In this issue
Highlights of the Quarter
Featured PPHI Specials
Disease Alert
Performance Review July-Sept 2016
Volume 5 No. 3(July-Sept 2016)
PPHI Sindh Quarterly Health Bulletin
It’s a PPHI Media Cell Presentation © 2016
Photography by
Printed at Blue Bells
3 PPHI SINDH Quarterly Health Bulletin
Overhauled integration of Preventive,Curative
& Nutrition* interventions
To reduce the maternal deaths by one fourth
To reduce preventable deaths of newborns
and children < 5 years by one third
Improved control of the disease outbreaks
To ensure the universal access to sexual and
reproductive health-care services
Revamped nutrition intervention*
Strengthened and equipped infrastructure
Value-added support to the vertical programs
State-of-the-art modern warehouses
Solarization of the 24/7 health facilities
Upgraded online resource modules
Online testing services for recruitment
Upgraded online monitoring
mechanism(MoM)
Establishment of specilized Preventive &
Curative wings
Establishment of Research & Training Wing
Public service mass campaigns
Accredited postgraduate programs for the
HCPs
*in selected districts
Mission 2016-17
4 PPHI SINDH Quarterly Health Bulletin
Health
Department
42%PPHI Sindh
58%
PHC Healthcare Distribution
(PPHI & HD)
Health Department Sindh
PPHI Sindh
Welcome
1. Highlights of the Quarter 1.1. Primary Health Care
1.2. PPHI Speacil Interventions
1.3. Quarters Key Highlights
1.4. Capacity Building -MCPC 3rd Phase
1.5. 5th Family Planning Campaingn
1.6. Health Promotion & World Health Days
2. PPHI Special 2.1. Kausar Hospital Khairpur
- A Challenge and An Opportunity
2.2 From District Manager’s Desk-Sanghar
2.3 PPHI Heroes - Featured Medics
2.2. Triumph of Unforeseen Talent
2.3. Disease Alert – Dengue Fever
2.4. From Researchers Desk – Postpartum
Haemorrhage in SAARC Countries –
Asystemic Review of Risk and Protective
Factors
3. Quarterly Performance 3.1. Health Services Performance Top 5
Districts
3.2. Maternal, Newborn & Child Health
Indicators
3.3. Quarter’s Quick Review
3.4. Top 5 Communicable Diseases
3.5. Top 5 Non Communicable Diseases
3.6. Regional Performance - Key Indicators
3.7. Monitoring of Monitors Review
3.8. In-house Medical Claims Overview
IN THIS ISSUE
On the cover…
PPHI Sindh is a Public-Private Partnership with the
Government of Sindh (GoS). The first agreement for
PPHI was signed back in February 2007 by Mr. Syed
Sardar Ahmed, former Minister for Health. PPHI’s
journey started from District Kashmore and
gradually expanded to 22 Districts of Sindh
(excluding Benazirabad and 6 districts of Karachi).
The need for partnership emerged because of a
crucial need of time; GoS had an infrastructure of
over 20 billion rupees for delivering Primary
Healthcare (PHC) in the province. Tragically, this
was either sub–optimally operational or altogether
dysfunctional. This valuable infrastructure had to be
made optimally operational therefore the
government of that time decided “contracting–out”
the management of government’s PHC
infrastructure to a Nonprofit Service Provider. This
responsibility was first handed over to Sindh Rural
Support Organization (SRSO) in 2007 and then to
PPHI Sindh in 2013. The original design included
integration of all vertical programs and transfer of
the management of integrated PHC package.
However, only the management of health facilities
was transferred to PPHI while vertical programs
were not relegated. PPHI Sindh is headed by a
Board of Directors comprising of 9 members and 3
ex-officio members from GoS and run by an
experienced management. PPHI management has
recently expanded and established MNCH wing,
Research & Training wing and a Media Cell,
ensuring sustainable growth of the organization.
A Family coming out of a PPHI Health Facility after an OPD
consultation – BHU Plus Dano Dhandhal District Tharparkar
PPHI Sindh started its journey in February, 2007 with the
objective of revitalizing health services in rural Sindh. The
immediate goal was to ensure that health facilities were fully
functional, providing health services to all persons within
their reach. A dedicated and competent management team
was hired, which embarked with full vigor to achieve this
objective. Within a short time, facilities had regular
attendance of doctors and staff as well as continuous medical
supplies.
Owing to PPHI’s efforts, health indicators, especially infant
and maternal mortality have consistently improved. PPHI has
focused on mother and child health and has continuously
improved delivery coverage all over Sindh. It has set up
round the clock delivery facilities at 24/7 MNCH Centers and
implemented Infection Prevention Protocols. Family planning
initiatives led by PPHI have successfully reduced family size
whereas health awareness sessions have pushed
communities to use the BHU as their main health provider.
Today, 1139 health facilities in 22 districts managed by PPHI
are the main healthcare providers in rural Sindh. Many have
labor rooms and ultrasound machines. Female doctors and
PPHI trained midwives are available even in remote areas.
Medicines are provided free of cost and lab tests are carried
out regularly for all patients. Uninterrupted power supply is
ensured by providing generators and moving towards solar
energy solutions.
PPHI Sindh’s achievements would not have been possible
without the support of the Government of Sindh. The
Government’s cooperation has made it possible for PPHI to
follow its mission and achieve phenomenal growth in a short
span of time. Moreover, the commitment of PPHI’s Board,
management, staff and partners deserves appreciation who
are dedicated to achieving the organization’s objectives.
I believe that a dynamic organization like PPHI will continue
to add value and become the leader in service delivery in
Sindh. PPHI’s work has made a sustainable impact in primary
health, improving and saving lives of the marginalized in rural
areas, who otherwise would have no means or access to basic
healthcare. I foresee PPHI Sindh going from strength to
strength and wish the best to the CEO, Dr. Riaz Ahmed
Memon, the management and staff as well as all those who
have extended their support and contributed to its success.
Fazal-ur-Rehman Chairman PPHI Sindh
Board of Directors
Chairman
Mr. Fazal-ur-Rehman
Members
Mr. Muhammad Nazar Memon
Mr. Tasneem Siddiqui
Dr. Suleman Sheikh
Mr Farooq Haroon
Mr. Mushtaq Shah
Mr. Khalid. M. Soomro
Dr. Saeed Qureshi
Dr. Nighat Shah
Provincial Office
Chief Executive Officer
Dr. Riaz Ahmed Memon
Chief Operating Officer
Mr. Ghulam Ali Soomro
Chief Financial Officer
Mr. Muhammad Aqib Qureshi
Director Health Services
Dr Abdul Sattar Chandio
Director Procurement
Syed Shahid Ali
Principal Officer
Mr. Abdul Ghaffar Surahio
Provincial Engineer
Mr. Ghulam Mustafa Malik
Company Secretary
Ms. Farah Yamin Khan
District Manager- Hq.
Mr. Iqbal Qureshi
Chief Auditor Executive
Mr. Hans Hussain Soomro
Legal Ad
Mr. Parvaiz Ahmed Memon
Organizational
Body A Word by the Chairman
BHU Basic Health Unit
CPR Contraceptive Prevalence Rate
CSG Community Support Group
DHIS District Health Information System
DHQ District Headquarter
EPI Expanded Program on Immunization
FMO Female Medical Officer
FP Family Planning
GD Government Dispensary
GoS Government of Sindh
HCP Healthcare Provider
HD Health Department
HF Heath Facility
HR Human Resource
HTN Hypertension
IUCD Intra Uterine Contraceptive Device
IYCF Infant & Young Child Feeding Practices
LHV Lady Health Visitor
LHW Lady Health Worker
MCHC Maternal & Child Healthcare Centre
MNCH Maternal, Neonatal & Child Health
MW Midwife
NSP Nutrition Support Program
NVD Normal Vaginal Delivery
OCP Oral Contraceptive Pill
OTP Out Therapeutic Program
PHC Primary Health Care
PNC Postnatal Care
POP Progesterone Only Pills
PPH Postpartum Hemorrhage
PWD Population Welfare Department
RHC Rural Health Centre
RUTF Ready to Use Therapeutic Food
SAM Severe Acute Malnutrition
SoP Standard Operational Procedure
SRSO Sindh Rural Support Organization
THQ Taluqa Headqaurter
ToR Terms of Reference
WHO World Health Organization
Acronyms
1.
