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A STRATEGY TO REDUCE

MATERNAL MORTALITY IN
DISTRICT GUJRAT

Company
LOGO
Company
LOGO

GROUP - 5

MSPH - 2009
Health Services Academy

TEXT TEXT TEXT


Dr. Abdul Dr. Dr.
DR. Fizza
Wali Khan Shumaila Hammad
Company
LOGO Agenda

1. INTRODUCTION

2. PROJECT

3. STRATEGY

4. ACTIVITY PLAN & GANTT CHART

5. BUDGET

4. LIMITATIONS
Company
LOGO

INTRODUCTION

DR. FIZZA
Company
LOGO INTRODUCTION
 Maternal health refers to the health of women
during pregnancy, childbirth and the postpartum
period
 Each year over half a million women in low-
income countries die from complications
associated with childbearing

 99% of maternal deaths occur in developing


countries.

 1/3 of them occur in SEA.

 Millions more suffer pregnancy-related


morbidities and chronic long-term disabilities
related to pregnancy and childbirth
Company
LOGO Introduction cont . . .
 How can one integrate nutrition and
reproductive health?
 Programs need to go beyond the global aim
of reducing fertility and mortality
 Adolescent girls should be included in
supplementary-feeding programs before
malnutrition becomes a causative factor in
maternal mortality
 The nutrition component of existing prenatal
programs needs to be stable measured in
terms of maternal anthropometry instead of
just infant survival
Company
LOGO
Company
LOGO PREVALENCE OF ANEMIA BY PROVINCE (PERCENT)

80
Pregnant women All women

60

40

20

NWFP Punjab Sindh Balochistan Pakistan


Company
LITERACY RATES FOR PUNJAB DISTRICTS –
LOGO BY MALES AND FEMALES
LiteracyRatesforPunja
R
bD
an
istricts
kedfro mHighesttoLowestRa
– b
te
yM
sforM
a
a
le
le
sa
s
ndFemalesaged10+years

FemaleLiteracyRates MaleLiteracyRates

Raw alpindi 68 87
Chakw al 57 84
Jhelum 59 78
Sialkot 65 75
Lahore 67 75
Attock 40 73
G ujrat 57 73
M ianw ali 37 73
G ujranw ala 62 72
Narow al 49 72
Sargodha 46 69
T.T.Singh 46 68
Khushab 36 68
Faisalabad 52 68
Mandi Bahauddin 48 66
Hafizabad 44 64
Sahiw al 45 64
Khanew al 36 62
Jhang 31 60
Layyah 32 59 %E xcess
Sheikhupura 41 58 ofMalesto
M ultan 35 56 F
e males
Vehari 30 56
Pakpattan 30 55
Bahaw alnagar 34 54
D.G .Khan 24 54
O kara 33 53
Bhakkar 20 53
Rahim yarKhan 31 52
Lodhran 23 51
Kasur 32 51
M uzaffargarh 22 48 ExcessofMa les
Rajanpur 20 47 Females overFemales

Bahaw alpur 28 47

0 10 20 30 40 50 60 70 80 90 100

%Literate
Company
LOGO Causes of Maternal Deaths
(Pakistan)
H e p a t it is
A n e m ia H o s p iCt a ol m m u n i t y
A b o r t io n - r e la t e d
O b s t. L a b o r
T o x e m ia
S e p s is
H e m o rrh a g e
0 5 10 15 20 25 30 35 40
MMR 276
Company
LOGO

276,000 women
suffer from
maternal illness and
disability
Company
LOGO

GUJRAT
Company
LOGO

AREA 3192 Sq .km


 District Gujarat an
ancient district of POPULATION 2.54 MILLION
Pakistan located in
between two famous
rivers, i.e., River POPULATION 642/KM (2)
DENSITY
Jehlum and River
Chenab in Province URBAN 25.62%
Punjab POPULATION
Company
LOGO GUJRAT VS PUNJAB
Gujrat vs Punjab Health Indicators (MICS-Punjab; 2007-08)

Indicator Gujrat Punjab Year

Care provided by LHW 75% 50% 2007-08

Total fertility rate 5.5 4.7 2003-04

Use of contraception (any method) 37% 32% 2007-08

Ante-natal care 85% 53% 2007-08

Post-natal care 65% 41% 2007-08

Skilled attendant delivery 68% 43% 2007-08

Institutional deliveries 60% 38% 2007-08


Company
LOGO URBAN-RURAL POPULATION
DISTRIBUTION OF GUJRAT
P o p u la tio n d is trib u tio n o f d is t. G u jra t

