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| Assessing Community Needs |
| Identifying Resources |
| Developing the Infrastructure |
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Women's Wellness Center Model Overview
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Understanding the Special Healthcare Needs of Women — The Reality of Post-Socialist Systems
In the years following the collapse of the former Soviet Union, the already incomplete and fragmented healthcare services that previously existed for women eroded further, leaving huge gaps in coverage for many of the nearly 180 million women living in this region. The transition to a market economy and breakdown of state-supported social and health systems resulted in a decrease in economic self-sufficiency for millions of women, according to studies conducted by UNICEF. This financial instability-coupled with increased rates of tobacco use, alcohol and drug abuse, unsafe sexual practices, intimate partner violence (IPV), and a host of other medical and behavioral concerns-has led to reduced life expectancy for women in more than half of the countries in these regions.
- Reported cases of breast cancer in Ukraine have risen some 70 percent over the past two decades and, with little education about early detection or access to reliable mammography equipment, diagnosis often comes too late.
- Limited access to contraception has made abortion the primary method of birth control in many countries throughout the region, and early terminations outnumber births by as much as two-to-one in many of these nations.
- Fewer women than men are currently infected with HIV/AIDS, but prostitution and easy access to intravenous drugs have led to a marked increase in some areas.
- Some 15,000 women die and more than 50,000 are hospitalized each year as a result of IPV in Russia alone-more women die each year from domestic abuse than from automobile accidents.
Bridging the Gap — Designing a Comprehensive Approach to Women's Health
Since 1997, however, AIHA partners have sought to fundamentally change both the way women's health is viewed and how clients are treated in these regions. Drawing upon the strength of existing partnerships between hospitals in the United States and the NIS and CEE, AIHA brought together key medical professionals, educators, and policymakers to form the Women's Health Task Force. Members of the Task Force participated in a series of workshops and meetings to build consensus on priorities and approaches for attaining universal goals such as reducing the number of unintended pregnancies, screening for diseases ranging from diabetes to breast cancer, and educating patients on healthy lifestyles. The Task Force also worked to formulate a women's wellness program and create a model for Centers that provide access to a wide range of clinical services and educational outreach programs.
WWCs fill a void by providing not only diagnostic screening and clinical services for both acute and chronic conditions, but also much-needed patient and community health education and support programs. For the first time, women in the NIS and CEE can come to a single place to seek treatment and advice on health-related matters ranging from cancer, cardiovascular disease, and diabetes to family planning, maternal care, behavioral health, and menopause. Women are empowered through programs that teach the value of good health and the importance of taking charge of their own well-being by adopting healthier lifestyles, performing monthly breast self-examinations, and avoiding situations that put them at greater risk.
Meeting the Needs of Individuals and Communities — A Positive Vision of Women's Health
WWCs provide a comprehensive range of primary care services within the setting of an ambulatory care facility, as well as offer a wide variety of health promotion, disease prevention, and educational programs such as classes, public education campaigns, telephone hotlines, and support groups addressing topics from domestic violence and substance abuse to coping with cancer. The Centers seek to improve the quality of life-not just of the patients they treat, but their families and communities as well-by empowering women to play an active role in their own healthcare through ongoing dialogue with the clinical staff and participation in the decision-making process. Although each facility is uniquely structured to meet the particular needs of its community, a core group of services is offered at each AIHA partnership WWC.
Creating an Atmosphere of Comfort and Efficiency — Inside a WWC
Using a common set of guidelines that include recommendations for staffing, facility design, and equipment, each WWC seeks to address the particular healthcare needs of women in its catchment area.
Most WWCs have three physicians-two ob/gyns and one general practitioner or internist-and a chief midwife who supervises one or two others. Additional staff generally include an administrator, a nurse who serves as a receptionist/patient flow manager, a nurse or midwife in charge of patient education, and a part-time psychologist or social worker. Some Centers also employ a part-time business or marketing professional.
A typical WWC has as many as four examination rooms, one treatment or procedural room, and an education room. The Centers also have offices for healthcare providers, laboratory space, utility rooms, bathrooms, a storage area, and a staff room. Equipment at each Center typically includes sterilizers, microscopes, blood pressure devices, doppler monitors, colposcopes, examination tables, lamps, and laboratory supplies. All Centers are also equipped with televisions, VCRs, slide projectors, a wide variety of printed materials pertaining to women's and children's health issues, and anatomical models used to help patients understand their bodies and the changes that can occur as a result of pregnancy, aging, or disease.
Core WWC services include:
- Family planning and reproductive health programs, including fertility and contraception counseling;
- Perinatal care, including pregnancy, breastfeeding, and childbirth classes;
- HIV/AIDS and STI prevention, detection, treatment, and management;
- Cancer education and screening, including pap smears, breast exams, and mammograms;
- Mental health education, counseling, and support groups related to issues such as depression, domestic violence, and rape;
- Telephone hotlines for counseling and crisis intervention;
- Substance abuse education, identification, and cessation;
- Chronic disease education, screening, treatment, or referrals;
- Education and, if needed, clinical interventions for peri- and postmenopausal women;
- Healthy lifestyle education, including nutrition and exercise counseling;
- Adolescent health programs, including sex education and peer support groups; and
- Community outreach on a wide array of issues.
