In Hungary, child and family protection belongs to the scope of health-visitor service. In 2015, the Hungarian health-visitor system – with its 100-year-long history – was declared to be part of the Hungarian heritage (hungaricum).
According to the committee, “the Hungarian health-visitor system provides preventive care to almost the whole spectrum of the country’s residents, thereby becoming unique within the European health care services”.
The health-visitor system’s scope of activities
The Hungarian health-visitor system’s scope of activities includes preserving good health conditions, disease prevention and health promotion and development. Health-visitors perform their tasks on a specific frontier of healthcare, collaborating with other healthcare workers. Their activities are defined by legislations, specific protocols and directives.
They provide complex service, including health promotion and family protection:
- they keep close contact with the people they care for, and provide them advice regarding healthcare, social-, and mental hygiene related topics;
- they organize screening programs;
- they organize vaccination programs;
- they organize health promotion campaigns and other social programs for the people they care for.
The health-visitor’s tasks are defined in the Act CXXIII of 2015 about the primary care’s scope of activities, and in the 49/2004 ESzCsM Decree, according to which, the health-visitors’ most important activities are the followings:
- family and women-protection, including counseling and family care;
- organizing screening programs for women aged 25 to 65 years (e.g., for cervical cancer screening);
- providing care for women during pregnancy, for puerperal and breastfeeding mothers;
- providing child care for children from infancy until the establishment of their student status;
- performing health-visitor tasks in kindergardens and primary schools;
- providing child care for children in school-age who require nursing care at their home;
- collaboration with social-, public school-, family-, youth-, civil-, religious-, cultural networks and other organizations;
- participating in child protective services.
The frequency of health-visitor counseling and mandatory family visits, the number of people health-visitors need to provide care for (currently 250 children in school-age), and the administrative tasks are regulated by law. The regional and the county’s health-visitors’ professional supervision is provided by the chief health-visitors working at government offices.
In Hungary, the health-visitors’ tasks are based on disease prevention:
- Primary prevention: improving health condition, decreasing/eliminating risk factors, promoting health-consciousness and regular physical activity, etc.
- Secondary prevention: early identification and recognition of risk factors, lesions and diseases.
- Tertiary prevention: providing care for those with permanent diseases, for the disabled and for the handicapped, and monitoring their condition and social status and providing help for them.
The levels of the health-visitor system
Health-visitors form a part of the primary care system, but they perform their tasks in educational institutions, they participate in social care, child protective services, civil and charity sevices too. They perform their activities autonomously.
- Regional health-visitors – they perform health-visitor tasks in kindergardens and provide protective and preventive services for women.
- School health-visitors – their job is to provide school-health-care services for children aged 6 to 18 years and for those above the age of 18 who study in daytime educational programs. They help in the management of mandatory medical examinations, screening tests and vaccination programs. They also participate in the registration, monitoring and helping of those who need special care.
- Health-visitors working at obstetric wards – they help pregnant women, puerperal and breastfeeding mothers. They prepare infants to be discharged and they ensure health promotion and education for mothers.
- Health-visitors working at the family care service – their tasks involve family planning consultations provided outside of educational institutions, helping pregnant women in need, and providing pre- and post-abortion counseling.
Health-visitor tasks provided for children under the age of 3
Health-visitors play a crucial role in fetus-, child- and mother protection. Their primary role is to create a safe environment suitable for the proper physical and mental development of the infant/child, and to recognize the factors that impede the children’s proper development.
Their field of activity also expands to ensuring special care if the children are ill or there is an environmental threat.
Health-visitor service for pregnant women
Pregnant women first meet their health-visitor at the beginning of their pregnancy: after verifying the pregnancy, the obstetrician issues a certificate of the pregnancy with which the mother has to contact the designated health-visitor (based on the woman’s home or place of residency). The health-visitor issues a booklet for pregnancy monitoring.
Pregnant women have to participate in health-visitor counseling usually in every 4-6 weeks (but at least 4 times), in case of premature delivery, at least once, in order to become eligible for motherhood support.
Health-visitors perform the following examinations during the counselings:
- measuring body weight and height;
- measuring blood pressure and pulse;
- measuring abdominal circumference;
- fetal heart rate monitoring;
- urine examination;
- lower extremity observation and examination;
- general counseling regarding pregnancy;
- answering the mother’s questions.
After child birth, the health-visitor monitors the recovery of the puerperal mother and the development of the child. They are notified by the hospital of the child birth, so that they can plan a family visit within the first 48 hours (except for weekends and holidays) after the baby’s hospital discharge. In the first 6 weeks after birth, they visit the family every week, then in every month (or more frequently if the mother wishes). The health-visitor gives advice to the mother about the upcoming tasks and potential problems: breastfeeding, diaper changing, bathing and dressing up the baby and advice on sleeping routine, etc.
The mother has to present with her baby at health-visitor counseling every month, then yearly. There are additional, so-called mandatory status examinations, on which they have to present at the 2nd, the 3rd, the 4th, the 6th, and the 9th months of infancy.
On status examinations, the health-visitor:
- measures the baby’s weight and length;
- at certain age, they measure the head and chest circumference, too;
- they discuss the tasks related to the baby’s development, nutrition and their care;
- they check if the baby’s development corresponds to their age;
- after reaching the 1st year of age, they help in issues regarding the babies’ speech and movement development, teaching and socialization of the babies.
Screening exams are performed at the age of 1 year, 18 months, 2 and 3-years.
Recently, there have been a change in approach regarding the tasks of health-visitors, it has gained a partner-like, helping attitude: health-visitors provide a health-conserving and developing service by their family-centered-approach.
The history of the health-visitor service
In 1915, the Belgian Princess Stéphanie founded the Országos Stefánia Szövetség (National Stéphanie Association), which became later the Association of Health-visitors. The purpose of the association was to solve the era’s epidemiological problems, such as the high rate of infant and mother deaths and other serious epidemiological issues (e.g. tbc). The aim of the Association of Health-visitors was to provide a family-centered care, counseling and prevention services for women, infants, children and youngsters. They achieved indefeasible merits, e.g. the development and implementation of the vaccination system.
The Hungarian health-visitor service is unique worldwide. It is not regulated by EU acts. In the EU member countries, there is a similar health-visitor system, but that is not as complex as the Hungarian one, which provides health-visitor care from the child birth until the age of 18 years. In Hungary, the health-visitors are well-trained specialists with a college certificate/degree, and only those can perform health-visitor’s tasks who possess that type of certificate.