HIGHLIGHTS
OF THE
QUARTER
1.1. Curative & Preventive Services at PPHI Health
Facilities
Ultrasonography at BHU Makhan Samo - District Mirpurkhas
Medic Couple at PPHI Health Facility – BHU Moosa Khatyan District Hyderabad
Primary Health Care
Primary healthcare (PHC) refers to
"essential health care" that is based on
scientifically sound and socially
acceptable methods and technology,
which make universal health care
accessible to all individuals and families in
a community. It is through their full
participation and at a cost that the
community and the country can afford to
maintain at every stage of their
development in the spirit of self-reliance
and self-determination".
WORLD HEALTH ORGANIZATION. DECLARATION OF ALMA-ATA. ADOPTED AT THE INTERNATIONAL CONFERENCE ON PRIMARY HEALTH CARE, ALMA-ATA, USSR, 6–12 SEPTEMBER 1978.
Immunization
Maternity Services
Maternal & Child Health Care
Neonatal Care
Family Planning Services
Ultrasound Services
Ambulance Services
Community Support Group Network
Diagnosis of common ailments and Treatment by
Skilled Health Care Providers with Follow up and
Referral
Provision of Essential Drugs including
Micronutrient Supplements
Provision of Anti-Snake Venom, Anti-Rabies
Vaccine and Anti-Tetnaus Serum
Laboratory Services
Maternal, Neonatal & Child Health PPHI on the Directives of CM Sindh is Upgrading 150 More BHUs to
BHU Plus in FY 2016-17
PPHI made special efforts by making an extra mile by upgrading
120 6/6 BHUs to 24/7 BHU Plus with an ample workforce of female
Health Care Providers (HCPs). These round the clock maternity
centers are equipped with diagnostic labs, standby ambulances,
ultrasound services and a supply of nutrition supplements like iron,
folic acid and multivitamins. Besides that, newborn care and
Helping Baby Breath (HBB) corners are other valuable initiatives.
Family Planning Services Family Planning services are an integral component of our primary
healthcare services as it directly affects the quality of maternal and
child health. PPHI Sindh is committed to reduce maternal and
newborn mortality in Sindh and is convinced that by adopting
effective strategies, this could be reduced remarkably. Further, it
aims at the accessibility of quality family planning services in the
far-flung areas of Sindh where the unmet need for family planning
is very high. Its existence in rural areas makes clients more
comfortable for the follow up or in case of any possible
complications.
Comprehensive Emergency Obstetric Care
at RHCs & THQs Though PPHI’s prime domain is PHC but the organization has
gradually expanded its operation to secondary care at its rural
health centres. Moreover, specialist doctors at taluka and district
headquarter hospitals have also been deployed under PPHI
contract.
Services & Facilities
24/7 Labour Rooms
Postpartum Family Planning
Immunization
Laboratory Services
Free Medicines
Free Ultrasound Services
24 Hours’ Ambulance
Services
Cesarean Section Underway RHC Tandojam – PPHI Hyderabad
1.2. PPHI Special Interventions
Lady Doctors for the Rural Areas When the organization started its operations in 2007, HR gap was of a
big concern. No lady doctors were willing to serve in the rural areas
of Sindh. So PPHI remedied this with some extraordinary efforts and
successfully deployed lady doctors at most of the rural health facilities
with attractive packages. Right now the organization has some
impressive numbers with 419 lady doctors and 1049 LHVs/MWs in 22
districts of Sindh.
District Health Information System (DHIS) PPHI has successfully implemented DHIS with 100 percent compliance
that could be shared with the stakeholders with a high degree of
confidence. This comprehensive health information system ultimately
helps in evidence based decision making for improved healthcare. A
third party evaluation by Contech International (USAID) back in 2015
have reported PPHI’s DHIS data accuracy over 86 percent.
24/7 Ambulance Service All 24/7 PPHI health facilities are provided with a standby ambulance
with trained driver. In the first phase, 66 ambulances, including six
Advanced Cardiac Life Support (ACLS) ambulances and 25 Basic Life
Support (BLS) ambulances were purchased and recently 55 more
ambulances have been added to the fleet.
Vertical Program Support PPHI has been supporting the EPI program, knowing its importance.
When PPHI took over, out of 1142 health facilities, only 425 had
immunization services. The organization added 155 additional cold
chain points at its existing health facilities and appointed vaccinators.
Adding more value to it, in 2015 PPHI purchased 332 electric and Solar
Ice Lined Refrigerators (ILRs) and handed them over to the EPI
program, to further strengthen immunization coverage. Recently PPHI
Sindh has been handed over the administrative side of EPI for district
Dadu and Khairpur.
Provision of Quality Supplies & Medicine At PPHI, patient safety is our top priority, we are committed to protect
our provision of drugs and medical supplies from substandard
manufacturing practices and counterfeit products. In addition to this,
the essential drugs supply is fostered by provision of life saving highly
expensive Anti Snake Venom (ASV), Anti Rabies Vaccine (ARV) and
Anti Tetanus Serum (ATS) for the patients.
“The ultimate goal of
primary health care is
better health for all”-
WHO
WHO has identified five key
elements to achieving that
goal:
Reducing exclusion
and social
disparities in health
(universal coverage
reforms)
Organizing health
services around
people's needs and
expectations
(service delivery
reforms)
Integrating health
into all sectors
(public policy
reforms)
Pursuing
collaborative
models of policy
dialogue
(leadership
reforms)
Increasing
stakeholder
participation
Restoration & Repair of the Health Facilities At the time of takeover the situation of overall health infrastructure
was shabby and around 182 health facilities were illegally occupied.
That was one of the hefty challenges to restore or evacuate the
buildings and make them operational, all possible efforts were
made for their immediate restoration.
Approval of SNEs PPHI received 158 health facilities without approved SNEs (building
without budget). PPHI prepared documents, chased files and finally
after two years of incessant struggle, 115 SNEs were approved.
Number of approved HFs were constructed in the following years i)
1989 (15 HFs), 1992 (26 HFs), 1993 (15 HFs), 1995 (26 HFs), 2000 (8
HFs) and 2003 (26 HFs).
Value Addition to the PPHI Health Facilities PPHI has added more extra value to its health facilities by
establishing 679 laboratories, 118 with mini laboratories, radiology
services and more. Many restricted health facilities have been
provided permanent electricity, water supply, gas supply and 37
have been solarized.
State of the Art Modern Medicine Warehouses Three modern medicine warehouses in district Thatta, Badin and
Khairpur have been completed at a total cost of Rs. 62 million and
all three are operational since 2013. Fourth warehouse in
Hyderabad is under construction and would soon be operational.
Establishment of PPHI Head Office PPHI Head Office was established on ownership basis worth Rs. 60
million back in 2014. The building as been converted to a fully
equipped provincial unit to deliver the best.
Solarization of PPHI Health Facilities PPHI has planned to solarize its 500 health facilities in the first phase
with a total estimated cost of Rs. 200 million. For long term utility of
the investment, quality of the solarization has extensively been
worked on.
PPHI Laboratory Services – District Umerkot
Essentials of
Primary
Healthcare
PEOPLE’S FIRST
CONTACT
Serves as an entry point into
the health care system, and
the first source of care for
most health needs
ACCESSIBILITY
Offered within people’s
communities, at a price they
can afford
COORDINATED
Manages care across levels
of the health care system,
referring patients to
specialists as needed &
effectively following upto
ensure improvement
PEOPLE-CENTERED
Organized around the health
needs and expectations of
people rather than diseases
COMPREHENSIVE
Delivers a broad spectrum of
preventative, promotive,
curative & palliative care
CONTINUOUS
Connects people with
trusted providers who
address their ongoing health
needs throughout their lives
.
