National Conference of Helping Hand: Save Mothers Save Future MDG 5

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National Conference of Helping Hand Save Mothers
Save FutureMDG 5IMPROVING MATERNAL HEALTH in
PAKISTAN Evidence-informed policy Advocacy,
Approaches Tools, Access to utilization and
Strengthening Health Systems for quality maternal
health careAn overview of situation in
PakistanMaternal Health in Maternity

• Dr. FH Mian
• Health Section
• Planning Commission
• Government of Pakistan
• Islamabad, November, 2013

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Mother, Mother-ship Maternity

• The sweetest word in practice
• The holiest status in spirit
• The noblest of creature for nature
• The hardest job in performance
• The worst of exposure to odds
• The difficult most labors in delivery
• The difficult most period of life
• The weakest nutrition in foods
• The poorest access to health services

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Magnitude of Issues in Maternity

• Demographic profile
• Total population 184.4 millions
• Female population (15-49 years) 89.06 millions
• Rural population 114.5 millions
• Rural female (15-49 years) population 55.3
  million
• Total fertility rate 3.3
• Female life Expectancy at birth 66.5 years
• Mortality due to maternal causes
• National 276/100,000 live birth
• Baluchistan 768/100,000 live birth
• Skilled birth attendance 45
• Female literacy Rate Total 47 Rural 35
• Iron deficiency anemia 51
• Access to piped drinking water Total 35
  rural (21)
• Access to safe sanitation 61

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Maternal Health in Public Sector

• Tertiary healthcare facilities 49
• District Headquarter hospitals 135
• Tehsil Headquarter hospitals 762
• Rural Health Centers 560
• Basic Health Units 5263
• Maternity Child Health Centers 963
• Number of Community Mid Wives 31,503
• Numbers of Lady Health Workers 92,758
• Number of lady health visitors 13,678

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National Maternal, Newborn Child Health Program

• Development financing in the project
• Capital cost of the project Rs. 20 billions
• DFID financing 90 millions sterling pounds
• AusAID financing 30 millions Australian
  dollars
• Expenditure till June, 2013 Rs. 3.09 billions
  out of GOP 67 million pound out of DFID
  support 14 million Australian dollar out of
  AusAID assistance
• Major objectives in maternal health
• Improvement in health status of poor
  marginalized mothers through
• Integrated delivery of comprehensive MNCH
  services at district level
• Trainings deployment of Community Midwives
• Provision of comprehensive family planning
  services
• Strategic communication for MNCH
• Strengthening of Program Management
• Partnership arrangement through TRF RAF
• Technical Assistance
• Research studies

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Performance of the NMNCH Program

• Antenatal Coverage
• Urban as 85 Rural as 65
• Skilled birth attendance
• Urban as 65 Rural as 45
• Improvement of emergency obstetric care at 104
  DHQ 142 THQ hospital
• Community Midwives
• 8927 trained
• 7232 deployed
• Renovation of 594 first level care facilities
• Provision of kits to Midwives
• RAF funded 52 research projects
• TRF provided TA in 112 districts

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Additional Assistance in Maternal Health

• Women Health Project
• National Program for PHC Family Planning
• Elimination of Neonatal Tetanus in EPI
• National Blood Transfusion
• Social health insurance
• Norwegian government assistance
• UN family WHO assistance
• Save the Children Fund assistance in postnatal
  care
• MCH-USAID-Sind

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Reforms in Health Sector

• 18th Amendment in Constitution of Pakistan
• Devolution of health sector to provinces
• Federal funding to devolved projects in 7th NFC
  Award
• Regularization of Lady Health Workers
• Coordination at federal level
• Provincial financing in devolved development
  projects
• Pakistan Primary Healthcare Initiative
• Social health protection in maternity

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Issues Challenges in Maternal Health

• Sustainable financing by provinces
• Skilled birth attendance in maternity
• Technically approached behavior change
  communication
• Advocacy for technical approach in family
  planning
• Social health insurance through social protection
• Establishment of 24/7 emergency services at FLCF
• Effective referral system with feedback
  follow-up mechanisms
• Use of innovative technologies, e-health
  m-health
• Provision of blood transfusion services at RHC
• Domestic working mothers their daughters
• Maternal health of rural poor illiterate women
• Mothers among Internally Displaced Persons
• Mothers of Urban Slums in rapid urbanization

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Way Forward in Maternal Health

• Integrated approach of development programming
• Attention to post natal care
• Evidence based estimation of MMR
• Health System Strengthening
• Skilled birth attendance in designing of maternal
  health developments
• Health insurance through social protection
• Economic growth oriented planning
• Health management information system
• Advocacy awareness for behavior change
  communication