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National maternal newborn & child health punjab

National maternal newborn & child health punjab. MDG 5:. Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio MATERNAL HEALTH INDICATORS 1) MMR 2) SBA 3) CPR 4) TFR 5) ANTENATAL COVERAGE. Goal of the program.

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National maternal newborn & child health punjab

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  1. National maternal newborn & child health punjab

  2. MDG 5:. Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio • MATERNAL HEALTH INDICATORS 1) MMR 2) SBA 3) CPR 4) TFR 5) ANTENATAL COVERAGE

  3. Goal of the program To reduce maternal and child deaths and illnesses by improving their health status particularly of the poor and the marginalized.

  4. Objectives

  5. DETERMINANTS OF MATERNAL SURVIVAL IN PAKISTAN GENERAL (SOCIOECONOMIC AND CULTURAL FACTORS) A) Poor hygiene and sanitary conditions B) Unsafe drinking water C) Poverty D) Low literacy (Female) E) Low level of Health awareness F) Urban Vs Rural disparity regarding development and provision of resources G) Poor nutritional status of mother

  6. DETERMINANTS OF MATERNAL SURVIVAL IN PAKISTAN (Contd) H) Mothers age and parity I) Interval between births J) Level of women empowerment L) Natural disasters

  7. MATERNAL HeaLth ChallengesBOTTLENECKS APPLICABLE TO ALL MATERNAL HEALTH INTERVENTIONS • Facility Level • Staff absenteeism & Frequent postings / transfers • Gender and skill imbalances • Urban -Rural disparities for availability of health professionals • Lack of clearly defined referral mechanisms • Inappropriate locations • Poor maintenance of Health Facilities • Insufficient funding and issues of supplies • Management issues including supervision & monitoring • Non availability of necessary equipment, medicines and supplies

  8. MATERNAL Health Challenges BOTTLENECKS APPLICABLE TO ALL MATERNAL HEALTH INTERVENTIONS • Community Level • The most underserved pockets of population still not covered by Lady Health Workers (60 % coverage) • Insufficient availability of skilled birth attendants • About 48% of the deliveries being conducted by TBAs, • Community Midwifery program recently introduced. Currently 6000 CMWs trained but there are deployment issues • Low confidence in public health facilities • Socio-cultural diversity coupled with low literacy and lack of awareness resulting in inappropriate behaviors and practices related to maternal health

  9. EFFECTS ON VARIOUS OUTPUTS DUE TO DETERMINANTS AND BOTTLENECKS A) LOW SBA RATE B) LOW LEVEL OF ANTENATAL COVERAGE C) T.T IMMUNIZATION COVERAGE FOR PREGNANTS IS LOW D) LOW CPR AND HIGH TFR E) HIGH PREVELENCE OF ANEMIA F) LOW REFERRAL RATES OF COMPLICATED CASES DURING ANTENATAL AND AT THE TIME OF DELIVERY G) LOW PROPORTIONATE OF ASSISTED VAGINAL DELIVERY AND C-SECTION VS NORMAL DELIVERY IN HEALTH FACILITIES H) HIGH INCIDENCE OF SEPTIC ABORTIONS

  10. ESSENTIAL ELEMENTS OF MATERNAL CARE. • Care Before Pregnancy • HTSP • Family Planning • Improved Nutrition Care During Pregnancy • Maternal immunization for tetanus toxoid • Nutritional support (including iron and folate supplementation) • Birth planning including transportation • Counseling on breast feeding • Recognition of danger signs and treatment or referral as needed • Where appropriate— - Presumptive malaria treatment - Syphilis screening and treatment - Voluntary counseling and testing for HIV

  11. Care During Childbirth • Skilled birth attendance at delivery • Clean delivery: hand-washing, clean space, clean cord care • Recognition of danger signs (for mother) and treatment or referral as needed

  12. Continued & Routine Visits with a Trained Health Care Provider • Early postnatal visit • Recognition of danger signs (e.g., fever) for mother with treatment or referral as needed • Post partum family planning

