rashid_increasing utilization and managing mnh services in pakistan

8/2/2019 Rashid_Increasing Utilization and Managing MNH Services in Pakistan

1/23

Chief Ministers Health Initiativefor

Attainment & Realization ofMDGsCHARM

Revitalizing Maternal health care in 7 Districts of Punjab


2/23

GOAL !

Reducingmaternal, infantand child

mortality andmorbidity by

targetingpreventable

causes


3/23

CountryPakistan

Iran

Turkey

Source: State of World Population, 2010

MMR276

33

44

IMR72

18

26

CPR32

70

71

Inst. Del30%

97%

90%


4/23

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


5/23

HealthServices

Tertiary Care


6/23

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


7/23

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


8/23

Household

Basic

EmONC

Facility

(BHU/RHC)

Comprehensive

Facility

(THQ/DHQ)

Teaching

Hospital

LHW

PGR


9/23

Layyah


10/23


11/23

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


12/23

To expedite transfer of informationfrom community to central MIS

To have Immediate feedbackautomatically from the system

To reduce HR requirement for data

entry


13/23

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


14/23


15/23
http://utrack.ufone.com/syntracx/login.phphttp://utrack.ufone.com/syntracx/login.phphttp://utrack.ufone.com/syntracx/login.phphttp://utrack.ufone.com/syntracx/login.phphttp://utrack.ufone.com/syntracx/login.phphttp://utrack.ufone.com/syntracx/login.php


16/23

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


17/23

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


18/23

Effective and efficient reporting andmonitoring

Time saving

Cost effective

Quality Assurance

Immediate data entry

Immediate feed back


19/23

25

136 145164

145 141

Baseline Q 1 Q 2 Q 3 Q 4 Q 5

Average ANC: BHUs

1

18 20

3037 34


Average Deliveries: BHU

2

2228 36

5863


Average PNC: BHUs

3

2023 22

26 27


Average FP: BHUs


20/23

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)


21/23

FreeTreatment

Incentivesto mothers

(NBK, CDK)

Safety andsecurity to

female staff


22/23

Shortage of funding after devolution Integration

Building partnerships

Scaling up Phased approach


23/23

rashid_increasing utilization and managing mnh services in pakistan

Documents