1. Saving Children’s lives through Community based Interventions
Syed Anwar Mahmood
Federal Secretary (Health)
Government of Pakistan

2. Outline Community Based Interventions (CBI):
A success story- The Lady Health Workers’ Programme
Policy and Programmatic Response
Building Partnership
CBI in Emergency

3. Child Health IMR – per 1000 live births 153 million population
102 77 40 61 20 60 80
100
120
1990
2003-4
2015
GAP
153 million population
66% Rural
>22 million children
under 5 yr
300,000 infants die every year, out of which 160,000 are neonatal deaths;
51% of children are anemic and 37% are underweight.

4. Health System Tertiary Referral Hospital Secondary Facility-based care
University Hospital
Referral Hospital
Secondary
District Hospital
Sub-district Hospital
Facility-based care
Primary
Rural Health Centre
Family and
Community
Packages
Outreach
Basic Health Units

5. The Lady Health Workers’ Programme

6. The Lady Health Workers’ Programme
Initiated in 1994
Targets mainly community based MCH care through resident LHWs
Basic, refresher and continuing training
Basic medicines/ supplies/ IEC material provided for preventive care
System of supervision
Unit Cost: $ per LHW per year
$ per person per year

7. The Lady Health Workers’ Programme:
Intervention Areas:
Community Organization
Maternal Health
Child Health (ARI, EPI, CDD)
Nutrition
Family Planning
First Aid, Care of Sick - Common diseases and their prevention
Hygiene and Sanitation
Management Information System

8. Key Findings of the Third Evaluation of the LHWP
Significant impact on a range of health outcomes.
A substantial impact on the uptake of important primary health services which include:
Childhood vaccination rates;
Lower rates of childhood diarrhoea;
An increased uptake of antenatal services;
Positive impact on reversible methods of contraception.
Providing more services to low income households than any alternative service provider in the public sector.
Third Evaluation conducted by Oxford Policy Management Ltd – UK

9. Support to LHWs from PHC facilities is very weak:
What are the Gaps?
Support to LHWs from PHC facilities is very weak:
Poor vaccination services
SBA services – very low especially in rural area
Non availability of EmOC and referral services
Need for upgrading knowledge and skills of LHWs in the areas of:
Community based child health care
Maternal and neonatal health issues

10. Poor Performing Districts:
What are the Gaps?
Poor Performing Districts:
Lack of management capacities
Shortage of good trainers and supervisors
Need for Initiatives and reforms in LHWP for progress:
Programmatic interventions
Management and organization
Monitoring and evaluation system

11. Policy and Programmatic support
Policy/Strategic Documents:
National Health Policy
LHW Programme Strategic Document
Nutrition
EPI Policy
Population policy
Development and endorsement of an integrated MCH policy and operational plan
Harmonization of PRSP, MDGs related to MCH strategies

12. Building Partnerships
Global:
Joining the Global Partnership
National:
Provinces and district governments
Professional bodies
GoP sectoral partners
Development partners
Public Health Forum (April 2005)
Private sector, NGOs and civil societies

13. Case Study- Community Based Interventions in Emergency

14. Earthquake 8th October, 2005
Worst disaster in Pakistan
Deaths beyond 73,000 (70% were children and women)
Wounded more than 145,000
More than 5.5 million population affected
60-80% of health facilities destroyed
1,150 Patients Amputated
541 Spinal Injuries

15. 27,401 8,026 35,427 Mobilizing Health Workers
Total number of Health Professionals Mobilized
27,401
Community & Lady Health Workers
8,026
Total
35,427
Spray Teams
181 Team days
EPI Teams
4,062 Team days
Mental Health Teams 14
Medical/Surgical Teams 29
Public Health Teams 28
Health Education Teams 05

16. Lady Health Workers in Disaster Areas
Mapping of 3311 LHWs and 124 Supervisors completed (23 LHWs and 1 LHS died).
Rest of LHWs mobilized through:
Grievance counselling sessions
Regular meetings/ coordination with health
facilities/ supervisors
Provision of supplies and emergency medicines
LHWs worked as adhoc nursing staff in health facilities.
LHWs are now holding Grievance counselling and health education sessions with community.
Distributing 800,000 Hygiene & Sanitation kits among women.
Providing primary health care services in tented villages by establishing ‘Tent Health House’.

18. Support from Health System to CBIs is pre-requisite.
Conclusion
CBIs are effective not only in normal circumstances but also during emergencies/ disasters
Support from Health System to CBIs is pre-requisite.