Health System Strengthening
In the initial years after its independence in 1991, the country’s rapid growth was matched by major strides in mother and child health care. Mortality rates fell and immunization rates rose, to name just two positive indicators. Yet the pace of improvement has slowed in recent years and failed to keep up with the country’s broader economic gains. UNICEF has been working with the Ministry of Health, non-governmental agencies and others to develop strategies and action plans to help the country make additional gains.
As the country moved away from its socialist past and through its economic and political transition, health initiatives helped prevent hundreds of unnecessary deaths of children. The country achieved the impressive results in reducing under-five mortality, from 36 per 1,000 live births in 1990 to 11 per 1,000 live births in 2008. Skilled birth deliveries are almost universal outside of the Roma community. Immunization rates have been steady at around 95 percent for the past decade. In 2003, the country became the first in the region to be certified as iodine-deficiency free. HIV/AIDS rates are at less than 0.1 percent.
To overcome these deficiencies, UNICEF has developed the Health System Strengthening Project to help the Ministry of Health and other relevant public health groups improve their planning, budgeting and implementing of public health programs for mothers and their children. This includes the creation of long-term policies with clear and integrated targets, instead of continuing to rely on short-term projects that are updated from year to year, or scrapped.
In practical terms, this means that as part of a broader plan to improve mother and child health care, medical equipment must be kept up to standards, and outreach services expanded. Health professionals must be adequately trained to provide high quality and newly recommended vaccines, and curricula at medical and nursing colleges meet the latest international guidelines. Regional differences must also be recognized so that medical resources are divided in a way that ensures the neediest parts of the country get adequate resources.
UNICEF is also undertaking a broad nutrition plan to tackle anemia, one of the biggest causes of complications during pregnancies. One part of this strategy includes surveying about 8,000 households to assess the quality of their diets. The results of the survey will help determine the scope of an anticipated UNICEF-supported flour fortification program which will ensure stable foods contain adequate mineral and vitamins to improve the health of the mothers and decrease the number of complications at birth.