September-October, Issue #9-10 (29) USAID IN SIGHT LINC CRIMEAN INITIATIVE: OFF TO A QUICK START mprovement in the well-being of citizens – the aspiration of Scholkine, as well as Bakhchysaray and Bilohirsk raions – to assist them any economic development activity – is the paramount goal of with the development and implementation of economic development USAID’s new project, the Local Investment and National Com- strategies. The goal of these efforts is to make the cities and raions petitiveness project (LINC). LINC will assist Ukrainian cities and more competitive and appealing for investment, and thereby to ensure regions to shape a strategic vision and move down the path to their sustainable economic development. Icommunity sustainability by enhancing their economic competitive- Based on a trilateral protocol signed in July 2009 between by ness and thus creating more jobs and investment opportunities. USAID, Ukraine’s State Land Cadastre Centre and Crimea’s Land The LINC project kicked off in mid-April, and since then it has Resources Committee, the project began developing a pilot unifi ed established itself in Crimea. The property registry in Crimea’s LINC Initiative consists of two Bilohirsk raion. The registry is a components: improving the busi- "The project will help to build communities single system of ownership rights ness enabling environment; and whose economies possess competitive jobs and registration that will provide a enhancing enterprise competitive- opportunities for years to come. That will mean that complete and accurate database ness. In Crimea the project aims of land plots and buildings, as well to improve economic governance, Crimea’s young people will stay where they were as their owners and users. When pilot the development of a unifi ed raised, cities will thrive, and Crimea will be a place developed and implemented, the property registry, and undertake a registry will strengthen not only competitiveness enterprise devel- with communities as rich as the culture and history the transparency of the Crimean opment program. of the peninsula itself.” property market, but also the According to Howard Ockman, Republic’s business-enabling envi- LINC’s Chief of Party, "the project Howard Ockman, LINC Director ronment, making it more attractive will help to build communities to investors. whose economies possess competitive potential, and will create jobs A streamlined permitting system, in the form of one-stop shops, is and opportunities for years to come. That will mean that Crimea’s also currently in process. LINC is lending a hand to Crimean raions in young people will stay where they were raised, cities will thrive, and rendering their one-stop shops into effective units, where entrepre- Crimea will be a place with communities as rich as the culture and neurs will be able to obtain building permits effi ciently and in a timely history of the peninsula itself.” manner. LINC also plans to help Crimea increase competitiveness Since April, LINC has signed protocols of intention with six of its industries and individual enterprises, and with a focus on the Crimean cities – Bakhchysaray, Bilohirsk, Feodosia, Kerch, Saky and tourism and agriculture sectors. Æ4 UUSAID-TrainedSAID-Trained DDoctoroctor HHelpselps INSIDE CCombatombat TTBB iinn FFeodosiaeodosia THIS ISSUE Irina Alekseenko, a bacteriologist and an exem- plary laboratory specialist, has been working as the head of the TB lab in Feodosia, Crimea, for 10 years. LINC Crimea Initiative: Off to a Quick Start She vividly remembers the time when chest X-ray page 1 was the primary method for diagnosing tuberculosis (TB). Candidly sharing her opinion on the practice, she notes: “This method had questionable effi cacy USAID-Trained Doctor for TB case detection. In addition, resources associ- Helps Combat TB in ated with mass photo-fl uorography were far from Feodosia page 1 cost-effective.” TB is one of the major public health problems in Ukraine today. With an estimated TB case rate Simferopol Maternity Spreads Modern Birth of 106 cases per 100,000 people, Ukraine has the Practices in Crimea eighth highest rate of new TB cases in Europe and page 2 Eurasia. TB mortality in Ukraine is high too, with 10,000 Ukrainians dying of TB each year. Crimea is among the regions with the highest mortality rates, Pushkino Residents with alarming growth in TB-related mortality during Learn to Solve Local recent years, at 24.5 TB deaths per 100,000 people Issues though Public in 2007, up from 14.4 deaths per 100,000 people in Hearing page 2 1997. There has also been