1.3. Quarter’s Key Highlights
Establishment of Training and
Development Wing at PPHI Sindh In order to make sustainable model for capacity
building of health care providers working at PPHI
health facilities, PPHI’s management decided to
establish a dedicated Training and Development wing
in the organization. The goal of this division is to
increase capacity of health care providers and
auxiliary staff working in PPHI health facilities to
improve quality of health services delivery and adopt
evidence based best practices.
Recruitment of MNCH
Coordinators for 22 Districts MNCH Coordinators will serve as focal
person for ensuring capacity building of
health care providers at PPHI facilities by
providing training through various
approaches such as classroom based
training, on the job training/coaching, role
plays, case studies etc. Additionally, their
role requires them to visit the facility to
monitor the quality of maternal and child
health services being provided at the
facilities.
Initiated 6 Weeks Training
Program for Midwives
PPHI’s innovative idea of upgrading BHUs
into BHU Plus has been very successful.
Hence, upon observing this success Chief
Minister of Sindh proposed to upgrade 100
more BHUs into BHU Plus by June 2017.
Therefore, to fulfil the gap of human
resources, PPHI Sindh devised a strategy in
which newly graduated midwives looking
for work were interviewed and shortlisted.
These shortlisted candidates will have to
undergo a 6 weeks training which includes
1 week theoretical training conducted by
MNCH Coordinators and experienced
Female Medical Officers already working at
PPHI facilities while 5 weeks practical
training at BHU Plus under supervision of
FMOs and midwives. Successful trainee
midwives after the completion of 6 weeks
training will be offered to work at selected
PPHI health facilities under CM’s initiative.
Internship Program PPHI Sindh has recently started initiative of
administering a 2 week internship program for
students studying in 12th grade from renowned
schools of Karachi like Karachi Grammar School,
Lyceum School etc. These students are given a task
related to their area of interest this includes tasks
related to administration, communications, data entry,
literature review, proof reading documents etc.
Students with parent’s consent are also taken on field
visits to the health facilities that enables them to
experience how the health system operates at the
district level.
Message from the
Chairman
Major
Achievements of the
2nd quarter
MCPC Modules Post-Partum Hemorrhage and its
management at PHC
Pre-eclampsia & Eclampsia
Abortion
Prolonged / Obstructed Labor and
Use of Pantograph
Puerperal Sepsis
Shock
Infection prevention Protocols
Clinical Approach to the Patient with
fever during pregnancy.
"Capacity building
remains one of the most
challenging functions of
development. It brings
more power to the
provider’s end
ultimately bringing
improved and
sustainable health to the
communities”.
Dr Abdul Sattar Chandio
-Director Health Services, PPHI Sindh
1.4. Capacity Building
Management of Complications in Pregnancy &
Childbirth 3rd Phase Trickle Down Trainings About 15% of pregnancies undergo some complications at one point
or the other. If complications remain unidentified, this may lead to
catastrophic consequences for maternal and newborn health. Given
that the masses are living in rural suburbs of Sindh and have no access
to PHC, we need extra effort to train the HCPs. A multiphase training
program was conceived and materialized in this quarter where more
than 345 HCPs have been trained.
The HCPs have been mastered in most common maternal and
neonatal complications that may really play well in decreasing
maternal, fetal and neonatal morbidity and mortality. First three
phases of the training have already been completed but spot revision
and follow up is need based and an on-going process being
replicated by the technical team of the district wherever needed.
Objectives
1) To build capacity of the HCPs to improve the quality of
maternal, newborn and child health.
2) Early identification, initial management and timely referral.
3) To replicate the updated guidelines and protocols for the
improved skills.
5) To reduce disease burden and mortality.
MCPC Trickle Down Trainings
Phase I. Training of Trainers at Provincial Level (May 2016)
Phase II. Training of Medics at District Level by the Master Trainers
(June 2016)
Phase III. Training of Paramedics by the Medics (July-Sept 2016)
Phase IV. Spot Revision & Follow-up (On-going)
Group Excercise during MCPC Training – PPHI Khairpur Mirs
MCPC Phase 2 Training by the Master Trainers Region III & IV – PPHI Khairpur
AUGUST CAMPAIGN
HIGHLIGHTS
Total Clients 18655
Jadalle 9155
IUCD 1310
Injectable 3488
COC 3037
POP 103
Condom 1490
Tubal Ligation 44
1.5. 5th Family Planning Special
Campaign
21, 506 Family Planning Clients in the
Campaign
Family Planning is a voluntary adoption on the basis of
knowledge, attitude and practices by the couples. This gives
them freedom to decide the size of thier family and the related
standard of living. Consequentially, it promotes the quality of
life, contributing to the social development of the nation.
PPHI Sindh started special family planning camps on quarterly
basis. The focus of these camps are on Long Acting Reversible
Contraceptives (LARC) i.e. Jadelle and IUCD. These camps are
organized at selected PPHI health facilities mostly BHU Plus.
Both female and male medical officers are available for
providing counselling and family planning services.
Additionally, free transport is also provided to the clients who
are interested to get contraceptives. Awareness regarding FP
camp are disseminated through electronic media, by
announcements in mosques and community meetings.
Furthermore, community mobilization through LHWs is also
done. This exercise has brought exceptional results and the
response has been overwhelming every time.
From August 9-11, 2016 PPHI organized fifth successful camp,
the main highlights of the campaign are 9745 Jadelle insertions
(compared to 4190 in the first camp), 1711 IUCDs including 88
tubal ligations with thousands of the short term of family
planning visits with in the three days of the campaign. These
numbers are result of great team work and commitment to
improve health indicators of Sindh.
The total Couple Year Protection (CYP) by this year is coming to
136907, till date more than 20,000 implants are inserted by
trained PPHI health care providers at PPHI health facilities.
Similar activities took place on the following dates 27-29
October, 2015, 10-12 June, 2015, 9-11 February, 2016 and 10-12
May, 2016.
Client Registration During a Family Planning Camp – PPHI Sukkur
CPR of Pakistan
35% (2012-13)
Goal 3: Ensure healthy
lives and promote well-
being for all at all ages
By 2030, ensure universal access to
sexual and reproductive health-care
services, including for family
planning, information and education,
and the integration of reproductive
health into national strategies and
programs.
"& when we both were
desperate for the child
spacing but there was no
one to help us in this as
we live near Indian
border where life is an
everyday challenge. One
day I heard about PPHI’s
family planning camp at
Hirar Deeda on a radio
show.
We just came here where
my wife has got this long
lasting capsule fixed and
even now I can feel that
freedom of mind. All I
need to say is, PPHI is like
a blessing to us”.
Mr. Rano Mal -A Peasant from Taluka
Nagarparkar
17
89
31
7 68
9
71
6
8
35
2
15
60
17
8
19
0
26
3
3
14
0
24
28
63
1
16
73
14
85
32
65
4
33
78
18
4
93
6
57
3
60
34
4
0
500
1000
1500
2000
2500
3000
3500
4000
Jaddel IUCD Injectable COC POP Condom
Contraceptives Breakup
Hyderabad Mirpurkhas Larkana Sukkur
Sukkar Larkana Hyderabad Mirpurkhas
Total Clients 5506 6909 3879 2361
Total Clients with Long Term FP
Method3562 3059 2106 1738
0
2000
4000
6000
8000 5th Family Planning Camp Performance
Focusing more on Postpartum Family Planning &
Longterm Reversible Contraception During the special campaigns PPHI focuses on PPFP and long term
methods those are more effective and reliable than the ordinary
contraceptive methods.
5th Family Planning Campaign Publicity Bannar in Shahi Bazar – PPHI Umerkot
1.6. Health Promotion &
World Health Days…
Highlights International Health Days Observed.
