PROJECT PAPER
Tauseef Akhund Research Officer Paediatric Department. Agha Khan University Karachi Pakistan
Title:
Establishment of Maternity Homes at Union Council Level
Problem:
High Maternal Mortality in Rural Areas
Rationale:
In rural areas of Pakistan due to lack of skilled birth attendants, percentage of deliveries conducted by skilled birth attendants is very low and there is no proper referral system for complicated obstetric cases, resulting in high maternal mortality ratio in rural areas. We will address this problem by establishing maternity homes at union council level by training community midwives in rural areas, after training LHWs on maternal care. LHWs will provide ante natal examination to pregnant women, in addition they will refer complicated cases to maternity homes and established obstetric care centers.
Interventions:
- Agreement with district government
- Community meetings
- Training of locally selected midwives
- Establishment of maternity homes at union council level
- Training of LHWs on maternal care
- Conduction of baseline survey
- Maternal care of pregnant women by LHWs
- Establishment of referral system
- Establishment of maternity fund committee
- Monitoring and reporting
- Evaluation
Strategy:
After signing agreement with district government, local matriculation passed married women will be selected (one in tow union councils). There will be one year quality midwifery training for them. During this period community meetings will be held at district, tehsil and union council level to enhance the participation / awareness of community in establishing maternity homes. LHWs will be trained on providing maternal care examination to pregnant women and referral systems. At secondary level already practicing gynecologist will be identified and selected, keeping in view the emergency handling capacity of obstetric care centers. An agreement will be signed with these centers for providing concessions and quality care to referred cases.
Baseline survey will be conducted by LHWs to establish baseline indicators like percentage of deliveries conducted by skilled and unskilled birth attendants, maternal mortality ratio, % of pregnant women having more than three ante natal examinations and different traditions regarding maternal care. After analyzing this data baseline indicators will be established to compare the results at different stages and at the end of project. Simultaneously a control area will also be identified and selected for comparison.
After completion of community midwifery training, maternity homes will be established one in two union councils thus covering the whole rural area of district. LHW will ensure registration of pregnant women of their catchments areas in concerned maternity homes for ante natal examination and delivery. Midwife will ensure at least one antenatal examination of complicated case in emergency obstetric care centers.
A maternity fund committee will be established by local community members, which will arrange fund for deserving cases. Half of the fee of the midwife will be contributed in this community fund. District and tehsil level monitoring committee will monitor the affairs of these committees. District and tehsil level monitors and LHS will continuously monitor the working of LHWs, maternity homes and emergency care centers. Every month indicators taken from LHW monthly reports, maternity homes and emergency obstetric care center records will be compared with already established baseline indicators and indicators of control area to assess whether we have achieved our objectives or not.
Place and duration:
District Gujarat of Punjab province and Hyderabad of Sindh province. Project duration is of four years.
Indicators:
- % of pregnant women registered in maternity homes
- Number of pregnant women examined by LHWs
- % of deliveries conducted by skilled birth attendants
- % of complicated cases delivered in emergency obstetric care centers
- Number of live births
- Number of maternal deaths
Cost Estimate:
Six million Rs. For four years