high growth in the number Irina Alekseenko examines a smear simple of new cases of TB during the past decade – from for mycobacterium tuberculosis (Photo by V. 38.2 new cases per 100,000 people in 1997, to Fauna NGO Helps Æ4 Save Birds from Avian Matyukhin) 85.2 cases per 100,000 people in 2007. Infl uenza page 3 USAID Insight 2 September-October, Issue #9-10 (29) SIMFEROPOL MATERNITY HELPS SPREAD MODERN BIRTH PRACTICES IN CRIMEA Dr. Oleh Tikholaz, the Head Physician of the Kerch Maternity USAID’s Maternal and Infant Health Project, which has been working on Hospital, had always strongly believed in traditional Soviet birthing reducing maternal and infant morbidity and mortality rates in Ukraine practices and so did not favor Ministry of Health adoption of maternal since 2003. Simferopol Maternity Hospital # 2 was the fi rst Crimean and child care protocols recommended by the World Health Organi- Maternity to participate in project activities. Today, fi ve years later, the zation (WHO). “I was convinced that traditional maternity practices, Simferopol facility successfully provides high quality perinatal care, serv- including Rakhmanov beds, a husband-free environment in a delivery ing as a training site to educate Crimean health professionals in new room and separate nurseries for newborns were the most correct clinical guidelines. Since 2004, 650 health care providers (ob/gyns, neo- practices to implement, and natologists, midwives and I was positive that this is the nurses) have participated in way it should be in every training courses organized Ukrainian maternity. When by the maternity. I was invited to Simferopol After fi ve years of col- Maternity Hospital #2 for a laboration with the USAID USAID-supported training project, the Simferopol Ma- course in evidence-based ternity has achieved measur- perinatal practices, I was able results in reducing un- dumbfounded by what I saw. necessary medical interven- Husbands and relatives were tions during delivery. 89% in delivery rooms while wom- of deliveries at Simferopol en were in labor; infants and Maternity Hospital #2 are mothers were together in the now classified as normal, postpartum department; and compared to 32% in 2004. there were no Rakhmanov In addition, the use of post- beds; instead, women were partum anesthesia dropped choosing positions in which from 9% in 2004 to 0.9% in to deliver!” 2008; the rate of episiotomy During the training declined from 22% in 2004 course, however, Dr. Tikholaz to 1.5% in 2008; and the gradually began to realize that practice of companion de-

the ideas that had seemed Happy Together. A woman is warming her baby on her chest after the deliv- liveries increased from 17% outrageous at first were ery with her husband (Photo: Oleksandr Golubov) in 2004 to 61% at the end starting to make sense. He of 2008. The maternity also found especially interesting the story of a trainer from the hospital successfully reduced the rate of mother-to-child HIV transmission who had experienced a 180-degree shift in attitude, changing from a to less than 2% by making elective Caesarean section (C-Section) an “non-believer” to a strong supporter of modern birthing technolo- option for HIV-positive women. (A scheduled C-Section, which takes gies. By the end of the course, Dr. Tikholaz’s attitude had changed place before labor and before the rupture of membranes, reduces completely, too. “Thanks to my colleagues in Simferopol, I understand exposure of the newborn to maternal blood as it moves through the the importance of these new practices. Now I’m certain that upon my birth canal). return from training I will do my best to introduce these technologies Results have been seen, in fact, in all project supported facilities in in my maternity, and I will establish individual delivery rooms and throw Crimea. For example, effective implementation of warm chain technol- away Rakhmanov beds.” ogy, in which a baby is kept warm through either the mother’s body Æ4 Evidence-based perinatal care training is an important component of heat or warm clothing covering the infant, helped to reduce Pushkino Residents Learn to Solve Local Issues though Public Hearing rimea often suffers from For approximately 2,000 Pushkino council. When councils are not responsive droughts, but in the case of the residents, the river is the source for life and to the needs of local citizens, public hearings Vostochnyi Bulganak River, the well-being. “Can you imagine life in the village are a way that people can force the local drought is man-made. Local without water?” asked Muzafar