Funded By

Project Update July 2013

REDUCING MATERNAL AND NEONATAL MORTALITYRSPN with its partners, Thardeep Rural Development Programme and the Health and Nutrition Development Society, aims to develop a community based system to remove the three delays women face in access to Emergency Obstetric and Neonatal Care (EmONC) in parts of Pakistan, not servedby the government’s Lady Health Workers(LHWs). Using a quasi non-randomised study design, interventions are being implemented in the Union Council of Khudabad and are being compared with the similarly sized, demographically matched non-intervention Union Council of Kamal Khan, both located in Dadu, Sindh.

This is a 22-month research project thatbegan in January 2012, and is being funded by the Maternal and Newborn Health Programme,Research and Advocacy Fund (RAF). Theresearch will generate evidence in favour

interventions to improve the quality and accessibility of EmONC services in non-LHW covered areas of Pakistan.

43% Private

33% Home

7% BHU/MCH Center

17% DHQ

DELIVERY STATUS

IN PAKISTAN

3 OUT OF 5BIRTHS TAKE PLACE

IN THE HOME

FOR EVERY

LIVE BIRTHS, 100,000

RURALWOMENEACHYEARDIE

319

MORTALITYRATE IS

58/1000LIVE BIRTHS

NEONATAL

(PDHS 2006-7)

The project’s interventions are focused on increasing the level of skilled birth attendance and institutional deliveries in the area, and improving the uptake of EmONC services.

availed VHC support

Rs. 1,455,95245 WOMEN

raised by VHCs

384 institutionaldeliveries

women availed antenatal health services at least once658

women visited238440 MALE + FEMALE

CRPs trainedLack of knowledge and delays in deciding to seek healthcare

Transportation to healthcare facility

Receiving treatment at the healthcare facility

THE THREE DELAYS

Community mobilization through male and female Community Resource Persons (CRPs)

Forming Village Health Committees (VHCs) to support women and children

Strengthening the health system (BHU, MCH center, DHQ) for delivery of quality EmONC services

INTERVENTION STRATEGY PROGRESS

Married Women of Reproductive Age, with husbands and extended families, identified and counseled on maternal and neonatal health

854Pregnancies Identified

Mothers vaccinatedfor Tetanus Toxoid

Neonates immunized

2406

831

1374 Quarterly Trend - VHC Support to Pregnant Women for Delivery

WOMEN GIVEN VHC SUPPORT

No. of PW supported by VHCs

37

May-July 2012

Aug-Oct 2012

Nov 12-Jan 2013

Feb-Apr 2013

May-July 2013

4149

66 52

HIGHLIGHTS

END LINE SURVEY CONDUCTED IN DADUJune 2013: An end line survey was conducted in the intervention union council of Khudabad as well as the control union council of Kamal Khan to analyze the knowledge levels, attitudes and practices regarding EmONC in the area. The end line survey, conducted by a team of 52 enumerators, will be compared with the base line survey results to track changes in mindsets and behaviors surrounding pregnancy related healthcare.

The 17-day survey, which was both qualitative and quantitative, consisted of an initial census followed by questionnaires, in-depth interviews, focus group discussions, a detailed birth audit, and an assessment of government health facilities in the area. Information was gathered from both married men and women.

The information gathered will provide a clear picture of the activities that take

WORLD POPULATION DAY CELEBRATIONSJuly 2013: A rally was held in Dadu to celebrate World Population Day, the theme of which was Preventing Adolescent Pregnancies. A walk was jointly organised by the Department of Population Welfare (DoPW) and civil society organizations working in the area, which began at the DoPW o�ce and ended at the Press Club of Dadu. A wide range of government and non-governmental agencies participated, including Community Midwives (CMWs) and Lady Health Visitors (LHVs), representatives from government hospitals, as well as PPHI, TRDP, RSPN, GreenStar Social Marketing and HANDS. Members of the Local Support Organization (LSO) of Khudabad were also present at the rally.

After the walk, a seminar was held at the HANDS o�ce where the issue of adolescent pregnancies was discussed by participants and ways to tackle the issue were suggested.

