Thailand Nursing & Midwifery Council

1. Thailand Nursing & Midwifery Council is warmly welcomed to Mrs. Nisab Akhtar who received Princess Srinagarindra Award 2007 for a special lecture on Nursing in Pakistan

2. HISTORICAL OVER VIEW OF NURSING PROFESSION IN PAKISTAN

3. HISTORICAL OVER VIEW OF NURSING PROFESSION IN PAKISTAN Nursing is synonymous with various caring expressions like, treatment, nurture, tending & attention. Nursing is science, maths and high-tech, all coupled together with the art of care. It is challenging both mentally and physically. The parameters of the word nursing are well illustrated by a mother who is sole portrait of love and affection while

4. she is nursing her child: Thus it goes without saying that nursing is as old as humanity. All civilizations had adopted some means to take care of their sick and injured. As humanity is blessed with virtue of mutual relationships and caring for others. This care & look after of ailing humanity is done formally by Nursing Professionals, an integral part of any health care system.

5. NURSING IN PAKISTAN The year 1947 was an eventful year when Pakistan appeared on the Map of World as an independent country as a result of division of India under the able leadership and guidance of Father of the Nation. QAUID-I-AZAM MUHAMMAD ALI JINNAH.

6. The emergence of new country although a matter of great rejoices and jubilations was accompanied by unprecedented difficulties and problems. One of the major handicaps faced by Pakistan at the time of independence was shortage of experienced Govt. functionaries and Nursing profession could by singled out to be the worst hit.

7. At this juncture the very fabric of nursing set up was found severely damaged and nursing activity stood still at the very outset, all over the new country. This situation and crisis in nursing services was created as British Nurses who were holding administrative portfolios in hospitals falling in Pakistan returned to UK and non Muslim Nurses migrated to India.

8. The vacuum created due to the exodus of these Nurses created a critical situation, as only 350 qualified nurses were left behind in Pakistan to cater for a population of one hundred millions . Most of the hospitals were without any nurse and plight of the patients is any body’s guess. The division of India also brought with it the biggest transmigration of population ever seen in the world.

9. The journey undertaken by Muslims migrating to Pakistan was full of unimaginable hardships. Most of them traveled hundreds of miles on foot, starving, facing gruesome murderous attacks, and braving inclement weather. In this way thousand of wounded, sick, men, women and children refugees were entering Pakistan everyday.

10. This alarming inflow of sick and wounded was adding fuel to the fire. It was humanly impossible for the scanty nursing staff, to provide even First Aid what to speak of any curative treatment and help.

11. EMERGENCY ARRANGEMENTS Rising to the call of MOHTRAMA FATIMA JINNAH sister of The Quaid-i-Azam

12. and MOHTRAMA RAINA LIAQAT ALI KHAN wife of The First Prime Minister of Pakistan

13. woman folk of Pakistan although ignorant of nursing practices volunteered to work in hospitals to ease the situation as for as possible. These volunteers were given two weeks elementary training in practical nursing procedures to induct them into wards.

14. In the second step, Auxiliary Nursing scheme was introduced. Under this scheme three months intensive training was imparted to the recruited Nurses and they were sent to different hospitals to fill in the gap. This was the beginning of the Nursing services in Pakistan in 1947. But we had a long way to go to stand on firm footing.

15. Another obstacle to be crossed was that almost all the training institutions for nurses were located in India and Pakistan was left with only 4 nursing schools for training nurses and that too with skeleton teaching staff. This start posed an up hill task ahead but we have toiled hard and presently there are

16. NURSING TRAINING INSTITUTIONS • Schools of Nursing95 • Schools of Midwifery96 • Public Health Schools22 • Colleges of Nursing06

17. We started with only 350 qualified Nurses and this number also included some old retired nurses called back to work; By the grace of GOD we have made tremendous progress and presently we have • Registered Nurses 39000 • Registered Midwives 24500

18. This situation is still far from satisfactory. The population of Pakistan has increased to 1600 million. Presently we have a ratio of One Nurse for 4636 persons which is very low. This situation is being further complicated by well known phenomena of double burden of diseases in developing countries, where health systems have to cope with both communicable and non communicable diseases concurrently.

19. The system has also to address the needs of increasing number of aging people and ever increasing number of young age groups due to population explosion. We are working hard for scaling up of services and improving skills by expanding training facilities and creating positive work place environments.

20. These are the themes duly acknowledged and accepted by global consultations and National conference held in Islamabad March 2007. The process will be strengthening the nursing and midwifery services and will help in achieving the millennium development goals (MDG’s) fixed.

21. NURSING SET UP IN PAKISTAN The goal of Nursing in Pakistan is to enhance the quality of life of our populace by ensuring provision of health care for the comfort and well being of patients, by promoting, maintaining and restoring health, preventing illness, injury or disability, caring for the sick and old, and collaborating with other members of the health team to achieve the above goals.

22. Nurse’s function in a variety of settings at each level of the health care system. The following Nursing bodies are functioning to administer and deliver the goals of nursing objectives. • Pakistan Nursing Council • Director General of Health Govt. of Pakistan • Directorates of Nursing (for each province) • Pakistan Nurses Federation

23. PAKISTAN NURSING COUNCIL Pakistan Nursing Council is a regulatory body established by Govt. of Pakistan in 1948. and all nursing affairs are regulated by PNC. The Council is empowered by ACT of Parliament and some of the main functions of the council are

24. To maintain register of • Qualified Nurses. • Qualified Midwives. • Qualified Lady Health Visitors. • To develop and implement uniform regulatory mechanism in education & services. • To control the Nursing Examination Boards.

