Transcript 7. Dr Saeeda MNCH attock

MNCH Program, District Attock
By: Dr. Saeeda Khatoon
DMCH, MCPS.
Ex. Public Health Specialist,
MNCH Attock.
Contents

Introduction to the key interventions
and achievements

Bottlenecks/the difficulties faced

Lessons Learnt and Way forward
DISTRICT PROFILE
•
Area
6,857 Sq Km
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•
Tehsils
UCs
6
72+3(Cantt areas)
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Cities
Villages
6
440
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Population
1519855
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Tehsils wise population
Pop
Density- 242/sq.km
Tehsil-Pindigheb
219450
Tehsil-Attock
281963
Tehsil-Hasanabdal
162328
Tehsil-Jand
262469
Tehsil-Hazro
282o17
Tehsil-Fatehjang
261974
Health Facilities
Sr.No
Name of HF
No. of HF
1
District Headquarter Hospital
01
2
Tehsil Headquarter Hospital
05
3
Rural Health Centers
05
4
Basic Health Units
62
5
MCH Centers
09
6
Others (Dispensaries)
7
Training Centers
Public Health Nursing School
01
General Nursing School
01
DHDC
01
National MNCH Program
Component-wise Interventions
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Integrated Delivery of Comprehensive MNCH Services
Training and Deployment of Community Midwives
Provision of Comprehensive Family Planning Services
Strategic Communication for Maternal , Newborn & Child
Health
Strengthen Program Management
Component -1Integrated Delivery of Comprehensive MNCH Services
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Infrastructure renovation of all THQ &DHQ
Hospitals has been done.
Necessary Equipment ensured in Primary
& Secondary Health Care Facilities
including Color Doppler in DHQ.
Skills assessment of SBA done,
Proper Referral .
Provision of 24/7 Basis EmONC Services at RHCs

Basic EmONC Training of staff with local resources.
Sr.No.
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Cadre
No. of Participants
1
Woman Medical Officers
05
2
Charge Nurses
07
3
Lady Health Visitors
66
USG Training of WMOs of RHCs
LHVs were trained in Basic EmONC at PIMS.
IMNCI Training of MO & WMO & LHVs.
Component -2Training and Deployment of Community Midwives
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Selected from Rural Union Councils
1per 10000 population
18 month training consisting of Theory &Practical in
DHQ Hospital, RHCs & RHS-A.
Examination by NEB
Evaluation by DEC.
Deployment in communities.
Training
Construction of CMW school building
Monitoring of Training
New Initiative for CMWs basic health
support (First Aid) in collaboration with
Rescue 1122.
Deployment of Community Midwives
To Increase acceptance
Seminars in Community
Medical Camping at CMW home.
Component -3Provision of Comprehensive Family Planning Services
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DCO/DPWD/EDO (Education) were involved for
improvement of FP services.
Refresher training of deployed CMWs.
Regularly collection, analysis, compilation and
submission reports.
Consolidated Demand submission.
Motivational session at Girls high School
arranged in collaboration with DPWD and
Education department.
Component -4Strategic Communication for Maternal , Newborn & Child Health

