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 Dr Zubaida

 Pakistan Intro Dr Zubaida
 District Intro Dr Farrukh
 Intervention Intro Dr Sadia
 Intervention details 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 4.1 %
 Population Growth Rate 1.94 %
 Infant Mortality Rate 78/100,000 live
 Maternal Mortality Ratio 276/100,000 liv
 Skilled attendant at birth 38.8%
 Health Care deliveries 34.2%
 Women receiving ANC 61%
 Contraceptive Prevalence Rate 30

PDHS survey of Pakistan 2006 - 07

 MMR IN PROVINCES OF
PAKISTAN

MMR in provinces of Pakistan

500
404
400 364

300 259 242

MMR

200

100

0
Baloch NWFP Punjab Sindh
Provinces
CAUSES OF MATERNAL DEATHS

Sepsis
16 Post Partum
Hamerrhage
36
Pre/Eclampsia
15

Induced Septic
Abortion Ante Partum
16 Hamerrohage
17
 PUNJAB’S PROFILE – Comparable
Indicators
INDICATORS PAKISTAN PUNJAB MDGs 2015
EDUCATION:
 Literacy Rate (%) 54 54 88
 Male Literacy Rate (%) 66 63 89
 Female Literacy Rate (%) 42 44 87
 Net enrolment ratio in primary 51 51 100
education

HEALTH:
 Infant Mortality Rate per 82 77 40
thousand live births.
 Maternal Mortality Rate per lac 350 314 140
live births.
 Immunization of 1 year children 40 66 >90
against measles (Proportion)

GENDER: 0.57 1.00

 Ratio of Girls to Boys in Primary 0.93
Education Net 0.65 1.00
 Ratio of Literate females to males 0.83
(15-24 yrs)
A Preview Of D.G.Khan

Total Population – 1643000 million

Male : Female Proportion – 52 : 48
Urban : Rural Proportion – 86: 14
D. G. Khan
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 54 %

Female 24 %
Primary School Enrolment 34 %
rate
IMR 93 %

CPR (modern methods) 19 %

HH Covered by LHW’s 29 %
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) 1178
Lab Assistant 29
TOTAL 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. To increase awareness regarding the safe-
motherhood among population 15 and above
(man, women, elderly, influential, people)
2. 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
 Women education
 Family
 Influential people
1. Health Facility Level
 Responsiveness of providers
 Regular training
 24 Hrs working
 Private hiring for after 2pm services
 Private provider subsidy
1. National Level
 Local and regional Advocacy
 Inter-sectoral approach
 Political ownership
 Policy amendment/new policies
Community level
Intervention
 Women Education/awareness
 Health
 Hygiene/Nutrition
 Risk Signs recognition
 ANC Checkups
 Safe Motherhood
 Family
 Men( husband/head )
 Elderly ladies
 Influential people
 Imam/Religious leaders
 Counselors / Nazim
 Political Leaders
 MOST EFFECTIVE
INTERVENTION
CURATIVE PREVENTIVE
24 hrs availability: Increase awareness
 public health facility regarding family
 gynecologist/consulta health among general
community
nt
 USG services
 All people aged 15yrs
and above.
 Free Medication
 through liaison with
NGO’s
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
 Male and female out reach workers
 Private health care providers
 Phase 2 Training of personnel
 Phase 3 Pilot Programme
 Phase 4 Implementation
 Phase 5 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
TOKEN FOR
LHV’s REFERRAL

PUBLIC
LHW’s FACILITY
DHQ/THQ

LOCAL PRIVATE
NEAR WORKERS FACILITY SUBSIDIZED
MISSES SERVICES
5 Assumptions of
intervention
1. Involvement of religious scholars and
influential people
2. Support groups facilitation
3. Involvement of male members
4. Token scheme for ANC
5. 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
Salaries and Allowances 4 10

Regular staff 0.083

Staff hired for project 0.25

Monitoring 0.005 / comt /mon 6 15

Evlution

TA/ DA 0.25/quarter 2 5

Pilot Program

Conducting pilot project 0.006 /comt /mon 7.2 18

Logistics 0.0066/ 3 mon 2 5

IEC Material 0.008 /annum 0.8 2

Utilities 0.33 /month 4 10

Procurement of Durable Goods 6 (capital budget) 6 15

Multi Media/ Computers

4*4Pick up (total 3)

Repair and Maintenance 1/quarter 4 10

CONTINGENCIES 4 /annum 4 10

TOTAL 40 40 100
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. Beckers S,midth F.testing the effectiveness of including husbands
in safe mother hoodintervention.2003:249-261
2. 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
3. Fikree F, midth F.Maternal mortality in different pakistani
sites:ratios, clinical causes and determinents. Acta obstet
Gynaecol Scand 1997:637-645.
4. PAIMAN: Communication, Advocacy and Mobilization (CAM)
Strategy , USAID.
5. HUMAN RESOURCES FOR HEALTH IN THE PUBLIC SECTOR IN
PAKISTAN – 2006, National HIMS Program Ministry of health;
WHO Pakistan.
6. http://www. who.int/reproductive-
health/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