Karauseinov, government to consider an issue. residents claim that the river the head of the village council, in an inter- After learning how to conduct such hear- Cdidn’t dry up naturally - businessmen from a view with STB, a national television channel. ing, 155 citizens of Pushkino came together nearby raion (district) built canals from the “People here live from cattle-breeding and and forced the local council to place this river to fi ll artifi cial lakes in order to service gardening, neither of which is possible with- item on their agenda. The council has since their private fi sh breeding business. out water,” he said. asked the Crimean Republic’s Committee on The Vostochnyi Bulganak runs through Local residents turned to USAID for Water Resources management to look into the Sovietsky and Kirovsky raions (districts) assistance to solve this issue after failing to the issue. Additionally, an interdepartmental in the north-eastern part of Crimea. Local convince their local town council to place commission was established at the republic residents recall that fi ve years ago, the fl ow of the issue on their agenda. Through a USAID level which plans to require the fi sheries to the river was so strong and noisy that it was project, implemented by the International reverse their re-routing of the river. Citizens diffi cult to fall asleep. Now, the riverbed often Republican Institute and the Crimea-based are now optimistic that the river will follow runs close to dry and is being overtaken by Tatar Youth Center, citizens learned how its natural boundaries. Local resident Galina weeds and lizards. Consequently, water levels to conduct a public hearing according to Derkach in thanking USAID stated: “This in the village are also extremely low - hardly established legal procedures, which in turn, public hearing was possible because of your suffi cient to water even tomato sprouts, and under Ukrainian law, requires that the issue support. Thank you for helping us protect cattle and poultry are also without water. be addressed at the next meeting of the local our rights.” USAID Insight September-October , Issue #9-10 (29) 3

FAAUNAUNA NNGOGOS HEELPSLPS SAAVEVE BIIRDSRDS FFROMROM AVVIANIAN INNFLUENZAFLUENZA lthough Avian Infl uenza (AI) district, an area at high risk of AI outbreaks. said that if Mr. Arsievych does this, we can has disappeared from the Based on local experience, the fi lm told the do it as well.” headlines, it remains a very real story of how the residents of Zavet-Leninsky The film and the TV program were threat, particularly in Crimea, dealt with AI outbreaks in the village during broadcast by a local television channel, reach- Ukraine, a poultry production 2006. The fi lm demonstrated how to build ing as many as 30,000 residents of Dzhankoy Aregion at the crossroads of bird migratory wire coops to protect domestic birds from district. Video materials were also provided routes. contact with wild birds and how to separate to 52 village schools to allow over 15,000 To raise awareness of the continuing poultry from other animals to minimize the school-children to watch this fi lm before the potential threat of AI and motivate rural risk of AI infection. autumn bird migration. Valentina Pyshkina, a residents and poultry raisers to utilize The fi lm also featured a local expert, the teacher from Dzhankoy described the poten- safe poultry handling practices, USAID and Director of the Naturalist and Environmental tial impact of this fi lm, saying “Our schoolchil- partner organizations implemented several Protection Center Mykola Arsievych, who de- dren are extremely active. In the past, they innovative activities. In 2009, for example, the scribed how his team preserved the center’s participated in a youth team competition on Rapid Response to Avian Infl uenza project con- exotic birds during the outbreak. In an in- AI prevention. I’m sure that after watching

