Selection Criteria
Scope of Work
Training of Supervisors
Future Plans
LADY HEALTH SUPERVISORS
Lady Health supervisors are recruited to provide supervisory support and ensure quality performance by the LHWs. Supervisor collects progress reports, guides and discusses about their problems. At end of each month supervisor compiles evaluation reports and submit to the districts.
Selection Criteria
Laid down criteria is:
Age between 22 - 45 years
Education atleast Intermediate
Resident of the catchment area
Preferably married Top
Scope of Work
To provide “Supportive Supervision” to LHWs which includes:
Identifying deficiencies
Providing technical / backup support
On the job training Top
Training of Supervisors
After selection, supervisors undergo an extensive three phased training for a period of one year.A special Supervisors’ manual has been developed for the purpose of training.
TopOne supervisor is assigned the task of supervising 30 LHWs. A vehicle is provided in order to facilitate them in supervising
FUTURE PLANS
Recruitment / Training of 100000 LHWs.
Improvement of Referral System.
Strengthening of community involvement through Health Committee.
Training of district managers in management and logistics
Integration of PHC services.
Introduction of upgraded LHW-MIS.
Logistics planning workshops for district managers.
Sustainability of programme through provincial governments.
Sunday, January 18, 2009
Briefing Note for Balochistan Survey Report
Over the past seven years the Lady Health Worker Programme (LHWP) has become important to the Government of Pakistan's plan to raise the health status of women and children in villages and poor urban areas. From 1999-2002 an extensive external evaluation of the programme was conducted. This briefing note presents a summary of information collected from the evaluation's quantitative surveys and available in the Balochistan Survey Report.
Reporting on the Evaluation Results The Balochistan Survey Report presents information, collected through quantitative surveys, on the performance of the LHWP in Balochistan. It is one of a series of reports providing the results of the evaluation. In addition to Provincial reports there are also three national level reports: the Final Report which addresses key policy, service delivery and programme management issues, the Quantitative Survey Report providing an extensive analysis of the quantitative results; and The Financial and Economic Analysis which details the costs of the LHWP.
The Balochistan Survey Report The Balochistan Survey Report covers:
The level of compliance with the Programme's recruitment and training criteria
The range and level of preventive, pro-motive, curative and referral services provided by the Lady Health Worker (LHW)
The difference between high performing and poor performing LHWs
The activities of the LHW including hours of work and the number of registered clients.
The knowledge and skills levels that the LHW and her supervisor bring to their jobs.
The quality of the organisational support received by the LHW and the Lady Health Supervisor (LHS).
Service Delivery
Over 30 million people are receiving services from a LHW in their village, which has cost on average of Rs. 26,500 per LHW per year over the life of the programme. This is a low rate of funding and is having a negative impact on the level of service delivery. A fully funded programme would be more expensive but service levels and health outcomes would be a lot better. This is important because LHW services are having a positive impact on the health of the poor, particularly women and children. LHWs are contributing directly to improved hygiene and higher levels of contraceptive use, iron supplementation, growth monitoring and vaccinations amongst their clients. Almost three out of four communities report that the LHW has generally improved people's life in the village.
On average only 32 percent of the LHWs clients in Balochistan are receiving the preventive and promotive services for which they are eligible (see Figure 1).
Reporting on the Evaluation Results The Balochistan Survey Report presents information, collected through quantitative surveys, on the performance of the LHWP in Balochistan. It is one of a series of reports providing the results of the evaluation. In addition to Provincial reports there are also three national level reports: the Final Report which addresses key policy, service delivery and programme management issues, the Quantitative Survey Report providing an extensive analysis of the quantitative results; and The Financial and Economic Analysis which details the costs of the LHWP.
The Balochistan Survey Report The Balochistan Survey Report covers:
The level of compliance with the Programme's recruitment and training criteria
The range and level of preventive, pro-motive, curative and referral services provided by the Lady Health Worker (LHW)
The difference between high performing and poor performing LHWs
The activities of the LHW including hours of work and the number of registered clients.
The knowledge and skills levels that the LHW and her supervisor bring to their jobs.
The quality of the organisational support received by the LHW and the Lady Health Supervisor (LHS).
