THE CHALLENGES IN UNDER DEVELOPED THIRDWORLD COUNTRY

Transcription

1 THE CHALLENGES IN UNDER DEVELOPED THIRDWORLD COUNTRY HCPA IN QUALITY IMPPROVEMENT! Dr. Nighat Shah MCPS, FCPS, MRCOG Society of ob/gyn Pakistan 1

2 Scheme of Presentation: Introduction : Pakistan Health Care Association Different Vertical Programmes / Projects Bridging the gap HCPA, NGOs, Govt. FIGO Project / Fistula Project Barriers, Gaps, Shortages Overcoming barriers / hurdles What have the projects achieved How can the progress be measured 2

3 HEAVY POPULATION BURDEN 3

4 Introduction: Pakistan home to 160 million mostly poor people (60% below poverty level). Socio cultural, economic, norms are anti women. Women are mostly poor, pregnant and powerless. Less than 50% women & men are educated. Health infrastructure is inadequate and more concentrated in urban areas. Health care professional association include - PMA, Pakistan Medical Association - SOGP, Society of Ob/Gyn Pakistan PNFWH - NCMNH, National committee on Maternal, Neonatal 4

5 Different Vertical Programmes / Projects - Mainly CME (for medical professionals, for paramedical, students & general public) - Conferences (Academic and scientific session and workshops) - Community work: Training ambulance drivers, Sensitizing Politicians, Sensitizing Religious Scholars. Fistula camps, Gynae operations, Medical camps, public awareness. - Ethical practice / standardization of medical education and practice 5

6 COLLABORATION WITH PAKISTAN NATIONAL FORUM ON WOMEN S HEALTH Midwifery Pictorial Simple Midwifery Where Women have no Doctor Textbook of Midwifery 6

7 COLLABORATION WITH PAKISTAN NATIONAL FORUM ON WOMEN S HEALTH Emergency Labour Management Infection Prevention Managing Complications in Pregnancy Manual of Teaching Nursing and Midwifery 7

8 SOGP PROJECT / FISTULA PROJECT: SOGP/ FIGO did capacity building in RHC, the hospital was non functional which was built, renovated, equipped and professional doctors / nurses were hired. Community started availing services, trust was built and the number of out patient and inpatient services. Problems: - Cost, Sustainability - Corruption - Govt. not involved - Hiring Professional 8

9 COMMUNITY BASED INTERVENTIONS TO REDUCE MATERNAL AND PERINATAL MORTALITY AND MORBIDITY IN RURAL SINDH, PAKISTAN FIGO SOGP Project Saving Mothers & Newborns November 1, 2006 to Oct 31st, 2010 (4 Years) 9

10 Project initiation Health facility needs assessments Non functional Female ward. RHC Gharo TBA in BHU Ghari Wah. 10

11 Project initiation Health facility needs assessments OT / Labour Room, SZMC, Mirpursakro 11

12 Facility Readiness SZMC Renovated Labour Room 12

13 Facility Readiness SZMC OT- ready 13

14 Facility Readiness SZMC OT is functional 14

15 FISTULA PROJECT: In collaboration with UNFPA, PNFWH, Fistula Project was taken up, whereby, Training was given to health professional in all four province for fistula repair. A hospital specially for this problem now stands in Karachi where by surgeries are done without cost. Community camps are regularly organized for repair of fistula in far fetched rural areas. 15

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19 QUALITY IMPROVEMENT Any process or tool aimed at reducing the quality gap in the systemic and organisational functions according to the dimensions of quality The basic principles are common sense, customer focus, strong leadership, involvement of people, process approach, systemic approach to management, continual improvement, factual approach to decision making and mutually beneficial supplier relationship 19

20 QUALITY IMPROVEMENT: An army of dedicated / committed people is required. Government has to be seriously engaged. HCPA have to dedicate more time, energy & resources Most of the Projects are in the initial period and may faze out because of funding. There is a wide gap of leadership, time, commitment. 20

21 HOW CAN THE BARRIERS BE ERADICATED: Bridging the gap, bringing politicians, NGOs, and HCPA on one table to rationalize scarce resources. Training, sensitizing, midwifes, nurses and doctors Seriously engaging government, community leaders, media, taking all stake holders along Building up sensitivity in the youth so that next generation wakes up to reality. 21

22 WHAT HAS THE PROJECT ACHIEVED SO FAR: Overall it has in creased sensitivity, awareness. Decrease in Maternal Morbidity / Mortality. 22

23 MEASURING, REPORTING OF HCPA CONTRIBUTIONS: Quality improvement stands on good information as well as expertise in problem detection and solution, therefore has to be proper data & documentation. Protocols and regular trainings on infection control, mva, Labour ward management Accountability and audits specially confidential inquiries in maternal mortality 23

24 IN CONCLUSION: HCPAs have to support networks and collaborate to foster sharing of data, resources, and disseminate findings Develop, validate new methods for the measurement of quality in maternal health care, to include optimal health outcomes Create mechanisms and tools for providers that promote adherence to and use of standards.hcpas have to continue for constant quality improvement so that goals and outcomes are met 24

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