(upper left) Mira Sirotina of the village Solnechnoye, Simferopol raion, is demonstrating proper poultry handling, which she has in- troduced after watching the documentary produced by Fauna NGO (Photo by Olena Shevchenko); (upper right) Mykolay Melnik and his son Andriy are reading fl yers distributed by an AI mobile team as a part of the awareness campaign in their village of Prydi, Kirovskiy raion (Photo by Olena Shevchenko); (lower left) Director of the Naturalist and Environmental Protection Center Mykola Arievych feeds the birds. By sticking to biosafety rules and practices, all birds have been saved in Center's park during Avian Infl uenza in 2006 (Photo by Vladimir Danilov) ducted a small grant program for Crimean terview, Mr. Arsievych explains: “By sticking the fi lm they will remind their parents and NGOs focused on educating communities to biosafety rules and practices, not a single neighbors about AI and its risks.” about AI threats and encouraging improved bird perished in our park during the Avian Lyudmila Yatsishina, the head of the poultry handling practices to protect house- Infl uenza outbreak in 2006.” He emphasized Dzhankoy district veterinary department, holds from AI. how important it was to share these prac- expressed deep gratitude to USAID and to Fauna, a children’s NGO working on eco- tices with others to increase preparedness Fauna for the fi lm. “It’s very timely indeed, as logical issues, was one of the grant awardees, for future outbreaks. Avian Infl uenza is a real threat and it exists proposing a Public Awareness Campaign on In the fi lm, Mykola Betyn, the head of all the time," she stated. The USAID project Avian Infl uenza Prevention in the Sivash Area of the Zavet-Leninsky village council, recalled was very helpful – in the past we worked Southern Crimea. The NGO worked in close the situation back in 2006. “We were really together in mobile teams and trained our cooperation with veterinary and emergency frightened then. And though there have not specialists in veterinary medicine. Now, services specialists and USAID implementing been any cases registered for the last few we continue to promote awareness. Every partner International Relief and Develop- years, we continue to remind residents about year, more and more households are turn- ment Inc. to produce a short fi lm and TV AI risks. The fi lm produced by Fauna is based ing to safe poultry handling practices. And program which aimed to raise awareness of on our experience, which proved effective we, vet practitioners, are proud of our AI among the rural residents of Dzhankoy in real life situations. After the fi lm, people achievements.” USAID Insight 4 September-October, Issue #9-10 (29) LINC TO ENHANCE CRIMEA'S ECONOMIC SSimferopolimferopol MMaternityaternity DDemonstratesemonstrates RResultsesults AAfterfter COMPETITIVENESS AAdoptingdopting NNewew PPerinatalerinatal PPracticesractices Æ1 In an effort to introduce an industrial park model into Crimea (an area zoned and planned for the purpose of industrial development), LINC sponsored a study tour to the Czech Republic in July for a group of Crimean regional and local level offi cials. The experience of the Czech Republic in creating and operating industrial parks and attracting foreign direct investment was seen as particu- larly relevant to Crimea’s prospects. As Sev- astopol City State Administration Economy Department Head Elimdar Akhtemov told the on-line newspaper Novy Sevastopol, the group “had an opportunity to learn what our neighbor, the Czech Republic, has achieved. The country once had been in about the same Æ2 hypothermia from 69% in 2004 to 1% perinatal period. In Crimea, the project cur- unenviable plight as Ukraine, so for us it is in 2008. In addition, improved perinatal rently works with 8 (of 22) maternities, 11 extremely important to learn what it has done care contributed to improved delivery out- women’s clinics and 15 pediatric polyclinics. to rise to a modern economic level.” comes, with 2008 rates of maternal mortality These facilities support approximately 12,500 Following the study tour, representatives in USAID project sites averaging 7.6%, com- births, or 44% of the estimated 27,000 deliver- of the Crimean government and munici- pared to the national rate of 25.8%. ies that occur in the Crimean Republic each palities gathered in Dzhankoy to discuss the Since 2003, the USAID-supported Mater- year. To achieve sustainable implementation of development of industrial parks as a strategic nal and Infant Health (MIHP) Project has sup- evidence-based perinatal practices in Crimea, approach to creating favorable conditions for ported activities aimed at improving maternal the project plans to cover facilities supporting investment attraction in Crimea. and infant health care, particularly during the 85% of all births in the region. FFeodosiaeodosia IIntroducesntroduces QQualityuality ControlControl inin TBTB LabsLabs Æ1 USAID has supported a TB control program in Ukraine since implementing partner PATH invited her serve as an assistant trainer 2000. Its current project, TB Control Partnerships in Ukraine, cov- during several TB microscopy testing and quality-control training courses ers 10 administrative