Service Delivery
Over 30 million people are receiving services from a LHW in their village, which has cost on average of Rs. 26,500 per LHW per year over the life of the programme. This is a low rate of funding and is having a negative impact on the level of service delivery. A fully funded programme would be more expensive but service levels and health outcomes would be a lot better. This is important because LHW services are having a positive impact on the health of the poor, particularly women and children. LHWs are contributing directly to improved hygiene and higher levels of contraceptive use, iron supplementation, growth monitoring and vaccinations amongst their clients. Almost three out of four communities report that the LHW has generally improved people's life in the village.
On average only 32 percent of the LHWs clients in Balochistan are receiving the preventive and promotive services for which they are eligible (see Figure 1).
DARRAHEA DUE TO DRINGKING WATER
More than 10 million of the world's children die each year before reaching the age of five. Sadly two of every three of these children die from easily preventable, treatable diseases such as diarrhea, pneumonia, malaria, measles, and tetanus, and from the conditions like malutrition. In addition, HIV/AIDS continues to be a leading contributor to the deaths of young children in Africa. The CORE Group, a coalition of nongovernmental organizations, is a global leader in responding to health issues that place children at risk. Since 1997, the CORE Group and its members have worked across the developing world to aid mother, father and community leaders in improving the health of their children.
DARRAHEA DUE TO DRINGKING WATER
More than 10 million of the world's children die each year before reaching the age of five. Sadly two of every three of these children die from easily preventable, treatable diseases such as diarrhea, pneumonia, malaria, measles, and tetanus, and from the conditions like malutrition. In addition, HIV/AIDS continues to be a leading contributor to the deaths of young children in Africa. The CORE Group, a coalition of nongovernmental organizations, is a global leader in responding to health issues that place children at risk. Since 1997, the CORE Group and its members have worked across the developing world to aid mother, father and community leaders in improving the health of their children.
Saturday, January 17, 2009
SAVE THE CHILDREN IN WINTER
Save a Child's Life this Winter
India, Health
The Winter Warmth Appeal gives blankets and warm clothing directly to families and children who live on the streets and in desperately poor communities in Bihar India read updates from the field
How You Can Help:
Make a one-time monthly recurring donation
$10 - Buys a warm woolen double size blanket
$20 - Buys 10 warm scarves and mufflers
$30 - Buys 10 warm woolen children's hats
$40 - Buys 10 warm children's gloves
$50 - Provides a Hot meal for 50 Street Children
$60 - Buys 10 warm woolen children's sweaters
show more
$3,183 - Will fully fund this project
show less
INFORMATION ABOUT HEATH IN QUETTA AND BALOCHISTAN
Health Services (1997)
No. of Doctors (m/f)
No. of Nurses (m/f)
No. of Paramedics (m/f)
No. of Beds
No. of Units
Hospitals
191/83
24/254
195/6
1373
5
Dispensaries
13/8
-
34/2
4
13
RHCs
2/1
-
9/3
8
1
BHUs
30/30
-
60/60
-
30
MCHC
0/1
-
10/10
-
9
SHS
2/1
-
10/0
-
3
Health Auxiliary
-
-
6/0
-
3
T.B. Clinic
-
-
-
-
-
Dental Clinic
-
-
-
-
-
Mobile Dispensaries
1/0
-
3/0
-
1
Private Clinic
n.a
n.a
n.a
n.a
n.a.
Total
363
278
408
1385
65
Unit/population ratio
1864:1
2435:1
1659:1
488:1
10414:1
Source:
Directorate of Health, Government of Balochistan, QuettaIf we compare the health status of women in district Quetta to that of males, then we find that their health is poor. The females feed the children. She also provides food to the male members of the family and only then she feeds herself. The health status of migrant women is worst. There is no data available regarding the calorie intake of the females and males. However, the quality of food which is used by migrants (Afghan female refugees) is poor. Hakeem and eastern doctors are operating in the district. Due to low fees charged, people often visit them. A substantial number of homeopathic doctors is present in the district. Some quacks are also found sitting on the pavement.
Most people are uneducated so they cannot differentiate between a good doctor and quack.
Health System
Normally two types of health facilities are available in the District, curative and preventive. As far as prevention is concerned, this includes vaccination of mothers and children up to the age of 5 years through immunisation coverage, which according to the Health Authorities is:
Children up to the age of 11 months were immunized for BCG, DPT and Measles in Quetta district, Their coverage was 97%, 66% and 60% respectively. For those children whose age was between 12 – 23 months the percentages were 23%, 15% and 24% respectively. Ante-natal vaccination is of two types: vaccination to pregnant women and, secondly, care of the pregnant mother. Pregnant women were given TT1 and TT2 for prevention (58% and 42% respectively). According to the district health authorities, the infant mortality rate is very high. This is due to non-hygienic conditions, illiteracy, lack of information etc. The maternity death rate is also high, through it is less as compared to rural districts.