  13. TEN STEPS FOR MAINSTREAMING MATERNAL HEALTH IN THE SYSTEM WHO has made these recommendations for makingmaternal health a viable program area at the countrylevel: 1. Specify specific goals for reduction in maternal mortality rates. 2. Write and adopt a national policy supporting a countrywide maternal health strategy. 3. Conduct advocacy among multiple partners at the highest levels to mobilize resources. 4. Adopt a country strategy providing options for programs in districts with different health infrastructures and mortality situations

  14. TEN STEPS ----Contd 5. Mainstream maternal health through coordination between maternal and child survival and other health areas, as well as cooperation with other sectors. 6. Develop partnerships among governments, NGOs, professional bodies, academia, and developmental partners at regional and country levels. 7. Establish universal registration of births and deaths. Reach consensus on key indicators for maternal health. (Use these data for supportive supervision within the health system.) 8. Include key indicators within national surveys and national health management information systems. 9. Strengthen maternal care capacity through systematic training, skills development, and logistics. 10.Conduct operations research to establish an evidence base for innovative programs

  15. Financial Status

  16. Note 1- The released amounts has been mentioned in the year when these were released from the Finance Department Govt. of the Punjab. • The end of 2011-12 26% fund (Rs. 2099.127 M) were released against total allocation of Rs. 8088.621 M. • The Govt. of Pakistan decided to continue funding till June 2015 @ funds released in 2010-11. Revised / New PC-I (2012-15) having total cost 3558.180 Million is under the process of approval at CDWP. • DFID share Rs. 642.026 Million per year (One Year allocation up to 2014 is already available in program for the year 2011-12 released 2012-13) & GOP (PSDP) share Rs. 544.034 million per year up to 2015. • 356 Million of DFID, 136.017 Million of GOP under the process of release from Finance Department Punjab

  17. INTRODUCTION OF A CADRE OF CMWS TO INCREASE SKILLED BIRTH ATTENDANTS (sbA) RATE

  18. Community midwives Target : 6346 Total Recruited: 5717 Passed Out: 4367 Deployed CMWs: 3947

  19. Provincial CMWs Performance (Jan - Jun 2013)

  20. CIVIL WORKS 1) COMMUNITY MIDWIFERY SCHOOLS / HOSTELS2) RENOVATION WORKS IN DHQ HOSPITALS3) RENOVATION WORKS AT THQ HOSPITALS

  21. PICTURES OF RENOVATION WORKS THQ Hospital, Haroonabad DHQ Hospital Bahawalnagar THQ Hospital Mankera THQ Hospital Shahpur

  22. PICTURES OF CMW SCHOOLS CMW SCHOOL ATTOCK CMW SCHOOL BAHAWALNAGAR CMW SCHOOL JHELUM

  23. TRAININGS

  24. Training Details

  25. Provision of 24/7 comprehensive and basic emonc services

  26. STANDARDS FOR BASIC AND COMPREHENSIVE EMOCFOR A FACILITY TO MEET THESE STANDARDS, ALL SIX OR EIGHT FUNCTIONS MUST BE PERFORMED REGULARLY AND ASSESSED EVERY THREE TO SIX MONTHS. BASIC EMOC FUNCTIONS PERFORMED IN A HEALTH CENTRE WITHOUT THE NEED FOR AN OPERATING THEATRE■ IV/IM ANTIBIOTICS■ IV/IM OXYTOXICS■ IV/IM ANTICONVULSANTS■ MANUAL REMOVAL OF PLACENTA■ ASSISTED VAGINAL DELIVERY■ REMOVAL OF RETAINED PRODUCTS

  27. COMPREHENSIVE EMOC FUNCTIONSREQUIRES AN OPERATING THEATRE AND IS USUALLY PERFORMED IN TEHSIL/DISTRICT HOSPITALSALL SIX BASIC EMOC FUNCTIONS PLUS:■ CESAREAN SECTION■ BLOOD TRANSFUSION