areas, including Crimea, in an effort to assist the conducted by bacteriologists who had completed an intensive train- Government of Ukraine to implement international best TB prevention, ing-of-trainers (TOT) program. During these courses, Ms. Alekseenko diagnosis and control practices. High quality laboratory testing is very observed how effi ciently her colleagues trained other laboratory important for accurate TB diagnosis: therefore, USAID assistance in specialists. Later on, she also participated in a TOT course, becoming Crimea gives focus to strengthening laboratory quality control proce- acquainted with the challenges of adult learning and practicing how to dures for TB smear microscopy, culture and drug susceptibility testing. use adult training methodologies. Development of skilled lab specialists is also essential to improving the As a member of the project training team, Ms. Alekseenko has detection both of new TB cases, as well as cases of drug resistant TB, already conducted multiple training courses for laboratory special- which is growing rapidly in Ukraine. ists in primary health care facilities in Feodosia. “Building the skills of When USAID-supported activities got underway in Crimea in 2005, doctors and laboratory specialists in primary health care is extremely Ms. Alekseenko participated in a course aimed at orienting laboratory important, as they are the ‘fi rst line resource’ for a patient with any specialists to international standards for laboratory diagnosis of TB. At symptoms,” explained Ms. Alekseenko. “Strengthening their knowledge the training course, she learned about smear microscopy testing and and expertise leads to timely TB diagnosis and referral of a patient with laboratory quality control procedures. Ms. Alekseenko observes that a smear-positive result to a TB dispensary, which, in turn, helps break smear microscopy is one of the most effective methods available today the epidemiological chain of the disease.” for early diagnosis and confi rmation of TB, commenting, “I learned that Thanks to USAID-supported TB training programs, Ms. Alekseenko though an abnormality on a chest X-ray may lead a clinician to suspect has achieved two goals. First, she has signifi cantly enhanced her presen- TB, he or she cannot confi rm whether a person has TB without labora- tation skills and become a qualifi ed trainer who is now invited to train tory confi rmation.” in other project oblasts such as Odessa, Kharkiv and Kherson. Second, Following her training, Ms. Alekseenko effectively applied her new with Ms. Alekseenko’s assistance, Feodosia’s laboratory specialists have knowledge and skills, reorganizing work processes at her laboratory to all been trained in smear microscopy and quality smear microscopy meet the standards recommended during training. With the assistance practices have been established in all TB laboratories in primary health of the chief doctor of Feodosia City TB hospital # 2, she established care facilities in Feodosia. Feodosia’s laboratory specialists are now more areas for collecting sputum and showed staff how to prepare smears confi dent in the results they produce. Overall, the improved quality of correctly and ensure reliable laboratory diagnostic results. smear microscopy has had clear results, with the number of smear-posi- During a round table discussion in Feodosia, Ms. Alekseenko gave tive cases detected in the city increasing tenfold, leading to considerable a speech on the progress achieved at her TB laboratory and showed a increases in numbers of patients referred to TB dispensaries. video on the innovations she had introduced. It was the fi rst time she Ms. Alekseenko stated optimistically, “I am grateful to the USAID had made a presentation to a large audience, and she felt very nervous. project staff for the unique opportunity they provided me to become “I was really anxious, as for the past 10 years I had never spoken in public. a trainer on internationally recommended strategies for TB diagnostics. I work in the lab, and bacterium and microbes are my only listeners,” she The confi dence which I’ve gained through the project helps me motivate said half-jokingly. “But I liked the experience of my fi rst presentation other laboratory staff to perform quality work. I am sure that establish- and started thinking about how to enhance my presentation skills.” ing an effective system of TB diagnosis will lead to successful control of Recognizing Ms. Alekseenko’s aspiration for further training, USAID the tuberculosis epidemic both in my city and in Ukraine as a whole.”