MNCH Program, District Attock By: Dr. Saeeda Khatoon DMCH, MCPS. Ex. Public Health Specialist, MNCH Attock.

Contents Introduction to the key interventions and achievements    Bottlenecks/the difficulties faced    Lessons Learnt and Way forward

DISTRICT PROFILE Area 6,857 Sq Km Pop Density- 242/sq.km Tehsils 6 UCs 72+3(Cantt areas) Cities 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

Health Facilities Sr.No Name of HF No. of HF 1 District Headquarter Hospital 01 2 Tehsil Headquarter Hospital 05 3 Rural Health Centers 4 Basic Health Units 62 5 MCH Centers 09 6 Others (Dispensaries) 7 Training Centers Public Health Nursing School General Nursing School DHDC

National MNCH Program Component-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.

Training Construction of CMW school building Monitoring of Training New Initiative for CMWs basic health support (First Aid) in collaboration with Rescue 1122.

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 Monitoring and Supervision of Health Facilities and CMWs . Financial Management:- Monthly meetings:- EDO(Health), MS, SMO, Gynecologist, MO I/C, LHVs, CMWs Seminar at CMW Community level and Community meetings. Monthly reporting: Health Facilities performance reports. CMWs performance reports. PHS/SO performance report. Monthly Expenditure report. Verbal Autopsy reports. Civil work status report. TEAM WORK

Component -5- Strengthen Program Management REGULAR MEETINGS WITH 1: DEPLOYED CMWS 2: LHVS 3:WMO (MNCH) TO IMPROVE MNCH SERVICES.

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

SKILLED BIRTH ATTENDENTS Deliveries by SBAs increased

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

CMWs Performance ANC & Deliveries by CMWs Family Planning Consultations by CMWs

CMW Performance CMWs are performing better then their area Basic Health Units BHU Name No. of Deliveries conducted 1/2013 to 5/2013 at BHU 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 20 Sadia bibi+Iram Naz BHU Kharpa Niak Bakhat GRD Nara 30 Tasarad Bibi MCHC Thatta Sobia Bibi BHU Shamsabad 09 Farzana Sadique GRD Makhad 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 die Causes 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 motivation Community Participation in selection of CMWs. Motivational campaign at provincial , District &Community levels. Fully Functional Health Committees in communities. Involvement of Community Representatives for acceptance of CMW in community. Building confidence Participation of care providers CMWs & other Community health Workers in Motivational sessions. Improved Communication . d

Health Facilities Primery & Referral care Proposed Strategies / Solutions for Improvements A continuum for Maternal, Newborn and Child Health Adolescence Pre- pregnancy Pregnancy Birth Post partum Neonatal Post natal Maternal Health Infancy Childhood Linking the Places of care giving Health Facilities Primery & Referral care Communities House hold

Proposed Strategies / Solutions for Improvements Human Resources involved LHW,CMW & LHV 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) BH U RHC Places involved CMW Home Basic Health Unit RHC, THQ & DHQ MNCH Program & National Program Population Welfare Department THQ/DHQ

Thank You Hoping for the Best NATIONAL MATERNAL NEWBORN AND CHILD HEALTH PROGRAM Hoping for the Best