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

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

4. DISTRICT PROFILE Area 6,857 Sq Km Pop Density- 242/sq.km Tehsils 6 UCs
72+3(Cantt areas)
Cities
Villages
440
Population
Tehsils wise population
Tehsil-Pindigheb
219450
Tehsil-Attock
281963
Tehsil-Hasanabdal
162328
Tehsil-Jand
262469
Tehsil-Hazro
282o17
Tehsil-Fatehjang
261974

5. 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

6. 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

7. 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 .

8. 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

9. Component -2- Training and Deployment of Community Midwives
Selected from Rural Union Councils
1per population
18 month training consisting of Theory &Practical in DHQ Hospital, RHCs & RHS-A.
Examination by NEB
Evaluation by DEC.
Deployment in communities.

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

11. Deployment of Community Midwives
To Increase acceptance Seminars in Community Medical Camping at CMW home.

12. 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.

13. Component -4- Strategic Communication for Maternal , Newborn & Child Health
Seminar at District Level.

14. 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

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

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

17. SKILLED BIRTH ATTENDENTS Deliveries by SBAs increased

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

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

21. 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

22. 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,

23. Still Mothers die Causes of Maternal Deaths

24. 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.

25. 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.

26. Proposed Strategies / Solutions for Improvements Two way Process
Improvement in services
Improvement in acceptability of services

27. 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.

28. 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

29. 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

30. 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

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