It has been studied that maternal (MMR 800 per 100,000 live births) and Infant mortality rate (IMR 105 per 1000) is highest in Pakistan among other developing countries (MICS-2010). The condition in rural areas of Balochistan is worst. It is estimated that more than 50% of the disease-load case are Cholera, Diarrhea, Respiratory tract infections and skin diseases as a result of poor quality of life and unhygienic environment inside and outside the houses. Lack of priority for social sector services including health both preventive and curative, inadequate budget, improper infrastructure, inadequate live saving medicine & trained staff, illiteracy, dependence on Daiz (Traditional Birth Attendances), remote areas and scatted population are major reasons behind this graving situation in health care system.
BRSP goal in health sector is to contribute in poverty reduction by improving health service of target communities of the province. Health sector aims to improve the health status by enhancing demand for health services through social mobilization, improving the infrastructure of health facilities, capacity building of the health personals, improving the governance, improving the access to health services, policy advocacy for health prioritization in planning at provincial level and provision of equipments and addressing the issues of missing facilities. Major components under Health are Primary Health Care, B-EmOC services, C-EmOC services, addressing the Reproductive Health issues, Polio eradication, Malaria control interventions and organizing Mobile Service Units in far flung and mountainous areas of the target districts.
BRSP since its inception ensured provision of primary health care and reproductive health services to communities in 15 districts of Balochistan. Where, 96 health facilities were provided with medicine and medical equipments, 56 health facilities, physical infrastructure improved 4,500 disposable delivery and hygiene kits delivered and 1307 rapid diagnostic testing kits also provided till date.
Pakistan is a malaria endemic country with an estimated annual number of malaria cases at 1.6 million.1 Approximately 24.84 million of the population residing in 38 highly malaria endemic districts are at risk of malaria. The majority (80%) of malaria in Pakistan is caused by Plasmodium vivax, while the remaining 20% is caused by P. Falciparum2. Malaria endemic is heterogeneous in Pakistan. Thirty seven percent of malaria cases3 are reported from the districts and agencies of Federally Administered Tribal Areas (FATA) and Balochistan bordering Afghanistan and Iran. Malaria transmission is seasonal, with peaks in summer (June September) for vivax malaria and late-summer and winter (August- November) for falciparum malaria. The Government of Pakistan is implementing Malaria Control Program (MCP) in 72 malaria endemic districts of Pakistan with the public sector resources and in 19 highly endemic districts with the support from the Global Fund (Round 7).
The proposal for Round 10 has a goal to reduce burden of malaria by 75% in 38 highly endemic districts of Pakistan. This goal has been set in accordance with MDG targets because Round 10 proposal coincides with MDGs timeline. The target 38 districts for Round 10 proposal include 19 current districts of the Global Fund Round 7 and proposed 19 additional districts for Round 10. The total target population living in these 38 highly malaria endemic districts are estimated at 24.84 million people. Main emphasis of this proposal is on effective case management, multiple prevention measures, including universal coverage with LLINs and IRS and community awareness. In light of experiences and lessons learnt from Global Fund Rounds 7 implementation in Pakistan, the national malaria strategic framework has been revised. The proposed interventions in Round 10 are based on national strategic framework and TRP comments on Round 9 proposal. In addition, this proposal has specifically taken into consideration current flood emergency situation in the country and its potential implications on malaria epidemiology in the endemic districts.
Global Fund has taken Save the Children International (SCI) as principle recipient for this project while SCI has taken two sub recipients (NRSP and Marlin) in Balochistan that can implement this project in 6 highly endemic districts of Balochistan. Looking towards the physical presence of BRSP in Balochistan, NRSP has taken Balochistan Rural Support Program (BRSP) as sub-sub recipient for implementing Malaria control interventions in District Chagai, Kharan and Washuk (bordering districts of Balochistan)
BRSP is implementing the project in Kharan, Washuk and Chagai since Sept, 2012. 63 Health facilities (23 Microscopy centers and 40 Rapid diagnostic centers) in entire districts are focused under the project activities, so far BRSP has renovated all the microscopy centers by establishing the laboratories, upgraded 40 health facilities as RDT centers and furniture provided to all the facilities while established 63 Long lasting insecticidal nets (LLIN) Distribution outlets.Project aims to facilitate the public sector in controlling malaria in these districts by building the capacity of health staff in diagnosis and proper treatment of the malaria patients, provision of medicines, providing awareness to the community for prevention from Malaria and providing LLIN�s and implementing Indoor Residual Spray (IRS) at household level.
BRSP has distributed 20,755 LLIN in the targeted districts while covered 5088 HH through IRS till June 2013, while trained31 public sector health personals trained on Malaria Microscopy who will make functional the laboratories at district and facility level for provision of diagnostic services to the communities , 45 public and private sector health personal's trained on the use of RDT, 69 public sector health staff trained on LLIN distribution strategy developed by Save the Children for Malaria project, 84 public and private sector health staff trained on uncomplicated Malaria case management for provision of timely and proper treatment to Malaria suspected cases, 74 public sector health staff trained on MIS, data management and reporting tools at district level
This project aims to increase access and demand of marginalized communities to quality health services especially basic-emergency obstetric care (B-EmOC) and comprehensive-emergency obstetric care (C-EmOC) 24/7 in Khuzdar, Kharan and Jhalmagsi districts, Balochistan.
After a detailed assessment of health facilities was carried out focusing; 16 BHUs regarding staffing (LHVs), repair and renovation, provision of medicine, fueling of generators and 3 DHQs were assessed regarding staffing, equipments/furniture, medicine, repair and renovation of OT/labor rooms, repair and renovation of ambulances including their fuelling and provision of generators plus fuelling and Medicine Supplies to 16 BHUs and 3 DHQs and equipments for DHQs have been procured and handed over to respective districts. Recruiting Gynecologist, anesthetist, Women Medical officers, staff nurse, LHVs to strengthen the facilities as per requirements. 50 HCPs, 100 LHWs and 200 TBAs with the involvement of COs, VOs and HMCs were nominated for trainings. Till date 200 TBAs, 100 LHWs and 29 HCPs have been trained. Health awareness sessions were also conducted at the community level.Similarly, 48,415 people have been facilitated through 308 Mobile Service Units, 175,407 individuals including women & children benefited from focused/supported health facilities. Moreover, 5,869 women and children screened for malnutrition, 1,532 severely and moderately malnourished children diagnosed and treated, whereas 4,554 lactating and pregnant women treated for malnutrition till date.
In total, of the clients interviewed, 60% in Khuzdar, 54% in Kharan and 55% in Jhal Magsi have been referred by COs, TBAs or HMCs to health facilities. The monthly data received from the facilities in Khuzdar, Kharan and Jhal Magsi revealed that 44.96% beneficiaries of project health centers are women, while seeking services in the shape of ante-natal and post-natal, and overall attendance of women at health facilities.
According to the results of the Client/patient Exit Interviews at health facilities conducted on a quarterly basis, 63% clients/patients in Khuzdar, 58% in Kharan and 57% in Jhal Magsi expressed their satisfaction over the services provided in the target facilities.