Ministry of Health by vivi07

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									Ministry of Health

Saving Children’s lives through Community based Interventions

Syed Anwar Mahmood
Federal Secretary (Health) Government of Pakistan

Ministry of Health

Outline
• Community Based Interventions (CBI):
A success story- The Lady Health Workers’ Programme

• Policy and Programmatic Response • Building Partnership • CBI in Emergency

Child Health IMR
120 – per 1000 live births

Ministry of Health

• 153 million population
•66% Rural

100
80 60

102 77 77 61 40

GAP

• >22 million children under 5 yr

40 20 0

1990

2003-4

2015

• 300,000 infants die every year, out of which 160,000 are neonatal deaths; • 51% of children are anemic and 37% are underweight.
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Health System
Tertiary
University Hospital

Ministry of Health

Referral Hospital

Secondary
District Hospital Sub-district Hospital

Facility-based care
Primary
Rural Health Centre

Outreach
Basic Health Units

Family and Community Packages
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Ministry of Health

The Lady Health Workers’ Programme

The Lady Health Workers’ Programme
 Initiated in 1994  Targets mainly community based MCH care through resident LHWs  Basic, refresher and continuing training
100000 90000 80000 70000

Ministry of Health

No. of LHWs

60000 50000 40000 30000 20000 10000 0

 Basic medicines/ supplies/ IEC material provided for preventive care System of supervision

94

95

96

97

98

99

00

01

02

03

04 20

19

19

19

19

19

19

20

20

20

20

Unit Cost: $ 500-1000 per LHW per year

$ 0.5 - 1 per person per year
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20

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The Lady Health Workers’ Programme:

Ministry of Health

Intervention Areas:
 Community Organization  Maternal Health

   

Child Health (ARI, EPI, CDD) Nutrition Family Planning First Aid, Care of Sick - Common diseases and their prevention  Hygiene and Sanitation  Management Information System
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Key Findings of the Third Evaluation of the LHWP
Ministry of Health

• Significant outcomes.

impact

on

a

range

of

health

• A substantial impact on the uptake of important primary health services which include:
– – – – Childhood vaccination rates; Lower rates of childhood diarrhoea; An increased uptake of antenatal services; Positive impact on reversible methods contraception.

of

• Providing more services to low income households than any alternative service provider in the public sector.
Third Evaluation conducted by Oxford Policy Management Ltd – UK 8

What are the Gaps?

Ministry of Health

• Support to LHWs from PHC facilities is very weak:
– Poor vaccination services – SBA services – very low especially in rural area – Non availability of EmOC and referral services

• Need for upgrading knowledge and skills of LHWs in the areas of:
– Community based child health care – Maternal and neonatal health issues

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What are the Gaps? • Poor Performing Districts:
– Lack of management capacities – Shortage of good trainers and supervisors

Ministry of Health

• Need for Initiatives and reforms in LHWP for progress:
– Programmatic interventions – Management and organization – Monitoring and evaluation system

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Policy and Programmatic support • Policy/Strategic Documents:
– – – – – National Health Policy LHW Programme Strategic Document Nutrition EPI Policy Population policy

Ministry of Health

• Development and endorsement of an integrated MCH policy and operational plan • Harmonization of PRSP, MDGs related to MCH strategies
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Building Partnerships • Global:
– Joining the Global Partnership

Ministry of Health

• National:
– – – – – Provinces and district governments Professional bodies GoP sectoral partners Development partners Public Health Forum (April 2005)

• Private sector, NGOs and civil societies
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Ministry of Health

Case StudyCommunity Based Interventions in Emergency

Earthquake 8th October, 2005 • Worst disaster in Pakistan • Deaths beyond 73,000 (70% were children and women) • Wounded more than 145,000 • More than 5.5 million population affected • 60-80% of health facilities destroyed • 1,150 Patients Amputated • 541 Spinal Injuries

Ministry of Health

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Mobilizing Health Workers
Ministry of Health

Total number of Health Professionals Mobilized Community & Lady Health Workers

27,401 8,026

Total
Spray Teams EPI Teams Mental Health Teams Medical/Surgical Teams Public Health Teams Health Education Teams 181 Team days 4,062 Team days 14 29 28 05

35,427

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Lady Health Workers in Disaster Areas
Ministry of Health

• •

Mapping of 3311 LHWs and 124 Supervisors completed (23 LHWs and 1 LHS died). Rest of LHWs mobilized through:
• Grievance counselling sessions • Regular meetings/ coordination with health facilities/ supervisors • Provision of supplies and emergency medicines

• •

LHWs worked as adhoc nursing staff in health facilities. LHWs are now holding Grievance counselling and health education sessions with community. Distributing 800,000 Hygiene & Sanitation kits among women. Providing primary health care services in tented villages by establishing ‘Tent Health House’.

• •

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Expected and actual trend of mortality after earthquake
Immediate deaths due to the disaster (1st Wave in 1000s) Mortality from infections from wounds/nontreatment (2nd wave in 1000s)

Ministry of Health

Mortality from disease outbreaks/ epidemics (3rd wave in 1000s)

Expected Trend

Observed Trend In Earth quake Affected Areas in Pakistan

(< 500 deaths) EQ

Immediate TIME

(< 50 deaths)

0- 10 days

0-45 days

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Conclusion

Ministry of Health

• CBIs are effective not only in normal circumstances but also during emergencies/ disasters • Support from Health System to CBIs is pre-requisite.
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