4069 Health Education School &
Community Sessions in the Quarter
Pre-defined Health Promotion
Themes for the Quarter
- Population Explosion and Importance of FP
- Menace of Viral Hepatitis in Pakistan, its
Course & Prevention
- Role of ORS and Zinc in Treatment of
Diarrheal Disease & Metronidazole
Misconceptions
- Safe Maternity Practices
School Health SessionsCommunity Health
SessionsCSG Meetings
Community
Participation114415 6542 5245
0
20000
40000
60000
80000
100000
120000
140000
Community Participation Performance
7.2 billion* World Population - From 1950 to 2010 the
global population of the world nearly
tripled in size.
120 people per square
mile World’s Population Density
182.1 million** Pakistan is the sixth most populous country
*United Nations Department of Economic and Social Affairs.
Population Division, Population Estimates and Projections Section.
World Population Prospects: The 2012 Revision. ** World Bank, Utited States Census Bureau
11th July World Population Day World Population Day is a great event being
celebrated all through the world annually on 11th of
July and is meant to bring awareness towards the
worldwide population issues. The first World
Population Day was held in 1987, inspired by people’s
interest in world population reaching 5 billion.
World Population Day focuses attention on the urgency
and importance of population issues in the context of
overall development plans and programs.
World Population Day was celebrated at PPHI health
facilities to increase people’s awareness on various
population issues such as the importance of family
planning, including gender equality, poverty &
maternal health. Special health sessions were
conducted to celebrate world population day.
Health Education Session in Progress BHU Hatri – PPHI Hyderabad
28th July
World Hepatitis Day The theme for this year's global campaign is elimination.
Key approaches to tackle the menace of hepatitis is to
expand vaccination programs for hepatitis B; focus on
preventing mother-to-child transmission of hepatitis B;
improve injection, blood and surgical safety; “harm
reduction” services for people who inject drugs; and
increase access to diagnosis and treatment for hepatitis
B and C.
About Hepatitis Viral hepatitis – a group of infectious diseases
known as hepatitis A, B, C, D, and E – affects
hundreds of millions of people worldwide,
causing acute and chronic liver disease and
killing close to 1.4 million people every year,
mostly from hepatitis B and C. It is estimated
that only 5% of people with chronic hepatitis
know of their infection, and less that 1% have
access to treatment.
On World Hepatitis Day, 28 July 2016, WHO calls on policy-makers, health workers and the public to "Know hepatitis - Act Now?"
182.1 million (2013)*
Pakistan's estimated population in 2015 is
over 191.71 million, making it the world's
sixth-most-populous country.
1.6 percent*
Population Growth Rate
3.26 birth rate*
Of people with hepatitis are unaware of
their infection.
*World Bank
26th September
World Contraception Day WHO marks 26th September as World Contraception
Day, Promotion of family planning – and ensuring
access to preferred contraceptive methods for women
and couples – is essential to securing the well-being and
autonomy of women, while supporting the health and
development of communities.
Allowing women to choose whether, when, and how
many children to have achieves progress on global
health goals. PPHI Sindh celebrated world
contraception day by organizing special campaign at
selected PPHI health facilities for providing counselling
and family planning services.
400 million*
Viral hepatitis affects 400 million
people globally and, given the size of
the epidemic, anyone and everyone
can be at risk.
95 percent*
Of people with hepatitis are unaware of
their infection.
7 million*
Lives can be saved between 2015 and
2030, WHO advises.
*World Health Organization
2.
PPHI
SPECIAL
Performance
2016
OPD 52,732
ANC-1 11,145
ANC Revisit 3,390
PNC-1 2,867
NVD 2,173
C-Section 1,183
Indoor Admissions 4,946
Lab Investigations 38,376
Ultrasounds 13,343
2.1. KAUSAR HOSPITAL KHAIRPUR 40 bedded 24/7 MCHC gifted by Islamic Republic of Iran -A challenge and an opportunity If you saved one life, you saved entire humanity (Al-Quran). Kausar
Hospital Khairpur under the umbrella of PPHI Sindh is trying to save
hundreds of lives per month and treating thousands of patients with
the sole motto of prompt quality care. This is an invaluable gift of
Iranian Government and Honorable Chief Minister of Sindh to poor
and downtrodden people of the region.
Kausar Hospital is a comprehensive maternal, neonatal and child
healthcare Centre which is providing all components of tertiary care
health facility. It is benefitting the community by reducing prevalent
inequalities through free of cost access to quality services.
As per cited performance, the magnitude of financial benefit to poor
people is about Rs. 285 Million within a span of 15 months. The average
number of C-sections and normal vaginal deliveries at Kausar Hospital
are 7-12 and 10-15 per day respectively.
Apart from antenatal, natal, postnatal, malnutrition and pediatric
cover, Kausar Hospital is providing coverage to emergency
gynaecological and obstetrical life-threatening emergencies. Since
last month, Kausar team have operated 17 patients with severe state of
shock especially due to uterine rupture and placenta previa type-3
and type-4. Moreover, Kausar Hospital has achieved a distinction in
this state that it is even accepting the rejected cases of other public
sector hospitals. The patients’ and attendants’ level of satisfaction has
been analysed time and again and it has been found 100% satisfactory
except with a sole complaint of provision of waiting area for male
attendants in outside premises of the hospital.
Kausar Mother & Child Healthcare Centre - PPHI Khairpur
Pediatric coverage extends from comprehensive neonatal
care in NICU up to pediatric care. Many pediatric cases with
complicated diseases are effectively diagnosed and
treated.
Kausar Hospital is being planned to be extended with
Capacity Building Institute and Research Wing of PPHI
Sindh. CBI will be imparting on-job capacity building
courses to all medics, paramedics and other staff of PPHI
Sindh on routine and rotation basis. Moreover, Central
laboratory is also being planned for which sentinel sites will
be MCHC centres of the district and/or region.
The new initiative into neonatal care which is being
planned for Kausar Hospital is Kangaroo Mother Care
(KMC). KMC is a natural incubation method of care of
preterm infants. The method involves infants being carried,
usually by the mother, with skin-to-skin contact. This is
intended for health professionals responsible for
the care of low-birth-weight and preterm infants. The
initiative will be first one within the province. PPHI Sindh
through Kausar Hospital Khairpur is committed for free of
cost, prompt and quality care to the marginalized people of
the region.
Cesarean Section in Progress - PPHI Khairpur
Services at Kausar
Hospital Khairpur Cesarean Section
Safe Blood Transfusion
observing universal HIV
precautions
Treatment of Sepsis (infections)
Treatment of Hypertensive
Disorders (Pre-
eclampsia/eclampsia)
Treatment of prolonged or
obstructed labour,
Post-abortion care (PAC)
Treatment of Post-partum
Hemorrhage (PPH)
Treatment of incomplete
miscarriage
Manual removal of placenta.
Assisted Delivery using forceps
or suction
Newborn Resuscitation
Maternal and Child
Immunization
Prenatal, Obstetrical and Post-
Partum Care
Infection Prevention & Helping
Baby Breath
Modern Methods of Family
Planning (long term and short
term)
Diagnosis and Treatment of
Major Infectious Diseases
Kangroo Mother Care (KMC)
234
156
218
290
183
343
234
157
220
0
100
200
300
400
NVDS C-Sections Malnutrition cover
Performance Overview Of Kausar Hospital Khairpur July-Sept
July Aug Sep
About the District
Manager
Mr Fida Hussain Lashari
graduated in Political Science
from University of Sindh,
Jamshoro then did his Masters
in Sociology. Previously
worked as a section officer in
Chief Minister Secretariat.
Joined PPHI in September
2015. Since then he has been
posted in District Sanghar. Mr.
Fida is another good addition
to PPHI Sindh.
Sanghar’s Famous Fish Kur’ro.