U rban
28%

Rural
Urban

Rural
72%
Company
LOGO
Company
LOGO

PROJECT
DR. SHUMAILA
Company
LOGO ASSUMPTIONS FOR MATERNAL MORTALIY

Preventive Curative

1 Nutritional deficiency Home based deliveries

2 Lack of awareness Lack of skilled birth


attendants
3 Lack of family planning Post-partum hemorrhage

4 Lack of proper ante-natal Infection


care
5 Poverty Prolonged labour
Company
LOGO “NIGAR”
 TITLE OF PROECT
 Nutritional intervention in Gujrat for adolescent &
reproductive age group women (NIGAR).
 Aim of the project
 To reduce maternal mortality and morbidity in
Gujrat.
 Objective of the project
 To reduce maternal mortality by 40% through
implementation of a nutritional intervention
program in CBA in 3 years in district Gujarat.
Company
LOGO “NIGAR”
 Slogan of the program
 “MAAN TAWAANA,
KHUSH-HAAL GHARANA”
“NIGARPROJECT WORKER”
“NIGAR REGISTRATION CARDS”

“NIGAR BAGS”
 Logo of the program
Company
LOGO Coverage of the project

 Three tehsils of District Gujrat with


population of 2.54 million.

 Names of the tehsils:


1). Kharian
2). Gujarat
3). Sarai alamgir
Company
LOGO HEALTH FACILITIES AT GUJRAT
Name No.
Aziz Bhatti Shaheed 1
(DHQ) Hospital, Gujrat
T.H.Q. Hospital, Kharian 1
Maternity Hospitals 2
Civil Hospitals 2
Rural Health Centers 9
Basic Health Units 89
Blood Transfusion Centers 2
Civil Dispensaries 2
Rural Dispensaries 22
Govt. Rural Dispensaries 3
M.C.H. Centers 10
Company
LOGO UNION COUNCILS OF DISTRICT GUJRAT

 Achh Chak Manju  Langrial, Gujrat


 Addowal Chakori Bhalowal  Malka
 Ajnala, Pakistan Chakori Sher Ghazi  Mandeer
 Alamgarh Chechian  Miana Chak
 Amra Kalan Chopala Noonanwali
 Bagrianwala Deona Panjan Kissana
 Baharwal Dhoria  Sabour
 Bareela Fateh Bhand  Sehna
 Barnali Gochh  Sikaryali
 Baroo Haji Muhammad  Tanda, Gujrat
 Beharaj Jaura  Thikrian
 Bido Bhatti Khawaspur  Thutha Rai Bahadar
Chak Jani Kotla Arab Ali Khan  Warachanwala
Company
LOGO INSTITUTIONAL ORGANOGRAM OF HEALTH DEPARTMENT

D is t r ic t H e a lt h O f f ic

D is t r ic t H o s p P i tr ao l g r a Am d s m in is t

T e h s i l LH a o d s y p Hi t a e l aI m l t h m Wu n o i z r ak et i or s

R u r a l H e a lt h C e n t e r

B a s ic H e a lt h U n it
Company
LOGO PROJECT IMPLEMENTING UNIT

 Project coordinator - EDO health


 Assistant project coordinator - 3
DDHO of three tehsils
 Training and monitoring facillators- 3
 Office assistant- 1
 Community Mobilizers 3
 Lab technician supervisor- 1
 Out reach workers- 18 - 20
 Drivers- 3
 Existing staff of the health facilities
 LHWs’ of district Gujrat
Company
LOGO

STRATEGY
Company
LOGO TARGET GROUP

 1).Primary target group -


Pregnant ladies

 2).Secondary target group-


Women of child bearing age
Company
LOGO STRATEGIC PLAN

1. PRIMARY TARGET GROUP 2. SECONDARY TARGET GROUP


(Pregnant women) (CBA women)

Key Strategy Key Strategy

Activities Activities

Key components Key components


Company
LOGO PRIMARY TARGET GROUP
(PREGNANT WOMEN)

 Key strategy:
 Improvement in anemia & malnutrition in
pregnant ladies.
 Improvement in ante-natal & post-natal
visits of the pregnant women.
 Improve FP services & TT vaccination
coverage
Company
LOGO

 Key components:
 Incentive based Registration of all pregnant
women for nutritional intervention.
 Providing iron, folic acid, vitamin A and
nutritional supplements (fortified oil) to pregnant
women on monthly basis during 3rd month of
pregnancy to 6th month after pregnancy.
 All registered pregnant women to be counseled
for family planning & given TT coverage.
Company
LOGO ACTIVITIES

