Integration of obstetrics and gynecology services into primary health care

Abstract

In the historical dimension in Ukraine, family medicine (SM) was founded as a pilot project in the Lviv region in 1987. In 1992, after the successful introduction of the elements of the SM, a decision was made to reorganize the district service in the SM. This process was designed for several years and its implementation was planned in 5 stages: Stage I - UT (local therapist) perform the functions of doctors whose specialization is as close as possible to therapy; Stage II - UT replace doctors of narrower specialties; Stage III - UT provide not only primary health care (PTD), but also monitor patients with chronic diseases; Stage IV - UT provide obstetric and gynecological care, and pregnant women seek help from a family doctor; Stage V - complete retraining of UT, who must become qualified general practitioners - family medicine (GP-SM).The introduction of obstetric and gynecological services in the medical department was planned at stage IV, this process was long-awaited and provided, first of all, the training of family doctors in obstetric and gynecological technologies and skills. And only in 2002, the sectoral Order of the Ministry of Health of Ukraine No. 503 of 28.12.2002 «On the improvement of outpatient obstetric and gynecological care in Ukraine» for the first time defined the features of the functions of a family doctor to provide obstetric and gynecological care, and the Order of the Ministry of Health of Ukraine dated 15.07.2011 No. 417 “On the organization of outpatient obstetric and gynecological care in Ukraine”, the functions of the GP-SM on obstetric and gynecological care were expanded.However, taking into account the results of the analysis, the integration of obstetric and gynecological services at the PHC level is extremely imperfect, which makes it inaccessible to the population, ineffective in the preventive direction, unattainable for organizing the treatment process in cases of gynecological diseases. In addition, there are legal conflicts between the sectoral order on PMP No. 504 «On the approval of the procedure for the provision of primary health care», which does not define examination and instrumental obstetric and gynecological technologies for GP-SM, and the designated clinical protocols approved by orders of the Ministry of Health of Ukraine which do not contribute to the integration of obstetric and gynecological services at the PHC level.