Professional Documents
Culture Documents
Group VII
Dr Afzaal, Dr Ali Raja, Dr Majeed,
Dr Muhabbat, Dr Waseem
Demographic Data
• Population 152785
• Area 5792 Sq.Km
• Population Density 20person/km2
• # of Tehsils 1
• # of U/Cs 10
• Literacy Rate33.59%
– Male 48%
– Female 19.5%
RH Indicators of Noshki
Doctor
26%
Other SkAt
TBA
Relative
No-one
40%
22%
Maternal Mortality
• The main reasons for the high rates of maternal
mortality are:
is based on 3 pillars:
• Family Planning
• Skilled attendance at (all) births
• Emergency Obstetric Care
Five Assumptions
1. Lack of Health seeking behavior of people towards
SBA or facility based delivery
2. Lack of awareness among the TBAs/LHWs and other
family members regarding the identification of danger
signs
3. Non-availability and geographic distribution of facilities
– non-availability of equipments and supplies – non-
availability of means of communication – 24/7
4. Lack of positive supervision and effective monitoring
5. Poor resources Management – planning and
budgeting, Posting and retention – low quality of life
Possible Curative Interventions
• Skilled Birth Attendants at all Births
• Intrapartum Care based in Health center
• Antenatal and Post natal care
• Emergency Obstetric care
• Quality Care of Reproductive health
services
• Post Abortion care
Possible Preventive
Interventions
• Awareness
• Family Planning
• Capacity Building (Trainings)
• Women empowerment
• Nutrition and micronutrients
• Exclusive Breast feeding up to 6 months
• Female literacy
• Poverty Reduction
• Discouraging early age marriages
• Couple counseling (Male involvement)
Identified Curative/Preventive
intervention
• Curative Intervention
– Skilled Birth Attendants at all Births
• Preventive Intervention
– Awareness regarding the utilization of
maternal health services
Due to Clustering of mortality around
delivery and dominance of Hemorrhage,
infection and hypertension;
and keeping in view the geographical and
cultural barriers of the District We focus to
intervene the three DELAYS.
3 Ds approach
• First: Delay in deciding to seek care for a
perceived obstetrical complication (community)
• Second: Delay in reaching the appropriate
facility (transport)
• Third: Delay in receiving appropriate care at the
facility (skilled care)
• Put emphasis on the third delay, which should
come first. Useless to address the other two if
quality care is not ensured in health facilities.
MNH Upgrade and
Training make fully
BCC operational
Transport,
Dai telecom
RHC/
DHQH
H o m e BHU
Comp.
Basic
A EmOC
SB
LHW EmOC
Village
Framework-SADA Project
SADA Project
(SAFE DELIVERY APPROACH)
District Noshki
Aims and Objective
• Aim
– Improved health status of women by
reducing maternal deaths in District Noshki
• Objective
– To reduce maternal deaths by 75% in
District Noshki in 3 years.
– To raise awareness among 100% general
population of District Noshki regarding RH
services utilization in 3 three years
Organogram of SADA Project
EDO (H)
(Chairman)
District Coordinator
(SMO)
WMOs LHVs/CMWs
Coordination of District Support
Team (Multisectoral Approach)
• Health Department
• People’s Primary Health Care Initiative
• LHWs Program
• Population Welfare Department
• Education Department
• NGOs and Line Departments
District Maternal Health
Committee (DMHC)
• A committee will be formulated for regular monitoring
and on job supervision of SADA Project
• The committee meeting will be conducted on quarterly
basis
• Members will be
– Distt. Nazim/DCO Chairman
– EDO (H) Secretary
– Distt. Coordinator SADA Project Member
– MS DHQ (H) Member
– All LMOs Member
– Anesthetist Member
– LHVs of Basic EmOC facilities Member
Spot Map
AFGHANISTAN Kishingi
osta
n M
m B
Ana A
S
T
Dak Mengal U
C Jamaldini Noshki city N
H G
A
G Ahmed Wal
Mal
A
• DHQ
I • CEmOC
KHARAN • BEmOC
Target Population
• All Women of Reproductive Age Group
• All adult males
• Elderly women of the community
• All influential leaders of the community
• Ulemas and Masjid Imams
• Male and Female councilors
Strategies for first delay
• Awareness regarding Girls Primary Education
• Skill Development of LHSs and LHWs in Inter
Personal Communication and Counseling.
• All LHWs will be trained in to identify danger signs
and improve appropriate referral.
• Seminars on RH/youth/gender issues.
• Health Education Sessions at Girls and Boys High
Schools & Colleges.
• Documentaries/ RH messages & gender issues in
local cable network.
• Celebration of International Days (population,
mothers, midwives, women's days)
Strategies for Second delay
• Provision of 6 fully equipped ambulances
(one for each Basic EmOC facility)
• Repair of existing ambulances.
• Reactivation of Village Health
Committees for Community Transport
System
• Wire Less Loop/ Land line phone for
selected LHWs/ LHS/ Health Facilities
and Ambulances on ownership
Strategies for Third delay
• Establishment of Comprehensive EmOC at DHQH 24/7.
• Establishment of Basic EmOC at 02 RHCs & 04 BHUs.
• Labour rooms at these health facilities.
• Repair/renovation of Health Facilities & Residences for
Female Staff.
• Posting of Anesthetist at DHQ
• Posting of LHVs/CMW at all Basic EmOC facilities.
• Financial and other incentives for the health care
providers
• Capacity building of Lady Medical Officers / LHVs /
Paramedics in Safe Delivery practices, Infection
prevention, HMIS, RH, FP, STI, etc.
Strategies for Third delay
• Provision of medicines, minor equipment,
and consumables
• Maternal Mortality Conference at District
level on Quarterly basis.
• Refresher Management Courses at AKU
Karachi for District Health Managers.
• Laboratory support
Strategies for Third delay
• Three Months Training of 03 LMO in Cesarean
Section at AKU Karachi.
• Two Months Training of Anesthetic & OT
Assistant in Operation theater at BMCH Quetta
• Three month training of one LMO in Ultrasound at
SPH Quetta
• HMIS orientation workshop for HCPs in two
batches
• Verbal autopsy on maternal & Neonatal death
But the main argument for
institutional delivery remains Quality
of care
Good experience with providers encourages use of
care – cost is not a major concern in such situations
Women’s perspectives about quality of care
Respect by health service providers- not to be abused
or scolded- talk and smile…particularly at night…
Sensitivity to needs, including respect for dignity
Care and support, explanations, choices
Costs
MADAD Cards
(Medicine availability for diseases after delivery)
• 15% of deaths occur due to puerperal
infections
• MADAD Cards are introduced to decrease
the deaths due to puerperal infections
• MADAD Cards will be issued by LMO to
the near misses
• Each MADAD Card will help these women
to get prescribed medicines with in range
of Rs.3000/=
Indicators of Monitoring and
Evaluation
• Process Indicators
– # of Deliveries by SBA
– # of Deliveries At Health centers
– # of C/Section
– # of Referrals to CEmOC
• Out come Indicators
– %age of Deaths due to maternal cause
– %age of mothers with complications
– %age of Normal Births
Future Plans
• Monthly IUDs camps at RHCs
• PG Rotation
• Establishment of Midwifery school at
Noshki
Activity Plan
Work Plan WEEK 1:
SADA
RAHE
SADA
THANKS