Rashid_Increasing Utilization and Managing MNH Services in Pakistan
Transcript of Rashid_Increasing Utilization and Managing MNH Services in Pakistan
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Chief Ministers Health Initiativefor
Attainment & Realization ofMDGsCHARM
Revitalizing Maternal health care in 7 Districts of Punjab
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GOAL !
Reducingmaternal, infantand child
mortality andmorbidity by
targetingpreventable
causes
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CountryPakistan
Iran
Turkey
Source: State of World Population, 2010
MMR276
33
44
IMR72
18
26
CPR32
70
71
Inst. Del30%
97%
90%
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Health Allocations 2005-06 to 2010-11
0
5000
10000
15000
20000
25000
30000
35000
40000
2005-06 2006-07 2007-08 2008-09 2009-10 2010-11
years
healthallocationsR
s.
inmillion
Federal MoH
Punjab
Sindh
KPK
Balochistan
Courtesy: Dr. Asad Hafeez
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HealthServices
Tertiary Care
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Human Resources:
Insufficient human resource / Vacant Post Insufficient skills of HCPs
Lack of accountability (Absenteeism)
Inappropriate behavior / attitude of HCPs
Weak Linkages of community with HealthFacility
Disintegrated services
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Integrated RH, FP, Nutrition and Immunization Services
Community BasedInterventions, Child
Health Weeks, IMNCI
Social Mobilization, Awareness,Motivation
(Health Education Seminars)
NGO workers/ Motivators /
Volunteers
LHWs,CMWs
Facility Based
Interventions
Basic EmONC
BHUs
1. Additional HR
2. Ensuring 24/7services
RHCs
(MinimalSupport)
Comprehensive EmONC
(Minimal Support andStrengthening)
RHC THQ DHQ
Monthly
Rotation of PG
Students from
Tertiary Care
Rotation of
WMOs along
portable USG
(Once a week)
Community mobilization and
awareness about ANCs, Birth
Preparedness Delivery by
SBA, PNCs & FP
SMS/Online Report Submission
SMS/Online Monitoring using
web based software
Ambulance Service
Ambulance
Pay for
performance
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Household
Basic
EmONC
Facility
(BHU/RHC)
Comprehensive
Facility
(THQ/DHQ)
Teaching
Hospital
LHW
PGR
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Layyah
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Monitoring of monitors byuse of android basedhandsets
Linkage with communitythrough voice messagesfor achieving MDG 4 and 5
Initial Phase: 7 Districts
Will be replicated acrossprovince from July
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To expedite transfer of informationfrom community to central MIS
To have Immediate feedbackautomatically from the system
To reduce HR requirement for data
entry
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Reports received from each BHU by SMS Daily Report
Delivery Report
Referral Report
Monthly reports received in excel format Online reporting system: Development in progress
http://punjabmodel.gov.pk/health_reports/daily.phphttp://punjabmodel.gov.pk/health_reports/delivery.phphttp://punjabmodel.gov.pk/health_reports/delivery.phphttp://punjabmodel.gov.pk/health_reports/daily.php -
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Central Serverat Provincial
Level
Patient/Client
Monitors
MS/Inchargeof CEmONC
Facility
Congratulations & FeedbackFP Advice
IYCF AdvicePNC/Vaccination Advice
LHV atfacility
Daily reportReferral reportDelivery report
Referralinformation
Compiled reportsIndividual Staff MembersFacility wiseDistrict compiled reportProvincial Compiled report
LHS reporting& monitoring
FinalOutcome
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ChildBirth
Confirmation Message tostaff
First message to client:Congratulations,feedback & complaints,
advise for early initiationof breast feeding
CentralServer
Way Forward:Voice Messagesinstead of text
messages
Second message to client:Exclusive breast feeding,
immunization: BCG & Poliozero, Post natal checkup
Third message to client:Immunization, Post natalcheckup, family planning
Immunization ReminderMessages based on EPISchedule and date of birthsubmitted by LHW
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Effective and efficient reporting andmonitoring
Time saving
Cost effective
Quality Assurance
Immediate data entry
Immediate feed back
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25
136 145164
145 141
Baseline Q 1 Q 2 Q 3 Q 4 Q 5
Average ANC: BHUs
1
18 20
3037 34
Baseline Q 1 Q 2 Q 3 Q 4 Q 5
Average Deliveries: BHU
2
2228 36
5863
Baseline Q 1 Q 2 Q 3 Q 4 Q 5
Average PNC: BHUs
3
2023 22
26 27
Baseline Q 1 Q 2 Q 3 Q 4 Q 5
Average FP: BHUs
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25 1 2 3
400
14737 58 26
1150
ANC Delivery PNC FP OPD
Baseline @Rs. 240,000 per monthCurrent Running Cost @Rs. 80,000 per month (additional)
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FreeTreatment
Incentivesto mothers
(NBK, CDK)
Safety andsecurity to
female staff
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Shortage of funding after devolution Integration
Building partnerships
Scaling up Phased approach
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