AKDN-health department partnership hailed

CHITRAL, Dec 27: A one-day dissemination seminar to share findings of the final evaluation of the Chitral Child Survival Program (CCSP) was organised by the Aga Khan Foundation (Pakistan) and program partners; Aga Khan Health Service, Pakistan (AKHS,P) and Aga Khan Rural Support Programme (AKRSP). District Health Officer Health Chitral, Dr. Israr Ullah, was the chief guest on the occasion, says a press release. In his remarks, he appreciated the contribution and achievements of Child Survival Program for improving maternal, neonatal and child health status in Chitral. He said the partnership between AKDN and Department of Health Chitral has been exemplary in many health service areas including child immunization, management of tuberculosis and strengthening health services delivery in three government health facilities at Shagram, Mastuj and Garum Chashma on the basis of public private partnership. He stated categorically that as a result of strong partnership between Department of Health Chitral and Aga Khan Health Service, Pakistan, Chitral was declared a polio free district in 2005 by the Provincial Department of Health government of Khyber Pakhtunkhwa.” Dr. Zafar Ahmed, General Manager, Aga Khan Health Service Pakistan for Khyber Pakhtunkhwa and Punjab Region, in his presentation shed light on Community Midwife (CMW) model and explained about selection, training, deployment, supervision and performance assessment processes for 28 Community Midwifes that AKHSP had followed for implementation of Chitral Child Survival Program. He said “CMWs have played pivotal role in providing essential maternal, neonatal and child services at door step of 28 remote communities in Chitral and AKHSP has been advocating with provincial Department of Health for absorption of those community midwifes in mainstream health system in order to sustain maternal, neonatal and child services.” Farid Ahmed, Manager Community Based Saving Groups(CBSGs) in Aga Khan Rural Support Programme Chitral, highlighted the dire need and process of establishment of Community Based Saving Groups in his presentation. Both the presenters informed the audience that maternal, neonatal and child mortality and morbidity are high in Chitral due to lack of awareness about the major risk factors associated with maternal and child health; inadequate road infrastructure, long distances and travel time and cost of transportation to reach referral facility. According to the baseline survey conducted in 2009 under the Chitral Child Survival Program, 26% of pregnant mothers did not have access to antenatal care due to lack of awareness; 27 % due to high cost and 36% due to difficulties of travelling to health facilities providing such care. Responding to the above challenges, CCSP was implemented in 28 of the most remote and isolated mountainous community clusters in Chitral district during the period 2008 to 2013. The objective of the programme was to reduce maternal, neonatal and child mortality and morbidity by increasing access to and utilization of the obstetric and neonatal continuum of care in the target communities. During the programme, Aga Khan Health Service, Pakistan selected and trained 28 Community Midwives. After the 18-month training, which was conducted in collaboration with the Government Department of district Chitral, the CMWs were deployed in their respective communities. Aga Khan Rural Support Programme mobilised communities and established 421 Community Based Saving groups (CBSGs) in the selected 28 communities. Young and educated women participated more in the CBSGs. The purpose of establishment of CBSGs is to reduce financial barriers of women to access maternal, neonatal and child health services. According to a final evaluation report, 15% women had availed loan from CBSGs to receive services from community midwifes particularly to pay fee for delivery. Ms. Khunza, a Community Midwife from Paksh village of Chitral, represented her fellow community midwifes in the seminar. She shared her own story and informed the audience about the challenges she has been facing while providing services to people in remote villages in her valley where distance and difficult terrain are the biggest challenges. However, she said she has been successful in her job due to tremendous support she has received from her family and the village health committee. She has conducted 89 skilled deliveries in a population of 3000 during last two years. The participants were inspired after listening to her story and applauded her contribution to improve maternal, neonatal and child health services in her area. Dr Sharif Ullah Khan, Senior Programme Officer Health, Aga Khan Foundation (Pakistan), while presenting the findings of the final evaluation report of the Program said that “CCSP has achieved remarkable results in improving skilled birth attendance, provision of care and access to financial services to women for seeking maternal and neonatal care in Chitral.” He added that village health committees established during the course of the project have strengthened the community based referral system and there has been a wide acceptance of the CMW model implemented by AKHS,P to improve healthcare services in Chitral. He stated that through the CBSGs, women have been encouraged to save money and have had better access to loans for emergency needs including health care. It was noted that women who had membership in CBSGs were four times more likely to avail Maternal, Neonatal and Child Health services from CMWs then those who were not part of any such group. The evaluation has concluded that “CCSP has contributed significantly to increase knowledge about maternal, neonatal and child health, financial access and coverage of skilled delivery through implementation of CMW and CBSG interventions and this model has great potential for replication in other parts of Chitral district and other districts of Khyber Pakhtunkhwa.” The evaluation report has also recommended that the Department of Health, Khyber Pakhtunkhwa make an allocation in the health budget to include the 28 CMWs trained under this project in the mainstream health system in order to continue maternal, neonatal and child services in the remote communities of District Chitral. In the interim period, AKHS,P will continue to provide supportive supervision to 28 CMWs to ensure quality of services provided by them. It has also been recommended that AKRSP should develop a mechanism to provide regular supervisory support to the existing CBSGs in Chitral and also mobilize Local Support Organizations to ensure sustainability.    ]]>