Mr Fida Hussain Lashari – DM
PPHI Sanghar BHU Plus Rukan Bur’ra – District Sanghar
2.2. From the District
Manager’s Desk… Featured District
District Sanghar – Region Mirpurkhas
One of the largest districts of Sindh province with a total area of 6650
square kilometers. It was named after a pious fisher-woman, Mai
Sanghar for more than a century according to some folk tales.The
district has remained a seat of historic significance during the British
raj where the uprising for the independence emerged under the
command of Pir Syed Sibghatullah Shah Rashidi.
Its rich in natural resources and known to be biggest cotton
producing districts of the country. According to the 1998 census of
Pakistan, the district had a population of 917, 863 of which 22.13%
were located urban areas whereas majority still lives in villages.
According to legend, the bodies of Sohni Mahiwal, the titular heroes
of one of the four popular tragic romances of Sindh, were recovered
from the Indus River near Shahdadpur city and are buried there. The
Tomb of Sohni is situated in Shahdadpur, which is 40 kilometers (25
mi) from Sanghar and 75 kilometers (47 mi) from Hyderabad.
INTERVENTION OF PPHI SINDH IN SANGHAR
PPHI Sindh took over administration of 58 BHUs, 24 GDs, 7 DCDs and
01 Unani Shifa Khana in the year 2008, PPHI has 73% share of total
primary health care in the district. However, the statistics over the
years have shown that communities of rural Sanghar have posed
their trust upon PPHI Sindh and in that way, people of faraway
catchment areas got benefit from the services.
Indicators Target JUL’16 AUG’16 SEP’16
Daily OPD Attendance 190000 160228 175645 121406
Full Immunization Coverage 2217 1873 2180 2337
Antenatal Care (ANC-I) coverage 2871 3229 3217 2446
ANC Revisit - 3218 3415 2703
Delivery Coverage at Facility 700 661 751 685
Total Visits for Family Planning 3918 1950 2312 1740
Pregnant women received TT - 2
vaccine
- 1316 1466 1275
1st Postnatal Care Visit (PNC-1) in
the facility
- 994 1183 948
PNC-Revisit - 219 325 368
CSG Meetings - 150 172 181
Women waiting for doctor’s consultation at PPHI family planning Centre
– PPHI Sanghar
By taking a step further, 6 round-the-clock fully equipped
MCHCs were established within the BHUs during the year
2014. Making it a landmark achievement given the harsh
dynamics, lowest percentage of female professional staff in
the province and the lack of basic facilities with deteriorated
infrastructure, PPHI succeeded to provide quality services in
the district.
Presently PPHI Sanghar has added 3 more round-the-clock
MCHCs and therefore now 09 HFs 24/7, with normal labor
services. Currently 45 HFs out of 81 HFs are also working as
6/6 MCHCs. Additionally, 5 local females will also join PPHI
Sanghar health facilities after completing their Midwifery
course, which will certainly put a positive impact on the
overall maternal & child health services.
It is among the top five districts in context of performance with
152426 outpatient (new cases), 2926 normal deliveries, 2001
family planning visits & 2130 fully immunized cases
Sanghar Quick Facts
Area 6650 km2
Talukas
Union Councils 70
Population (C1998) 917, 863
Population (2013) 1, 453, 028
Population Density
Literacy Ratio 30.87%
*Pakistan Bauru of Statistics
Patient at Central Registartion Point -PPHI Sanghar
Key indicators July-December 2016– PPHI Sanghar
CHALLENGES & RECOMMENDATIONS FOR THE CHANGE
Scattered population, low human development index, lack of health awareness, limited functional
health facilities with lack of professional staff are key challenges of the districts. Based on experience
and extraordinary dynamics of Sanghar, here are some recommendations for improving social and
health indicators in Sanghar;
Provision of clean drinking water to all the areas, including Khipro (Desert Area/Achhro Thar).
Provision of basic infrastructure, especially roads and electricity (Solarization of HFs) in rural
areas.
Enhancement of MCHC facilities at primary health care level along with an ensured quality of
emergency obstetric services at all THQs and RHCs.
Modern & long-term family planning interventions on war footing.
Establishment of Nutrition Stabilization Centers and nurseries with sufficient staff at all THQs.
Filling the human resource gaps by providing the professional staff with sufficient wages,
residential facilities i.e. staff colonies with all basic educational and health facilities at Taluka
level, pick drop facility, etc.
Improvement of the preventive health services on emergent basis, especially by completely
over-hauling the immunization services.
Improved secondary healthcare deliverance in the district.
2.3. PPHI Heros… Best Medical Officer BHU Jamraou 30 – PPHI Sanghar
Dr Atta-Ul-Mustafa Medical Officer, BHU 30 Jamrao is a very competent, professionally sound and
assiduous health care provider. He has been working as a medic since May 2009. Due to his extra
ordinary efforts and his generously courteous behavior he has been an inspiration to many including
the communities he has worked in. He has made his HF as a model BHU with high standards of
punctuality of staff, cleanliness and quality of services.
He is diligent in the performance of his duties. By virtue of his personal strife and coordination
through community mobilization and participation, BHU 30 Jamraoo has shown improvement in
service delivery, record keeping and store management. His supportive role for female staff
including FMO and sonologists has enhanced delivery, ANC, PNC and ultrasound service for the
underprivileged women of Sanghar.
Along with the mentioned services reworded by him during his tenure has been commendable. It
would be tantamount to injustice to endorse the services of such tremendous doctor. PPHI Sindh honors and endorse her undeniable services, as he is a real asset for the organization.
Personal Profile
Dr Syed Atta-ul-Mustafa belongs to
Village Rawtiani of district
Sanghar. He did his graduation
from LUMHS in 1999. After
graduation started working as a
medical officer in Murshid Hospital
Karachi and Ashfaque Memorial
Hospital Karachi. He Joined PPHI in
May 2009 and since then he has
been working with PPHI Sindh.
Dr Ata ul Mustafa BHU Jamarao 30 – PPHI Sanghar
About BHU Plus Jiando
Rind
Jinado Rind Mother & Child
Health Care Centre is about 45
kms away from Sanghar. Where,
before PPHI, health service
delivery was very poor. But after
taking over management of Said
BHU, PPHI turned this facility into
MCHC 24/7.
Now, MCHC Centre Jiando Rind
is working at maximum level of
service delivery in OPD, follow
ups, NVD, DNC, ANC, Family
Planning (IUCD).
A big share of highest deliveries
was from Jiando Rind MCHC
Centre. This MCHC Centre is
successful and the credit of its
success goes to Dr. Rizwana
Khokhar. She is sedulous and
diligent asset of our organization.
Dr Rizwana Khokhar BHU Plus Jiando Rind – PPHI Sanghar
Best Female Medical Officer BHU Plus Jiyando Rind Sanghar Dr. Rizwana Khokhar, Female Medical Officer is posted at BHU
Plus Jiando Rind at PPHI Sanghar since February 2010. She is
professionally sound and competent health professional, puts
all her efforts to make bring best to her catchment area
population in the best of her capacity. Her efforts reflect while
looking into the MNCH section of the health facility.
She has persuaded the population by frequent counseling
sessions for the people understanding the importance of
maternal and child health. Likewise she has done a lot for the
birth spacing eventually leading the region in FP procedures.
With her efforts & interpersonal communication skills NVDs
ratio has raised many fold. Now this BHU Plus takes lead every
time in the district.
She is also a trainer in MCPC, PCPNC and HBB. Her
contribution for establishing BHU Plus Khadro is applauded
which is now working very well and giving more than 100
NVDs.
Dr. Khokhar’s exemplary services to the community are
enough to motivate the other health care providers to serve
the poor and underprivileged rural communities. PPHI Sindh
honors and endorse her indubitable services, as she is a real
asset for the organization.
PPHI awarded me a fully funded scholarship of 2 years
Midwifery Training Program. I excelled there and after
the completion of my training got a guaranteed job at a
PPHI health facility in my village where there were no
lady healthcare providers really willing to work,
ultimately making mothers and neonates vulnerable.
