Transcript 幻灯片 1 - ESD Proj

Pakistan’s Approach to
and Experiences in
Scaling-Up MNCH-FP
Best Practices
Rashid JoomaM D
Director General Health
Government of Pakistan
Why BPs were selected in 2007?
• Maternal and childhood disease account for 40
percent of the burden of disease
• High maternal mortality in Pakistan due to PPH,
more than a quarter deaths (PDHS 2006-07)
• High child mortality (94 per 1000 livebirths)
• High unmet need for contraception (25 percent)
• Large proportion of unplanned pregnancies end in
induced abortion (PDHS 2006-07)
• High proportion of too closely spaced pregnancies
• Access to FP service through public facilities low
Pakistan and MDGs
Development Indicators
Maternal Mortality Ratio
2010
(most recent)
MDG 2015
276
140
320 ( Rural )
Child Mortality Rate
94 (06-07)
52
Neonatal Mortality
54 (06-07)
25
Skilled Birth Attendance
39 (06-07)
90
Ante Natal Care (4 visits)
28
90
Contraceptive
Prevalence Rate
30
40
Best Practices Selected for
Pakistan - 2007
• Active management of Third Stage of Labor
(AMSTL)
• Healthy timing & spacing of pregnancies
• Expanding contraceptive method choice
• Post Abortion Care - FP
• Involvement of Ulema for MNCH/FP
• Newborn Resuscitation & Hypothermia
• Diarrhea- Introduction of Low Osmolarity
ORS and Zinc
• Pneumonia Case Management by LHWs
• Post-natal care by LHWs
Scaling-Up Process - 1
• Consensus on Country Action Plan 2007
• Country Team’s Follow-up and Advocacy
• Consensus building efforts at national level
catalyzing in Karachi Meeting
• Partnerships developed – with bilateral and
Multi-lateral Projects and espPvt Sector / NGOs
• Signing of Karachi Declaration (Federal and
Provincial Health and Population Welfare)
Scaling-Up Process - 2
• Changes in Policy, Programmes and Five
Year Plans, Strategies, and Implementation
• Measures Institutionalized for sustainability
• Political Commitment to move forward
• Opening up opportunities for civil society
organizations
Progress to date
Child Health
Prevention & Management of Diarrhea
– Inclusion of Low Osmolarity ORS and Zinc by LHWs
Program
– Almost all LHWs already trained under Community IMNCI
– Low osmolarity ORS and Zinc included in facility based
IMNCI training module and HCPs trained
– PNC Protocol of LHWs revised in the light of UN Joint
Statement
Post Natal Care (Results)*
– 30% reduction in neonatal mortality rate in intervention
clusters
– Skilled attendance at birth increased from 18% to 30%
Child / Newborn Health
Prevention & Management of Neonatal Hypothermia
– Health care provider trained in EMNC (50 districts)
– Almost all LHWs trained ( 60% Coverage of Pakistan)
Neonatal Resuscitation
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HCPs trained in EMNC on new born resuscitation in 50 districts
Preventive messages on birth asphyxia included in LHW manual
LHWs trained for mouth to mouth resuscitation
CMW curriculum includes hypothermia and resuscitation
Prevention & Management of Pneumonia by LHWs
– Syp amoxicillin included in LHWs and MNCH Programs
Active management of Third
Stage of Labor (AMSTL)
Introduced in 34 focus districts across the country
Active human resource development to promote
AMSTL at national level
– Training material
– Pre-service Training of CMWs in AMSTL
– Training to WMO/LHVs/Nurses in AMSTL and use of
Partogram
In districts selected for promoting use of AMTSL, facility
level use rate has reached to 87%
Post Abortion Care
– Training & infection prevention training in PAC/
MVA (in 10 districts)
– LHWs and supervisors provided facility based
orientation training on post-abortion care, FP
counseling and services for post-abortion and
postpartum
– Active support in training and services by NGOs
across many districts
– Establishment of PAPAS – a consortium of
stakeholders
Mobilizing Religious Leaders for RH/FP
TA to the Ministries of Health and Population Welfare to design and
support :
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Government’s own initiative to address the barrier
Gazette notification of Core Group comprising Muslims, Christian
and Hindu religious scholars
A compendium of Quranic injunctions, quotes from Ahadeeth, and
decrees (Fatawa) pertaining to FP/RH
Acceptance and endorsement of this material by main religious
authorities including Council of Islamic Ideology
Designing a Comprehensive training manual for orientation of RLs
on FP/RH initially for Muslim population, and subsequently for
other major minorities
Scaling up of RLs program across Pakistan by the Government
Healthy Timing and Spacing of
Pregnancies
• HTSP approach included in new policies
• Ministry of Health new strategy to Reposition
Birth Spacing as Health Approach
• Increased commodities/ better supply system
for LHWs program
• Capacity building of providers and managers
• Introduction of newer technologies
Plans for the Future to Scale up
• Commitment and Road Map for scaling-up Best
Practices especially integration of BPs through
the Health Delivery System
• Incorporating birth spacing and FP services
under MNCH/ LHW Programs addressing needs
of poor women experiencing miscarriage /
abortion / PP-FP
• Operational Plans – Provincial and District level
putting BPs into practice
• Improving supervisory system and quality
assurance
Plans for the Future to Scale up - 2
• Involve civil society organizations to mobilize
resources and promote all BPs esp birth spacing
services
• Strengthening monitoring BP implementation
• Contraceptive Security and LMS
Challenges
• Scaling up to reach the poorest and youth
• Ever increasing demand for services
• Training/ keeping providers, particularly
outreach workers, up to date technically
• Involving health facilities in HTSP
• Maintaining consistent commodity security
• Financing
– Addressing Resources Constraints
• Governance/ Monitoring processes
– Provincial and District level ownership
Conclusion
• Government’s strong commitment to achieve
MDG 4 and 5
• Pakistan’s progress in BPs is on track
• Pilot test evidence used to scale up
• Support from private sector encouraging
• Development partners support is critical