Comprehensive Community-Based Public Health Prevention Project in Pskov, Russia
Goals: The goals of the Comprehensive Community-Based Public Health Prevention Project in Pskov, Russia are: (1) to improve reproductive health outcomes, by reducing high rates of abortion and STIs, by increasing use of protective contraceptive methods; and (2) to increase life expectancy and improve quality of life, by reducing high rates of diabetes and stroke, by implementing community-based health promotion activities focusing on improving dietary and physical activities and reducing smoking and alcohol consumption, in Pskov, Russia.
The project is based in the city of Pskov, which is the capital of Pskov Oblast. Pskov Oblast is one of 86 states in the Russian Federation. It is located in the North-West of Russia and borders three countries: Estonia, Latvia and Belarus. The city of Pskov has a population of 197,047 people.
Background: Russia is currently losing population – deaths exceed births by almost one million people each year – due to an unprecedented increase in mortality rates, especially for men, and a declining fertility rate. According to US AID, these trends are projected to lead to a one-third drop in population over the next generation. If these trends persist, they will have serious social, political and economic repercussions for the future stability of the country.
Currently, life expectancy for Russian men is 59 years and Russian women 72 years, compared to 76 years for men and 81 years for women in western Europe. An overwhelming proportion of the premature deaths in Russia are due to chronic diseases, especially heart disease, stroke, and diabetes, which share many risk factors in common. Mortality rates from chronic diseases in Russia are 2-3 times higher than in the US and European Union countries. The problem is particularly acute in Pskov Oblast (“state”), which has the highest mortality rate of all 86 states in the Russian Federation.
With respect to reproductive health, Russia has a maternal mortality rate that is four times higher than the US and an infant mortality rate that is more than twice as high. Available data indicate that three out of five pregnancies in the country end in abortion. Critically, two out of three Russian women who have abortions suffer health complications as a result; one in ten women is left sterile by the procedure. Complications related to abortion account for one-quarter of all maternal deaths in the country. In Pskov, the annual number of abortions equals the number of births.
Methods/Activities: The project is designed to address the bookends of Russia’s demographic crisis, declining fertility rates and increasing mortality rates. The project uses a training-of-trainers (TOT) model based on the principles of community-based participatory research (CBPR). The project aims to achieve at maximum feasible participation of community members in all phases of the investigation, for three purposes: (1) to demonstrate respect for community autonomy, by assuring that community members endorse the project goals and find the methods acceptable; (2) to elicit ideas from community members for potential health interventions; and, (3) to strengthen the capacities of participants themselves to gain control over the conditions that affect their health. These purposes operate simultaneously in a mutually reinforcing process.
For the reproductive health component, the project trains community volunteers to educate young people about sexual health risks, especially primary reliance on abortion as a means of birth control. Using a “training of trainers” model, members of the local reproductive health care team have been trained by US and Russian experts, and they are now engaged in conducting monthly trainings designed to impart essential skills and knowledge to 2-3 peer educators and adult counselors from each high school and college in Pskov. These peer educators and counselors provide education and counseling to high school and college students about the costs and consequences of unplanned pregnancies, the health risks associated with unprotected sexual activity, in particular, the sequelae of STIs and the concomitant risk of HIV/AIDS, and excessive reliance on abortion as the primary method of birth control. The project is directed by Dr. Galina Nevalyonnaya, Chief of Obstetrics & Gynecology for the Pskov City Health Administration. The project provides direct reproductive health counseling services to an estimated 10,000 youth living in Pskov each year.
With respect to chronic disease prevention, the project aims to increase public awareness about the benefits of early screening and preventable lifestyle risk factors for chronic diseases. The four main project activities are:
- to disseminate culturally-tailored mass media education materials on chronic disease risk factors;
- to conduct community education programs about lifestyle risk factors and implement various health promotion activities (such as initiating walking/jogging/running groups, healthy cooking classes, smoking cessation classes, etc);
- to increase screening rates; and
- to improve the control and self-management of patients diagnosed with diabetes, stroke and CVD.
This three-year project likewise uses a “training of trainers” model, focusing on community volunteers to conduct the community education programs. Drawing on formative research conducted in collaboration with our Community Advisory Board, the media campaign and community education programs are designed to encourage residents to seek screenings for blood pressure and cholesterol. Using community volunteers, the project has initiated free screening opportunities for high blood pressure at places such as health fairs and grocery stores. Based on known risks and symptoms, community volunteers also use paper screening tests to identify community members at high risk and undiagnosed and refer them to city health clinics for definitive diagnosis. In addition, we have initiated diabetes self-management educational materials, classes and social support groups. The chronic disease prevention project is headed by Dr. Konstantin Gilyov, head of neurology, and Dr. Marina Alexandrokova, head of nephrology, for the Pskov City Health Administration.