  28. As per WHO, UNICEF & UNFPA standards Comprehensive & Basic EmONC services are required as follows 01 comprehensive: 500,000 population4 basic: 500,000as per standard required: comprehensive: 190 basic: 760current situation:comprehensive: 127 basic: 419gapscomprehensive: 63 basic: 341

  29. Progress on output level indicators (Output 1) 24/7 Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) Services

  30. Progress on output level indicators (Output 1) 24/7 Basic Obstetric and Neonatal Care (BEmONC) Services

  31. Procurement of logistics

  32. Progress on output level indicators (Output 3) • Procurement of IT Equipment for: • 1. MCH Cell 36 • 2. Nursing Schools 26 • Procurement of Furniture for • 1. MCH Cell 36 • 2. Hostel / Classroom Furniture 26 • Procurement of Transports • 1. Toyota Van 52 • 2. Jimny Jeep 36 • Procurement of Medical Equipment. • 1. CTG Machines 52 • 2. CMWs Kits 3000 • Procurement of Teaching Aids for School of Nursing. • 1. Midwifery Training Material 30 Sets • Procurement of Medicine for 11 Districts. • Procurement of Safe Delivery Kits for 36 Districts. • Procurement of Printing Material • 1. IMNCI Books 2. EmONC Books • 3. CMW Tools 4. CMW Manual

  33. Problems and issues

  34. PROBLEMS/ ISSUES 1) RELATED TO PROGRAM • 2) CHALLENGES FACED BY THE CMWS • Insufficient training, CMW Tutor issue • Procedural Issues in Deployment and Certification: • Inadequate skill sets and referrals: • Financial issues: • Mobility and security problems: • Acceptance by the communities: • Lack of Coordination with the other service providers: • De-motivation:

  35. 3) Problems related to establishment of basic and comprehensive emonc centers1) accessibility issues2) human resource related issues (availability/ training)4) Problems related to human resource1) difficult to retain on low pay package as compared to counterparts2) demand for permanent job

  36. Solutions

  37. RECOMMENDATIONS • In light of all the problems described above, the following remedial measures are suggested: • 1. Community integration for better uptake: • 2. Improve Skill-set: • 3. Clearer Job Descriptions and Coordination: • Health Facility Linkages: • 5. Alternate financial viability models: • 6. Revisit the CMW Strategy:

  38. WAY FORWARD • CONTINUATION IN THE TRAINING PROGRAM OF CMW--- TO INCREASE COVERAGE UPTO 5000 AS WELL AS URBAN SLUMS AND INCREASING THE OVERALL POOL OF SBAs • INCREASING THE NUMBER OF BASIC EMOC AND COMPREHENSIVE EMOC CENTRES (RHS+ Model), THEIR EVEN DISTRIBUTION, UTILIZATION RATES IN DEALING COMPLICATIONS AND STRENGTHENING THEIR REFERRAL LINKAGES • PREPARATION OF TRAINED HUMAN RESOURCE IN PROVIDING MCH SERVICES. • PROMOTING THE CONCEPT OF TASK SHARING • INCENTIVE BASED PACKAGES • STRONG POLITICAL COMMITMENT AND INTERSECTORAL COORDINATION

  39. WAY FORWARD (Contd) • 7) MOBILE RURAL AMBULANCE SERVICES • 8) MIS SYSTEM WITH PROPER ANALYSIS AND FEEDBACK • 9) INTRODUCING HEALTH FACILITY BASED MATERNAL DEATH AUDIT AND ITS REVIEW, STRENGTHENING VERBAL AUTOPSY • 10) PROVISION OF SERVICES IN INTEGRATED FORM

  40. WAY FORWARD Contd------ 11) SUPPORTING EVIDENCE BASED, COST EFFECTIVE AND HIGH IMPACT INTERVENTIONS e.g. Assuring availability of antibiotics, Oxytocics, IV fluids and Oxygen Infection prevention Use of Misoprostol and Magnesium sulphate

  41. THANK YOU

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