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

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

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.

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

The Lady Health Workers’ Programme

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

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

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

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

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

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

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

Case Study- Community Based Interventions in Emergency

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

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

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’.

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.