Pakistan

For a summary of MCHIP work that has ended in Pakistan, click here.

MCHIP Sindh

Start and end dates: February 2013 to September 2017

MCHIP Partners Involved

Jhpiego, Save the Children, PATH, John Snow, Inc.

Key Partners in Country

Department of Health, DKT Pakistan, People’s primary Health care initiative, Population Welfare Department, Lady Health workers Program, Dev Con, Integrated Health Services, Family Planning Association of Pakistan, Rural Support Program Network, HOPE

Description of work

The project intends to reduce maternal, newborn and child morbidity and mortality by ensuring 24/7 access to MNCH services across Sindh Province. Specific strategies are:
1) Supporting all cadres of skilled birth attendants to ensure a full range of high-quality MNCH services through public and private facilities;
2) Mobilizing communities to create and sustain a demand for high-quality MNCH services;
3) Establishing transport and telecommunication systems for improved referral and transport in the event of complications; and
4) Facilitating the development of a viable ecosystem for MNCH services in Sindh by addressing bottlenecks and improving the functioning of the market system.

Technical Scope

  • Maternal Health
  • Newborn and Child Health
  • Family Planning
  • Nutrition
  • Immunization
  • Community Mobilization

Scale/Coverage

15 districts in Sindh Province: Dadu, Khairpur, Tando Allah Yar, Thatta, Tharparkar, NosheroFeroze, Sukkur, Umerkot, Sanghar, Jacobabad, Gothki, Shikarpur, Mirpurkhas, Matiari and Larkana.

Integrated Approaches

  • Quality Improvement
  • Nutrition
  • Immunization
  • Referrals
  • Tele Health
  • M-mentoring

Key Results to Date

  • At the community level, through Women Support groups (WSGs), MCHIP has reached more than 700,000 women with MNCH messages in 5 districts of Sindh. These WSGs are conducted by MCHIP-trained Lady Health Workers (LHWs). The Program developed 235 master trainers on WSGs who in turned trained 3,206 LHWs to conduct WSGs. These LHWs conduct 4,500 to 4,700 WSGs per month.
  • MCHIP developed 413 master trainers in 10 districts who trained 2,118 LHWs on chlorhexidine counseling and distribution. Their distribution of 3 gm chlorhexidine tubes has prevented an estimated 30,000 newborns from sepsis. A 97% rate of application compliance was found among 300 mothers who were monitored within 24 hours of delivery. The Program also procured 190,000 chlorhexidine tubes from Nepal.
  • The Program introduced real time monitoring using wireless communication and smartphone technology, and found 875 WSGs were reaching more than 70,000 people. The findings directly informed improvements to the LHW program, LHWs, and their supervisors.
  • At the facility level, MCHIP trained 694 skilled birth attendants (SBAs) from 15 districts on Helping Babies Breathe (HBB), supplied related kits to 283 public and private facilities, and established HBB services in 283 facilities. Over 10 months in 10 districts, MCHIP-trained SBAs participated in 49,447 deliveries, successfully resuscitating in 99% cases requiring the procedure.
  • To date, MCHIP has trained 1,329 local transporters to support 177 MNCH centers, who have transported 2,056 women from communities to facilities. Moreover, nearly 7,000 women were referred by LHWs to the 177 MNCH centers connected with trained transporters via the transporter directory.
  • MCHIP is working with five midwifery schools. All 42 faculty members have been trained in teaching skills, and students are reporting clinical exposure for deliveries, antenatal care, and postnatal care due to engagement from the MCHIP assigned medical officers at clinical sites. At the end of the second year, the schools reported an increase in admission from 94 to 155 students, and an attendance rate at or above 80%. MCHIP also facilitated minor renovations at the schools to facilitate the development of skills labs.
  • The Program is also providing technical assistance to the national and provincial governments, including development of technical resources and promotional materials. MCHIP developed consensus to roll out chlorhexidine for prevention of newborn sepsis through the national working group, and fostered a strategic partnership with key in-country organizations to expand high-quality MNCH services in Sindh and beyond.
Select Health and Demographic Data for Pakistan
GDP per capita (USD) 802.00
Total Population 185,756,305
Maternal Health
Maternal Mortality Ratio (deaths/100,000 live births) 276
Skilled birth attendant coverage 52
Antenatal care, 4+ visits 73
Child Health
Neonatal mortality rate (deaths/1,000 live births) 55
Infant mortality rate (deaths/1,000 live births) 74
Under-five mortality (deaths/1,000 live births) 89
Percentage of Children under 5 for whom treatment was sought for acute respiratory infection 64.9
Oral rehydration therapy for treatment of diarrhea 36.7
Nutrition
Children under 5 years who are stunned (moderate or severe) (%) 44
Children under 5 years who are wasted (moderate or severe) (%) 15
Children under 5 years who are underweight (%) 32
Women 15-49 who are overweight or obese (%) 40
Immunizations
Diphtheria-pertussis-tetanus vaccine coverage (3 doses) 88
Percent of districts with >80% DPT3 coverage 72
DPT3 coverage equity ratio (wealthiest:poorest quintile) 2.24
Family Planning
Modern contraceptive prevalence rate 26
Total fertility rate 3.8
Health Systems
Density of physicians (per 1,000 population) 0.8
Density of nurses & midwives (per 1,000 population) 0.6
Total Health Expenditure per capita (USD) 23.00
Sources: All data are from the Pakistan Demographic and Health Survey 2013 unless otherwise noted. http://www.tradingeconomics.com/pakistan/gdp-per-capita, http://www.census.gov.pk/index.php, Pakistan Demographic and Health Survey 2007, National Nutritional Survey, 2011, Maternal and Child Health Program Indicator Survey, 2013, http://data.worldbank.org/

To view health and demographic data for Sindh, click here.