situation of maternal health: pakistan
DESCRIPTION
Situation of Maternal Health: Pakistan. Dr. Nabeela Ali Chief of Party PAIMAN. Demographic Profile. Population164 Million Population Rural67% Growth Rate1.9% Total fertility rate4.1 births Contraceptive use30%. Public sector hospitals 906 Basic Health Units5,290 - PowerPoint PPT PresentationTRANSCRIPT
Situation of Maternal Health: Pakistan
Dr. Nabeela Ali
Chief of Party
PAIMAN
Population164 Million
Population Rural67%
Growth Rate1.9%
Total fertility rate4.1 births
Contraceptive use30%
Demographic Profile
Public sector hospitals 906 Basic Health Units
5,290 Population/Bed 1,536 Doctors
122,798 Nurses
57,646 Midwives
25,000 Lady health Workers
96,000
Issues in National Perspective
Every hour in Pakistan: Three women die due to maternal causes Thirty newborn babies die in first month of life
Interventions needed to reduce maternal and newborn mortality: Skilled Birth Attendance Referral and transportation systems Health facilities providing emergency
obstetric and newborn care (EmONC) Awareness of community on key health
messages and behaviors.
Maternal Health Indicators
Pregnant women receiving prenatal care
61%
Births attended by skilled personnel
39%
Women receiving postpartum care
22%
Source: PDHS 2007
Key Women’s Health Indicators
There are almost 29 million women of reproductive age
More than 5 million women become pregnant each year
Three delays (in decision making, in transportation, and in receiving care) contribute towards high MMR of about 350-500 per 100,000 live births
A large proportion of deliveries are conducted by unqualified personnel (62%)
Contraceptive Prevalence Rate is 30%-34%
Unmet need for FP is 33%
Women’s HealthTrends in Pregnancy &
Delivery
Where do we stand ?Where do we stand ?
CountryLife
Expectancy
Infant
Mortality
Rate
Under 5
Mortality
Rate
Population
Growth
Rate
Pakistan 64 74 98 1.9
Bangladesh 62 46 69 1.7
India 63 63 87 1.5
Source: Pakistan Economic Survey 2004-05
MMR by District, 1993
50
289
463
593
673
360
523
120
Karachi
Pishin
Lasbela
Loralai
Khuzdar
Abbottabad
Mansehra
Peshawar
Urban Rural Gap – “One” Antenatal Visits Urban Rural Gap – “One” Antenatal Visits
Source: PSLSM 2004-05
22%26%
40%
60%63%
66%
Target 100%
0%
20%
40%
60%
80%
100%
120%
1998-99 2001-02 2004-05 2008 2012 2015
Urban Rural Target
Recommended Four Antenatal Visits !!
•There is wide Gap between urban-rural for one antenatal visitThere is wide Gap between urban-rural for one antenatal visit
•Further, it is required to have at least 4 antenatalFurther, it is required to have at least 4 antenatal
•From 40% we have to reach 100% rural women seeking at least one antenatal visitFrom 40% we have to reach 100% rural women seeking at least one antenatal visit
Health – Human Resource Development Health – Human Resource Development
0
20000
40000
60000
80000
100000
120000
7th plan1993
8th plan1998
2000 2001 2002 2003 2004
Doctors Midwives Nurses LHVs LHWs
Status Quo in the number of LHV, Midwives and Nurses Status Quo in the number of LHV, Midwives and Nurses
0 20 40 60 80 100 120
Nepal
Bangladesh
Bhutan
Indonesia
India
Maldives
Myanmar
Sri Lanka
Thailand
DPR Korea
SBA% NMR/1000
Correlation between neonatal mortality rate and SBA
We Pledged in September 2000 The Millennium Development Goals
Goal 4Reduce child mortality by two
third between 1990-2015
Goal 5Reducing maternal mortality by
three quarters between 1990-2015
Status of MDG - Maternal Health (Goal 5)
MMR – per 100,000 live births
500
350
140
5
230
0
20
40
60
80
100
120
1990 2003/4 2015
GAPGAP
Target 2015: 140 per 100,000 live
births
Current rate: 350 per 100,000 live
births
At current pace MMR in
2015: 230 per 100,000 live
births
2000 20152005
15 years for achieving MDGs
Opportunity
Window10 years
Can Pakistan Achieve MDG
Goal 4 & 5 ?? Is our progress since 2000 on track ?