There are 5 government hospitals working in the district. They provide treatment facilities to men and women. However, there is no separate government hospital for ladies. Moreover, there are hospitals run by various organizations for their staff members and their families, like Railway, WAPDA, Cantonment Board, Combined Military Hospital (CMH) etc. They also provide treatment facilities to general public. As mentioned before, there are at least 30 private hospitals in Quetta. The treatment cost of private hospitals is much higher than that of the government controlled hospitals. There is no data available to show the exact number of patients who visit the hospitals. However, according to the Medical Superintendent Civil Hospital Quetta, more than 5,000 patients daily visit the hospital for treatment. These patients include indoor and outdoor patients. According to the District Health Officer (DHO), the patients visiting RHCs, BHU, Dispensaries etc is annually more than 272,000. The absence of data makes it difficult to estimate the cost per patient, per contact. However, in the private sector the cost per patient per contract may range from at least Rs.100/= to Rs.3000/=, depending on the type of disease and on the type of specialist/doctor and the test recommend by him.
There is no data available regarding the private sector involvement in health activities to demonstrate the number of registered cases as a percentage of the total population. Some sketchy data is available which cannot be used to compute the percentage of the population visiting hospitals.
Two other types of facilities are available. The homeopathic way of treatment is popular among the masses due to the belief that this type of treatment has no side effects. Moreover, its medicines, are comparatively cheaper. People also visit Hakeems who treat them with traditional oriental herbs and shrubs.
As far as family planning services are concerned, they are being provided in all D.H.O offices and also in the civil hospital. There is a growing awareness and public approval
in favour of family planning. This may be due to the electronic media campaign and thedemonstration effect witnessed by the society. Due to this, in 1996 more than 1,700
women made use of family planning services. It is worth mentioning that patients from outside the district and even from Afghanistan visit Quetta for treatment. One reason is the proximity of Quetta to Afghanistan.
Major Disease Incidence
As far as gender specific diseases are concerned, the women suffer from acute respiratory diseases, anaemia, skin infection, renal disease and worm infection, whereas male are plagued by diarrhoea/dysentery, fever including malaria, jaundice and worms infestation.
Special Health Services
1. There is a number of special health services which are provided by provincial government to improve or facilitate health programmes. The Primary Health Care and Family Planning Programme is initiated by provincial government under the Prime Minister’s Health Programme. It is further cemented through the involvement of international donors e.g W.F.O, U.NH.C.R and W.H.O. The objective is to provide health services to the community at an affordable rate. This programme caters the needs of mother and child care, providing them with nutritious food e.g. milk & ghee. Also it provides information regarding family planning and subsidised family planning medicine and contraceptives. Under this Programme (P.H.C) prevention and control of infectious diseases, immunisation and provision of essential drugs is also available. It also provides health education, treatment of common illness and provides awareness about the treatment of common illness and sanitation
2. The Traditional Birth Attendant (T.B.A) Programme. In the rural sector, middle aged women traditionally work as birth attendants. In the recent past they used to work without any formal training. But now most of them are trained by the Health Department. They are paid by the Health Department as well as by those who receive their services.
Administration of Health Services
As an example the organizational chart of Quetta’s main hospital is given
Fatima Jinnah General and Chest Specialist Hospital
Medical Superintendent
Administrator
Specialists
Assistant Medical Suptd:
3 Senior Specialists
R.M.O
2 Junior Specialists
M.O.SThe main hospitals in the district are:
1: B.M.C Complex Hospital
2: LRBT Hospital
3: Sandeman Civil Hospital
4: Fatima Jinnah General & Chest Hospital
5: Helper Eye Hospital
6: Police Line Hospital
7: Railway Hospital
8: Leprosy Hospital
GO/NGO/private, etc. involvement in Health Development
Health facilities are provided mostly by the provincial Government. International donors like Red Crescent, WHO, UNICEF and Alkhidmat also help in providing finance for eradication of certain diseases. Health facilities are provided through the interaction of different health units. Most of them are established by the provincial government. There are private clinics, homeopathic clinics, Hakeems and local medical practitioners. The society gets the health care through all the units shown in the table. Presently, a children’s hospital is being constructed with the help of the German government.
Health Facility
Loc. Govt.
