Assessment of Promoters and Barriers to Effective Health Services for Women and under 5 Children in

Communities

Study Rationale

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• Baseline for CHN• UC Kharak

Key Objectives1. Identify the barriers and promoters for MNCH

service availability, utilization accessibility and quality at the community level

2. Identify priority policies and interventions that can most reduce under 5 deaths & closely align with WV Pakistan’s MNCH program.

3. Guide CHN campaign strategy, in relation with WV Pakistan programs.

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Demographic Profile• District Population 3.58 million• Tehsil Muzaffargarh 1.35 million• Kharak (Rural Union council) 42,355• Estimated pregnancies/month 1524• Target Population in surveyed Households– Female Population 51%– Male Population 49%– <5 year 38%

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Study Methods HHS: 150 were randomly selected having

children under 2 years or pregnant at the time of survey

HFA: 3 BHUs, RHC and DHQH CCA: LHW, LHV & TBA (5 each) FGD: mothers and fathers (1 each) IDI: LHS and CMWs trainer (1 each) SSI: District and provincial health managers KII: Development partners

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Key Findings of our Research

ANC During Pregnancy

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Delivery & Early Newborn Care

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Delivery & Early Newborn Care

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Safe Delivery Practices

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Safe Delivery Practices

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Safe Delivery Practices

• Infants breast feeding after delivery – Immediately after birth 19%– Less than ½ hr 10%– ½ hr to 1 hr 17%– 1hr and 24 hrs 33%

• Infants who received Colostrum 63%

• Breast feeding awareness in CBAWs 83%

• PNC-1 follow-up 29%

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Birth spacingOpinion about Birth Spacing

2 years 57% 3 year 26% more than 3 years 16%

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Management Basics• Staff JDs were deficient at most surveyed

facilities• Service delivery protocols were not seen at

any of the surveyed facilities

• IEC Material deficient at most surveyed facilities

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ANC-1 at 3 BHUs

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Normal Delivery at 3 BHUs

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PNC-1 at Primary Health care Facilities

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Availability of medicines and lab services

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Community Perspective• LHWs and TBAs were recognized as “first

approach” health care providers for the community because people preferred to deliver within their community

• Community recognition, demand for functional public health facility and utilization is existent

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Recommendations 1. Community based care-CMWs2. Referral mechanism3. Increased awareness about ANC, SBA and PNC etc4. Enhanced supervision5. The HR -infrastructure -accessible health facilities6. Data and information system utilization7. Missed opportunities for Immunization8. Local level advocacy9. Horizontally integrated vertical programmes

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