To investigate the changes in the provision of preventive health services in terms of woman and child health after reorganization of the primary health care services.

The primary care system in Turkey has undergone fundamental changes as a part of Health Transformation Program during last decade. But there was no community-based study to evaluate these changes.

This community-based and cross-sectional study was conducted in 2010, just before the reorganization of primary care services and in 2015, five year after the reforms. The 30×7 cluster sampling method was used in Zümrütevler quarter of Maltepe District. The socio-demographic characteristics of the participants, the presence of the physician who can be consulted for any health problem, the presence of smokers at home were questioned. The women aged 18 years or older and gave consent provided information about history of pregnancy and birth, the number of follow-ups during pregnancy, family planning method usage, cervical and breast cancer screening, breastfeeding duration, vaccinations, and prophylactic iron and vitamin D supplementation for their children.

After the reorganization of primary care, more people stated that they had physicians to whom they could consult for all kinds of health problems (27.8 versus 44.7%; P<0.001) and that physician was the primary care physician (30.2 versus 64.7%; P<0.001). The reported frequency of at least one smoker at home was decreased after reorganization of primary care (63.6 versus 53.1%; P=0.034). There were no significant differences in terms unplanned pregnancy, the use of family planning method, the number of pregnancy follow-ups and the frequency of Pap smears and mammography. There are no significant differences in terms of healthy children follow-ups, vaccination, vitamin D and iron supplementation (P>0.05). It was found that the duration of total breastfeeding increased after reorganization of primary care (P<0.001).

Physical activity has become a major public health concern even in early childhood. This article exemplifies physical activity promotion in practice as described by public health nurses from Finnish primary health care.

We gathered the data by purposive sampling in five regional focus groups with 24 informants working in child health clinics provided for all families with children below school age. Statements associated with physical activity promotion were extracted out of verbatim transcripts. Frequency counting complemented qualitative analysis of the content of statements.

Child-centred evaluation provided by public health nurses focused on motor development, basic sporting skills and amount of activities outdoors and play and exercising habits of the child. Family-centred evaluation focused on the general activity level of the family or a member of the family and resources for physical activity. Activation and support included nearly the same issues brought up for discussion during check-ups, as a basis for counselling, or as points of reinforcement. Contradictory to a family approach in health care, most of the statements (78% out of 223 statements) were child centred. Forcefulness of statements revealed that assessment of physical abilities, including motor development, was the only topic applied with every child. Other topics were more selectively targeted for children and families with mild special needs: for example overweight, clumsy, insomniac, or restless children and sedentary families.

Even though special needs should receive specific attention in health care, we suggest more concern on physical activity of every child and the whole family in practice in order to meet modern health promotional challenges. Although the Finnish child health clinic system is unique due to its vast coverage and frequent contacts with every child and the family, the findings from this explorative research might inspire other community practitioners to start analysing their own work in view of this research.