Slow Will business as usual work ?
No Are extraordinary measures
warranted? Yes
The triangle of death……
Lack of awareness
Unskilled birth attendants
Poor access to EmONC
Traditional culture of birthing
Continuum of Care Scenarios
Family TBA Skilled Attendant
Nursing Care
Obstetrician
Poorly developed Intermediate Well developed
Rationale: Linking High Priority to SBA More than 75% of deliveries take place at home
in rural communities The postpartum period is one of the most
vulnerable for both mother and newborn, yet neither health programs nor mothers and families recognize this vulnerability.
For mothers, death at delivery, immediately thereafter, and during the first week of the baby’s life account for more than 60%
For newborns 50% of deaths are within 72 hours after delivery (The World Health Report 2005).
Add to this mounting death toll the stillbirths that alone total nearly 3.3 million annually.
Government’s Response To Achieve MDGs MNCH Cell created in the Ministry National MNCH Policy and Strategic Framework
developed Prime Minister endorsed the National MNCH
Program in April 2005 Islamabad Declaration unanimously adopted by
Federal, Provincial, District Governments and development partners
PC-1 implementation started as of June 2007 12,000 Community Midwives (CMWs) to be
trained in next five years.
Investment in health is growing but is not enough
CURRENT HEALTH INVESTMENT BY GoP & PARTNERS 2004-5
MoH & DoHs74%
MoPW5%
UN system5%
Bilaterals6%
Multilateral10%
GoP (MoH & DoHs)= Rs 45 billions
Partners= Rs 11 billions
Priority Areas Community Midwives trained and placed in rural
communities Provision of Basic and Comprehensive EmONC
services Comprehensive family planning services Nutrition interventions National Program for FP & PHC Creating awareness and demand for services
H om e
LHW
TBA
Village
CEmOc
DHQ/ THQ
Obstetric Emergencies (bypass RHC)
BEmOC
BHU/RHC
IEEC
11
Training22
Training33
Upgrade, Train
55
Transport44 Upgrade,
Train
66
From Home to Hospital
CMW
A Shared Responsibility
Mother The woman prepares for birth and values and seeks skilled care during pregnancy, childbirth and postpartum period
Family The family supports the pregnant woman’s plans during pregnancy, birth and postpartum period.
Community The community advocates and facilitates preparedness and readiness to carry out the required actions.
Provider The provider is responsible for providing skilled care during normal and complicated pregnancies, birth, and postpartum period in accordance with the standards specified in the protocols.
Facility The facility must be adequately equipped, staffed, and managed in accordance with the QA service standards to assure that skilled care is provided for the pregnant woman and the newborn.
Policymakers Policymaker creates an environment that supports the survival of the pregnant woman and the newborn.
Challenges at Hand
CBI……. The Rationale …Low & Inequitable Distribution of Health Resources
Tertiary Hospital
Secondary Health Care
PHC
1%
9%
90%
PopulationServed
40%
45%
15%
Health Expenditure
(Source: P&D Division 1994)
PHC Wing ,Ministry of Health
Health–Human Resource Development
0
20000
40000
60000
80000
100000
120000
7th plan1993
8th plan1998
2000 2001 2002 2003 2004
Doctors Midwives Nurses LHVs LHWs
Status Quo in the number of LHV, Midwives and Nurses
Confidence in Public Sector Facilities?
Source: PSLSM 2004-05
72%
20%
5%
2% 2%3%
1%
64%
21%
4%2%
1%
7%
2%
67%
21%
2% 2% 1%
5%
1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Private Disp/Hosp
Public Disp/Hosp
RHC/BHUs Hakeem Homeopath Chemist Others
Urban
Rural
Overall
Quality issue lead to lack of confidence in Public sector which is resulting in high out of pocket expenditure for the poor
Communication Challenges Information gaps regarding MNH behaviors Wide spectrum of population Cultural barriers Mass media penetration Reaching out to women behind walls
Media Support Increasing awareness and demand for
MNH services through communication strategies that empower individuals and communities to seek and expect quality MNH services
Advocacy for positioning Safe Motherhood as a key human and development issue.
Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it is the only thing that ever has.
Margaret Mead