Today I am serving my people with pride, where I have
helped many to the best of my capacity.
Moreover, PPHI has given me power to be a helping
hand of my family financially with dignity.
Ms. Bhaou Mehboob
PPHI Sanghar
2.3 The Triumph of the
Unforeseen Talent of Sindh... Ms. Bhaou and her husband Mehboob a jobless graduate had some
amazing things to share while they were asked for this featured
story. This is truly inspirational and portrays symbolic chemistry of
a Sindhi couple. Both took the toughest decision against the social
duress and just broken the shackles and the rest is known to us that
how an Unforeseen talent triumphed.
When both were jobless and were looking for some decent
livelihood. Bhaou’s husband found a scholarship training cum job
advertisement in a sindhi daily. He discussed it with his spouse and
instantly applied for the scholarship. When she appered before the
selection panel nobody ever wandered that she would be the best
graduate of the batch. Simultaneously both had to face extreme
defiance and the couple have had gone through the tormenting
outrage everyday as if they had brought disgrace to the family and
the village.
Bhaou came along with her husband to Karachi, completed 2 years
midwifery training by hooks or crooks, not only this but she
excelled by securing the highest marks in the batch & not only this
she was pledged as the best graduate.
But since she has joined back as a midwife near to her place of
residence, she has served many. Now contrary to the said the
situation is entirely different as Bhaou has helped many in saving
lives and people have started pursuing them actually.
The story does not end here there are still many who are source of
naussance to them and the couple keeps on listening the jabbing
taunts of the people around but now Ms.Bhaou and Mehboob have
more ardor and are more intend towards their kids as they want to
see them the future doctors.
Under this Midwifery Training
Program 75 matriculate girls
have graduated on a fully
funded scholarship by PPHI
Sindh and 50 are in the process.
Ms. Bhaou and Family – Village Kamal Khan Leghari District Sanghar
Measures for Vector
Control Protect your houses from
mosquitoes and remove
breeding places by removing
water accumulates and
garbage.
Regularly check for the
stagnant water in pot plants,
wheelbarrows, roof guttering
and birdbaths.
Cover fresh water tanks and
cisterns
Spray under beds and behind
curtains with residual surface
spray.
Keep you houses well lit and
ventilated.
Use screening for the doors
and windows
Use mosquito nets preferably
impregnated nets
Wear light colored full
clothing especially during the
dark hours.
Use mosquito repellents in
outdoors.
*Source Pakistan Today
2.4. Disease Alert… Dengue Fever
Dengue is a mosquito-borne viral infection causing a severe
flu-like illness and, sometimes causing a potentially lethal
complication called severe dengue. The incidence of dengue
has increased 30-fold over the last 50 years. Up to 50-100
million infections are now estimated to occur annually in over
100 endemic countries, putting almost half of the world’s population at risk.
Transmission
The full life cycle of dengue fever virus involves the role of
mosquito as a transmitter (or vector) and humans as the main
victim and source of infection.
Signs & Symptoms Sudden, high fever
Severe headaches
Pain behind the eyes
Severe joint and muscle pain
Fatigue
Nausea and Vomiting
Skin rash, which appears two to five days after the onset of
fever
Mild bleeding (such a nose bleed, bleeding gums, or easy
bruising)
Treatment There is no specific medicine to treat dengue infection. If one is
suspected to have dengue fever, one should use pain relievers
with acetaminophen and avoid medicines with aspirin, which
could worsen bleeding. The patient should also rest, drink
plenty of fluids, and invetigate the case thouroughly . If the
condition worsens in the first 24 hours should be hospitalized immediately to be checked for any possible complications.
Herbal remedies that are proven to cure Dengue Fever – LiveLonger.com Aedes Aegypti (Tiger Mosquito) is the Primary Vector of Dengue
2.5. From the Researcher’s
Desk… POSTPARTUM HAEMORRHAGE IN SAARC
COUNTRIES-A SYSTEMATIC REVIEW OF
RISK AND PROTECTIVE FACTORS - DR. MUHAMMAD BAKHSH RAJA DHAREJO
DM KHAIRPUR A
Background and Rationale PPH is the leading cause of maternal deaths worldwide with
escalating global incidence from 1.5% to 4.1% during first
decade of twenty first century, despite the number of
interventions by international organisations and
governments. Sustainable Development Goals (SDGs) have
replaced Millennium Development Goals (MDGs) in 2015 by
reconsidering the priority of the maternal health. PPH is a
preventable public health emergency in developing
countries due to soaring incidence rates. The majority of
maternal and child health policies and programmes primarily
focus on clinical aspects of PPH by adopting small individual
studies while failing to recognise and address social and
public health factors due to lack of composite research
evidence of the region. A substantial number of maternal
deaths are as a result of limited access to maternal healthcare
services, their poor quality and lack of awareness. Moreover,
there are number of primary studies conducted in South Asian
countries regarding risk and protective factors of PPH but
there is a substantial gap in literature for a holistic
comparative account of factors associated with PPH, which
could be generalizable and reproducible into local, national
and regional policies.
Aim To identify various risk and protective factors of PPH in South
Asian countries.
Methods A systematic review which explored databases of MEDLINE,
Science Direct, CINAHL in addition to Discover and Google
Scholar for relevant primary research studies through
inclusion and exclusion criteria. The studies were
systematically searched and screened in accordance with
standard methodology of Centre for Reviews and
Dissemination University of York. The data was extracted into
MS-Excel spread sheet. Additionally, quality appraisal of each
research study was conducted. The results were thematically
analysed by narrative synthesis in postpartum period and
psychosocial status of partners are associated socio-
behavioural protective factors associated with PPH.
Recommendations*
Preventive
Scheduled Antenatal Care
Adequate Birth Spacing
Controlled Chronic Diseases
Balanced Diet and Prompt
Application of good methods
of obstetrical care in a
hospital setting reduces the
risk for presentation with PPH
Curative
The use of uterotonics for the
prevention of PPH during the
third stage of labour
In settings where skilled birth
attendants are not present
and oxytocin is unavailable
Administration of misoprostol
(600 µg PO) by community
health care workers In settings where skilled birth
attendants are available, CCT
is recommended for vaginal
Births
Late cord clamping
(performed after 1 to 3
minutes after birth) is
recommended for all births
while initiating simultaneous
essential newborn care
*These rocommondations are not
part of the research abstract.
Results The review identified five categories of risk and protective factors
associated with PPH. Increasing maternal age, nulliparity,
primigravidity and grand-multiparity are associated biological
risk factors. Besides, Uterine atony, placental tissue retention,
abnormal placentation including gestational trophoblastic
neoplasia, trauma or tears of genital tract, assisted abortion,
antepartum haemorrhage, multiple pregnancies, any history of
previous PPH and obstetric complication, polyhydramnios, and
uterine rupture are investigated as obstetric risk factors while
level of antenatal care and visits during the gestation is the
obstetric protective factor against PPH. Moreover, anemia, sepsis,
infections, coagulopathy, gestational diabetes mellitus,
macrosomia, maternal obesity, hepatitis C infection, dengue
fever, pre-eclampsia and eclampsia are identified as medical risk
factors. Furthermore, prolonged labour duration, obstructed
labour and home based deliveries are recognised as clinical
settings related risk factors. While, active management of third
stage of labour, instrumental mode of delivery, hospital based
booked deliveries, and trained birth attendant are the clinical
settings related protective factors for PPH. Lastly, literacy and
awareness of mothers, adequate hydration level, and intake of
milk by mother during gestation, rest in postpartum period and
psychosocial status of partners are associated socio-behavioural
protective factors associated with PPH.
Conclusion and Implications The research has a potential to benefit in devising holistic
reproductive and maternal health policies and practices which
may plug the existing gaps in postpartum care at local, national
and regional levels. Moreover, due to deficiency of substantial
literature evidence, it has been recommended to conduct
randomised controlled trials in Afghanistan, Bhutan and Maldives,
to explore the temporal association of identified risk and
protective factors with PPH.
