By: Dr. Saeeda KhatoonDMCH, MCPS.

Ex. Public Health Specialist,

MNCH Attock.

MNCH Program, District Attock

Contents   Introduction to the key

interventions and achievements

   Bottlenecks/the difficulties faced

   Lessons Learnt and Way forward

• Area6,857 Sq Km Pop Density-

242/sq.km• Tehsils 6 • UCs 72+3(Cantt areas)• Cities 6• Villages 440• Population 1519855

• Tehsils wise population

Tehsil-Pindigheb 219450

Tehsil-Attock 281963

Tehsil-Hasanabdal 162328

Tehsil-Jand 262469

Tehsil-Hazro 282o17

Tehsil-Fatehjang 261974

DISTRICT PROFILE

Health Facilities Sr.No Name of HF No. of HF

1 District Headquarter Hospital 01

2 Tehsil Headquarter Hospital 05

3 Rural Health Centers 05

4 Basic Health Units 62

5 MCH Centers 09

6 Others (Dispensaries)

7 Training Centers Public Health Nursing School

01

General Nursing School

01

DHDC 01

National MNCH ProgramComponent-wise Interventions

Integrated Delivery of Comprehensive MNCH Services

Training and Deployment of Community Midwives Provision of Comprehensive Family Planning Services Strategic Communication for Maternal , Newborn &

Child

Health Strengthen Program Management

Component -1-Integrated Delivery of Comprehensive MNCH

Services

Infrastructure renovation of all THQ &DHQ Hospitals has been done.

Necessary Equipment ensured in Primary & Secondary Health Care Facilities including Color Doppler in DHQ.

Skills assessment of SBA done, Proper Referral .

Provision of 24/7 Basis EmONC Services at RHCs

Basic EmONC Training of staff with local resources.

USG Training of WMOs of RHCs LHVs were trained in Basic EmONC at PIMS. IMNCI Training of MO & WMO & LHVs.

Sr.No. Cadre No. of Participants

1 Woman Medical Officers 05

2 Charge Nurses 07

3 Lady Health Visitors 66

Component -2- Training and Deployment of Community

Midwives

Selected from Rural Union Councils 1per 10000 population 18 month training consisting of Theory

&Practical in DHQ Hospital, RHCs & RHS-A. Examination by NEB Evaluation by DEC. Deployment in communities.

New Initiative for CMWs basic health support (First Aid) in collaboration with Rescue 1122.

Construction of CMW school buildingMonitoring of Training

Training

Deployment of Community Midwives

To Increase acceptance Seminars in Community Medical Camping at CMW

home.

Component -3- Provision of Comprehensive Family

Planning Services

DCO/DPWD/EDO (Education) were involved for improvement of FP services.

Refresher training of deployed CMWs. Regularly collection, analysis,

compilation and submission reports. Consolidated Demand submission. Motivational session at Girls high

School arranged in collaboration with DPWD and Education department.

Component -4-Strategic Communication for Maternal , Newborn &

Child Health

Seminar at District Level.

Component -5-Strengthen Program Management

TEAM WORK

Seminar at CMW Community level and Community meetings.

Monitoring and Supervision of Health Facilities and CMWs .

Financial Management:-

Monthly reporting: Health Facilities performance reports. CMWs performance reports. PHS/SO performance report. Monthly Expenditure report. Verbal Autopsy reports. Civil work status report.

Monthly meetings:- EDO(Health), MS, SMO, Gynecologist, MO I/C, LHVs, CMWs

TEAM WORK

Component -5-Strengthen Program Management

REGULAR MEETINGS WITH 1: DEPLOYED CMWS 2: LHVS 3:WMO (MNCH) TO IMPROVE MNCH SERVICES.

AchievementsANTENATAL CARE

No. of ANC consultations increased at Health Facilities (SOURCE DHIS)

SKILLED BIRTH ATTENDENTSDeliveries by SBAs increased

Distribution of Contraceptives

Regular supply of contraceptive ensured at health facilities & at CMW Home.

CMWs PerformanceANC & Deliveries by CMWs Family Planning Consultations

by CMWs

CMW PerformanceCMWs are performing better then their area Basic

Health Units

BHU Name

No. of Deliveries conducted 1/2013 to 5/2013 at BHU

No. of Deliveries conducted 1/2013 to 5/2013 by CMWs

CMW Name

BHU Kotsundki 10 18 Komal Saba

BHU Bolianwal 15 21 Uzma Bibi

BHU Sarwala 11 12 Gulnaz Manzoor

BHU Sojanda 13 14 Rubina Nisar

BHU Jangla 15 20 Sadia bibi+Iram Naz

BHU Kharpa 13 14 Niak Bakhat

GRD Nara 0 30 Tasarad Bibi

MCHC Thatta 0 13 Sobia Bibi

BHU Shamsabad

09 15 Farzana Sadique

GRD Makhad 0 20 Naseer Fatima

Reports Leading to further Actions

Critical analysis of Verbal Autopsy reports.

Meeting with local Dai’s of concerned communities

Meeting with Care Provider in HF

Liaison of CMW & local Dai’s,

Still Mothers dieCauses of Maternal Deaths

Barriers to Achieve MDGs 4&5

Shortage of Specialists at THQ Hospitals. Lack of linkage between places of service provision Health Facilities Accessibility problems. Weakness in skills. Lack of commitment. Problems of accountability. Less well functional health committees Lack of communication between patient/client and service

providers.

Difficulties faced related to CMWs Cultural prohibition in some areas. Suitable candidates (Married women) not found Training deficiencies & Inadequate skills Scattered catchment population & difficulties in

transportation (CMW’s Mobility and Security problems)

Financial Problems of CMWs Lack of communication & uncooperative HF Staff. Strong hold of local Dai.

Proposed Strategies / Solutions for Improvements

Two way Process

Improvement in services

Improvement in acceptability of services

Proposed Strategies / Solutions for Improvements

Two way Process

Improvement of services (Preventative, Basic & Comprehensive EmONC)

• Vacant post should be filled in HF• Strengthening of CMW’s Role. • Interlinking of places of service provision.• Improvement of Skills.• Job description at all levels to remove overlap of functions.• Efficient Transportation of referred patients.• Strong commitment at all levels.• Effective Monitoring & Evaluation.• Accountability.

Proposed Strategies / Solutions for Improvements

Two way Process

Improvement in acceptability of services Improved motivation1. Community Participation in selection of CMWs.2. Motivational campaign at provincial , District &Community

levels.3. Fully Functional Health Committees in communities.4. Involvement of Community Representatives for acceptance

of CMW in community. Building confidence1. Participation of care providers CMWs & other Community

health Workers in Motivational sessions.2. Improved Communication .

d

Proposed Strategies / Solutions for Improvements

A continuum for Maternal� Newborn and Child Health

Proposed Strategies / Solutions for Improvements

Places involved

Human Resources involved

LHW,CMW & LHV

BH U

RHC

THQ/DHQ

LHS,LHW.CMW

Medical Officer, LHV MWs (BHU level)

Gynecologist, WMO

(RHC,THQ and DHQ

Level)

PHS,DDO (H) SO, DC NP, Tutors CMW

(for monitoring )

WMO,LHV/ Motivator

(FWC PWD)

CMW Home Basic Health Unit

RHC, THQ & DHQ

MNCH Program & National Program

Population Welfare

Department

Thank YouHoping for the Best

NATIONAL MATERNAL NEWBORN AND CHILD HEALTH PROGRAM