Regional Strategies for Pro-family Policy in the Care of Rural Child

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REGIONAL STRATEGIES FOR PRO-FAMILY POLICY

IN THE CARE OF RURAL CHILD

Katarzyna Sygit,

1, A, B, C

0DUWD6WĊSLHĔ6áRGNRZVND

1, C, D

$QQD.UDMHZVND3ĊG]LN

1, A, E

Mariusz Kaczmarczyk,

1, C, E

_{Ewa Pielichowska}

2, D, E

1 6]F]HFLQ8QLYHUVLW\'HSDUWDPHQWRI+HDOWK3URPRWLRQ)DFXOW\RI3K\VLFDO&XOWXUHDQG+HDOWK3URPRWLRQ3RODQG 2 0HGLFDO8QLYHUVLW\RI:URFáDZ'HSDUWPHQWRI1XUVLQJ$QDVWHVLRORJ\DQG,QWHQVLYH&DUH3RODQG

A _{Study Design;}B _{Data Collection;}C_{Statistical Analysis;}D0DQXVFULSW3UHSDUDWLRQE_{Funds Collection}

Address for correspondence:

Katarzyna Sygit

Szczecin University, Faculty of Physical Culture and Health Promotion Al. 3LDVWyZ%EXLOGLQJ6]F]HFLQ3RODQG

Phone: +48 513 219 765 (PDLONV\JLW#SRF]WDRQHWSO

Abstract.

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Key words:

FKLOGUXUDOHQYLURQPHQWKHDOWKFDUHIDPLO\VXSSRUWLQJSROLF\

Introduction

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– WKHPDLQGLUHFWLRQRIDFWLYLWLHVLVDVVRFLDWHGZLWKSULPDU\SUHYHQWLRQDQGKHDOWKSURPRWLRQZLWKPDLQWDLQLQJ

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– VFKRROVKRXOGEHDQHQYLURQPHQWWKDWVXSSRUWVKHDOWKDQGDLPVDWKHDOWKSURPRWLQJVFKRRO%RXWLOLHU et al.1997; Hurelman et al. 1995).

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Currently, standards are the basis for monitoring the functioning of the health, mainly in schools.

7KHDLPRIWKHVWXG\ZDVRQWKHEDVLVRIWKHREWDLQHGUHVXOWVWRGHYHORSJXLGHOLQHVIRUWKHUHJLRQDOVWUDWHJ\ RIIDPLO\SROLF\LQWKHFDUHRIUXUDOFKLOGH[HPSOLILHGE\=DFKRGQLRSRPRUVNLHYRLYRGVKLS

Material and methods

SRYLDWVZHUHVHOHFWHGIRUUHVHDUFKIURPDPRQJWKHWRWDOQXPEHURIDOORIWKHSRYLDWVLQ=DFKRGQLRSRPRUVNLH SURYLQFH

,QWKHUDQGRPO\VHOHFWHGSRYLDWVWKHUHVHDUFKFRYHUHGDOOWKHVFKRROVZLWKFKLOGUHQEHORZ\HDUVRIDJH and adolescents aged 15–19 years of age from rural areas (information obtained from the Board of Education).

,QWKHSULPDU\VFKRROVVWXGLHVLQFOXGHGFKLOGUHQXSWR\HDUVRIDJH±HYHU\RQHIURPWKHthJUDGHXS

4. In the secondary schools/high schools, the youth aged 15–19 years was involved – everyone from the 2nd

and 3rdJUDGHXS:KHQGHWHUPLQLQJWKHVDPSOHVL]HDQGUDQGRPVHOHFWLRQWKHGHVLUHGSUHFLVLRQRIHYDOXDWLRQDQG UHSUHVHQWDWLYHQHVVRIWKHGDWDIRUWKHLQYHVWLJDWHG=DFKRGQLRSRPRUVNLHSURYLQFHZDVSURYLGHG 7KHVHOHFWLRQRIUHVHDUFKVDPSOHKDGUDQGRPWDUJHWHGFKDUDFWHUWDUJHWHGDVLWFRQFHUQVRQO\PLGGOHVFKRRO FODVVHVDQGUDQGRP±DVLWGLGQRWDSSO\WRLQGLYLGXDOVEXWWRD JURXSRISHRSOHVWXGHQWVRIWKHJLYHQFODVVOLYLQJ LQUXUDODUHDV7KHUHTXLUHGVDPSOHVL]HFKLOGUHQXSWR\HDUVDQG±\HDUVRIDJHLQWKLVVWXG\D common QDPHZDVXVHGUXUDOFKLOGUHQDPRXQWHGWR,QIRUPDWLRQRQWKHEHKDYLRUDQGKHDOWKQHHGVDVZHOODVVRFLR economic situation consisted of information obtained from the three surveys, i.e. from 6,971 children and 6,971 SDUHQWV