Tailoring Services — A Community-based Focus on Women's Health
While women's primary healthcare services are the foundation of all AIHA partnership WWCs, many individual Centers have successfully adapted the women's wellness model to better serve the needs of their communities. Partners at the WWC in Chisinau, Moldova, for example, determined that intimate partner violence was a serious concern for members of the community and responded by hosting the first AIHA partnership conference on domestic violence as a way to both increase awareness of the issue and to teach healthcare professionals how to identify the signs of abuse. In the port town of Odessa, Ukraine, high STI rates led Center staff to focus on public education and outreach campaigns geared toward preventing the spread of these diseases, while in Tirana, Albania, improving the overall health of the population resulted in health promotion programs targeting all age groups.
Certain Centers identified children and adolescents as a high-risk group within their communities and developed a number of programs to address their needs. Partners from Dubna, Russia, established school outreach programs using peer counselors to address topics such as conflict resolution and substance abuse, while in Iasi, Romania, staff at the WWC set up an Internet-based chat line that local youth can use to ask physicians, nurses, and psychologists questions of concern to them.
Family planning and maternal health are important issues at each WWC, but some have implemented unique programs such as Kiev's "School for Young Parents," which provides classes on pregnancy, birth, and neonatal care for couples. Fathers who participate in these classes can take part in the birthing process-a totally new concept in the region AIHA partnerships serve. Staff from the WWC in Kutaisi, Georgia, produced a television program to educate women on topics such as breastfeeding, child care, contraception, and healthy lifestyles, while the Center in Almaty is home to the only Lamaze School in Kazakhstan and offers 5-day training programs on family planning for ob/gyns, medical faculty, and family physicians from throughout the nation.
"Partners in Birth"
Another unique aspect of the WWCs is the "Partners in Birth" program, which prepares couples for family deliveries. The concept of fathers taking an active role during birth was-until recent years-unheard of in the NIS and CEE, but AIHA's Partners in Birth program is changing that by creating a positive psychological and emotional climate among prospective parents and staff in maternity hospitals. Two overarching goals of the program are to make both the pregnancy and birthing process as pleasant and free from complications as possible and to encourage the active involvement of fathers. To this end, WWC staff provide detailed information on prenatal nutrition, labor, and delivery. Couples learn a variety of special breathing and relaxation techniques, as well as proper postpartum hygiene for mother and baby, along with information on breastfeeding and childcare.
Breast health and screening services for cancers of the reproductive system play yet another key role at AIHA partnership WWCs. The Centers in Kiev, L'viv, and Odessa, Ukraine, for example, offer a wide range of clinical diagnostic services, participate in AIHA's Breast Health Program, as well as host a number of support groups for cancer patients and their families. The Erebuni WWC in Yerevan, Armenia, has established special protocols for early detection and treatment of cervical cancer and has hosted several international conferences for both clinicians and patients on the prevention of both cervical and breast cancer. AIHA's Breast Health Program not only provides clinical exams, but also focuses on teaching the basics of self-examination and encouraging healthy lifestyle choices. Additionally, as part of the Breast Health Program, some Centers have been equipped with state-of-the-art diagnostic tools and offer both ultrasound and mammography screening to patients who are self- or physician-referred.
With a large elderly population, programs for postmenopausal women are a focus area at the WWCs in Moscow and St. Petersburg, Russia, as well as in Mozyr, Belarus. In addition to clinical services, these Centers also offer psychological counseling for women and family members, and staff from the Moscow WWC periodically appear on Russian television shows to discuss topics such as hormone replacement therapy and healthy lifestyle choices.
Contributing to Sustainable Reform — A Commitment to Women's Health
"The health of women matters foremost to women themselves. It matters to their families, communities, and societies. Indeed, the health of women is a fundamental pillar that underpins sustainable human development."
The truth of this statement-made by Dr. Gro Harlem Brundtland, director-general of the World Health Organization, at the United Nations Commission on the Status of Women on March 3, 1999-is undeniable. Statistics gathered by countless national and international development organizations indicate that investing in women's health yields great social and economic dividends, yet the health of women often receives little attention throughout much of the world. AIHA partnership WWCs have been pioneers in the effort to usher in a new era of comprehensive healthcare for women throughout the NIS and CEE.
The continued replication of the WWC model is evidence of its valuable contribution to the development of successful regional approaches to women's healthcare services. AIHA partnership WWCs provide the ideal platform from which to expand programs in the area of women's health by presenting a standardized, reproducible model that is readily adaptable to local needs. The WWC in Chisinau, Moldova, for example, served as a model and training site for staff from two satellite facilities in Cahul and Drochia, which were created with local funds as well as information, education, and communication resources donated by UNFPA. With assistance from AIHA, local health ministries, and their Chicago partners, the Tashkent WWC established an affiliated Center to serve the needs of women in the rural environs of Uzbekistan. And the WWC in Minsk, Belarus-along with their partners from Pittsburgh-provided technical assistance and training for the staff of a facility in Mozyr, which provides healthcare services for women in the Gomel region of the country. In each instance, AIHA's investment is matched by local or national health authorities who provide not only financial backing, but renovated space and faculty resources as well.
AIHA partnership WWCs are models for innovative, comprehensive healthcare-not only for women, but for their families as well-across the NIS and CEE. The Centers herald a new era for women's health in these regions and inspire governmental agencies and private healthcare providers alike to shape programs that better meet the needs of women of all ages.
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