Current
In October 2007, then First Deputy Prime Minister Dmitri Medvedev, after visiting the MPRC in Balashikha, recognized the Balashikha Project on national television as the model to be followed for perinatal health care modernization throughout Russia. In its earlier stages, former President and Nobel Laureate Mikhail Gorbachev endorsed it: “A children's hospital in Balashikha will make it possible to improve the treatment of the children in our country. . . . It is important that people-to-people help is channeled through truly charitable organizations.”
The distinguished—and prescient—theologian and Advisor to FOR Founder Tom Murray, and the Reverend Dr. James J. Bacik perceived the Balashikha Project as “a new way of envisioning foreign aid.” (November 2002)
This prediction was realized in July 2009 when FOR’s Medical Director, Dr. Alfred W. Brann, Jr., represented FOR at the Civil Society Summit (CSS) in Moscow, held in parallel with the Presidential Summit of Presidents Barack Obama and Dmitri Medvedev. Dr. Brann, together with his Russian counterpart, Dr. Elena Baiebarina, Chief Neonatatologist for the Russian Federation Ministry of Health and leaders of the discussions of the Health Care Summit Public Health Working Group meeting at the Civil Society Summit, helped develop the principles adopted in the Working Group’s Report, based in part on principles tested with the unique success of the Balashikha Project.
The Summit gave FOR and its Balashikha Project a forum for discussion of its findings and the implications of its eight years of work as well as a much higher level of visibility with President Obama and other participants in the July Presidential Summit. A significant foreign policy outcome of the CSS was the Memorandum of Understanding between the Health and Human Services of the United States of America and the Ministry of Health and Social Development of the Russian Federation on “Cooperation in the Field of Public Health and Medical Science.” The purpose of this extraordinary agreement is to develop and strengthen cooperation in the fields of public health and medical and biomedical science, according to the principles—equality, reciprocity, and medical science—already developed and practiced at the Balashikha Project. It both underscores the importance of the work at Balashikha and smoothes the way for important international cooperation along the lines of Balashikha.
Specific ongoing initiatives include the development of bioethics standards for clinical practice and human research with the Moscow Oblast Ministry of Health and the I.M. Sechenov Moscow Medical Academy; the completion of a transportation system within the Moscow Oblast to ensure that infants needing intensive care get that care at sites appropriate for the infant’s needs including the Moscow Regional Perinatal Center (MRPC); and the mutual development of a distance learning system by the MRPC and the Sechenov Academy to ensure continued access to the latest perinatal practice guidelines and developments around the world.
Accomplishments in other listed components include:
1) Comprehensive Guidelines in Perinatal Care to be used in the Moscow Oblast are being written by adapting existing Russian medical practice to internationally accepted evidence-based medical practice.
2) The international perinatal surveillance system, with quality control programs has been implemented to monitor changes in critical reproductive health outcomes and is currently being evaluated.
3) Management systems for referral of high risk pregnant women are now in use, especially as regards antenatal evaluation of high-risk pregnancies with ultrasound and other tools for monitoring fetal growth and maturity.
Births at the Moscow Region Perinatal Center at Balashikha have consistently been greater than 3,000 per year, with an increasing high risk referral base, as manifest by an increasing low birth rate from 8.3% to 10.2%. The rate of >1.2% of very low birth weight births indicate an accurate recording of all products of conception >500 gm birth weight. The accurate recording of the types of stillbirths has allowed the recognition of the need for a more comprehensive improvement in women’s health before pregnancy and access to earlier and more comprehensive antepartum care and improved intrapartum care practices.
Despite the increasing risk status of women admitted to the MRPC from 2004 through 2008, the overall infant mortality rate has been reduced from 20.6 to 18.1/1,000 live births. This joint project with accurate comprehensive and transparent data, not only permits the improvement in the outcomes of pregnancy in the individual woman, but permits a continuous quality improvement program for women throughout the region, not only affecting maternal and infant mortality –but most importantly – morbidity in both the mother and infant.
Over the past six years, the success of the Balashikha Project has been evidenced by increased numbers of women electing to deliver in the Balashikha Center (from 900 to over 3,000 deliveries); by physician- and self-referral of high risk women from over half of the health districts of the Moscow Oblast; a documented survey showing an increase in maternal satisfaction with the perinatal health care they received; and the fact that the most up-to-date post-graduate education for perinatal health professionals in the Moscow Oblast now occurs at the MRPC.
In summary, the Balashikha Project, a comprehensive model for modernizing perinatal care, is ready for replication throughout Russia. If funding is obtained, upon direction from the Russian Federation Ministry of Health, FOR and WHO/CC/RH stand ready to help implement the Balashikha model in additional oblasts of the Russian Federation.
