Ministry of Health

Syed Anwar MahmoodFederal Secretary (Health)

Government of Pakistan

SavingSaving Children’s lives through Children’s lives through Community based Interventions Community based Interventions

Ministry of Health

OutlineOutline• Community Based Interventions (CBI):

A success story- The Lady Health Workers’ Programme

• Policy and Programmatic Response

• Building Partnership

• CBI in Emergency

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Ministry of HealthChild HealthChild Health

IMR – per 1000 live births

102

77

40

102

61

77

0

20

40

60

80

100

120

1990 2003-4 2015

GAPGAP

• 153 million population•66% Rural

• >22 million children under 5 yr

• 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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Ministry of Health

Referral HospitalTertiaryUniversity Hospital

SecondaryDistrict HospitalSub-district Hospital

PrimaryRural Health Centre

Basic Health Units

Facility-based care

OutreachFamily and Community

Packages

Health SystemHealth System

Ministry of Health

TheThe Lady Health Lady Health Workers’ ProgrammeWorkers’ Programme

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Ministry of Health

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

100000

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

No

. of

LH

Ws

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

The Lady Health Workers’ ProgrammeThe Lady Health Workers’ Programme

Unit Cost: $ 500-1000 per LHW per year $ 0.5 - 1 per person per year

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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

The Lady Health Workers’ Programme:The Lady Health Workers’ Programme:

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Ministry of HealthKey Findings of the Third Evaluation of the LHWPKey Findings of the Third Evaluation of the LHWP

• 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 of contraception.

• 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

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Ministry of Health

• Support to LHWs from PHC facilities is very Support to LHWs from PHC facilities is very weak: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 Need for upgrading knowledge and skills of LHWs in the areas of:LHWs in the areas of: – Community based child health care– Maternal and neonatal health issues

What are the Gaps?What are the Gaps?

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Ministry of Health

• Poor Performing Districts:Poor Performing Districts:– Lack of management capacities – Shortage of good trainers and supervisors

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

What are the Gaps?What are the Gaps?

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Ministry of HealthPolicy and Programmatic supportPolicy and Programmatic support

• 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

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Ministry of HealthBuilding PartnershipsBuilding Partnerships

• Global:– Joining the Global Partnership

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

• Private sector, NGOs and civil societies

Ministry of Health

Case Study- Case Study- Community Based Community Based

Interventions in EmergencyInterventions in Emergency

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Ministry of Health

• 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

Earthquake 8th OctobEarthquake 8th October, 2005er, 2005

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Ministry of Health

Community & Lady Health Workers

35,427Total

8,026

Mobilizing Health WorkersMobilizing Health Workers

05Health Education Teams

28Public Health Teams

29Medical/Surgical Teams

14Mental Health Teams

4,062 Team daysEPI Teams

181 Team daysSpray Teams

27,401Total number of Health Professionals Mobilized

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Ministry of Health

Lady Health Workers in Disaster Areas Lady Health Workers in Disaster Areas

• 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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Ministry of Health

Expected Trend

Observed TrendIn Earth quake Affected Areasin Pakistan

TIME

Immediate deaths due to the disaster (1st Wave in 1000s)

Mortality from infections from wounds/non-

treatment (2nd wave in 1000s)

Mortality from disease outbreaks/

epidemics (3rd wave in 1000s)

Immediate 0- 10 days 0-45 daysEQ

(< 500 deaths)

(< 50 deaths)

Expected and actual trend of mortality after earthquakeExpected and actual trend of mortality after earthquake

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Ministry of HealthConclusionConclusion

• CBIs are effective not only in normal circumstances but also during emergencies/ disasters

• Support from Health System to CBIs is pre-requisite.