2IWKHWRWDOQXPEHURITXHVWLRQQDLUHV±ZHUHREWDLQHGUHWXUQUDWHEXWDIWHUWKHUHMHFWLRQ RI LQFRPSOHWH DQG EODQN RQHV TXHVWLRQQDLUHV ± VXUYH\V ZHUH TXDOLILHG IRU IXUWKHU DQDO\VLV FRQWDLQLQJYDULRXVLQIRUPDWLRQGHVFULELQJWKHLQYHVWLJDWHGSUREOHP7KHUHSUHVHQWDWLYHQHVVRIWKHVWXG\ VDPSOHZDVPDLQWDLQHG,QGHYHORSLQJWKHGDWDFROOHFWHGGXULQJWKHVWXG\HOHFWURQLFFRPSXWLQJWHFKQRORJ\ZDV XVHG$SSURSULDWHGHVLJQRITXHVWLRQQDLUHVDQGGHYHORSHGFRGLQJDOORZHGWRHQWHUGDWDLQWRD FRPSXWHUGLUHFWO\ from the questionnaires – with full control of the formal and logical information. Analysis of the data took into account PDLQO\WKHFDOFXODWLRQRILQWHQVLW\UDWLRVRIWKHVRFLRPHGLFDOVLWXDWLRQDQGKHDOWKEHKDYLRURIUHVSRQGHQWVDQG analysis based on universal variables.

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– 7HVWRILQGHSHQGHQFH[ðDQG[ðWHVWZLWK<DWHV¶FRUUHFWLRQ6WUHQJWKRIWKHUHODWLRQVKLSZDVH[DPLQHGE\ calculating the coefficient of Yul that was a measure of correlation between the quality variables in the

table 2î2, or, in case of a larger number of features, Cramer’s V coefficient and Pearson’s C contingency

coefficient were calculated.

– 7HVWVIRUWZRLQGHSHQGHQWVDPSOHVLHQRQSDUDPHWULFWKHHTXLYDOHQWVRI6WXGHQWW±WHVWIRUXQUHODWHG

YDULDEOHV0DQQ:KLWQH\8 Test.

– 7HVWIRUQVDPSOHVLHWKHQRQSDUDPHWULFHTXLYDOHQWVRIDQDO\VLVRIYDULDQFH.UXVNDO:DOOLVUDQNVXP

WHVWDQG[ðPHGLDQWHVW

– 1RQSDUDPHWULF FRUUHODWLRQV 6SHDUPDQ¶V UDQN FRUUHODWLRQ FRHIILFLHQW XVHG WR GHVFULEH WKH VWUHQJWK RI

correlation of quality characteristics that can be ordered. Like the Pearson correlation coefficient, it takes

on a YDOXHRI±UV

– To analyze the reliability of the questions used to describe the health behaviors of rural children the

Cronbach’s Į coefficient was used.

Results and discussion

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Health care for children and young learners has been subject to the same legal regulations as well as the KHDOWKFDUHRIRWKHUDJHJURXSVRI3ROLVKVRFLHW\VLQFH7KHVFRSHRIKHDOWKVHUYLFHVDYDLODEOHWRFKLOGUHQ DQG\RXQJSHRSOHLVWKHVDPHDVIRUDGXOWVDQGKDVDOUHDG\EHHQGHILQHGLQWKH$UWLFOHSDUDJUDSKRIWKH$FW RI)HEUXDU\RQXQLYHUVDOKHDOWKLQVXUDQFH$FFRUGLQJWRWKLVSURYLVLRQWKH\DUHHQWLWOHGWRKHDOWKVHUYLFHV aimed at:

– SUHVHUYDWLRQRIKHDOWKDQGSUHYHQWLRQRIGLVHDVHVDQGLQMXULHV

– early detection of disease, – treatment,

– SUHYHQWLRQRIGLVDELOLW\0DNDUD6WXG]LĔVNDDQG8UEDĔVND:R\QDURZVNDDQG0D]XU

1RVSHFLILFOHJDOUHJXODWLRQVLQFRQFHUQLQJWKHWHUPVDQGVFRSHRISUHYHQWLYHKHDOWKVHUYLFHVIRUFKLOGUHQ DQG\RXQJSHRSOHKDYHFDXVHGSUREOHPVLQSUHYLRXVO\IXQFWLRQLQJV\VWHPRISUHYHQWLYHH[DPLQDWLRQV+HDOWKFDUH RIFKLOGUHQDQG\RXQJOHDUQHUVZDVGHSHQGHQWRQWKHVROXWLRQVDGRSWHGE\GLIIHUHQWIRXQGLQJERGLHVRIKHDOWKFDUH institutions and the Regional Health Funds. Nationally, organization of care was marked by great diversity. There ZDVZLWKGUDZDORIQXUVHVIURPVFKRROV7KHWDVNVRISUHYHQWLYHFKDUDFWHUSHUIRUPHGE\QXUVHVSUHYLRXVO\HPSOR\HG DWWKHVFKRROEHJDQWREHLPSOHPHQWHGZLWKLQWKHIUDPHZRUNRISULPDU\KHDOWKFDUHLQWKHFKLOG¶VSODFHRIUHVLGHQFH 7KHLUUDQJHLVWKHVDPHDVLQSUHYLRXV\HDUV6HUYLFHVZHUHUHDOL]HGZLWKLQWKHVFRSHRIFRPSHWHQFHRIWKHIDPLO\

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GRFWRUSULPDU\KHDOWKFDUHD IDPLO\QXUVHFRPPXQLW\PLGZLIH,QSULPDU\KHDOWKFDUHWKHUHDUHQRZWKHIROORZLQJ forms of organization and financing of nursing services in the school medicine:

– LQGHSHQGHQWSXEOLFKHDWKFDUHLQVWLWXWLRQ – LQGLYLGXDOFRQWUDFWV±LQGLYLGXDOQXUVLQJSUDFWLFHLQUHODWLRQWRPHGLFLQHHGXFDWLRQ – JURXSQXUVLQJSUDFWLFH±LPSOHPHQWHGXQGHUWKHJURXSFRQWUDFW – QRQSXEOLFKHDOWKFDUHIDFLOLW\±FUHDWHGE\QXUVHVK\JLHQLVWVRIVFKRROWRSURWHFWKHDOWKFDUH$PDGHR HWDO6DDUDQHQHWDO 7KH1DWLRQDO+HDOWK)XQGILQDQFHVKHDOWKEHQHILWVEXWGRHVQRWVXSSRUWWKHIXQGLQJRIQXUVHVSRVWVLQWKH HGXFDWLRQDOHQYLURQPHQW6WDWLVWLFDOGDWDIRUWKHVFKRRO\HDUUHSRUW0=VKRZDVLQSUHYLRXV\HDUV WKHLPSOHPHQWDWLRQRIXQLYHUVDOSUHYHQWLYHPHGLFDOH[DPLQDWLRQVUHPDLQHGDWWKHVDPHOHYHOEXWRQHFDQVHHWKHLU

PLQLPDOGURS3HUFHQWDJHRI\HDUROGFKLOGUHQDQGVWXGHQWVRIrd_{and 8}th _{grades and those of the last secondary}

VFKRROFODVVHVLQZKLFKUHVHDUFKZDVSHUIRUPHGZDVRQDYHUDJH±±GHSHQGLQJRQWKHFODVVDQGSODFH

of residence. A GHILQLWHUHGXFWLRQLQFDUU\LQJRXWSUHYHQWLYHH[DPLQDWLRQVZDVPDUNHGLQD JURXSRIVWXGHQWVRI

3rd JUDGHVUHVLGLQJLQWKHYLOODJHV6HUYLFHVIRUWKHKHDOWKSUHVHUYDWLRQGLVHDVHSUHYHQWLRQDQGHDUO\GHWHFWLRQRI

diseases in children and adolescents should be carried out by:

