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

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

3. Ministry of Health 3 Child Health IMR – per 1000 live births 102 77 40 102 61 77 0 20 40 60 80 100 120 19902003-42015 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. Ministry of Health 4 Referral Hospital Tertiary University Hospital Secondary District Hospital Sub-district Hospital Primary Rural Health Centre Basic Health Units Facility-based care Outreach Family and Community Packages Health System

5. Ministry of Health The Lady Health Workers’ Programme

6. Ministry of Health 6  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 The Lady Health Workers’ Programme Unit Cost: $ 500-1000 per LHW per year $ 0.5 - 1 per person per year

7. Ministry of Health 7 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 The Lady Health Workers’ Programme:

8. Ministry of Health 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. Ministry of Health 9 Support to LHWs from PHC facilities is very weak: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:Need for upgrading knowledge and skills of LHWs in the areas of: –Community based child health care –Maternal and neonatal health issues What are the Gaps?

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

11. Ministry of Health 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. Ministry of Health 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. Ministry of Health Case Study- Community Based Interventions in Emergency

14. Ministry of Health 14 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 Earthquake 8th October, 2005

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

16. Ministry of Health 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’.

17. Ministry of Health 17 Expected Trend Observed Trend In Earth quake Affected Areas in Pakistan TIME Immediate deaths due to the disaster (1 st Wave in 1000s) Mortality from infections from wounds/non- treatment (2 nd wave in 1000s) Mortality from disease outbreaks/ epidemics (3 rd wave in 1000s) Immediate 0- 10 days0-45 days EQ (< 500 deaths) (< 50 deaths) Expected and actual trend of mortality after earthquake

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