector have adopted the scenario that suggests that home visits are fully integrated into family practice team functions at municipal level. 

During home visits, families receive counselling on health-related issues, including immunization, breastfeeding, education and early stimulation, injury prevention, responsive and sensitive parenting and maternal health, including mental health.

Case study: the municipality of Dragash/ Dragaš

Located in the Sharr/Šar Mountains in the southernmost part of Kosovo, the picturesque municipality of Dragash/ Dragaš is home to 33,997 people. Around half of the population is Albanian, while the other half is Bosniak and Gorani (KAS 2013). The health sector here has 98 doctors, nurses and support staff, and access to health services is equal for all the communities (OSCE 2015). Home visiting began three years ago in Dragash/ Dragaš and has been tremendously successful. The objectives for implementing home visiting services in their municipality were clear to doctors from the Family Medicine Center. They have commitment and motivation to provide pregnant mothers and later their infants with good quality services.  Dr Ramadan Jashari, Director of the Family Medicine Center, says that these visits are really welcomed by families.

“During this period we didn’t have a single case of a family that has rejected home visit,” Jashari says. “On the contrary, nurses who conduct these visits are welcomed warmly.” The people of Dragash/ Dragaš regularly express their gratitude and appreciation for the visits, which only confirms the nurses’ motivation. “One of the nurses told me that a woman of the Bosnians-Gorani community told them that she is grateful that someone cares about them and visits them in their homes. This has a special importance to us,” Jashari said.

At first the visits were planned to be centralized, meaning that the nurses would go from the main Family Medicine Center to the families’ homes, but later it became evident that the costs required to do that were too high. They had to decentralize the home visits, and managed to do so by integrating in the visiting process two smaller Family Medicine Centers — one in the Bosniak-Gorani community and the other in the Albanian community. UNICEF has been a great help, Dr Jashari explains. “UNICEF helped us with logistics, with equipment; they organized meetings and training in cooperation with Ministry of Health officials” he says.

The nurses here - seven in total - seem to be highly motivated for the task and like doing the job. The main nurse and coordinator of home visits in Dragash/ Dragaš, Nexhibe Berisha, explains how she enjoys doing home visits. “I like it because I did this job before; I have worked for 37 years. And I have given a lot to this place,” she says. “Sometimes they [families] are better off [financially], but others are really in lack of basic needs. But they are hospitable and do not cause any problems.” Another nurse who conducts home visits, Badushe Bajraktari explains how well-received the visits are in this area. “We are very welcome because we are old nurses who have worked for a long time,” she says.

Perhaps the most important issue identified by the nurses during home visits in Dragash/ Dragaš is that there are a lot of misconceptions about pregnancy and early childhood development. It is the nurses who are most often confronted with misunderstandings on matters relating to health and wellbeing. it is for the nurses to change those misconceptions. A commonly encountered misconception among mothers in Dragash/ Dragaš is that breastfeeding does not give babies enough nutrients, and therefore exclusive breastfeeding is not sufficient. The reality is that exclusive breastfeeding in the first six months is what makes babies truly healthy, and adding other foods only increases the risk of babies catching diseases. “A woman who gave birth three months ago told me that she is breastfeeding as well as giving additional milk to the baby,” said Nexhibe, the main nurse, “She said her baby is not developing, and I told her she can’t do that and that for the first six months the baby should be exclusively breastfed”. The main Family Medicine Center tries to provide health services in the form of home visiting to all eligible Dragash/ Dragaš families.  

At this stage, Dragash municipality has exceeded expectations on the implementation of home visiting services.  Nurses have demonstrated strong motivation and willingness to reach more vulnerable families, and families are accepting them into their homes.

Dr Genc Ymerhalili, Director at the Kosovo Center for the Development of Family Medicine, suggested that despite improvements, difficulties remain. The main obstacles that home visiting faces are “insufficient resources (…) a low healthcare budget, a lack of payments for performance [of the nurses], motivation, lack of technical equipment, logistics issues, (…) coordination, and two-way macro- and micro-institutional communication,” says Ymerhalili. “Job descriptions for the family medicine teams — family physicians and nurses — are finalized, but are not in force,” he adds.  And indeed, as Dr Ymerhalili says, funding is a big obstacle for home visiting. The healthcare system in Kosovo is underfunded, and sustaining home visiting will require significant funds.

 

 
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