Strengthening neonatal and obstetric healthcare in the war-affected regions of Ukraine (October 2023) – Ukraine

By Milena Chodola and Dorota Zadroga

For 12 months, the Polish Medical Mission conducted a program in Ukrainian neonatology hospitals aimed at improving the standard of maternal and newborn care, training medical personnel in European standards and the latest national guidelines for patient care, including in wartime conditions.

Within the framework of the project “Strengthening neonatal and obstetric healthcare in the war-affected regions of Ukraine” which lasted from September 2022 to the end of August 2023, the Polish Medical Mission equipped neonatal intensive care units in 10 hospitals in Ukraine with specialized medical equipment – neonatal resuscitation stations, patient monitors and dual-syringe infusion pumps. The project was implemented in hospitals in the following cities: Kyiv, Dnipro, Chernihiv, Kharkiv, Chernivtsi, Zaporizhzhia, Poltava and Lviv. In its implementation, the Polish Medical Mission cooperated with the Association of Neonatologists of Ukraine, the Ukrainian NGO “Early Birds,” the National Health Service of Ukraine and the Ministry of Health of Ukraine.

At each of the 10 hospitals, PMM conducted monthly in-person sessions for patients to raise their awareness about patient rights, newborn care and caring for well-being, supplemented by regular online sessions. These sessions also discussed changes in the operation of hospitals and medical services due to the war in Ukraine, available medical packages within the National Health Service of Ukraine, and options for psychological support. Patients admitted that, despite sometimes being in the hospital for several weeks, they often had no knowledge of how the National Health Service of Ukraine’s packages functioned, how to be treated at the state’s expense, and their rights and options for psychological support. Doctors from 10 project hospitals also participated in training sessions on patient rights in Ukraine. At these trainings, doctors also learned about the issue of patient rights in the European Union. This is an important issue for Ukrainian hospitals in the context of Ukraine’s introduction of more EU solutions and practices into the Ukrainian system on the way to receiving membership in the European Union. Medical staff from the 10 participating hospitals were also trained in doctor-patient communication, including under wartime conditions. The trainings also included recommendations on the well-being of medical personnel, counteracting professional burnout and maintaining a work-life balance. The training and session program on patient rights were supervised and coordinated by patient rights experts Oleksandra Balyasna and Yevgeniya Kubakh.

As part of the strengthening of professional competence, the medical staff of the aforementioned hospitals took part in four-day in-person medical training courses on neonatal intensive care, post-intensive care and various perinatal problems of newborns and premature infants, among others. The training program was developed on the basis of European neonatal treatment standards, the latest international research, but also on the basis of the latest national clinical guidelines, and is designed to update and expand doctors’ knowledge and promote good practice in Ukraine. During the medical training sessions at each hospital, the trainers, together with the medical staff, discussed and tried to work out solutions to the current challenges of a particular hospital – concerning both difficult clinical cases at a particular hospital and working under wartime conditions. The medical training program as well as its coordination in hospitals was supervised by medical experts, Prof. Tetiana Znamenska and Prof. Olga Vorobiova. At the beginning and end of the training, the doctors filled out anonymous knowledge tests – the results show that about 95% of the participating doctors increased their level of knowledge in the topics covered in the trainings.

During monitoring visits that the trainers conducted several months after the training, they undertook to identify problems that may have gone undetected during medical training, and reassessed the level of doctors’ knowledge using a test of the knowledge gained during medical training. The trainers also analyzed in detail the work of neonatology departments in terms of adherence to national guidelines, international recommendations and clinical protocols, reviewed department reports with indicators and statistics (number of patients, morbidity, mortality, length of stay in hospitals), and assessed the quality of neonatal care, including premature and sick newborns. They also discussed the organization of primary and specialized care, taking into account the conditions of individual hospitals. On the basis of this detailed analysis and audit, the trainers jointly gave a rating to each hospital and made recommendations for further professional development of doctors and for improving the operation of hospitals under wartime conditions (preserving the availability and continuity of care for newborns and pregnant and post-partum women). After summarizing and approving the results of the assessment, the medical trainers, together with the staff of the hospital in question, developed an action plan for the hospitals and individual departments (including neonatal intensive and post-intensive care, labor and delivery, and postpartum). Each hospital received an individually prepared plan.

Hospital administration representatives from 10 facilities indicated in their reports after medical monitoring that the project’s activities helped ensure the necessary standards of patient care and reduce mortality in the unit during the reporting period. For example, at a hospital in Poltava, mortality in the neonatal intensive care unit decreased by 5.8 times during the reporting period. In one hospital in Dnipro, on the other hand, the mortality rate and treatment time in the neonatal intensive care unit decreased almost 2 times during the reporting period. At a hospital in Chernihiv, morbidity and mortality among premature babies in the neonatal intensive care unit decreased thanks to modern medical equipment received under the project – the morbidity rate fell by 8%, and the mortality rate fell by 5%.

In an effort to reach a larger audience, including those outside the 10 participating hospitals, on the Ukrainian medical online platform the Polish Medical Mission published a comprehensive course on patient rights, doctor-patient communication and preventing professional burnout for medical professionals, as well as a webinar on patient rights, well-being and neonatal care for patients from across Ukraine. Prominent Ukrainian experts were invited to participate in these events, including the head of the National Health Service of Ukraine, who spoke about available neonatology and obstetrics services during the war. It will also be used in the next year of the ongoing second edition of the project to support neonatology in 10 more hospitals in new locations in Ukraine.

Key statistics of the project:

– 1,717 female patients attended sessions conducted in 10 hospitals in both in-person and online formats, as well as a webinar for female patients from across Ukraine.

– 78 stationary awareness-raising sessions for female patients on patient rights, newborn care, doctor-patient communication, changes in the functioning of hospitals and medical services due to the war in Ukraine, and opportunities for psychological support.

– 2578 newborns had benefited from medical equipment purchased under the project by the end of August.

– 346 doctors from the 10 hospitals participating in the project took part in medical training, and 160 in training on patient rights.

– 995 doctors from across Ukraine took a course on patient rights registered with the Ministry of Health of Ukraine, conducted online on a Ukrainian medical platform, passed the test, received a certificate and credits from the Ministry of Health of Ukraine.

– During medical monitoring, 94.42% of medical professionals trained at medical training courses showed improvement in patient care.

– 8 live online trainings on patient rights, doctor-patient communication and preventing professional burnout for medical workers from 10 hospitals. They were attended by 160 health workers.

– 10 individual plans were developed to improve the operation of hospitals and individual departments under wartime conditions.

– 1 live webinar on the popular Ukrainian medical platform Medvoice for patients from across Ukraine.