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“THE CHALLENGES IN UNDER

DEVELOPED THIRDWORLD

COUNTRY”

“HCPA IN QUALITY IMPPROVEMENT !”

Dr. Nighat ShahMCPS, FCPS, MRCOG

Society of ob/gyn Pakistan

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Scheme of Presentation:

• Introduction : Pakistan

Health Care Association

• Different Vertical Programmes / Projects

• Bridging the gap HCPA, NGOs, Govt.

• FIGO Project / Fistula Project

• Barriers, Gaps, Shortages

• Overcoming barriers / hurdles

• What have the projects achieved

• How can the progress be measured

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HEAVY POPULATION BURDEN

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Pakistan home to 160 million mostly poor people (60%

below poverty level).

Socio – cultural, economic, norms are anti women.

Women are mostly poor, pregnant and powerless.

Less than 50% women & men are educated.

Health infrastructure is inadequate and more concentrated

in urban areas.

Health care professional association include

- PMA, Pakistan Medical Association

- SOGP, Society of Ob/Gyn Pakistan

• PNFWH

- NCMNH, National committee on Maternal, Neonatal

Health Cont…

Introduction:

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- Mainly CME (for medical professionals, for paramedical,

students & general public)

- Conferences (Academic and scientific session and

workshops)

- Community work:

Training ambulance drivers, Sensitizing

Politicians, Sensitizing Religious Scholars.

Fistula camps, Gynae operations, Medical

camps, public awareness.

- Ethical practice / standardization of medical education and

practice

Different Vertical Programmes / Projects

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COLLABORATION WITH PAKISTAN

NATIONAL FORUM ON WOMEN’S HEALTH

•Midwifery Pictorial

•Simple Midwifery

•Where Women have no Doctor

•Textbook of Midwifery

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COLLABORATION WITH PAKISTAN

NATIONAL FORUM ON WOMEN’S HEALTH

•Emergency Labour Management

•Infection Prevention

•Managing Complications in Pregnancy

•Manual of Teaching Nursing and Midwifery

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SOGP/ FIGO did capacity building in RHC, the hospital was

non functional which was built, renovated, equipped and

professional doctors / nurses were hired.

Community started availing services, trust was built and the

number of out patient and inpatient services.

Problems:

- Cost, Sustainability

- Corruption

- Govt. not involved

- Hiring Professional

SOGP PROJECT / FISTULA PROJECT:

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November 1, 2006 to Oct 31st, 2010

(4 Years)

FIGO – SOGP Project

Saving Mothers & Newborns

COMMUNITY BASED

INTERVENTIONS TO REDUCE

MATERNAL AND PERINATAL

MORTALITY AND MORBIDITY IN

RURAL SINDH, PAKISTAN

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Project initiation

Health facility needs assessments

Non functional Female ward. RHC Gharo TBA in BHU Ghari Wah.

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OT / Labour Room, SZMC, Mirpursakro

Project initiationHealth facility needs assessments

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Facility Readiness

SZMC Renovated Labour Room

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Facility Readiness

SZMC OT- ready

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Facility Readiness

SZMC OT is functional

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In collaboration with UNFPA, PNFWH, Fistula Project was

taken up, whereby,

FISTULA PROJECT:

Training was given to health professional in all four province

for fistula repair.

A hospital specially for this problem now stands in Karachi

where by surgeries are done without cost.

Community camps are regularly organized for repair of

fistula in far fetched rural areas.

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QUALITY IMPROVEMENT

• Any process or tool aimed at reducing the quality gap in the systemic and organisational functions according to the dimensions of quality

• The basic principles are common sense, customer focus, strong leadership, involvement of people, process approach, systemic approach to management, continual improvement, factual approach to decision making and mutually beneficial supplier relationship

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An army of dedicated / committed people is required.

Government has to be seriously engaged.

HCPA have to dedicate more time, energy & resources

Most of the Projects are in the initial period and may faze

out because of funding.

There is a wide gap of leadership, time, commitment.

QUALITY IMPROVEMENT:

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Bridging the gap, bringing politicians, NGOs, and HCPA on

one table to rationalize scarce resources.

Training, sensitizing, midwifes, nurses and doctors

Seriously engaging government, community leaders,

media, taking all stake holders along

Building up sensitivity in the youth so that next generation

wakes up to reality.

HOW CAN THE BARRIERS BE ERADICATED:

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Overall it has in creased sensitivity, awareness.

Decrease in Maternal Morbidity / Mortality.

WHAT HAS THE PROJECT ACHIEVED SO FAR:

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Quality improvement stands on good information as well

as expertise in problem detection and solution, therefore

has to be proper data & documentation.

Protocols and regular trainings on infection control, mva,

Labour ward management

Accountability and audits specially confidential inquiries in

maternal mortality

MEASURING, REPORTING OF HCPA

CONTRIBUTIONS:

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IN CONCLUSION:

HCPAs have to support networks and collaborate to foster

sharing of data, resources, and disseminate findings

Develop, validate new methods for the measurement of

quality in maternal health care, to include optimal health

outcomes

Create mechanisms and tools for providers that promote

adherence to and use of standards.HCPAs have to

continue for constant quality improvement so that goals

and outcomes are met

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