ACHIEVEMENTS Women Referredto a Health Facility

Women who Visiteda Health Facility

1st Antenatal Checkup

2nd Antenatal Checkup

3rd Antenatal Checkup

4th Antenatal Checkup

More than 4 Antenatal Checkups

Risky pregnancies

Deliveries

Postnatal Checkup

Neonatal Checkup

780

705

600

464

404

18

418

458

485

715

662

542

423

354

2

384

447

474

place before and after childbirth and facilitate a detailed analysis of the decision-making process for maternal and neonatal healthcare. It will also highlight the degree to which health seeking behavior prevails in rural communities, and what perceptions and experiences people, particularly pregnant women, have regarding institutional healthcare.

The end line survey will also o�er insight into the e�cacy of the community based systems which have been employed by the project, namely Community Resource Persons and Village Health Committees. Changes in the uptake of EmONC services as a result of the intervention will also be measured and recommendations will be made with respect to the sustainability and scale-up of the interventions.

Project Management & Text: Umme-laila Hussain (RSPN Communications)Designed & Printed by: DOT advertising (051-2352777)

Rural Support Programmes Network (RSPN)House No. 7, Street 49, F-6/4, Islamabad, PakistanTel: +92 51 2822476, 2821736, Fax: +92 51 2829115

www.rspn.org

All photographs are property of the Rural Support Programmes NetworkThis document is an output from a project funded by the UK Department for International Development (DFID) and the Australian Agency for International Development (AusAID) for the benefit of developing countries. The views expressed and information contained in it are not necessarily those of or endorsed by DFID, AusAID or the Maternal and Newborn Health Programme Research and Advocacy Fund (RAF), which can accept no responsibility or liability for such views, completeness or accuracy of the information or for any reliance placed on them.

“At first I was nervous about discussing maternal and neonatal health with people in my village, most of whom are much older than I am. But their interest and commitment to this sensitive issue encouraged me.”

Mehrab Khan Panhwar is one of two Community Resource Persons (CRPs) in the village Gul Hassan Panhwar of Dadu. Knowledge regarding pregnancy related issues is sparse in villages such as Gul Hassan Panhwar, where pregnancy is considered solely a women’s issue and giving birth at home is common. This area is not served by the government’s Lady Health Workers (LHWs), which further impedes access to information on maternal and neonatal health services and their critical importance.

When the project began in Gul Hassan Panhwar, Mehrab was selected for the role of the male CRP. He received training so that he could raise awareness for maternal and neonatal health issues and support pregnant women in going to the hospital for check-ups and to give birth. “For a long time, I have been trying to motivate people in my village to work together to deal with our own social and development issues,” says Mehrab, discussing his role as a CRP “I wanted to do something meaningful for my community.”

Mehrab conducted three awareness raising sessions with all of the married men of his village to educate them about maternal and neonatal health and related issues, such as how to prepare for an upcoming birth, arranging funds and transport, and the importance of family planning and immunisation for newborns. “Now when people have any questions or concerns about maternal and neonatal health they come to me, and I encourage them to visit a health facility,” says Mehrab.

Motivating Fathers and Husbands for Maternal and Neonatal Health

Mehrab’s Story

Since he has maintained regular contact with the married couples in his village, Mehrab has witnessed a real change in their attitudes toward maternal and neonatal health. “There has been a big change in people’s practices,” says Mehrab, “I see more and more men taking this issue seriously and taking their wives to health facilities for antenatal check-ups and birth.”

Mehrab is one of 40 other male CRPs working hard in villages across Dadu to educate their fellow community members about the importance of institutional healthcare for mothers and children. In rural Pakistan, where women often do not have a say in issues of their health or that of their children’s, CRPs such as Mehrab are bringing about a vital change in the attitudes which men have toward maternal and neonatal healthcare.

Mehrab is an active member of the local Village Health Committee and attends all their meetings, where he continues to discuss maternal and neonatal health and motivates couples to seek institutional healthcare.