Group 3 Rh

An Intervention on health education and awareness in general population of Distt. D.G.Khan Group 3 Dr.Farrukh,Dr.Zubaida Dr.Sadia,Dr.Nazish

Sequence to follow Global Intro  Pakistan Intro  District Intro  Intervention Intro  Intervention details 

Dr Zubaida Dr Zubaida Dr Farrukh Dr Sadia Dr Nazish

GLOBAL OVERVIEW   



Maternal Mortality: is defined as the death occurred due to maternal causes from conception up to 42 days after delivery 99% of all the maternal deaths occur in developing countries where 85% of world’s population resides. 1/3 of these deaths occur in south-east Asia. Less than 2/3 of a women in developing countries receives assistance from skill birth attendants during delivery. 45 Million deliveries each year not assisted by skill birth attendants in developing countries.

Pakistan – A Preview

Total Population – 164.6 million Male : Female Proportion 52 : 48 Urban : Rural Proportion 33.4 : 66.6 Population Density / Sq. Km 187/person Pakistan is the sixth most populous country in the world

DEMOGRAPHIC INDICATORS        

Total Fertility Rate Population Growth Rate Infant Mortality Rate Maternal Mortality Ratio Skilled attendant at birth Health Care deliveries Women receiving ANC Contraceptive Prevalence Rate

4.1 % 1.94 % 78/100,000 live 276/100,000 liv 38.8% 34.2% 61% 30 PDHS survey of Pakistan 2006 - 07

MMR IN PROVINCES OF PAKISTAN MMR in provinces of Pakistan 500

MMR

400

404

364

300

259

242

Punjab

Sindh

200 100 0 Baloch

NWFP

Provinces

CAUSES OF MATERNAL DEATHS Sepsis 16

Post Partum Hamerrhage 36

Pre/Eclampsia 15

Induced Septic Abortion 16

Ante Partum Hamerrohage 17

PUNJAB’S PROFILE – Comparable Indicators INDICATORS

EDUCATION:    

Literacy Rate (%) Male Literacy Rate (%) Female Literacy Rate (%) Net enrolment ratio in primary education

HEALTH:   

Infant Mortality Rate per thousand live births. Maternal Mortality Rate per lac live births. Immunization of 1 year children against measles (Proportion)

GENDER:  

Ratio of Girls to Boys in Primary Education Net Ratio of Literate females to males (15-24 yrs)

PAKISTAN

PUNJAB

MDGs 2015

54 66 42 51

54 63 44 51

88 89 87 100

82

77

40

350

314

140

40

66

>90

0.57 0.65

0.93 0.83

1.00 1.00

A Preview Of D.G.Khan

D. G. Khan

Total Population – 1643000 million Male : Female Proportion – 52 : 48 Urban : Rural Proportion – 86: 14 Growth Rate 3.31 Population Density / Sq. Km – 138/person Hospital in public sectors 4 RHC 9 BHU 53 MCHC 5 DISPENSARIES 62

HEALTH INDICATORS Health indicators of D.G.Khan Literacy rate

Male Female

Primary School Enrolment 34 % rate IMR 93 % CPR (modern methods)

19 %

HH Covered by LHW’s

29 %

54 % 24 %

Health personals DG Khan Cadre

Number

Medical Officers/GP’s

145

Total doctors

186

Nurses

49

Lady Health Visitors

69

Lady Health workers

941

Midwives

119

Paramedics (female) Lab Assistant TOTAL

1178 29 2716

Existing Initiatives to Reduce MMR      

Training of Community Midwives, and Dais under Women Health Project. Mobilization of LHWs and other Health professionals to ensure ante-natal, and post-natal care To increase Contraceptive Prevalence Rate (CPR), concept of Optimum Birth Spacing (OBSI) has been introduced. Availability of Contraceptives and increase in its demand has been encouraged through PWD MNH Project. USAID funded PAIMAN Project.

points to ponder       

This is the situation of every other district in Pakistan. No progress achieved unless the high MMR and IMR is controlled Low levels of education is the core hurdle in reducing MMR to desired levels. The male involvement is indispensable for the better health of the family. The political commitment of the leaders toward their respective areas can bring about a massive change. Effective ,efficient safe and culturally appropriate services are indispensable. Investment in prevention reduces health care cost and the burden of mortality and morbidity.

Aims and objectives 

AIM 



To reduce the maternal mortality and morbidity by minimizing the first 2 delays in health seeking in district DG Khan.

OBJECTIVES 1.

2.

To increase awareness regarding the safemotherhood among population 15 and above (man, women, elderly, influential, people) To improve the knowledge of local men and women about the high risk pregnancies and its outcomes and its potential risks to neonates.

Target population 

Whole community age 15 and above,    

Women Men Elderly (decision makers) Influential people (religious scholars, local leaders etc)

Levels of intervention 1.

Community level   

1.

Health Facility Level     

1.

Women education Family Influential people

Responsiveness of providers Regular training 24 Hrs working Private hiring for after 2pm services Private provider subsidy

National Level    

Local and regional Advocacy Inter-sectoral approach Political ownership Policy amendment/new policies

Community level Intervention 

Women Education/awareness     



Family  



Health Hygiene/Nutrition Risk Signs recognition ANC Checkups Safe Motherhood Men( husband/head ) Elderly ladies

Influential people   

Imam/Religious leaders Counselors / Nazim Political Leaders

MOST EFFECTIVE INTERVENTION CURATIVE 24 hrs availability:  public health facility  gynecologist/consulta nt  USG services  Free Medication  through liaison with NGO’s



PREVENTIVE Increase awareness regarding family health among general community All people aged 15yrs and above.

