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Dr. FH Mian Health Section Planning Commission Government of Pakistan Islamabad, November, 2013

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Dr. FH Mian Health Section Planning Commission Government of Pakistan Islamabad, November, 2013

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  1. National Conference of Helping Hand: Save Mothers Save FutureMDG 5–IMPROVING MATERNAL HEALTH in PAKISTANEvidence-informed policy & Advocacy, Approaches & Tools, Access to utilization and Strengthening Health Systems for quality maternal health careAn overview of situation in PakistanMaternal Health in Maternity Dr. FH Mian Health Section Planning Commission Government of Pakistan Islamabad, November, 2013

  2. Mother, Mother-ship & Maternity • The sweetest word in practice • The holiest status in spirit • The noblest of creature for nature • The hardest job in performance • The worst of exposure to odds • The difficult most labors in delivery • The difficult most period of life • The weakest nutrition in foods • The poorest access to health services

  3. Magnitude of Issues in Maternity • Demographic profile • Total population: 184.4 millions • Female population (15-49 years): 89.06 millions • Rural population: 114.5 millions • Rural female (15-49 years) population: 55.3 million • Total fertility rate: 3.3% • Female life Expectancy at birth: 66.5 years • Mortality due to maternal causes: • National: 276/100,000 live birth • Baluchistan: 768/100,000 live birth • Skilled birth attendance: 45% • Female literacy Rate: Total 47%; Rural: 35% • Iron deficiency anemia: 51% • Access to piped drinking water: Total; 35% rural (21%) • Access to safe sanitation: 61%

  4. Maternal Health in Public Sector • Tertiary healthcare facilities: 49 • District Headquarter hospitals: 135 • Tehsil Headquarter hospitals: 762 • Rural Health Centers: 560 • Basic Health Units: 5263 • Maternity & Child Health Centers: 963 • Number of Community Mid Wives: 31,503 • Numbers of Lady Health Workers: 92,758 • Number of lady health visitors: 13,678

  5. National Maternal, Newborn & Child Health Program • Development financing in the project • Capital cost of the project: Rs. 20 billions • DFID financing: 90 millions sterling pounds • AusAID financing: 30 millions Australian dollars • Expenditure till June, 2013: Rs. 3.09 billions out of GOP 67 million pound out of DFID support 14 million Australian dollar out of AusAID assistance • Major objectives in maternal health • Improvement in health status of poor & marginalized mothers through: • Integrated delivery of comprehensive MNCH services at district level • Trainings & deployment of Community Midwives • Provision of comprehensive family planning services • Strategic communication for MNCH • Strengthening of Program Management • Partnership arrangement through TRF & RAF • Technical Assistance • Research studies

  6. Performance of the NMNCH Program • Antenatal Coverage: • Urban as 85% & Rural as 65 % • Skilled birth attendance: • Urban as 65% & Rural as 45 % • Improvement of emergency obstetric care at 104 DHQ & 142 THQ hospital • Community Midwives: • 8927 trained • 7232 deployed • Renovation of 594 first level care facilities • Provision of kits to Midwives • RAF funded 52 research projects • TRF provided TA in 112 districts

  7. Additional Assistance in Maternal Health • Women Health Project • National Program for PHC & Family Planning • Elimination of Neonatal Tetanus in EPI • National Blood Transfusion • Social health insurance • Norwegian government assistance • UN family & WHO assistance • Save the Children Fund assistance in postnatal care • MCH-USAID-Sind

  8. Reforms in Health Sector • 18th Amendment in Constitution of Pakistan • Devolution of health sector to provinces • Federal funding to devolved projects in 7th NFC Award • Regularization of Lady Health Workers • Coordination at federal level • Provincial financing in devolved development projects • Pakistan Primary Healthcare Initiative • Social health protection in maternity

  9. Issues & Challenges in Maternal Health • Sustainable financing by provinces • Skilled birth attendance in maternity • Technically approached behavior change communication • Advocacy for technical approach in family planning • Social health insurance through social protection • Establishment of 24/7 emergency services at FLCF • Effective referral system with feedback & follow-up mechanisms • Use of innovative technologies, e-health & m-health • Provision of blood transfusion services at RHC • Domestic working mothers & their daughters • Maternal health of rural poor & illiterate women • Mothers among Internally Displaced Persons • Mothers of Urban Slums in rapid urbanization

  10. Way Forward in Maternal Health • Integrated approach of development programming • Attention to post natal care • Evidence based estimation of MMR • Health System Strengthening • Skilled birth attendance in designing of maternal health developments • Health insurance through social protection • Economic growth oriented planning • Health management information system • Advocacy & awareness for behavior change communication

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