Prov. Govt.
Fed. Govt.
NGO
Private
Internat. Donor
Hospitals
-
xxx
-
-
xx
x
Civil Dispensaries
-
xxx
-
-
-
-
Mobil Dispensaries
-
xxx
-
-
-
-
Basic Health Units
-
xxx
-
-
-
xx
Rural Health Centre
-
xxx
-
-
-
xx
MCH Centres
-
xxx
-
-
-
xxx
EPI Centre
-
xxx
xx
x
-
xxx
TB Centre
xxx
-
x
-
-
Family Welfare Clinic
-
xx
x
x
-
-
Family Planning Clinic
-
xx
xxx
-
-
xx
Private Clinic
-
-
-
-
xxx
-
Homeopathic Clinic
-
-
-
xxx
-
Hakeem/Local Medical Practitioner
-
-
-
-
xxx
-
VH Posts
-
-
-
-
-
Nurse Training School
-
xxx
-
-
-
-
Chemists
-
x
-
-
xxx
-
Legend:
-
x
xx
xxx
no involvement
minor involvement
substantial involvement
major involvementConclusion and major Development Issues
Although Quetta district has the best health infrastructure in the province, much
No. of Doctors (m/f)
No. of Nurses (m/f)
No. of Paramedics (m/f)
No. of Beds
No. of Units
Hospitals
191/83
24/254
195/6
1373
5
Dispensaries
13/8
-
34/2
4
13
RHCs
2/1
-
9/3
8
1
BHUs
30/30
-
60/60
-
30
MCHC
0/1
-
10/10
-
9
SHS
2/1
-
10/0
-
3
Health Auxiliary
-
-
6/0
-
3
T.B. Clinic
-
-
-
-
-
Dental Clinic
-
-
-
-
-
Mobile Dispensaries
1/0
-
3/0
-
1
Private Clinic
n.a
n.a
n.a
n.a
n.a.
Total
363
278
408
1385
65
Unit/population ratio
1864:1
2435:1
1659:1
488:1
10414:1
Source:
Directorate of Health, Government of Balochistan, QuettaIf we compare the health status of women in district Quetta to that of males, then we find that their health is poor. The females feed the children. She also provides food to the male members of the family and only then she feeds herself. The health status of migrant women is worst. There is no data available regarding the calorie intake of the females and males. However, the quality of food which is used by migrants (Afghan female refugees) is poor. Hakeem and eastern doctors are operating in the district. Due to low fees charged, people often visit them. A substantial number of homeopathic doctors is present in the district. Some quacks are also found sitting on the pavement.
Most people are uneducated so they cannot differentiate between a good doctor and quack.
Health System
Normally two types of health facilities are available in the District, curative and preventive. As far as prevention is concerned, this includes vaccination of mothers and children up to the age of 5 years through immunisation coverage, which according to the Health Authorities is:
Children up to the age of 11 months were immunized for BCG, DPT and Measles in Quetta district, Their coverage was 97%, 66% and 60% respectively. For those children whose age was between 12 – 23 months the percentages were 23%, 15% and 24% respectively. Ante-natal vaccination is of two types: vaccination to pregnant women and, secondly, care of the pregnant mother. Pregnant women were given TT1 and TT2 for prevention (58% and 42% respectively). According to the district health authorities, the infant mortality rate is very high. This is due to non-hygienic conditions, illiteracy, lack of information etc. The maternity death rate is also high, through it is less as compared to rural districts.
There are 5 government hospitals working in the district. They provide treatment facilities to men and women. However, there is no separate government hospital for ladies. Moreover, there are hospitals run by various organizations for their staff members and their families, like Railway, WAPDA, Cantonment Board, Combined Military Hospital (CMH) etc. They also provide treatment facilities to general public. As mentioned before, there are at least 30 private hospitals in Quetta. The treatment cost of private hospitals is much higher than that of the government controlled hospitals. There is no data available to show the exact number of patients who visit the hospitals. However, according to the Medical Superintendent Civil Hospital Quetta, more than 5,000 patients daily visit the hospital for treatment. These patients include indoor and outdoor patients. According to the District Health Officer (DHO), the patients visiting RHCs, BHU, Dispensaries etc is annually more than 272,000. The absence of data makes it difficult to estimate the cost per patient, per contact. However, in the private sector the cost per patient per contract may range from at least Rs.100/= to Rs.3000/=, depending on the type of disease and on the type of specialist/doctor and the test recommend by him.
