Newborn Care Through the Social and Behavioral Change Lens Experiences from Ethiopia, Pakistan, and Rwanda -- Jamali

1. Dr. Qamar Zaman Jamali
MCHIP, Pakistan
Revitalizing Lady Health Workers’
Role to Promote Newborn and Child
Health Care in Sindh, Pakistan

2. Content
– Background
– Introduction of Lady Health Worker (LHW)
Program
– Introduction to MCHIP Pakistan
– MCHIP Community Support Interventions and
Results
– Conclusion

3. Background
• Pakistan’s neonatal mortality rate is 45.5 (per
1000 live births) contributing 9% of annual global
neonatal death tolls (IGME 2015)
• Pakistan’s under- five mortality rate is 81.1 per
1000 live births.
• Over 245,000 newborn deaths a year in Pakistan
• Major causes include prematurity, birth-related
complications (birth asphyxia) and neonatal sepsis

4. Background
• In 2010 the health portfolio was devolved to
the provinces in Pakistan.
• Federal government retained the coordination
role.
• This restructuring has caused substantial
fragmentation within the health system.
• Although devolution provided opportunities
for provinces but it also resulted in financial
and management issues for provincial
governments as well.

5. Post-devolution Challenges With LHWP
• Budget constraints
• Poor management
• Problems in salaries payment
• Weak supplies and equipment provision
• Weak referral systems
• Poor integration of MIS with health system
• Poor reporting compliance and quality data

6. Introduction to LHW Program (LHWP)
 National Programme for
Family Planning and Primary
Health Care (FP&PHC). The
Programme popularly known
as "Lady Health Workers’
Program" (LHWP),
 More than 87,000 LHWs
working across Pakistan
 Program Launched in 1994.
Links communities with Health
Facilities.

7. Objective of the LHWP
The main objective of the LHWP was
to increase utilization of promotive,
preventive and curative services at
the community level particularly for
women and children in poor and
underserved areas.

8. Role of the LHW
• Raise awareness
• Provide basic services and family
planning
• Refer patients to nearby hospitals
• Organize health committees for men
and women
• Increase uptake of public health
initiatives

9. Introduction to MCHIP
• USAID Global Health’s
flagship maternal, newborn
and child health (MNCH)
program
• MCHIP Pakistan is a
consortium with Jhpiego as
lead and Save the Children,
PATH, JSI and local
implementing partners.
• Project duration:
Oct 2013- Sep2017

10. To improve the quality of
MNCH services across
Sindh, in both public and
private health sectors
Objective

11. Target Districts
• Thatta
• Tharparkar
• Tando Allahyar
• Dadu
• Khairpur
• Sukkur
• Jacobabad
• Naushero Feroz
• Sanghar
• Umerkot
• Larkana
• Ghotki
• Shikarpur
• Mirpurkhas
• Mitiari

12. Objectives of MCHIP Community Support

13. MCHIP Community Support interventions
• Introduction of Real Time Monitoring of
WSGs through android based applications
• Capacity building (Chlorhexidine,
Misoprostol, WSG, IPC Tool KIT, and
Referral mechanism)
• Advocacy events to promote positive
behavior on newborn and child health
care

14. Progress So Far
• Capacity Building:
• CHX/Miso – 13,547
• WSG – 3500
• Real time monitoring using android based application:
Monitored 11.6% of total 12,777 WSG meetings.
• Strengthening of Referral Mechanism
LHWs increased referrals from community to health
facility from 312 in Dec. 2014 to 38,810 in Dec. 2016.

15. Real-time monitoring
• Used wireless communication and
smartphone technology to monitor
the quality of WSGs
• A total of 12,777 WSGs (11.6%)
reaching over 148,000 people were
observed
• Findings used to provide direct
input/ feedback to the LHW
Program, LHWs, and supervisors
on improving the WSGs

16. LHWs Facilitation skills
77 78
65
59
76
82
71
63
68
84 83 83 82
88 88
67
76 76
0
20
40
60
80
100
Greetings to
Partcipants
Introduction of
Participants
Settings of
ground rules
Sensitization on
Topics
Information
Provided on topic
Use of IEC
Material
Sumarization of
discussion
Explore Solution Planning for next
SG meeting
Percentage
Quality of CSG as per set Protocols
q3-y2 q4-y4

17. Introduction of Chlorhexidine (CHX) for Cord Care in Pakistan

18. % of Newborn Topics Discussed During WSG Meetings
(Jan. 15 – Dec. 16)
16 17 17
19
7
13
0
20
40
Vaccination DangerSigns BirthPreparedness ExclusiveBreastFeeding NewbornDangerSigns Postnatal Care

19. Cases referred by LHWs
312 473
6,542
9,232
6,995
27,231
25,878
28,154
0
5,000
10,000
15,000
20,000
25,000
30,000

20. Conclusion
• LHWs are frontline health worker in health system of
Pakistan.
• Real time monitoring is an innovative approach to
monitor the quality of WSGs.
• Introduction of new high impact intervention
improved the knowledge and performance of LHWs.
• On the job coaching and supportive supervision are
keys to make LHWs’ role more effective.

21. Thank you