Студија на случај: Недоследности помеѓу теоријата и праксата

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НРЦ и тимот на експерти од областа на здравството се фокусираше на имплементација на Програмата за активна здравствена заштита на мајки и деца за 2014 година од страна на Центарот за јавно здравје – Кочани

 

Студијата на случај е изработена врз основа на консултациите со вработените во Секторот за примарна превенција во рамките на Министерството за здравство, и интервју и електронска комуникација со Директорката на Центарот за јавно здравје во Кочани.

Сите центри за јавно здравје во текот на јануари 2014 година биле известени од страна на Министерството за новата обврска врз основа на Законот за здравствена заштита на мајки и деца чл. 16 став 2 и 3 донесен во јануари 2014 година, а објавен во Сл. Весник на РМ, бр. 15/ 2014 објавен на 27. 01.2014 година, поточно од Програмата за здравствена заштита на мајки и деца. Министерството во февруари повторно ги известило Центрите за јавно здравје, при што било истакнато дека во Програмата е предвидена активност за ослободување од партиципација за микробиолошки брисеви, со дообјаснување дека таа се однесува за брисеви направени во 12 – 14 гестациска недела (иако ова ограничување не е дефинирано со Програмата објавена во Сл.весник) кај бремени жени од одредени категории, и тоа невработени бремени жени, бремени жени кои примаат социјална помош, бремени жени со минимални примања (иако во Програмата како целна група од оваа категорија се „бремени од семејства со минимални вкупни месечни примања).

Од обработената комуникација во студијата може да се забележи дека постојат одредени неусогласености, кои би можеле да бидат евентуална причина за неспроведување на мерката во некои средини. Така, дефинирањето на целната група во Програмата и во објаснувањата дадени после програмата од страна на Министерството за здравство е контрадикторно. За бремената жена да биде во една од категориите за кои би важело ослободувањето од партиципација, според Програмата треба да се оценат семејните вкупни примања, а во дополнителното објаснување се гледаат индивидуалните примања на вработената жена. Според Програмата, доколку жената е невработена автоматски припаѓа на целната група, а според дополнителните објаснувања од ресорното министерство – доколку е невработена, а осигурена преку сопругот, се бара потврда за примањата на сопругот, што би влијаело на тоа дали таа ќе припадне на целната група или не.

Друго забележување е и неусогласеноста помеѓу временската рамка (гестациската недела) за изведување на микробиолошките брисеви кај бремената жена. Додека во Програмата не е ограничена временската рамка за спроведување на микробиолошкиот брис кај бремената жена, насоките дадени од МЗ ја ограничуваат на 12 до 14 недела. Се претпоставува дека ова ограничување, како обид за допрецизирање на Програмата, е дадено за да стимулира правење на брис што порано во текот на бременоста, или пак од практични причини заради усогласување на терминот со оној кој се препорачува за ЕХО скрининг. Сепак, треба да се земе предвид и Упатството за начинот на вршење на здравствената дејност која се однесува на антенаталните контроли во бременоста, дадено од Министерот за здравство, каде скрининг за генитални инфекции се препорачува во првиот триместар од бременоста, а идеално во 10 седмица (според Упатството важечко во времето на спроведување на Програмата).

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