There is no data available regarding the private sector involvement in health activities to demonstrate the number of registered cases as a percentage of the total population. Some sketchy data is available which cannot be used to compute the percentage of the population visiting hospitals.
Two other types of facilities are available. The homeopathic way of treatment is popular among the masses due to the belief that this type of treatment has no side effects. Moreover, its medicines, are comparatively cheaper. People also visit Hakeems who treat them with traditional oriental herbs and shrubs.
As far as family planning services are concerned, they are being provided in all D.H.O offices and also in the civil hospital. There is a growing awareness and public approval
in favour of family planning. This may be due to the electronic media campaign and thedemonstration effect witnessed by the society. Due to this, in 1996 more than 1,700
women made use of family planning services. It is worth mentioning that patients from outside the district and even from Afghanistan visit Quetta for treatment. One reason is the proximity of Quetta to Afghanistan.
Major Disease Incidence
As far as gender specific diseases are concerned, the women suffer from acute respiratory diseases, anaemia, skin infection, renal disease and worm infection, whereas male are plagued by diarrhoea/dysentery, fever including malaria, jaundice and worms infestation.
Special Health Services
1. There is a number of special health services which are provided by provincial government to improve or facilitate health programmes. The Primary Health Care and Family Planning Programme is initiated by provincial government under the Prime Minister’s Health Programme. It is further cemented through the involvement of international donors e.g W.F.O, U.NH.C.R and W.H.O. The objective is to provide health services to the community at an affordable rate. This programme caters the needs of mother and child care, providing them with nutritious food e.g. milk & ghee. Also it provides information regarding family planning and subsidised family planning medicine and contraceptives. Under this Programme (P.H.C) prevention and control of infectious diseases, immunisation and provision of essential drugs is also available. It also provides health education, treatment of common illness and provides awareness about the treatment of common illness and sanitation
2. The Traditional Birth Attendant (T.B.A) Programme. In the rural sector, middle aged women traditionally work as birth attendants. In the recent past they used to work without any formal training. But now most of them are trained by the Health Department. They are paid by the Health Department as well as by those who receive their services.
Administration of Health Services
As an example the organizational chart of Quetta’s main hospital is given
Fatima Jinnah General and Chest Specialist Hospital
Medical Superintendent
Administrator
Specialists
Assistant Medical Suptd:
3 Senior Specialists
R.M.O
2 Junior Specialists
M.O.SThe main hospitals in the district are:
1: B.M.C Complex Hospital
2: LRBT Hospital
3: Sandeman Civil Hospital
4: Fatima Jinnah General & Chest Hospital
5: Helper Eye Hospital
6: Police Line Hospital
7: Railway Hospital
8: Leprosy Hospital
GO/NGO/private, etc. involvement in Health Development
Health facilities are provided mostly by the provincial Government. International donors like Red Crescent, WHO, UNICEF and Alkhidmat also help in providing finance for eradication of certain diseases. Health facilities are provided through the interaction of different health units. Most of them are established by the provincial government. There are private clinics, homeopathic clinics, Hakeems and local medical practitioners. The society gets the health care through all the units shown in the table. Presently, a children’s hospital is being constructed with the help of the German government.
Health Facility
Loc. Govt.
Prov. Govt.
Fed. Govt.
NGO
Private
Internat. Donor
Hospitals
-
xxx
-
-
xx
x
Civil Dispensaries
-
xxx
-
-
-
-
Mobil Dispensaries
-
xxx
-
-
-
-
Basic Health Units
-
xxx
-
-
-
xx
Rural Health Centre
-
xxx
-
-
-
xx
MCH Centres
-
xxx
-
-
-
xxx
EPI Centre
-
xxx
xx
x
-
xxx
TB Centre
xxx
-
x
-
-
Family Welfare Clinic
-
xx
x
x
-
-
Family Planning Clinic
-
xx
xxx
-
-
xx
Private Clinic
-
-
-
-
xxx
-
Homeopathic Clinic
-
-
-
xxx
-
Hakeem/Local Medical Practitioner
-
-
-
-
xxx
-
VH Posts
-
-
-
-
-
Nurse Training School
-
xxx
-
-
-
-
Chemists
-
x
-
-
xxx
-
Legend:
-
x
xx
xxx
no involvement
minor involvement
substantial involvement
major involvementConclusion and major Development Issues
Although Quetta district has the best health infrastructure in the province, much
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