Maternal and Child Health Services Policy in the German Democratic Republic

Abstract

The policies and structure of the human services system of the German Democratic Republic (GDR) which expresses a strong commitment to maternal and child health and related social services was investigated. The discussion presents a general description of the national health and social services system emphasizing the organization of ambulatory maternal and child services followed by an examination of selected health policies. The GDR constitution grants its citizens medical and social services. All health and medical care facilities belong to the state and all people working in the health care system are employed by the state with the exception of a small steadily decreasing number of private practices. Ultimate control of the health and social services system rests with the national Ministry of Health and Social Services. The intermediate administrative levels are the 15 counties (Bezirke); the local levels are the 219 districts (Kreise). Ambulatory health care including maternal and child services is provided by an organized network of clinics whose personnel and services vary with local needs. In most of the 15 counties of the GDR including rural areas there are favorable ratios of patients to primary care physicians i.e. general practitioners pediatricians and obstetrician gynecologists. Observations of maternal and child primary care services in numerous urban and rural sites were consistent with the health care provider distribution statistics. All women receive prenatal care and 89% have their 1st prenatal visit before the 16th week of pregnancy. Such coverage can be attributed to several factors. There is a concerted effort made in schools at work and in the communications media to emphasize the importance of ensuring good prenatal health. The health service system sponsors conveniently available courses for pregnant health. The health service system sponsors conveniently available courses for pregnant women. Working women are allowed paid time off to attend prenatal clinics an important benefit since 85% of pregnant women are employed. An example of a particularly effective health maintenance program is that provided for diabetic mothers. 1/3 begin the program prior to conception. Participation at well baby clinics is excellent and the organization of dental health services is designed to encourage utilization. In the GDR outreach services are provided primarily by the community nurse and the health and welfare worker. In addition to the administrative integration of health and social services at all government levels functional integration is particularly evident in the delivery of health maintenance services beginning in the prenatal period and continuing throughout childhood and adolescence. Health services are supplemented by an extensive program of financial and social supports designed to nurture young families.