Ministry of Health Saving Children s lives through Community

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 Ministry of Health IMR – per 1000 live births 120 • 153 million population • 66% Rural 100 102 77 80 77 60 • >22 million children under 5 yr 61 40 GAP 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. 3

Health System Ministry of Health Tertiary Referral Hospital University Hospital Secondary District Hospital Sub-district Hospital Facility-based care Primary Rural Health Centre Outreach Basic Health Units Family and Community Packages 4

Ministry of Health The Lady Health Workers’ Programme

The Lady Health Workers’ Programme Ministry of Health § Initiated in 1994 § Targets mainly community based MCH care through resident LHWs § Basic, refresher and continuing training § Basic medicines/ supplies/ IEC material provided for preventive care §System of supervision Unit Cost: $ 500 -1000 per LHW per year $ 0. 5 - 1 person per year 6

The Lady Health Workers’ Programme: Ministry of Health Intervention Areas: q q q Community Organization Maternal Health Child Health (ARI, EPI, CDD) Nutrition Family Planning First Aid, Care of Sick - Common diseases and their prevention q Hygiene and Sanitation q Management Information System 7

Key Findings of the Third Evaluation of the LHWP Ministry of Health • Significant impact on a range of health outcomes. • 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 Em. OC 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 9

What are the Gaps? Ministry of Health • Poor Performing Districts: – Lack of management capacities – Shortage of good trainers and supervisors • Need for Initiatives and reforms in LHWP for progress: – Programmatic interventions – Management and organization – Monitoring and evaluation system 10

Policy and Programmatic support Ministry of Health • Policy/Strategic Documents: – – – National Health Policy LHW Programme Strategic Document Nutrition EPI Policy Population policy • Development and endorsement of an integrated MCH policy and operational plan • Harmonization of PRSP, MDGs related to MCH strategies 11

Building Partnerships Ministry of Health • Global: – Joining the Global Partnership • National: – – – Provinces and district governments Professional bodies Go. P sectoral partners Development partners Public Health Forum (April 2005) • Private sector, NGOs and civil societies 12

Ministry of Health Case Study. Community Based Interventions in Emergency

Earthquake 8 th 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 14

Mobilizing Health Workers Ministry of Health Total number of Health Professionals Mobilized Community & Lady Health Workers 27, 401 Total 35, 427 Spray Teams EPI Teams 8, 026 181 Team days 4, 062 Team days Mental Health Teams 14 Medical/Surgical Teams 29 Public Health Teams 28 Health Education Teams 05 15

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’. 16

Expected and actual trend of mortality after earthquake Immediate deaths due to the disaster (1 st Wave in 1000 s) Mortality from infections from wounds/nontreatment (2 nd wave in 1000 s) Ministry of Health Mortality from disease outbreaks/ epidemics (3 rd wave in 1000 s) Expected Trend Observed Trend In Earth quake Affected Areas in Pakistan (< 500 deaths) EQ Immediate TIME 0 - 10 days (< 50 deaths) 0 -45 days 17

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. 18