– SURPRWLRQRIKHDOWK\EHKDYLRU

– carrying out screening in children under the age of 18,

– FUHDWLRQRIGLVSHQVDU\JURXSV

– SHUIRUPLQJYDFFLQDWLRQV

– SUHYHQWLRQRIGHQWDOFDUHIRUFKLOGUHQXSWR\HDUVRIDJH

The information obtained from the National Health Fund shows that the state of child care in the educational HQYLURQPHQWYDULHVJUHDWO\LQGLIIHUHQWUHJLRQVRIWKHFRXQWU\([HFXWLRQRIWKHWDVNVLVFDUULHGRXWLQDQDUELWUDU\ PDQQHUERWKLQWHUPVRILWVRSHUDWLRQDQGWKHPHWKRGRIILQDQFLQJ7KHLQIRUPDWLRQIURP1+)LPSO\WKDWWKLV VLWXDWLRQVKRXOGQRORQJHUH[LVW,WLVLPSHUDWLYHWRKDUPRQL]HWKHUXOHVRIK\JLHQHIXQFWLRQLQJLQWKHVFKRROVDFURVV WKHFRXQWU\LQFOXGLQJFKLOGUHQDQG\RXQJSHRSOHRIVFKRRODJH7KHUHWXUQRIQXUVHVWRVFKRROVLVVWULFWO\UHODWHGWR WKLVLVVXH)RVWHUHWDO

$FFRUGLQJ WR WKH FXUUHQW DGPLQLVWUDWLYH DQG RUJDQL]DWLRQDO GHWHUPLQDQWV WKH SRVWV IRU QXUVHV ZRUNLQJ LQ schools should be ensured by local government. Funding of school medicine could be found in the NHP financial UHVRXUFHV7KHEDVLFDFWLRQWRVWUHQJWKHQKHDOWKDQGSUHYHQWLQIHFWLRXVGLVHDVHVLVYDFFLQDWLRQ7KHUXOHVIRU immunization in children are defined in the Regulation of the Minister of Health and Social Welfare of 6 July 1998 on WKHSULQFLSOHVRISURWHFWLYHYDFFLQDWLRQDJDLQVWLQIHFWLRXVGLVHDVHV-RXUQDORI/DZV1RLWHP:R\QDURZVND HWDO=DWRĔVNL:+2:+2

&RPSXOVRU\YDFFLQDWLRQRIFKLOGUHQDQGDGROHVFHQWVLQFOXGHWXEHUFXORVLVGLSKWKHULDSHUWXVVLVWHWDQXVSROLR ZLGHVSUHDGPHDVOHVUXEHOODDQGKHSDWLWLVQHZERUQVDQGLQIDQWVDQGVWXGHQWVRIKLJKHUDQGVHFRQGDU\PHGLFDO VFKRROVPHGLFDOSHUVRQQHOH[SRVHGWR+%9LQIHFWLRQDVZHOODVUDELHVLQSDWLHQWVVXVSHFWHGRIEHLQJLQIHFWHG with rabies). Organization of immunization was conducted in accordance with the established rules:

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7KURXJKVDQLWDU\DQGHSLGHPLRORJLFDOVWDWLRQVWKH\ZHUHWUDQVIHUUHGWRXQLWVWKDWFRQGXFWYDFFLQDWLRQ ,PPXQL]DWLRQZDVSHUIRUPHGLQPDWHUQLW\ZDUGVRXWSDWLHQWFOLQLFVIRUFKLOGUHQDQGVFKRROV

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Following the introduction of health care reform, there has been a FKDQJH LQ SRLQW 9DFFLQDWLRQ LV WKH UHVSRQVLELOLW\RIWKHGRFWRURI3ULPDU\+HDOWK&DUH,QWKHILUVWKDOIRIWKHUHZDVD GHFUHDVHLQWKHSHUFHQWDJHRI

vaccinated children. This was associated with a ORVVRUNHHSLQJE\WKHLUSDUHQWVD VXEVWDQWLDOSDUWRILPPXQL]DWLRQ