Keywords PPH, Risk Factors, Protective Factors, South Asia
Conditions that
may increase the
risk for Postpartum
Hemorrhage
Placental abruption
Placenta previa
Overdistended uterus
Multiple pregnancy
More than one placenta
and overdistention of the
uterus
Gestational hypertension
or preeclampsia. (High
blood pressure of
pregnancy)
Having many previous
birth
Prolonged labor
Infection
Obesity
Medications to induce
labor
Medications to stop
contractions (for preterm
labor)
Use of forceps or
vacuum-assisted
delivery
3.
QUARTERLY
PERFORMANCE REVIEW
Badin Sanghar Khairpur-A Ghotki Mirpurkhas
Outpatient Visits
(New Cases)170155 152426 144314 139558 136435
170155152426 144314 139558 136435
020000400006000080000
100000120000140000160000180000
Outpatient (New Cases)
Sanghar Jacobabad Mirpurkhas Ghotki Khairpur-B
Normal Deliveries 699 675 647 622 617
699
675
647
622 617
560
580
600
620
640
660
680
700
720
Normal Deliveries
Sanghar Ghotki Mirpurkhas Khairpur-A Khairpur-B
Normal Deliveries 2964 2524 2436 2381 2358
2964
2524 2436 2381 2358
0
500
1000
1500
2000
2500
3000
3500
Antenatal 1
3.1. Health Services Performance
PPHI Top 5 Districts
Khairpur-A Mirpurkhas Badin Sanghar Dadu
Family Planning 2447 2171 2100 2001 1908
24472171 2100 2001 1908
0
500
1000
1500
2000
2500
3000
Family Planning Visits
Ghotki Khairpur-A Sanghar Khairpur-BNaushero
Feroze
Fully Immunized 2306 2138 2130 1962 1889
23062138 2130
1962 1889
0
500
1000
1500
2000
2500
Fully Immunized
ANC PNC TT2 Deliveries
Performance 123123 32684 56924 20666
Revisits 122373 16047
123123
32684
56924
20666
122373
16047
Maternal Care
Performance Revisits
Number of
Live Births
Number of Still
Births
New Born
ComplicationsPremaurity
Newborn
Resucitations
New Born Care 12312 327 577 165 377
0
2000
4000
6000
8000
10000
12000
14000
New Born Care
New Born Care
3.2. Maternal, Newborn & Child Health
3.3. This Quarter Performance
- A Quick Review…
Services at PPHI
Health Facilities
Treatment of Common
Diseases
Maternal & Newborn Care
Services including
Antenatal Care, Nutritional
Supplementation, Basic
Emergency Obstetric Care,
Postnatal Care, Emergency
Referral Mechanism for
Obstetric Emergencies,
Ultrasonology
Provision of Essential Drugs
Immunization
Family Planning including
Counselling on Cafetaria
Choice
Control of the Endemic
Diseases
Health Education via
Community and School
Health Sessions
Basic Laboratory Services
Radiography at Selected
Centres
Promotion of Food Supply,
Water Supply & Sanitation
6,346,714 Outpatient Visits 5,465,162 Last Quarter Over 5.4 million OPD visits in the quarter with ensured
quality diagnosis, treatment and management as per
guidelines.
972,43 Family Planning 100,885 Last Quarter
Good family planning strategies have
remarkable impact over the quality of life,
reducing maternal and neonatal morbidity
and mortality, ultimately contributing to
positive health outcomes.
115,202 Antenatal Visits 123,123 Last Quarter
Antenatal care is an essential part of pregnancy and
should start as soon as one finds out they are
expecting. Having a healthy pregnancy is one of the
best ways to promote a healthy birth.
20,666 Normal Deliveries
20,666 Last Quarter
Most of the ladies were pre-booked during all ANC
checkups including all services such as
deworming, iron and folic acid supplementation.
989 High risk pregnancies were closely followed
and were referred for comprehensive emergency
obstetric care.
42,067 Postnatal Visits 32,684 Last Quarter
Postnatal care is of great importance as it helps the
mother and the baby to achieve optimal health.
78,794 Fully Immunized 74,529 Last Quarter
The main objective of quality immunization is to assure the
provision of the quality immunization services that promote,
protect and preserve the children against the vaccine
preventable diseases.
726,212 Laboratory Tests 607,531 Last Quarter
Accurate and reliable diagnosis is the cornerstone of
disease management and control. Integration of
laboratory and other diagnostics at PHC is of great
importance, making comprehensive healthcare a complete healthcare
1,125,505 Follow Ups 921,563 Last Quarter
Good follow up amounts to quality healthcare
deliverance. Ideally all the new cases must be
followed excluding few exceptions to this rule.
3.4. Top 5 Communicable
Diseases…
Case Definitions
Acute Respiratory Infection
Any acute onset of cough with
mild fever, runny nose,
pharyngitis, laryngitis, otitis,
tonsillitis,
with normal breathing
and without any general
danger sign.
Acute Watery Diarrhoea
Acute diarrhea (passage of
three or more loose stools in
past 24 hours) with or without
dehydration. In case of
dysentery a person having 3 or
more loose stools over last 24
hours with visible blood in the
stool, abdominal cramps,
tenesmus, fever and anorexia.
Dermatitis & Scabies
Dermatitis, also known as
eczema, is a group of diseases
that result in inflammation of
the skin. They are
characterized by itchiness and
red skin.
Scabies is characterized by
rash or lesion and intense
itching especially at night.
Lesions prominent around
finger webs, wrists, elbows,
axilla, beltlines, thighs,
external genitalia, nipples,
abdomen, buttock folds, head,
neck, palms and soles of infants
may be involved.
Suspected Malaria
History of recent fever within
last 48 hours (may be
continuous or irregular in the
beginning), chills, headache,
body ache, weakness, anemia,
hepatosplenomegaly.
Worm Infestation
Worm infestation occurs when
worms live as parasite in the
human gastrointestinal tract.
1,118,517 Acute Respiratory Tract
Infections The disease is more prevalent in the
children under 5 years of age most of
the viral infections are self-limiting,
seldom requiring antibiotics but need
careful follow-up.
525,413 Diarrhoea/Dysentery The disease is prevalent in South Asia,
mostly involving children under five.
The treatment of most diarrheas
involves staying hydrated with clean
and safe drinking water, zinc sulphate
and no antibiotic usually.
797,773 Dermatitis & Scabies
Dermatitis and related syndromes are very
prevalent. Heat rashes, fungal disease,
photosensitive dermatitis, acnes and other
skin allergies are common diseases of
summer season.
317,207 Suspected Malaria
The disease is endemic in our part of the
world although many have developed
resistive immunity against it. It is prevalent
especially in children. There are major
issues with the management of malaria as
per guidelines.
37,725 Worm Infestation The helminthic worm infestation is very
widespread in rural Sindh, affecting a
majority of children under 5. PPHI
Sindh has all standard treatments
regimes available at all the HFs.
3.5. Top 5 Non-Communicable
Diseases…
Case Definitions Peptic Ulcer Disease
Gnawing pain, burning
discomfort, and tenderness in
the epigastric area are the
symptoms and signs most
commonly associated with PUD.
However findings are not
specific or sensitive enough to
diagnose this condition so
confirmed diagnosis is made on
laboratory basis.
Asthma
The chronic inflammation is
associated with airway
responsiveness that leads to
recurrent episodes of wheezing,
breathlessness, chest tightness,
and coughing, particularly at
night or in the early morning.
Dental Caries
Dental caries, also known as
tooth decay or cavities, is a
breakdown of teeth due to
activities of bacteria
Hypertension
Blood pressure measurements
are classified in stages,
according to severity:
Normal blood pressure:
<120/80 mmHg
Pre-hypertension:
120-139/80-89 mm Hg
Stage 1 hypertension:
140-159/90-99 mm Hg
Stage 2 hypertension:
>160-179/100-109mmHg.