 All ante-natal to be documented on registration cards


regarding nutrition, FP & TT services along with
complete checkup.
 LHW to be given incentives (Rs.50/client) on bringing
ante-natal to health facility (registration card will contain
referral name and signature of the LHW).
 Proper monitoring of anemia of high risk groups on
monthly basis at BHU.
 Referring to high risk groups from BHU to higher centers.
 Insuring follow up of referred patients from their
feedback & documenting that for future references.
 Training of health facility staff to identify anemic mothers
and refresher courses every 6 months.
Company
LOGO SECONDARY TARGET GROUP
(CBA WOMEN)

 Key strategy:
 Community based interventions:
 BCC intervention at community level
 Community mobilization
 Training of community based service
provider
 Mass media campaigns
Company
LOGO

 Key component:
 Method to improve nutritional status of women
and her family according to their own socio
economic and cultural conditions.
 Importance of good nutritional status for women
of child bearing age and pregnancy symptoms
and complications due to malnutrition and
anemia.
Company
LOGO Activities for community based interventions:

 Arranging health education sessions at the


councilors house for women of child bearing age
by out reach workers.
 Distribution of health education material to them.
 De-worming the women in CBA group on six
monthly bases.
 Display of charts and health education material
at sessions
 Distribution of specially designed menu charts
designed according to anthropological and
economic conditions.
Company
LOGO

 Meeting with influential persons, orientation of


village health committee, imams and select
community volunteers from each area.
 Formation of community support groups.
 Training of community based service provider
like LHW,
 School teachers & dais to be invited with
incentives in these health education sessions
Company
LOGO Activities for mass media campaign

 Weekly based program on FM radio stations.


(involving HCP, nutrition staff, community
personal, role models, success stories)
 Newspaper & local print media
 Wall painting with slogans
 Announcements in mosques by religious people
Company
LOGO

ACTIVITY PLAN

DR. HAMMAD
Company
LOGO “NIGAR” ACTIVITY PLAN

WEEK 1-2 WEEK 3-4 WEEK 5-6 WEEK 7-8

PLANNING NUTRITION POSTS RECRUITMENTOF TRAINING (PHASE1)


ADVERTISEMENT NUTRITION STAFF NUTRITION STAFFTOT
BUDGET
FROM WFP (5 DAYS)
ALLOCATION
RENOVATION OF TRAINING (PHASE 2)
MEETING WITH REQUIRED
HEALTH STAFF PURCHASING FACILITY STAFF
BUILDINGS (5 DAYS)
MEETING WITH
OTHER DEPT TRAINING (PHASE 3)
PRINTING /
TRAINING FIELD STAFF
MOU MANUALS (5 DAYS)
Company
LOGO “NIGAR” ACTIVITY PLAN

WEEK 9-10 WEEK 11-12 WEEK 13-14 WEEK 15-16

REGISTRATION MASS MEDIA


PROJECT COMPLETES COMPAIGN
EVALUATION
LAUNCHING STARTS
OF STAFF
CEREMONY
HE SESSIONS FACILITIES
START SERVICES
START
PILOT TESTING REGISTRATION HANDING OF
OF PREGNANT EQUIPMENTS & DISTRIBUTION
WOMEN STARTS MEDICINES TO OF OIL &
FACILITIES MEDICINES START
Company
LOGO “NIGAR” ACTIVITY PLAN

MONTH 5-7 MONTH 8-10 MONTH 11 MONTH 12

REFRESHER
ACTIVE ACTIVE ACTIVE COURSES
MONITORING MONITORING MONITORING (2 DAYS)

END YEAR
EVALUATION
REFRESHER PROJECT
COUSES (2DAYS) PASSIVE PASSIVE
MONITORING MONITORING 1 YEAR
EVERY 6TH MONTH COMPLETION
CEREMONY

REPLANNING
FOR NEXT YEAR
Company
LOGO GANTT CHART
1st YEAR

WBS Tasks Start End Duration % !st quarter 2nd quarter 3rd quarter 4th quarter
(Day Co
s) mp
let
e

1 PLANNING 3

2 BUDGET ALLOCATION 2

3 MEETING WITH HEALTH STAFF 3

4 MEETING WITH OTHER DEPT 4

5 MOU 2

6 NUTRITION POSTS 10
ADVERTISEMENT
7 RENOVATION OF BUILDINGS 10

8 RECRUITMENTOF NUTRITION 10
STAFF
9 PURCHASING 10

10 PRINTING / TRAINING MANNUALS 12


Company
LOGO GANTT CHART
11TRAINING (PHASE1) 5
12TRAINING (PHASE 2) 10
13TRAINING (PHASE 3) 10
14EVALUATION 5
15PILOT TESTING 5
16PROJECT LAUNCHING CEREMONY 5
17REGISTRATION OF PREGNANT WOMEN 12
18REGISTRATION COMPLETES 12
19HE SESSIONS START
20HANDING OVER TO FACILITIES 7
21MASS MEDIA COMPAIGN STARTS
22FACILITIES SERVICES START
23DISTRIBUTION OF OIL & MEDICINES
24ACTIVE MONITORING
25PASSIVE MONITORING
26REFRESHER COURSES (2 DAYS)
27END YEAR EVALUATION
28PROJECT 1 YEAR COMPLETION CEREMONY
29REPLANNING FOR NEXT YEAR
Company
LOGO