25. To develop and implement standard of education & services. • Conduct inspection of educational institutions. • Develop and enforce uniform curricula in all nursing schools.

26. DIRECTOR GENERAL OF HEALTH Director General of Health Services acts as advisory body for The Government. • To promote & develop nursing profession in the country by supporting & supervising all actions related to nursing, midwifery & Lady Health Visitors (LHV’s) • To coordinate & supervise nursing education through institutional inspections and awarding fellowships for higher nursing education.

27. To act as liaison between federal, provincial bodies and Pakistan Nursing Council . • To develop linkages and liaisons with international bodies / agencies. • To arrange conduct workshops, seminars conferences & conventions regarding nursing & nursing education.

28. PROVINCIAL NURSING DIRECTORATES Independent directorates of nursing have been established in all the four provinces of Pakistan. These directorates work in close cooperation with federal Director General of Health. This ensures solving problems with close cooperation.

29. PAKISTAN NURSES FEDERATION Another important body of the nurses is PNF (Pakistan Nurses Foundation) As per constitutional mandate PNF is responsible to • Work for welfare of Nurses, Midwives & LHV’s for the betterment of professions and safe guarding public rights and rights of the nurses. • To arrange workshops, seminars and national/international conferences for promotion of the nursing profession.

30. NURSING EDUCATION Following basic and higher education professional training courses are being offered for nursing in Pakistan.

31. BASIC DIPLOMA General Nursing 03 Years Midwifery 01 Year Public Health Nursing 02 years Community Midwifery 1 ½ years

32. DEGREE PROGRAM Post R.N. B.Sc Nursing 02 Years Generic B.Sc Nursing 04 Years (Direct entry into nursing) M.Sc Nursing 02 Years MPhil Nursing 02 years

33. NURSING EXAMINATION BOARDS Every province has independent nursing examination boards regulated by Pakistan Nursing council. The boards are responsible for holding nursing examination at various tiers. This briefly is the nursing set up for the present.

34. MIDWIFERY IN PAKISTAN Midwives are practitioners in their own right and take responsibility for antenatal, intrapartum, and post natal care of women uptil 28 days after the birth of a child or as required under a particular case. I have no hesitation to say that presently Pakistan is a country where maternal mortality rate MMR and infant mortality rate IMR is very high.

35. The main reason for this are the lack of facilities and in some cases social constraints. Currently almost 80% of women give birth in their homes and only 20% of these home deliveries are carried out under the supervision of skilled and trained birth attendants. The remaining deliveries are carried out by traditionally trained birth attendants called Dai in local language. This is one of the major cause of deaths amongst the mother, and newborns.

36. Further survivors in many cases develop complications because of deliveries conducted by unskilled hands which leads to many life long disabilities. We are trying to increase the number & availability of skilled & trained midwives across the country to bring down the death rate and improve the health of mother & child through better skilled midwives.

37. MIDWIFERY IN PAKISTAN

39. TYPES OF MIDWIFERY PRACTITIONERS There are four types of midwifery practitioners in Pakistan. • Nurses midwives • Lady health visitors midwives • Direct entry midwives • Traditional birth attendants (called Dai in local language)

40. Nurses Midwives All nurses undergo mandatory midwifery training during their basic nursing education. Nurse midwives practice in hospitals, clinics and also attend at birth centers and at homes. These are fully trained and educated in the subject of midwifery.

41. Lady Health Visitors Midwives LHV’s comprise the most important midwifery group of first and second level healthcare facility network functional in rural areas in the public areas. It will not be out of place to mention that we are an agro based country and majority of the population lives in villages. In this way this healthcare segment for women health is playing a crucial role.

42. Lady Health Visitors Midwives They are field workers and are in direct contact with the community for ensuring safe motherhood practices. They are trained & also serve as a referral link for complicated patients to higher health facility hospitals.

43. Direct Entry Midwives This type of midwives have basic education in the descipline of midwifery only related to care and looking after women and the child primarily during the child bearing cycle out of hospital settings and at homes. These midwives undergo short courses and do not have educational qualification to become nurse & LHV.

44. Direct Entry Midwives This arrangement is for bridging the gap between qualified health care attendants and the pregnant mothers.

45. Traditional Birth Attendants (Dai’s) There is another category of attendants which can be called traditional birth attendants or Dai in local language. These are untrained species available in the villages and are uneducated. These women have been working generation by generation and are filling the gap where there is no other alternate arrangement available.

46. Traditional Birth Attendants (Dai’s) This category is unaware of safe delivery of normal cases unaware of early signs & symptoms of high risk pregnancies. A country wide program has been started to train such midwives to give them primary knowledge. If this program is successful it is proposed to be replicated at a larger scale.

47. COMMUNITY HEALTH PROGRAM(LADY HEALTH WORKER) In order to strengthen this segment of primary health care lady health workers program has been launched and is being followed vigorously to deliver community based maternal and child health care. The lady health workers recruited are mostly educated local resident, of the villages.

48. These lady health workers are providing preventive promotive, and curative services in the communities where they live. Presently 85000 LHW have been recruited reaching 70% of the target population. The program covers almost all areas of Pakistan. The LHW are helping in safe motherhood activities including promotions of antenatal care, clean delivery practices and post natal care.

49. These LHW are being utilized for family planning program as well as they have been trained in the use of contra captives. This program is helping greatly in reducing MMR, IMR and also helping in family planning to check the increase in population.

50. CHALLENGES IN PRESENT SCENARIO NURSING SERVICES The number of nurses has increased since creation of Pakistan, but increase is unfortunately not in consonance with the increase in population and in turn increase in demand. Under the circumstances quality of the patient care has to be compromised in many cases due to acute shortage of nurses in the hospitals.