Based on average 2 or more
readings on 2 or more different
occasions after initial screening.
Diabetes
Symptoms of hyperglycemia
(polyuria, polydipsia,
unexplained weight loss, visual
blurring, genital thrush,
lethargy)
&
Raised venous glucose detected
once.
Fasting > 125 mg/dl
Random > 200 mg/dl
14,535 Diabetes Mellitus Diabetes mellitus, commonly referred to as
diabetes, is a group of metabolic diseases
in which there are high blood sugar levels
over a prolonged period. Even disease is
diagnosed and managed without following
the standard diagnostic guidelines at large.
158,058
Peptic Ulcer Disease It is a lesion in the lining of the digestive
tract, typically in the stomach or duodenum,
caused by the digestive action of stomach
acids. This is one of the most misreported
diseases on the clinical grounds.
35,580
Asthma A respiratory condition marked by attacks of
spasm in the bronchi of the lungs, causing
difficulty in breathing. It is usually connected
to allergic reaction or other forms of
hypersensitivity. Widely prevalent in both
urban and rural population.
59,512
Dental Caries Tooth decay is a common disorder, second
only to the common cold. It usually occurs in
children and young adults, but can affect any
person. Tooth decay is a common cause of
tooth loss in younger people. This is an
underreported disease.
21,714 Hypertension
HTN is an iceberg diseases with many of the
people living with it asymptomatically and
most of the patients are missed by the
physicians usually. Generally HCPs do not
follow the diagnostic criteria of 3
consecutive blood pressure readings failing
to manage it properly.
Last Quarter This Quarter
Hyderabad 25715 24284
Mirpurkhas 33458 31567
Larkana 26875 28537
Sukkur 36074 30814
Antenatal Care - 1
Last Quarter This Quarter
Hyderabad 23559 23984
Mirpurkhas 24129 25165
Larkana 24458 25584
Sukkur 25102 26152
Family Planning
3.6. Regional Performance This quarterly performance is actually based on the four key
indicators including outpatient visits, total number of antenatal
visits, normal delivery coverage and family planning visits.
The graphical analysis of the all four key indicators is shown
herein;
Last Quarter This Quarter
Hyderabad 1236596 1383284
Mirpurkhas 1603822 1803419
Larkana 1117986 1417082
Sukkur 1506758 1742933
Outpatient Visits
Last Quarter This Quarter
Hyderabad 4225 4825
Mirpurkhas 5632 6917
Larkana 4938 8193
Sukkur 5871 8311
Delivery Coverage
Focused ANC-1 1. Check for the Weight &
Nutritional Status
2. Check for the Anemia -
Hemoglobin
3. Check for the Blood Pressure
for early detection of
complications
4. Check for the Urine Albumin
5. Blood Grouping
6. Tetanus Toxoid Immunization
7. General Danger Signs
While birth is a natural
process, that does not
generally require
medical intervention, it
is still one that is fraught
with danger for women
and infants around the
world so it requires safe
preparation as well as
clean and safe
institutional delivery.
Key
Indicators
July-September
2016
Good quality of care in family
planning (services help
individuals and couples to meet
their reproductive health needs
safely and effectively.
Therefore, assessment and
improvement of the quality of
family planning services could
enhance family planning
services utilization.
An OPD visit is a medical
service provided that does
not require a prolonged stay
at a facility. This can include
routine services such as
checkups or visits to clinics.
0 50000 100000 150000 200000
Last Quarter
This Quarter
Last Quarter This Quarter
OCPs 36232 34619
Injections 33779 33789
Condoms 10287 88082
IUCD 2820 2896
Implants 12004 11853
Surgical 362 271
Family Planning Breakup
This Quarter Last Quarter
Hyderabad 15552 17486
Mirpurkhas 18744 21718
Larkana 15257 15086
Sukkur 24976 27869
Fully Immunized
Good quality of care in family
planning focuses on who can use
contraceptive methods safely,
providing guidance on the safety
of various contraceptive methods
in the context of specific health
conditions and characteristics.
Immunization is a proven tool
for controlling and eliminating
life-threatening infectious
diseases and is estimated to
avert between two and three
million deaths each year. It is
one of the most cost-effective
health investments.
3
3.7. Monitoring of Monitors…
PPHI has a very comprehensive monitoring,
data collection and analysis system that play
a vital role in quality assurance and in
forecasting improved real time health
planning according to desired needs. Since
PPHI operates in rural areas, MoM is a
revolutionary intervention where a monitor
is used for gathering first hand statistics
directly from the field. It improves analysis
and improvement of planning.
On the other hand, MoM has an advance
online dashboard with a real time
synchronization that gets the farthest
updates within the matter of seconds. The
dashboard could be accessed by the
authorized from anywhere around the
world, whenever one wants a have peep into
the things.
Quarterly Review of Mobile
Monitoring
The overall coverage of all four region for the quarter was
satisfactory whereas Mirpurkhas and Larkana regions
covered the set targets very well.
The main observations that were made during the data
analysis are as follow;
Many required sections of the reporting format
are often missed in reporting.
GPS positions are mismatched.
The HR codes of absentees are often mismatched.
Some of the indicators are filled without ensuring
the LQAS.
The formats need to be filled the way they are
designed. Even a single variable is of great
importance so the reporting must be meticulous.
Monitoring of Monitors Real Time Dashboard Mobile Interface
Salient Features
Tracking reporting individual
coverage and performance
District wise data analysis
Summary and frequency of
monitoring
Validation of the data source
by GPS and live shots
0
20
40
60
80
100
120
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Monitoring of Monitors Coverage Districtwise
Last Quarter This Quarter
PPHI Big Achievements
First and only Province to upgrade 122 BHUs to 24/7 BHU Plus (Maternal
Services)
Appointment of the Lady Doctors for the first time in Rural Areas of Sindh
with a total strength of 485 FMOs in 21 Districts of Sindh
Restoration of 182 Illegally occupied Health Facilities
Managed Approval of 158 SNEs out of 158 HFs
Repair and Renovation of over 982 HFs
Dedicated PPHI Research & Training Wing
Use of Technology with fully equipped ERP Modules like Human
Resource Maagement System, Job Portal, Financial Information System,
Medicine Invntory, cLMIS and more
Flood & Rain Emergency - Disaster Relief Services (2010-2012)
Smart Phone Monitoring
District Health Information System with 100% Compliance and 86 percent
Data Accuracy*
DIVIDEND OF PARTNERSHIP (Value for Money)**
Head Office worth Rs. 60M
Establishment of 03 Medicine Warehouses with District Offices worth Rs.
62M (Badin, Khairpur & Thatta)
3 Warehouese under Progress worth Rs. 75M (Hyderabad, Sukkur,
Larkana)
Ambulances worth Rs. 86M
Distribution of 332 ILRs worth Rs. 36M for EPI
141 Ultrasound Machines worth Rs. 63M
Establishment of 2 Eye Hospitals at Khairpur and Matiari worth Rs. 40M
ARV 275,000 Doses worth Rs. 115M In last 5 Years
MSPH Postgraduate Program for 25 PPHI Doctors worth Rs. 14.39M
Midwifery Training Program for 150 Girls worth Rs. 135M
PPHI Sindh – A Non Profit Organization Committed to Serve the People of Sindh
www.pphisindh.org | www.facebook.com/pphisindh | [email protected] | 0800-77755
Electricity won’t be a problem anymore!
PPHI Sindh
to Solarize all 24/7 BHU Plus
in 22 districts to ensure
round the clock quality
maternity services.
PPHI Sindh Just Introduced KMC*…
Kangaroo
Mother
Care*
could save
thousands of
babies each year. KMC* launched at
PPHI Kausar Hospital Khairpur & soon to be implemented throughout 22 districts of Sindh.