Chief Ministers Health Initiative for Attainment & Realization of MDGs

CHARM
Revitalizing Maternal health care in 7 Districts of Punjab

GOAL !

Reducing maternal, infant and child mortality and morbidity by targeting preventable causes

Country

MMR

IMR

CPR

Inst. Del

Pakistan Iran Turkey

276 33 44

72 18 26

32 70 71

30% 97% 90%

Source: State of World Population, 2010

Health Allocations 2005-06 to 2010-11

40000 35000 health allocations Rs. in million 30000 25000 20000 15000 10000 5000 0 2005-06 2006-07 2007-08 years 2008-09 2009-10 2010-11
Federal MoH Punjab Sindh KPK Balochistan

Courtesy: Dr. Asad Hafeez

Health Services Tertiary Care

Human Resources:
Insufficient human resource / Vacant Post Insufficient skills of HCPs Lack of accountability (Absenteeism)

Inappropriate behavior / attitude of HCPs Weak Linkages of community with Health Facility Disintegrated services

Integrated RH, FP, Nutrition and Immunization Services

Community Based Interventions, Child Health Weeks, IMNCI
Social Mobilization, Awareness, Motivation (Health Education Seminars)

Facility Based Interventions

Pay for performance

Basic EmONC

Ambulance

Comprehensive EmONC
(Minimal Support and Strengthening)

NGO workers / Motivators / Volunteers

LHWs, CMWs

BHUs
1. Additional HR 2. Ensuring 24/7 services

RHCs
(Minimal Support)

RHC

THQ

DHQ

Community mobilization and awareness about ANCs, Birth Preparedness Delivery by SBA, PNCs & FP

Rotation of WMOs along portable USG (Once a week)

Monthly Rotation of PG Students from Tertiary Care

Ambulance Service

SMS/Online Report Submission SMS/Online Monitoring using web based software

PGR

LHW Basic EmONC Facility (BHU/RHC) Comprehensive Facility (THQ/DHQ)

Teaching Hospital

Household

Layyah

Monitoring of monitors by use of android based handsets Linkage with community through voice messages for achieving MDG 4 and 5 Initial Phase: 7 Districts Will be replicated across province from July

 To expedite transfer of information from community to central MIS To have Immediate feedback automatically from the system To reduce HR requirement for data entry

Reports received from each BHU by SMS

Daily Report Delivery Report Referral Report

Monthly reports received in excel format

Online reporting system: Development in progress

LHV at facility

Patient/Client
Congratulations & Feedback FP Advice IYCF Advice PNC/Vaccination Advice

Daily report Referral report Delivery report

LHS reporting & monitoring

Central Server at Provincial Level

Referral information

MS/Incharge of CEmONC Facility

Monitors

Individual Staff Members Facility wise District compiled report Provincial Compiled report

Compiled reports

Final Outcome

Confirmation Message to staff

Child Birth
Central Server

Second message to client: Exclusive breast feeding, immunization: BCG & Polio zero, Post natal checkup

Way Forward: Voice Messages instead of text messages

Immunization Reminder Messages based on EPI Schedule and date of birth submitted by LHW

First message to client: Congratulations, feedback & complaints, advise for early initiation of breast feeding

Third message to client: Immunization, Post natal checkup, family planning

Effective and efficient reporting and monitoring Time saving Cost effective Quality Assurance Immediate data entry Immediate feed back

Average ANC: BHUs

136
25 Baseline Q1 Q2 Q3 Q4 Q5 145 164

Average Deliveries: BHU

37 30 141 20 34

145

18 1 Baseline Q1

Q2

Q3

Q4

Q5

Average PNC: BHUs

58 22 2 28 36 63 20

Average FP: BHUs

23 22 26 27

3 Q1 Q2 Q3 Q4 Q5 Baseline Q1 Q2 Q3 Q4 Q5

Baseline

Baseline @Rs. 240,000 per month Current Running Cost @Rs. 80,000 per month (additional) 1150

400 147 25 ANC 1 37 58

26
FP OPD

Delivery

PNC

Safety and security to female staff

Incentives to mothers (NBK, CDK)

Free Treatment

Shortage of funding after devolution

Integration Building partnerships

Scaling up
Phased approach