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8. Implementation framework
8. Implementation framework
Reform of the Reproductive Health System:
- develop the national concept of the reproductive health services;
- develop the reproductive health services within each district and city of the country;
- integrate the reproductive health services into the system of the primary health care;
- organize the full and comprehensive service of reproductive health care and family planning;
- set up the mechanism and terms of reference for the patients with the reproductive function disorders;
- develop regulations on family planning and reproductive health.
Access to and quality of services:
- provide reproductive health services within the system of the primary health care;
- increase the capacities of the family planning consulting offices and of the National Scientific Practical Center of Reproductive Health, medical genetics and the family planning in the counseling, prophylaxis, diagnosis and management of the patients with sexual and reproductive problems;
- develop and implement methodological and instructive guidelines and standards of the reproductive medical assistance.
Training the health services providers:
- Develop the university and post university studies curricular in the reproductive health for the family doctors and obstetricians gynecologists;
- introduce reproductive health topics into the university and post university study programs;
- develop methodological and instructive guidelines, standards of practical knowledge and skills for the reproductive health services providers;
- train the specialists of the family planning consulting offices, in accordance with the modules that would cover all the aspects of the reproductive health;
- run ongoing instructive seminars for the family doctors, obstetricians gynecologists, dermatologists venerologists and of the nurses in the reproductive health.
- Information, education, and communication:
- create a system of education for the health and family life within educational institutions;
- set up an informative, educational, communication system of reproductive health for people of reproductive age.
Gender equality:
assure equal provision of information and access to the reproductive health services for both women and men.
Research, monitoring, and evaluation:
- pass and promote definitions and classifications of the reproductive health accepted at the international level;
- set up a managerial and informational system of the reproductive health;
- develop record-keeping and monitoring documents in the family planning;
- develop annual report indicators in the reproductive health;
- promote qualitative services management in the reproductive health;
- set up within the National Scientific and Practical Center of Reproduction Health, Medical Genetics and Family Planning of a methodological center for coordination, registration, analysis and reporting in the reproductive health field;
- carry out a complex study of health care evaluation in the reproductive health;
- conduct periodic public studies in the health reproduction.
8.1. Family Planning
Improvement of the legal and normative framework:
- develop the family planning services in each family doctors centre, health centre, the family doctor office;
- Introduce the family planning service into the primary health care services;
- create some mechanisms as to provide the underprivileged groups with modern contraceptives free of charge or at an affordable price.
Access to and quality of services:
- develop health care standards for the national service of family planning;
- Integrate the contraceptive services within other services of the reproductive health;
- provide within the family planning services of the pre-conceptional advice, after the birth and abortion, to teenagers and young people, to sterile couples, to victims of violence and trafficking;
- Involve family doctors into the family planning and the reproductive health protection;
- provide free access to all the contraceptive methods, including the modern hormonal contraception and voluntary surgical sterilization.
Training of health services providers:
- introduce the family planning topics into the university and posgraduate study programs;
- develop methodological and instructive guidelines, standards of practical knowledge in the reproductive health and skills for the providers of the family planning services;
- run ongoing instructive seminars on reproductive health including at the working place of the family doctors, obstetricians gynecologists, dermatologists venerologists and the nurses;
- provide complex training to doctors of the family planning offices, obstetricians gynecologists, family doctors in all the relevant fields of the reproductive health: family planning, safe motherhood, the health of young people, the diseases of the reproductive organs, the abortion, the infertility, the violence, the trafficking, the genital and breast cancer, menopause, the sexual and reproductive health of men.
Information, education, and communication:
- promote education in the family planning at high schools, universities and other educational institutions;
- organize formation sessions in the family life education for the didactical and health personnel from schools;
- publish and disseminate among the population informative material on family planning;
- involve social associations and the civil society in the informative, educational and communicational activity in the family planning;
- the mass-media participation in educational and informative campaigns of family planning;
- involve the family doctors in the contraceptive education;
- develop the concept of communication between men and women in the family planning field.
