Reduce child mortality
Where we are?
In 2007 – 2008, Croatian maternity hospitals, according to childbirth registers, marked an increase in the number of children. The perinatal mortality rate decreased, while the causes of infant death in Croatia are no different than the causes of infant death in developed countries.
The share of uncontrolled and insufficiently controlled pregnancies has for many years been below 5% (in 2008, there were 3.2% of completely uncontrolled and 1.5% of insufficiently controlled pregnant women with 1-2 examinations during pregnancy). Health education about family planning and reproductive health, especially of schoolchildren and adolescents, as well as pregnant women, is of critical importance for the mitigation of this issue.
Target 2 – „Improvement of antenatal care" is implemented through primary healthcare provided to each health insured woman. The average number of examinations per pregnant woman in observed period was increased from 6 to 8 examinations. Pursuant to Health Protection Measures Programme, the ideal number of examinations is 10 clinical and 3 ultrasound examinations per pregnant woman. More than 65% of pregnant women had more than 9 examinations during pregnancy.
There is a sufficient number of multi-practical visiting nurses. According to the regulation on norms and standards of obligatory health care rights, one visiting nurse should cover 5,100 inhabitants, and that requirement is generally fulfilled. The Health Protection Measures Programme determines the standard number of visits to a pregnant women (1), new mother (2), newborn (2), and during the post-neonatal period (1). The attained number of visits to a new mother (3.4), newborn (3.9), pregnant woman (0.55), and post-neonatal period infant (1.8) testify to even above standard results.
There are 30 maternity hospitals in Croatia today, 15 of which carry the title "Baby-Friendly Maternity Hospital". However, it should be emphasized that all maternity hospitals have joined the program and have made significant steps in promoting breastfeeding and in the further humanization of conditions in Croatian maternity hospitals. Since the aforementioned program underlines the role of the community and breastfeeding support groups, it should be stressed that starting from 16 groups in 2006, there are now 101 groups, lead by visiting nurses and 5 groups from the civil society associations in 19 Croatian counties. When compared to 2008, 23 new breastfeeding support groups lead by visiting nurses were established in 2009 and, for the first time, such groups were organised in 7 counties. In December 2009, the total of 105 groups were active (100 groups organised by visiting nurses and 5 by NGO groups).
Communication improvement, especially the exchange of information within primary health services (gynaecologist and in-house medical service), would help reach a larger number of insufficiently controlled pregnant women.
With the aim of further improving the outcome of newborns in the categories of very low birth weight and extreme pre-term, it is necessary to increase the number of beds in high-level institutions for transported mothers, by reorganizing the number of beds within and between hospitals, and accordingly increase the number of infant beds.
Categorisation of hospitals is underway, and regional organisation of perinatal healthcare would be an integral part of this project. As a part of the „transport to your home" activity, it was proposed to prepare the transport organisation for entire county according to the recommendations of the profession and to define staff, equipment and financial resources required for plan realisation after proposed organisation.