MCHIP is a significant step toward saving the lives of mothers, newborns and children in Sindh. MCHIP began its operations in February 2013, working in 16 districts of Sindh; the Program is now closing down, leaving behind a legacy of improved maternal and child health services in over 1000 primary health facilities and 37 hospitals, both in public and private sector.
After five years of successful implementation, the MCHIP celebrated "Closing and Dissemination Event" on January 31, 2018 at Najmuddin Auditorium of Jinnah Postgraduate Medical Center, Karachi. Sindh Minister of Health, Minister of Population Welfare Department, Secretary Department of Health, Director General Department of Health, USAID officials, government officials from other provinces and representatives from all NGOs, donors and healthcare providers, attended the event. The program started with a welcome address by Dr Farid Midhet, Country Director Jhpiego, Pakistan, followed by a quick overview of the key interventions and achievements of the project. MCHIP strengthened the existing healthcare system by multifaceted institutional and human capacity building approaches. The facilities included Basic Health Units (BHU), Rural Health Centers (RHC), District Headquarter Hospitals (DHQ) and Tehsil Headquarter Hospitals (THQ) in addition to the clinics led by community midwives and other private medical centers. Some of the facilities were provided with basic construction and renovation support and equipment for establishing basic MNCH services with standard quality. MCHIP focused on improving knowledge and competency of healthcare staff, while building the institutional capacity of training institutions and professional organizations of the rural districts. During this program, MCHIP built the clinical and non-clinical skills of about 35,000 staff - including Lady Health Workers (LHWs), community midwives, lady health visitors and doctors. MCHIP also improved the services for referral and transportation of pregnant women to health facilities. Most importantly, MCHIP introduced family planning services for healthy timing and spacing of pregnancies.
Development of a productive community and facility-based workforce was complimented with effective MNCH and FP service delivery through Department of Health, Population Welfare Department, People's Primary Healthcare Initiative (PPHI), CMWs and private medical facilities. The Quality Improvement and Patient Safety (QIPS) initiative ensured respectful and patient-centered care through implementation of contextual service delivery and patient safety standards. The demand generation component of the project emphasized on creating awareness about maternal and newborn health and family planning among the targeted population. The improvement in the quality of care in conjunction with mounting health awareness resulted in increased service utilization at these facilities.
During the course of MCHIP project, almost five million women utilized the health facilities for antenatal care in the 15 districts. In addition, facility-based deliveries reached 67 per cent and contraceptive prevalence rate increased by 6 per cent points. As many as 80,000 misoprostol were prescribed and distributed to prevent postpartum haemorrhage. A significant cause of neonatal mortality is umbilical cord sepsis; MCHIP distributed 260,000 chlorhexidine tubes for applying it to newborn cord and preventing infections. Many babies die due to difficulty in breathing at birth, so MCHIP's intervention of Helping Babies Breathe (HBB) successfully resuscitated around 17,000 babies born with asphyxia. In collaboration with Department of Health's EPI Program, MCHIP developed an immunization registry. The monumental initiative provided an individual tracking system with follow-up SMS reminders, consequently the immunization rate significantly increased in these 8 districts. All these efforts were encouraged by continuous monitoring, evaluation and periodic reporting of all the initiatives. The big data originated from multiple sources during the project, was translated into meaningful information and shared with facility managers, district health officers and provincial teams for future program planning.
Since its inception, the sustainability of the program was reflected by continuous engagement of Sindh's Department of Health and its vertical programs. The technology and tools developed by MCHIP were transferred to Government of Sindh before the conclusion phase to avoid any interruption in the provision and monitoring of services. Chlorhexidine and misoprostol has been included in the essential drug list ensuring prompt availability to the eligible candidates. The QIPS tool will be utilized by all public facilities for identifying gaps and accordingly developing and implementing an action-plan. Sindh Healthcare Commission has shown great interest in adopting the tool for improving quality and regulating health facilities in the province.-PR