Gender equality:
- inform men and women about the right to choose in the field of family planning;
- orient the curricular and extracurricular education in the field of family planning to the same extent both for boys and girls;
- promote public education in the reproductive health, both for women and men;
- provide access to the contraceptive methods for women and men;
- provide equal access to family planning services both for men and women.
Research, monitoring, and evaluation:
- create an informational system in the family planning;
- create a national registration, monitoring and evaluation system in the family planning;
- carry out complex evaluation studies of the assistance in the family planning.
8.2. Safe Motherhood
Improvement of the legal and normative framework:
- adjust the prenatal health care standards, approved under the compulsory health insurance system to evidence-based health principles clinical guidelines in force;
- improve the criteria for the accreditation of health facilities involved in the provision of perinatal health care in accordance with the initiative „Making Pregnancy Safer”;
- set up protection mechanisms for the vulnerable social strata.
Availability, use and quality of services:
- promote concept „Family-friendly perinatal services” – an instrument of quality provision;
- improve the definitions and indicators of the perinatal health care system and train the personnel involved in the collecting and processing of the database on a continuous basis.
Training of health services providers:
- continue the posgraduate studies of the health personnel of the perinatal service in the priority fields: the principles of the perinatal services planning; the total quality management; evidence-based medicine; the essential care in obstetrics and neonathology; the prevention of the mother-to-child transmission of HIV;
- identify the training needs of the health personnel.
Capacities of women, families and communities:
- evaluate the level of knowledge, behavior skills and consumers’ satisfaction by the perinatal services;
- develop the national policy of family and community interaction in prenatal health care;
- develop the partnership between the perinatal services and the community;
- establish a mechanism as to encourage the active participation of mothers and community representatives, aimed at improving the perinatal care quality;
- strengthen the interpersonal and intercultural communication capacities and the skills of the health personnel from the system of mother and child health care.
Equal chances for women and men:
- involve both future parents in the preconceptive, antenatal, intranatal and postnatal periods;
- plan and implement interventions to identify and settle the problems related violence during the pregnancy.
Research, monitoring, and evaluation
- complete the development, approval and implementation of the guidelines on perinatal care indicators;
- improve and complete the existing instruments perinatal services assessment;
- carry out operational studies with the direct impact on the maternal and perinatal mortality and morbidity;
- establish the risk factors in the fulfillment of the reproductive function.
8.3. Sexual and reproductive health of teenagers and young people
Improvement of the legal and normative framework:
- develop the national concept on Youth-Friendly Health Services;
- organize the Youth-Friendly Health Services in every district and town;
- implement the family life education within the high school study program.
Access to and quality of services:
Provide youth-friendly services for the effective satisfaction of the sexual-reproductive necessities, including:
- information and education in the reproductive health;
- advice teenagers on inter-gender relations and equality;
- promote a responsible sexual behavior;
- prevent the violence against the teenagers;
- prepare for the family life, the responsible planning of a child’s birth and avoid the unwanted pregnancies and sexually transmitted and HIV infection.
- these services will provide and guarantee the privacy right of the teenagers, confidentiality and informed consent;
- Inform, advice and provide reproductive health services, prevent and treat sexually transmitted infections among the sexually active teenagers;
- Provide special support on the part of the family, the services providers and community to\for the pregnant teenagers during the pregnancy, birth and postnatal periods;
- pay special attention to vulnerable and disadvantaged young people;
- integrate within the youth-friendly health services the prophylactic, counseling, diagnosis, treatment, informative, educational and communication activities.
Training of health services providers:
- develop the instructive and methodological guidelines concerning the sexual and reproductive health of the teenagers and young people;
- organize ongoing instructive seminars for family doctors, obstetricians and gynecologists, dermatologists-venerologists and nurses in the sexual reproductive health of the teenagers and young people.
Information, education and, communication:
- involve and train those who are able to offer support to the teenagers in the responsible sexual and reproductive behavior, especially, parents and families, as well as the communities, schools, mass-media and teachers\trainers.
School Education:
- promote sexual education in schools, universities and other educational institutions;
- introduce the education in the problems dealing with responsible sexual behavior, inter gender relationships, the violence towards teenagers, the practices of responsible family planning, family life, the prevention of sexually transmitted infections and HIV\AIDS infection in the programs at all educational levels.