Seminar at District Level.
Component -5Strengthen Program Management
TEAM WORK
Monitoring and
Supervision of Health
Facilities and CMWs .
Monthly meetings:Financial Management:-
EDO(Health), MS, SMO,
Gynecologist, MO I/C, LHVs,
CMWs
Monthly reporting:
Seminar at CMW
Community level and
Community meetings.
Health Facilities performance reports.
CMWs performance reports.
PHS/SO performance report.
Monthly Expenditure report.
Verbal Autopsy reports.
Civil work status report.
TEAM WORK
Component -5Strengthen Program Management
REGULAR MEETINGS
WITH
1: DEPLOYED CMWS
2: LHVS
3:WMO (MNCH)
TO IMPROVE MNCH
SERVICES.
Achievements
ANTENATAL CARE
No. of ANC
consultations
increased at
Health Facilities
(SOURCE DHIS)
SKILLED BIRTH ATTENDENTS
Deliveries by SBAs increased
Distribution of Contraceptives
Regular
supply of
contraceptive
ensured at
health
facilities & at
CMW Home.
CMWs Performance
ANC & Deliveries by CMWs
Family Planning Consultations by CMWs
CMW Performance
CMWs are performing better then their area Basic Health Units
BHU Name
No. of Deliveries conducted
1/2013 to 5/2013 at BHU
No. of Deliveries conducted
1/2013 to 5/2013 by CMWs
CMW Name
BHU Kotsundki
10
18
Komal Saba
BHU Bolianwal
15
21
Uzma Bibi
BHU Sarwala
11
12
Gulnaz Manzoor
BHU Sojanda
13
14
Rubina Nisar
BHU Jangla
15
20
Sadia bibi+Iram Naz
BHU Kharpa
13
14
Niak Bakhat
GRD Nara
0
30
Tasarad Bibi
MCHC Thatta
0
13
Sobia Bibi
BHU Shamsabad
09
15
Farzana Sadique
GRD Makhad
0
20
Naseer Fatima
Reports Leading to further Actions
 Critical
analysis of Verbal
Autopsy reports.
 Meeting with local Dai’s of
concerned communities
 Meeting with Care Provider in HF
 Liaison of CMW & local Dai’s,
Still Mothers die
Causes of Maternal Deaths
Barriers to Achieve MDGs 4&5
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Shortage of Specialists at THQ Hospitals.
Lack of linkage between places of service provision
Health Facilities Accessibility problems.
Weakness in skills.
Lack of commitment.
Problems of accountability.
Less well functional health committees
Lack of communication between patient/client and service providers.
Difficulties faced related to CMWs
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Cultural prohibition in some areas.
Suitable candidates (Married women) not found
Training deficiencies & Inadequate skills
Scattered catchment population & difficulties in
transportation (CMW’s Mobility and Security problems)
Financial Problems of CMWs
Lack of communication & uncooperative HF Staff.
Strong hold of local Dai.
Proposed Strategies / Solutions for Improvements
Two way Process

Improvement in
services
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Improvement in
acceptability of
services
Proposed Strategies / Solutions for Improvements
Two way Process
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Improvement of services (Preventative, Basic & Comprehensive EmONC)
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Vacant post should be filled in HF
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Strengthening of CMW’s Role.
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Interlinking of places of service provision.
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Improvement of Skills.
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Job description at all levels to remove overlap of functions.
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Efficient Transportation of referred patients.
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Strong commitment at all levels.
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Effective Monitoring & Evaluation.
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Accountability.
Proposed Strategies / Solutions for Improvements
Two way Process
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1.
2.
3.
4.
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1.
2.
Improvement in acceptability of services
Improved motivation
Community Participation in selection of CMWs.
Motivational campaign at provincial , District &Community levels.
Fully Functional Health Committees in communities.
Involvement of Community Representatives for acceptance of CMW in
community.
Building confidence
Participation of care providers CMWs & other Community health Workers
in Motivational sessions.
Improved Communication .

Proposed Strategies / Solutions for Improvements
A continuum for Maternal, Newborn and Child Health
Adolescence
Prepregnancy
Pregnancy
Birth
Post
partum
Neonatal
Post natal
Maternal
Health
Infancy
Childhood
Proposed Strategies / Solutions for Improvements
Human Resources involved
LHW,CMW &
LHV
LHS,LHW.CMW
Medical Officer,
LHV MWs (BHU
level)
Gynecologist,
WMO
(RHC,THQ and
DHQ Level)
PHS,DDO (H) SO,
DC NP, Tutors
CMW
(for monitoring )
WMO,LHV/
Motivator (FWC
PWD)
BH U
Places involved
RHC
CMW Home
THQ/DHQ
Basic Health
Unit
RHC, THQ &
DHQ
MNCH
Program &
National
Program
Population
Welfare
Department
Thank You
NATIONAL MATERNAL NEWBORN AND CHILD HEALTH PROGRAM
Hoping for the Best