FDUGVZKLFKDUHWKHGRFXPHQWVQHHGHGWRFRQGXFWWKHYDFFLQDWLRQ7KHVHFDUGVVKRXOGEHNHSWLQWKHSODFHRI vaccinations. Following the introduction of the reform and the related right to choose a doctor, cards were given IURPRXWSDWLHQWSHGLDWULFFOLQLFVDQGVFKRROVWRFKLOGUHQ¶VSDUHQWV0DQ\RIWKHPGLGQRWSURYLGHWKHFDUGVWRSULPDU\ KHDOWKFDUHGRFWRUVDQGVRPHKDYHQRWFKRVHQXSWLOOQRZSULPDU\KHDOWKFDUHGRFWRUIRUWKHPVHOYHVDQGWKHLU FKLOGUHQ:R\QDURZVNDHWDO

0RVW SDUHQWV ZHUH DFFXVWRPHG WR WKH IDFW WKDW VFKRRO VXUJHULHV DQG GRFWRUV FOLQLFV FDOOHG FKLOGUHQ IRU LPPXQL]DWLRQ+RZHYHUPDQ\RIWKHGRFWRUVRI3ULPDU\+HDOWK&DUHLQWKHILUVWPRQWKVRISHUIRUPHGRQO\ LPPXQL]DWLRQLQFKLOGUHQUHSRUWLQJVSRQWDQHRXVO\7KXVDVVKRZQLQWKHUHSRUWIRUWKHILUVWKDOIRISUHSDUHG IRUWKH&KLHI6DQLWDU\,QVSHFWRUYDFFLQDWLRQGHFUHDVHGIURPD IHZWRVHYHUDOSHUFHQWLQVRPHSDUWVRIWKHFRXQWU\ HYHQPRUHWKDQ,QVRPHDFWLRQVZHUHWDNHQXSZLWKUHJDUGWRWKLV

– Health Insurance Funds were obliged to include immunization with contracting health services.

– 6DQLWDU\,QVSHFWLRQFRQGXFWHGWUDLQLQJIRUIDPLO\GRFWRUVZKRSUHYLRXVO\GLGQRWFDUU\RQYDFFLQDWLRQ

– $WWHQWLRQRIKHDGVRIQHRQDWDOREVWHWULFGHSDUWPHQWVZDVGUDZQWRWKHQHHGWRILOHLPPXQL]DWLRQFDUGVDQG

send them to family doctors.

– 6LJQLILFDQWSDUWRIWKHORVWYDFFLQDWLRQFDUGVZHUHUHFRYHUHGRUUHVWRUHG0DFQHQEDFKHWDO ,WVKRXOGEHQRWHGWKDWLQVRPHSURYLQFHVFRQGXFWLQJYDFFLQDWLRQLQVFKRROVXUJHULHVZDVPDLQWDLQHGRUUHVWRUHG 7KDQNVWRWKHVHDFWLYLWLHVDWWKHHQGRIWKHYDFFLQDWLRQVUDWHVUHDFKHGWKHSURSRUWLRQVFORVHWRWKHSUHUHIRUP rates. 7KHUHSRUWLQJGDWDVKRZWKDWYDFFLQDWLRQDJDLQVWWXEHUFXORVLVGLSKWKHULDSHUWXVVLVWHWDQXVSROLRKHSDWLWLV% LQLQIDQWVZDVSHUIRUPHGDWWKHOHYHORISUHYLRXV\HDUV,QFKLOGUHQRYHU\HDUVRIDJHYDFFLQDWLRQUDWHVZHUHDW 6OLJKWO\ORZHUSURSRUWLRQVZHUHREWDLQHGLQFKLOGUHQLQWKHVHFRQG\HDURIOLIHDERXW$ IHZSHUFHQWORZHUWKDQ LQSUHYLRXV\HDUVZDVWKLVUDWHREWDLQHGIRU\RXWKHVSHFLDOO\RIVHFRQGDU\VFKRROV'LVWXUELQJSKHQRPHQRQLVWKH UHGXFWLRQLQYDFFLQDWLRQDJDLQVW+HSDWLWLV³%´RIPHGLFDOVFKRROVVWXGHQWVYDFFLQDWLRQ±DQGVWXGHQWVRI PHGLFDOXQLYHUVLWLHVYDFFLQDWLRQV±D \HDUHDUOLHU±,Q:LHONRSROVNDUHJLRQYDFFLQDWLRQFRPSULVHG RQO\RIVWXGHQWV0DNDUD6WXG]LĔVNDHWDO:GRZLDNHWDO$VIDUDVWKHGHQWDOFDUHLVFRQFHUQHG FKLOGUHQDQG\RXQJSHRSOHDUHSURYLGHGZLWKWUHDWPHQWDQGSUHYHQWLYHGHQWDOFDUH'DWDFRYHULQJVHYHUDO\HDUV LQGLFDWHWKDWWKHSURSRVHGWUHDWPHQWLQYROYHVDERXWRIFKLOGUHQRIVFKRRODJHDQGFRPSOHWHGWUHDWPHQWDSSOLHV RQO\WRDERXWRIFKLOGUHQ

