Presentation at the Global Maternal Newborn Health Conference, October 21, 2015
Background: In Pakistan, antenatal care coverage and institutional delivery increased three folds over the past three decades, yet maternal and neonatal mortality rates remain stagnant. Most of mothers and newborns die on day of delivery and these can be prevented through simple cost effective interventions.
Methods: From 2012, MCHIP started upgrading health facilities to deliver integrated family planning and maternal and newborn health services at “MNCH Center” by skilled Birth attendant on 24/7 basis. Both public and private facilities are accredited when they deliver quality services on family planning, antenatal, postnatal, normal delivery and labor, BEmONC, immunization and nutrition. The program supports elements of package for day of birth which includes advance antenatal distribution of misoprostol, recognition of danger signs, birth preparedness, counseling on postpartum family planning, partograph use, correct use of uterotonic, Helping Baby Breath. Chlorhexidine for cord care, postpartum IUCD insertion, immunization and pre-discharge checklist. At present, the elements of the interventions are vertical and being implemented as pilots in different parts of the five implementation districts in Sindh. A total of 612 SBAs from 237 health facilities of 5 districts received competency based training, supportive supervisory visits from technical mentors.
Results: The service delivery statistics reflects steady progress in selected MNH indicators. Rate of PPIUCD insertion increased to 10% of deliveries. Out of 213,606 deliveries, 1,174 babies were reported needing resuscitation, and 97% (1,144) were successfully resuscitated till date. PNC pre-discharge checklist was used in 57% of total deliveries in three health facilities. Preliminary results show some decrease in early discharge, improved counseling on PPFP.
Conclusion: The challenges in implementation were different in public and private sector facilities, and was more in the later because of non-regulatory framework in the province. There were missed opportunities for integration of MNH services which need addressing in the future.