New Initiatives

Heatlth Council Funds

In order to achieve the targets of functionality index and to offer a good environment to obstetric cases, a special flexible funding mechanism in the form of health council funds has been established to ensure availability of petty cash / flexible budgets at the disposal of the health facility in-charge. An amount of Rs. 981.5 million was transferred for to health facilities for this purpose (table 18). Under this mechanism, commercial accounts have been opened for each of the below mentioned health facilities. The account is run by two signatories (MO/WMO and SHNS). Utilization of these funds is not governed by the routine Governmental procedures and have resulted in efficient and effective utilization of the given amounts. A detailed guidance note was shared with the districts for utilization of these funds. These funds were used for the following purposes:

  1. Improvement in facility outlook
  2. Ensuring availability of inputs for quality of care such as availability of clean drinking water, comfortable waiting area with appropriate lighting and ventilation, clean and tiled labour room
  3. Basic repair and maintenance of LHV quarters in selected health facilities (phase III 24/7 BHUs and BHU+

Facility Based Maternal and Child Health Records – The Blue Book

program mergingChecklists and record keeping tools play an important role in ensuring that the health care providers do not miss out provision of any essential service to the patients / clients. The Program has, therefore, developed a detailed patient records booklet that starts right from conception (ante-natal care) and goes on till the child is five years of age. The record book, therefore, covers the following aspects:

  1. Ante-natal history, examination and diagnostics
  2. Natal record including active management of third stage of labor and partograph
  3. Post natal section with checklists for essential activities to be performed such as cord care, early initiation of breast feeding and immunization
  4. Child growth monitoring and tracking of nutrition indicators (height, weight and MUAC)
  5. Childhood vaccinations according to EPI schedule
  6. Family planning record of mother

Community Based Maternal and Child Health Records – The Green Book

A special records booklet has also been developed for use at community level in Urdu language. This booklet also ensures continuum of care and starts right from conception till the child is five years of age. The booklet was piloted initially in two districts and later scaled to ten districts. The program is now scaling it up across all 36 districts.

Introduction of Chlorhexidine for Cord Care

Chlorhexidine for cord care is one of the proven cost-effective interventions to prevent neonatal mortality due to sepsis related with cord infections. The Program has provided Chlorhexidine for cord care in three pilot districts after training of the relevant staff. The intervention is now being scaled up across all 36 districts of the Province. Logistic and training support for the pilot intervention was provided by JSI-USAID and UNICEF respectively.

Provision of Job Aids

Specially designed job aids for LHVs have been provided at all 24/7 BHUs to help the LHVs in remembering key messages and protocols regarding obstetric and newborn care. These books are expected to contribute to improvement in quality of services provided by the LHVs.

Improvement in ANC through basic screening tests and Ultrasonography

The coverage of antenatal care is improving in the Punjab province at a fast pace due to expansion of basic EmONC services to 803 24/7 BHUs and through door to door counseling and referral through the Lady Health Workers. However, the quality of the antenatal care being provided is not up to the mark. The Program is taking a number of steps to improve the quality of ANC visits:

  1. Provision of rapid diagnostic test kits including those for Hemoglobin, Urine dip-stick, HBSAg, HCV, HIV and implementation of functionality index for input indicators related to antenatal and natal care; as described in the section on functionality index.
  2. Provision of checklists for antenatal history taking, physical examination and basic diagnostic tests; as described in the section on blue book.

As a next step in improving the quality of antenatal care, the IRMNCH&N Program will provide ultrasound machines at all 24/7 BHUs and will train the LHVs on use of these machines for basic screening. USG has a specific role in detection of complications / danger signs that can lead to morbidity and mortality during each of the three trimesters as given below. Although some of these conditions can be identified on the basis of history and examination, however, ultrasonography can significantly improve the accuracy of diagnosis and can thus assist the LHVs in appropriate and timely decision making. The procurement of USG machines is in process. Once the machines are available, the LHVs will be trained to use them for obstetric cases.

Maternal and Neonatal Death Surveillance and Reporting (MNDSR)

The IRMNCH&N Program, with technical assistance from UNFPA, is implementing MNDSR in all districts of Punjab, since August 2015. Different tools are being used for data collection in the form of verbal autopsies for each reported maternal or neonatal death. The purpose of this surveillance is reporting of every maternal and neonatal death that occurs at the community level, through LHWs; and at the facility level, through the health facility staff who was looking after the patient at time of death. Every maternal death and 10% of neonatal deaths reported through this system undergo verbal autopsy.