Based on the results of sociological research, it was found that the greatest access to high quality services LVSURYLGHGE\LQGLYLGXDORUJURXSPHGLFDOSUDFWLFHV7KHUHIRUHLQWKHDVVXPSWLRQVRIV\VWHPLFWUDQVIRUPDWLRQLQ health care it was assumed that the target system of dental care will function on the basis of network of dental SUDFWLFHVDQGGHQWDOVSHFLDOW\SUDFWLFHVZKLFKFRQFOXGHFRQWUDFWVZLWKWKH1DWLRQDO+HDOWK)XQG(IIRUWVVKRXOG EHPDGHWRSXWLQWKHOLVWRIHVVHQWLDOKHDOWKVHUYLFHVDYDLODEOHWRWKHLQVXUHGD free of charge dentist (Regulation of WKH0LQLVWHURI+HDOWKDQG6RFLDO:HOIDUHRI1RYHPEHU±DQHQWU\SHUWDLQLQJWRWUHDWPHQWRIFKLOGUHQIUHHRI charge in full range of services).

7KHUHVHDUFKUHVXOWVVKRZWKDWSHRSOHZLWKD KLJKULVNRIWRRWKGHFD\LQ3RODQGDFFRXQWIRURIWKH SRSXODWLRQRIFKLOGUHQDQGDGROHVFHQWVDJHG±\HDUV6LQFHWKHEHJLQQLQJRID SXEOLFFDUHSUHYHQWLRQ

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

care. The founding body for schools is a ORFDOJRYHUQPHQW&XUU\HWDO6RPHWDVNVSHUIRUPHGIRUKHDOWK

SURPRWLRQVKRXOGEHILQDQFHGE\WKHORFDOJRYHUQPHQWIURPWKHEXGJHWDOORFDWHGWRUHDOL]DWLRQRIWKHWDVNZKLFKLV WRSURWHFWDQGSURPRWHKHDOWK/RFDOJRYHUQPHQWLVUHVSRQVLEOHIRUWKHRUJDQL]DWLRQRIHGXFDWLRQDQGKHDOWKFDUHLQ WKHLUDUHD(QVXULQJWKHVDIHW\RIFKLOGUHQLQVFKRROVLVWKHUHVSRQVLELOLW\RIVFKRROSULQFLSDOV3DQDVLXNHWDO 6RLWVHHPVUHDVRQDEOHWKDWVRPHRIWKHWDVNVSHUIRUPHGLQVFKRROVE\QXUVHVLQOHDUQLQJDQGHGXFDWLRQ HQYLURQPHQWVLQWKHILHOGRIKHDOWKSURPRWLRQZHUHIXQGHGE\WKHORFDOJRYHUQPHQWVGLVWULFWFRPPXQH0HGLFDO care for children in schools is financed by the National Health Fund. In the current situation it becomes necessary WRSURYLGHJUDQWVWRORFDOJRYHUQPHQWVIRUWKHLPSOHPHQWDWLRQRIWKHWDVNVRIVFKRROK\JLHQHZKLFKVKRXOGEH RIFDSLWDWLYHFKDUDFWHUSHUVWXGHQW'HVHQEXU\DQG)DOFR*XLGHOLQHVIRUKHDOWKFDUHSURIDPLO\SROLF\ VWUDWHJ\LQWKH=DFKRGQLRSRPRUVNLHSURYLQFH

