Ms. Madina has a history of premature births. This is only her second child to survive from five pregnancies – one of her children died at this very same hospital unit in eastern Uzbekistan.

“The baby only lived for a few days,” said Ms. Madina. “It was 2.8 kg, was taken away from me to be treated, and did not survive.”

Positive changes

But that was six years ago and well before a joint initiative by the Ministry of Health of Uzbekistan, the European Commission and UNICEF, to improve mother and child health services across the country.

Ms. Madina’s new baby weighs less than two kg, but is clearly thriving and is allowed to be with her all the time. “The doctors include me in all aspects of the baby’s treatment,” she said.

Now at the end of the second year of implementation, this region is one of eight across the country, where 3,000 medical professionals have undergone training in newborn care. In addition, in those same regions, a total of 13,000 health professionals have received training in maternal, newborn and child care to monitor and improve the quality of medicine.

The project has already brought positive changes in health sector reform and quality of care. One of the main goals is to reduce Uzbekistan’s relatively high infant mortality rate of 34 deaths per 1,000 live births. This issue exists despite the fact that practically all births in the country are attended by a medical professional.

Improving skills

In the neighbouring region of Andigan, obstetrician and gynecologist Dr. Abdukhalieva Matluba is seeing a major transformation in services provided to pregnant mothers.

“Mothers are able to choose the position to give birth and can have husbands and relatives present,” said Dr. Abdukhalieva.

Fellow neonatologist Dr. Kodirova Manzura pointed out other benefits. “We’ve been taught the importance of breast milk,” she said, “and have introduced immediate contact between newborn babies and their mothers, which helps good breast feeding.”

The two doctors spoke in one of several newly completed training rooms. In another room, general practitioners and paediatricians from the Andigan region were being trained in Integrated Management of Childhood Illnesses (IMCI) techniques through a stimulating role playing session – alternately assuming the positions of doctor and patient – to hone their skills in correctly diagnosing early intervention.

“This exercise is very useful,” said paediatrician Dr. Toirova Uktamkhon during a break in the training. “Sometimes we have to find solutions quickly, so this helps to improve our skills.”

Tangible results

Overseeing the session was trainer Dr. Mukhitdinova Munavvar. “This will allow [health workers] to bring new skills into their practices,” she explained, “and ultimately to bring down child mortality.”

Evidence of just how far the system has developed after only two years of implementation arrived alongside a recent emergency in neighbouring Kyrgyzstan, which caused an influx of thousands of refugees – many with babies or in advanced stages of pregnancy.

Among the refugees was Mamakhanova Mashura, whose childbirth had to be induced ten weeks prematurely to avoid potentially life-threatening complications. Weighing just 900 grammes, her tiny baby would almost certainly have died in the past. Now, cared for in an incubator, she has every chance of flourishing to reach adulthood.

The infant is tangible proof of the changes that have taken place in Uzbekistan’s mother and child health services –and their translation into lives saved.