Parents’ involvement:
- promote the programs directed to parents’ education to supply the children with the necessary information referring to the sexual and reproductive health.
Youth for youth:
- promote „youth for youth” programs which will include seminars, team discussions, artistic activities, press and radio advertising and programs.
Involvement of young people:
- involve young people in the planning, implementation, and evaluation of the informational-educational-communicative activities;
- involve teenagers and young people in the planning and implementation of the youth-friendly health services.
Health services providers:
- involve the family doctors and health personnel of the family planning offices in the sexual and reproductive education of the teenagers and young people.
Mass-media:
- develop and distribute the up-to-date material with the help of the public campaigns and programs to inform the young people about the sexual and reproductive health.
Educational materials:
- publish and the distribute educational and informative materials for teenagers and young people.
Community involvement:
- involve the social associations and civil society in the informative, educational and communication activity with the teenagers and young people.
Gender equality:
- develop informative and educational programs concerning the sexual and reproductive health both for boys and girls. Support the educational and advisory mechanisms targeted at teenagers as to develop fair relations between genders.
Investigation, monitoring, and evaluation:
- integrate the data concerning the sexual and reproductive health of the teenagers and young people into the national managerial and informative system of the reproductive health;
- conduct an assessment study of the teenagers and young people’s needs;
- carry out periodical studies on the sexual and reproductive health of teenagers and young people.
8.4. Prevention and management of the reproductive tract infections:
- implement the diagnosis and treatment of sexually transmitted infections and HIV\AIDS infections within the family planning services;
- combine the family planning and primary health care system efforts in the early prevention and diagnosis of the sexually transmitted infections and HIV\AIDS infections;
- improve the legal framework concerning the prevention and management of the sexually transmitted infections and HIV\AIDS infections in accordance with the WHO recommendations;
- pass and implement the international classifications and definitions regarding the diagnosis and treatment of the sexually transmitted infections and HIV\AIDS infections.
Access to and quality of services:
- improve the reproductive age public access to the preventive services, diagnosis and treatment of the sexually transmitted infections and HIV\AIDS infections;
- develop health care protocols for patients who suffer from the sexually transmitted infections and HIV\AIDS;
- improve the counseling of patients who suffer from sexually transmitted infections and HIV\AIDS infections.
Training of health services providers:
- develop instructive and methodological health care guidelines of the of the patients who suffer from the sexually transmitted infections and HIV\AIDS infections;
- organize instructive seminars for the health personnel who provide preventive services, diagnosis and treatment of the sexually transmitted infections and HIV\AIDS infections.
Information, education, and communication:
- publish and distribute informative materials for people of reproductive age concerning the protection from the sexually transmitted diseases and HIV\AIDS infections;
- involve the family doctors in the counseling of the patients who suffer from the sexually transmitted infections and HIV\AIDS infections.
Research, monitoring, and evaluation:
- carrying out periodic studies concerning the spreading among the population of the reproductive age of the sexually transmitted infections and HIV\AIDS infections;
- complex evaluation of the preventive services, diagnosis and treatment of the sexually transmitted infections and HIV\AIDS infections.
8.5. Abortion and pregnancy termination services
Improvement of the legislative and normative framework:
- improve the regulations regarding the pregnancy termination;
- develop clinical guidelines, standards and the protocols on abortion care;
- use manual vacuum aspiration and medical abortion as the main methods of abortion;
- develop and implement the accreditation and licensing methodologies and criteria for specialists and medical institutions that provide pregnancy termination services.
Access to and quality of services:
- increase the access to safe and qualified services of pregnancy termination, by means of:
- development of quality standards, depending on the level of the medical assistance, for the medical institutions which provide abortion services;
- implementation in all the institutes of the country of the manual and electric vacuum aspiration method for pregnancy termination in the first trimester;
- implementation of the medical abortion in the pregnancy termination services;
- use of the modern methods recommended by WHO for the pregnancy termination in the second gestation trimester;
- implementation within the abortion services of the „patient oriented system” concept;
- use of the pain control methods, recommended by WHO: the psychological and verbal support before and during the procedure; lidocaine paracervical block in the abortion from the first trimester of the pregnancy;
- development of preventive services, diagnostic, treatment and referral standards for female patients with post-abort complications;
- training and involvement of the family doctors in the pre- and postabortion counseling.
