Saving Children’s lives through Community based Interventions

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. IMR– per 1000 live births 120 102 102 100 77 80 77 GAP 61 60 40 40 20 0 1990 2003-4 2015 Child Health • 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 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. TheLady 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: $ 500-1000 per LHW per year $ 0.5 - 1 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 byOxford Policy Management Ltd – UK

9. 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. 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. 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’.

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

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