Pakistan: Building capacity to ensure maternal and child health needs can be met in a sustainable way

Published: 18 May 2015 13:53 CET

By Aradhna Duggal, IFRC Health Communications

Since the 1990s, Pakistan has reduced its maternal mortality ratio by 50 per cent and infant mortality ratio by 30 per cent. However, it still remains off track with regards to meeting targets of Millennium Development Goals 4 and 5. The majority of under-five deaths are due to birth asphyxia, infections, pneumonia, diarrhoea and severe malnutrition. In terms of under-five mortality, it ranks 26 in the world (UNICEF). Pakistan remains one of only three countries in the world with endemic polio.

Multiple disasters such as earthquakes and floods coupled with armed violence has resulted in much damage and destruction to the social infrastructure including health facilities, especially in the tribal and rural areas of Pakistan. This situation has been further exacerbated by a shortage in nurses, paramedics and skilled birth attendants. Furthermore, there are major disparities between urban and rural areas in terms of access to health services. Routine immunization access and coverage in both urban and rural settings, remains a challenge.

The Pakistan Red Crescent Society operates three basic health units and one mobile health unit in three districts – Quetta, Sibi and Chamman, providing curative and preventive health services with special focus on mothers and children. The teams include male and female doctors, lady health visitors (part of the Government of Pakistan launched programme for family planning and primary care in 1994) and two community mobilizers, linking the communities with the formal health system.

The basic healthcare services package includes appropriate clinical and preventive services with access to free medicines. The priority diseases being treated include diarrhoea, acute respiratory tract infections and malnutrition among children.

In some areas, literacy levels are low and cultural values do not encourage women to make independent decisions. The National Society also provides counselling sessions to tackle cultural beliefs that prevent women from using family planning services as well as health checks and access to contraceptives. There has been a significant increase in uptake of family planning services, growth monitoring and child immunization.

In 2013, the four clinics run by Pakistan Red Crescent Society provided basic healthcare services to more than 70,000 vulnerable people including 27,000 women and 28,000 children. During the same period 15,000 clients accessed family planning services, 4,200 children were screened for growth monitoring and 4,400 children immunized for vaccine preventable diseases.

In another project, the Swiss Red Cross, in collaboration with the Aga Khan University and their local partner Mother and Child Care Trust, is contributing to the pool of lady health visitors by training and expanding midwifery skills and increasing their number at different levels of healthcare, i.e. village, basic health unit and secondary health provider (the thesil [administrative division] headquarters and district hospital) in rural areas of Dadu district, Sindh province.

The mother-in-law of a pregnant woman says, “We are very happy with the services this hospital [tehsil headquarters hospital] has given to us. We are poor, we cannot pay, but still everything is available. We are treated nicely with good behaviour by the staff. I brought my daughter-in-law to deliver here because I have full trust in the staff and that all goes well”.

The lady health visitors receive training in emergency obstetric care and resuscitation techniques and have access to emergency medicines. Furthermore, they receive regular on-the-job training not only in technical terms, but also in good conduct and behaviour, as well as in maintaining cleanliness and sterility. The lady health visitors are on call around the clock for deliveries, and conduct regular home visits. In cases of complications and emergency delivery, they go the extra mile and accompany pregnant women to the nearest hospital with vehicles specially available for emergencies. At the referral hospital, a lady health visitor is responsible for the quick administration and treatment of the referred pregnant women. The project is fully embedded in the governmental public health system and enjoys good collaboration among the different partners in health.

To improve infrastructure facilities, the maternal newborn and child health bay and paediatric wards in the thesil headquarter hospital has been renovated and equipped with the necessary instruments and essential lifesaving medicines. Likewise, basic health units have received essential medicines and equipment. Additional staff for medical care have also been hired. All medicines are available free of cost.

Furthermore, community mobilization activities to sensitize the community to the services and the transport system so that they can access the facilities are also carried out. The male community mobilizers support lady health visitors in raising awareness about safe delivery in a public facility among male members of the household.

The scale-up and presence of health workers who have been trained as midwives in target communities of Sindh province has resulted in an increase in uptake of antenatal care services by 50 per cent in basic health units and 100 per cent in the district hospitals. In two out of five basic health units the institutional deliveries have increased three-fold. In the district hospital the figures have gone up by more than two-fold. The utilization increased because of better level of quality of care being provided by medical staff, 24-hour attention, improved infrastructure, availability of drugs and improved quality of care and behaviour by the trained staff.

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Community health volunteers’ connections to the community and understanding of the context ideally places them as key resources in developing locally appropriate responses to health issues, encouraging community engagement and promoting sustainability thus improving access to reproductive, maternal, newborn and child health. The lady health visitor programme is key to provision of healthcare for rural women and children enabling them to access services at their doorstep.