Training of health services providers:
- create and implement an continuous training system for abortion service providers;
- train the health personnel of the family planning services and primary health care system in the pre- and postabortion counseling.
Information, education, and communication:
- organize and conduct the periodic campaigns of ongoing education of the population in the abortion problem and the risks of unsafe abortions;
- publish and distribute informative materials about abortion among people of reproductive age.
Research, monitoring, and evaluation:
- conduct a strategic evaluation of the abortion services;
- create the monitoring and evaluation system of the pregnancy termination;
- carry out periodic studies on abortion and its consequences.
- develop and implement a monitoring and evaluation system for the patients’ opinions regarding the pregnancy prevention services.
8.6. Sterility prevention and management
Improvement of the legal and normative framework:
- improve the legal framework regarding sterility;
- the standards development of the sterile couple;
- increase the capacity of the National Scientific and Practical Center of Reproductive Health, Medical Genetics and Family Planning in the diagnosis and treatment of the sterile couples.
Access to and quality of services:
- increase the access of the sterile couples to the family planning services;
- implement the modern technologies in the diagnosis and treatment of the sterile couple.
Training of health services providers:
- develop clinical guidelines and standards for the sterility-related services providers;
- instructive seminars in the field of sterility for the health services providers.
Information, education, and communication:
- publish and distribute the informative materials for the population about the sterility problems;
- organization educational and informative campaigns for the population regarding sterility.
Research, monitoring, and evaluation:
- carry out of periodic studies in the field of sterility;
- monitor and evaluate of the sterility phenomenon at the public level;
- develop a database in the field of sterility.
8.7. Prevention and Management of Domestic Violence and Sexual Abuse
Improvement of the legal and normative framework:
- improve the legislation on family violence and sexual abuse prevention and the protection of the victims' interests;
- develop a partnership between the state structures and the civil society.
Access to and quality of services:
- create some specialized centers in the counseling of the victims of family violence and sexual abuse;
- involve the family planning service in the counseling of the victims of family violence and sexual abuse.
Training of services providers:
- develop the instructive and methodological guidelines concerning the counseling of the family violence and sexual abuse victims;
- organize seminars for the family planning office doctors and family doctors and the training of the specialists from the multidisciplinary equipments (policemen, social assistants, teachers) concerning the counseling and the conduct of the family violence and sexual abuse victims. Develop the postgraduate curricula in counseling and assistance for the family violence and sexual abuse victims.
Information, education, and communication:
- publish and distribute the informative materials for the population concerning the family violence and sexual abuse;
- organize educational and informative campaigns for the population regarding the phenomenon of the family violence and sexual abuse;
Gender equality:
- provide equal conditions and chances both for men and women within the informative and educational campaigns;
- provide equal access for men and women to counseling and care for the family violence and sexual abuse victims.
Research, monitoring, and evaluation:
- carry out studies about the family violence and sexual abuse problems;
- monitor and evaluate the family violence and sexual abuse phenomenon;
- create a database and develop relevant indicators in this field.
8.8. Prevention of Trafficking in Human Beings
Improvement of the legal and normative framework:
- improve the normative acts regarding the fight against the trafficking in human beings and the assistance of its victims;
- develop the partnership between the state structures and the civil society.
Access to and quality of services:
- develop specialized centers for trafficked victims;
- involve the family planning office doctors, family doctors, and social assistants in the counseling and assistance of the trafficked victims.
Training of health and social services providers:
- develop instructive and methodological guidelines in the counseling and assistance of the trafficked victims;
- organize seminars for the family planning office doctors and family doctors in the counseling of the trafficked victims;
- develop the postgraduate instructive curricular for the doctors in the counseling and assistance of the trafficked victims.
Information, education, and communication:
- publish and distribute informative materials among the different social strata on the fight against the trafficking in human beings;
- organize and conduct informative campaigns for the population regarding the trafficking in human beings phenomenon;
Gender equality:
- provide equal access of men and women to the informative and educational process, aimed at fighting the trafficking in human beings;
- provide equal access of trafficked men and women to the respective assistance services.