PLANNING

IMPLEMENTATION
EVALUATION
EVLUATION “NIGAR”

MONITORING
Company
LOGO

BUDGET
DR. ABDUL
WALI KHAN
Company
LOGO BUDGET DISTRIBUTION FOR 3 YEARS

TOTAL % % Allocated Remaining %

1st Year 100 40 60


2nd Year 70 30 30
3rd Year 30 30 00

Note: Initial budget subdivision will be


for 1 year. At the end of 1st year, next
year budget will be subdivided.
Company
ANNUAL BUDGET ALLOCAION
LOGO
CONTINGENCIES Salaries and
Repair and 10% Allowances
Maintenance TA/ DA
10%
10% 5%

Medicine
Procurement of 15%
Durable Goods
15%

Utilities
10% Others Fortified Oil
STATIONARY
2% 18%
5%

Salaries and Allowances TA/ DA


Medicine Fortified Oil
STATIONARY Others
Utilities Procurement of Durable Goods
Repair and Maintenance CONTINGENCIES
Company
LOGO SALARY BUDGET DIVISION
Line Item Unit No. Unit Cost Total cost % of total
per year annual
(millions) budget

Salaries & 4 10
Allowances

Regular per month 1.10.083 million


existing staff

Staff hired per month 1.20.25 million


for project

TA/ DA Per visit 1.30.25 2 5


million/quart
er
Company
LOGO NON-SALARY BUDGET DIVISION

Medicine 1.40.005 6 15
Million per faciltiy
Per month

Tab. Iron per 1.4.1


facility/month
Tab. Folic acid Per 1.4.2
facility/month
Syp. M/Vit with per 1.4.3
iron facility/month
Fortified Oil Per 1.50.006 7.2 18
facility/month Million per faciltiy
Per month

Stationary facility/3 1.60.0066 2 5


months million/3 months
Others 1.70.008 0.8 2
million/annum
Company
LOGO Utilities 1.80.33 4 10
million/month
Telephone per month 1.8.1

Electricity per month 1.8.2

Water per month 1.8.3

POL per month 1.8.4

Procurement 1.96 million 6 15


Of (capital budget)
Durable Goods
Weighing Machines per T & M 1.9.1
officer
Essential per facility 1.9.2
Laboratory. Equ.
Suzuki jeep per 1.9.3
(total 3) subdivision

Others 1.9.4
Company
LOGO Repair and 2.11 million per 4 10
quarter
Maintenance
Transport vehicle per 2.1.1
month

Equipment per 2.1.2


six months

Others Quarterly 2.1.3

CONTINGENCIES per annum 2.24 million per 4 10


annum

TOTAL 40 million 40 100


Company
LOGO

INDICATORS
PROCESS OUTCOME
1. # of pregnant women registered 1. % of maternal deaths
2. # of A/N visits 2. % of normal deliveries
3. # of P/N visits 3. % of deliveries with complications

4. # of iron & folic acid tablets


distributed

5. # of fortified oil cans (5L)


distributed

6. # of HE sessions held
Company
LOGO WHATS NEW ? ? ?
 INCENTIVES
 20% extra salary to existing involved staff
 T/A, D/A to all others
 REFRESHMENTS
 After each health sessions
 GIFTS
 To successful clients
 ROLE MODELS & SUCCESS STORIES
 From the community on FM radios & print media
 LAUNCHING CEREMONY
 Will involve high level officials & respected people from communities
 Full media coverage
 ADVOCACY
 ANNUAL CEREMONY
 Awards to best ten families
 Awards to best facility & field staff
Company
LOGO LIMITATIONS

 Lack of political will, commitment & motivation


 Difficulty in access to all the women at house holds level
 Religious limitations for women regarding attending
health sessions
 Lack of motivation of HCPs’ specially lady health workers
 Lack of awareness due to illiteracy and poverty
 Lack of ownership among community for the project
 Lack of funds
 Sustainability ? ? ?
Company
LOGO

THANKS

QUESTIONS ACKNOWLE
??? TEXT TEXT
D-GEMENTS