Why Preventive strategy ? Time consuming but more effective in the long run  Benefit is many folds as message is spread from person to person  Community is directly involved leading to better responsiveness  Social hurdles better handled through prevention  Effects remains through generations 

Phases of intervention 

Phase 1

Recruitment  

Phase  Phase  Phase  Phase 

2 3 4 5

Male and female out reach workers Private health care providers

Training of personnel Pilot Programme Implementation Quarterly Evaluation and regular monitoring

Awareness package contents  

 



Female workers would gather a group of women and educate them about the key messages Focus on key messages being imparted to the audiences through the context of her own story of being near miss. Distribute brochures at the end The male worker who would be the husband of the women would address the key issues with the male members of the women being counseled in the morning Forth nightly meeting would be conducted with the influential people of that community as well.

Cont’d…, 





 

The female worker will meet the LHW of her area and give her the list of pregnant women she has counseled for ANC on weekly basis so that the can be visited. The LHW after her initial assessment will ascord her to the LHV of that area who will decide if there she is a high risk case or normal. For all the normal pregnant ladies the periodic follow up visits by facilitated through the local worker High risk cases would be given a token for referral to the public or private facility. The token will ensure her free access to the public and subsidized at private facility.

Components of intervention NORMAL

HIGH RISK LHV’s

TOKEN FOR REFERRAL

PUBLIC FACILITY DHQ/THQ

LHW’s

NEAR MISSES

LOCAL WORKERS

PRIVATE FACILITY

SUBSIDIZED SERVICES

5 Assumptions of intervention 1. 2. 3. 4. 5.

Involvement of religious scholars and influential people Support groups facilitation Involvement of male members Token scheme for ANC Communication through near miss women for ANC and risk signs recognition

PROJECT BUDGET Project Budget Line Item

Unit Cost in Mill

Tot. Cost / Yr in mil.

% of tot Yr budg

4

10

0.005 / comt /mon

6

15

0.25/quarter

2

5

0.006 /comt /mon

7.2

18

Logistics

0.0066/ 3 mon

2

5

IEC Material

0.008 /annum

0.8

2

0.33 /month

4

10

6 (capital budget)

6

15

Repair and Maintenance

1/quarter

4

10

CONTINGENCIES

4 /annum

4

10

40

40

100

Salaries and Allowances Regular staff

0.083

Staff hired for project

0.25

Monitoring Evlution

TA/ DA Pilot Program Conducting pilot project

Utilities Procurement of Durable Goods

Multi Media/ Computers 4*4Pick up (total 3)

TOTAL

CURRENT ISSUES    

Lack of awareness/ women education Professional and managerial deficiencies Low trend of delivery by skilled birth attendant In time accessibility to maternal health care services especially EMOC services



Lack of integration between public and private sector



Focus on curative medicine than preventive treatment for reducing MMR



Poor primary health care services i.e. BHU’s

Personal narrative… In spite of the fact that the delivery was normal and in a well reputed hospital still I played between life and death and had a narrow escape. Between 10am to 1am first primary heamrrohage,went to DIC,intubated twice,transfused 7 bags of blood 4 FFP and when my eyes opened and asked the doctor standing next to me that am I going to die she was silent and I said to her I have a strong faith in God that I will be fine,she replied its so good to hear that you have faith because I have lost it. And amazingly not a single drop of blood after that. My faith kept me alive for I had to live for my child ….

Conclusion Definition of RH It’s the sate of complete physical, mental, and social well being not merely the absence of disease or infirmity relating to the reproductive system ,its functions and processes.  Holistic approach 

UN 1995

Safe motherhood

CONCLUSION 20-30% of normal deliveries end up in complications leading to death irrespective of the avoidance of all the 3 delays  Its not only the physical health but the mental health as well which should taken into account.  Cherish the women in your life  Give her at least the respect which she deserves to get for being the carrier of the future generation in her womb. 

Refrences 1. 2.

3.

4. 5.

6.

Beckers S,midth F.testing the effectiveness of including husbands in safe mother hoodintervention.2003:249-261 Fasil A. Assessment of indicators for level of knowledge about maternal and neonatal complication in area of Pakistan: population association op Pakistan 2002:171-181 Fikree F, midth F.Maternal mortality in different pakistani sites:ratios, clinical causes and determinents. Acta obstet Gynaecol Scand 1997:637-645. PAIMAN: Communication, Advocacy and Mobilization (CAM) Strategy , USAID. HUMAN RESOURCES FOR HEALTH IN THE PUBLIC SECTOR IN PAKISTAN – 2006, National HIMS Program Ministry of health; WHO Pakistan. http://www. who.int/reproductivehealth/publications/maternal_mortality_2005/index.html, accessed 14 August 2008

THANKS

Prerequisites for intervention Primary survey  Pre launching general meeting to introduce the idea with Local NGOs, MCH program coordinator, LHS coordinator, Private HSP.  Pilot Program  Launching Ceremony 