Research, monitoring, and evaluation:
- carrying out the periodic studies in the field of trafficking in human beings;
- evaluate and monitor the trafficking in human beings phenomenon at the national level;
- create a database and develop relevant indicators on trafficking in human beings.
8.9. Early Diagnosis of the Genital and breast cancer
Improvement of the legal and normative framework:
- develop the national concept on the early diagnosis of the genital and breast cancer;
- organize the cervical cancer screening.
Access to and quality of services:
- perform the women’s screening for the genital and breast cancer within the system of primary medical care;
- involve the family planning office doctors in the early diagnosis of the genital and breast cancer.
Training of the health services providers:
- develop the instructive and methodological guidelines on the diagnosis of the genital and breast cancer;
- organize seminars for the family planning office doctors and family doctors in the counseling, early revealing and the patients behavior with genital and breast cancer.
Information, education, and communication:
- publish and distribute informative materials among the population on the prevention of genital and breast cancer;
- organize and conduct the informative campaigns among the population on the prevention of genital and breast cancer.
Research, monitoring, and evaluation:
- improve the national register of the genitary and breast cancer;
- carry out periodical investigation studies of the genitary and breast cancer problems.
8.10. Sexual health of the Elderly
Improvement of the legal and normative framework:
- develop and adopt regulations on health care for elderly people in the sexual health problems;
- introduce the sexual health care for the elderly people into the health reproductive services.
Access to and quality of services:
- improve the elderly people access to the health reproductive services;
- involve the family planning office doctors and the family doctors in the counseling of the elderly people with sexual health problems.
- develop the health care standards in the endocrine and sexual disorders of the elderly people.
Training of health services providers:
- develop instructive and methodological guidelines in the behavior of the elderly people with endocrinal and sexual disorders;
- organize instructive seminars for the health personnel who provide services for the elderly people with sexual health problems.
Information, education, and communication:
- publish and distribute informative materials about the sexual health for the elderly people;
- organize and conduct the informative campaigns among the population concerning the sexual health of the elderly people.
Research, monitoring, and evaluation:
- carry out of the periodic studies in the field of the sexual health of the elderly people.
8.11. Sexual and Reproductive Health of Men
Improvement of the legal and normative framework:
- restructure the family planning service so that it offers advice to men as well;
- develop men counseling standards within the family planning offices.
Access to and quality of services:
- provide men with medical-friendly services, available and addressed to the unsatisfied necessities.
The men-oriented services will include:
- prevention‚ screening and treatment of the sexually transmitted diseases, including HIV/AIDS;
- counseling concerning the family planning and contraceptive methods;
- diagnosis and treatment of sterility;
- counseling and the treatment of the sexual disorders;
- screening of the male genital-urinary cancer;
- facilitation of the men participation at contraceptive counseling of the couple;
- Implement the vasectomy as an elected method of contraception for the couples who fulfilled the reproductive necessities;
- promote the boys’ education and counseling within the youth-friendly health services.
Training of the health services providers:
- develop the instructive and methodological guidelines of counseling and communication with men, for the family planning services providers;
- train the family planning office and the youth health clinics’ personnel in the men counseling;
- organize instructive seminars for the family doctors, obstetricians and gynecologists, dermatologists-venerologists and nurses in the men counseling.
Information, education, and communication:
- publish and distribute informative materials (brochures, posters) for men in the field of the family planning;
- involve the social associations and mass-media in the sexual education of men;
- organize the informative and educational campaigns oriented to the:
- encouragement of the communication within the couple;
- common decision taking regarding the reproductive option and family planning;
- increase of the men’s role in prevent the sexually transmitted infections and unwanted pregnancies;
- increase of the role and responsibility of men during the pregnancy and after the child’s birth;
- prevention and the reduction of the male violence in the family.
Research, monitoring, and evaluation:
- assess the knowledge, attitudes and practices of the men in the reproductive health;
- develop a monitoring and evaluation system of male contraception and the men’s reproductive health.