&RYHULQJZLWKDQDFWLYHDQGSUHYHQWLYHPHGLFDOFDUHVWXGHQWVIURPWKHUXUDOHQYLURQPHQW

– systematic assessment of the health of students and early detection and treatment of congenital malformations,

– LPSURYLQJWKHHIILFLHQF\RILPPXQL]DWLRQ

2. Provision of universal and regular dental care to rural children:

– LPSOHPHQWDWLRQRILQWHQVLYHKHDOWKHGXFDWLRQIOXRULQHSUHYHQWLRQVHDOLQJRIILUVWPRODUVILVVXUHV

3UHYHQWLRQDQGUHVROXWLRQRISUREOHPVRIDGGLFWLRQWREDFFRDOFRKROGUXJVSV\FKRDFWLYHVXEVWDQFHV

– SURWHFWLRQRIWKH\RXQJHVWJHQHUDWLRQDJDLQVWWKHGDQJHUVRIDGGLFWLRQ

– IDPLO\VXSSRUWLQWKHILJKWDJDLQVWDGGLFWLRQRIWKHLUFKLOGUHQ

4. Promotion of a healthy lifestyle in a rural environment and taking actions for one’s own health and the health of one’s family.

,PSURYHPHQWLQWKHOHYHORIKHDOWKHGXFDWLRQHVSHFLDOO\LQGLVDGYDQWDJHGUXUDOFRPPXQLWLHV – health Education – at school setting,

– health Education – at family setting.

&UHDWLRQLQDOOORFDOJRYHUQPHQWVPXQLFLSDOLWLHVFRXQWLHV±SURPRWLRQSRVWVDQGKHDOWKHGXFDWLRQ

– PRQLWRULQJ DQG FRQGXFWLQJ KHDOWK SURPRWLRQ DW VFKRRO OHYHO WKH IDPLO\ OHYHO LQ FROODERUDWLRQ ZLWK

organizations working at that level),

– VXEVWDQWLYHYHULILFDWLRQRIVWDIIZKHUHWKHUHDUHDOUHDG\VXFKSRVWV±NHHSLQJRISDSHUVGHSDUWPHQWVRI

KHDOWKSURPRWLRQDQGKHDOWKHGXFDWLRQ

7. Providing jobs for nurses in schools (after the introduction of system solution – reactivation of school hygiene):

(7)

'HYHORSPHQWRIVSRUWVLQIUDVWUXFWXUH – DFWLYDWLRQRIWKHVSRUWVWHDPV – FRQVWUXFWLRQRIJ\PVDQGSOD\LQJILHOGVWRHQVXUHVDWLVIDFWLRQRIQHHGV – GLVVHPLQDWLRQRIFRUUHFWLYHJ\PQDVWLFVIRUUXUDOVFKRROVFXUUHQWO\RQO\RIVFKRROV:GRZLDNHWDO

Conclusions

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can also be a clear identification of sources of funding for school hygiene, which will ensure a FRPSUHKHQVLYH FRQVLVWHQWFDUHIRUFKLOGUHQDQG\RXWKUHJDUGOHVVRISODFHRIUHVLGHQFH5DVPXVVHQHWDO

References

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Mackenbach J.P., Meerdlng W., Kunst A.E. (FRQRPLF,QHTXDOLWLHVLQKHDOWKLQ(XURSD8QLRQ.RPLVMD(XURSHMVND/XNVHQEXUJ 0DNDUD6WXG]LĔVND08UEDĔVND$$OFRKRO&RQVXPSWLRQ3DWWHUQV$PRQJ<RXQJ3HRSOHIURP5XUDO$UHDVRI/XEOLQ3URYLQFH$QQ

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Cite this article as:

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Regional Strategies for Pro-family Policy in the Care of Rural Child