KARACHI – Most of the government-run health facilities in Sindh – particularly those belonging to Hyderabad, Sanghar and Karachi districts – are not properly staffed. As a consequence, a considerable time is wasted before treatment of pregnant women having complications starts there.
In many cases, women are referred to other facilities, which leads to further delay. This explains why the maternal mortality rate (MMR) is high in the province. These observations were made by Dr Talat Rizvi of Unicef at one of the scientific sessions of the two-day national symposium on reproductive health, which opened in Karachi on September 20, at the Aga Khan University.
She said if the government was committed towards decreasing the MMR, it must get its priorities right. “Every EDO must decide if he wants to have a large number of health centres that are inadequately staffed or have only a manageable number of facilities that are properly staffed and which are in a position to deliver,” said Dr Rizvi.
She pointed out that in Hyderabad alone there were more than 200 health centres many of which were short of badly-needed staff. “We have many centres which have doctors but don’t have operation theatre technicians. Then there are hospitals which have OT staff but don’t have anaesthetists.”
Dr Rizvi was of the view that the health department should review the staff position at all the health centres under its control. She also spoke about the need to monitor the performance of the staff continuously.
Making a presentation on an initiative under the ongoing Women’s Right to Life and Health programme, Dr Rizvi said interventions were made at 10 of the 27 health centres falling in the selected districts of Karachi, Sanghar and Hyderabad. “Of these 27 centres, standards improved tremendously at 10 while 10 others are doing fairly well.”
The success stories happened due to the support extended by the then health secretary and the recent involvement of the councillors and Nazims concerned, she added.
Dr Farid Midhet of the Asia Foundation, Islamabad, spoke at length of an initiative that was undertaken to reduce maternal deaths in Khuzdar, Balochistan. Under this programme, he said, awareness was created about the delays that occur in the community – both at the households and transporters level.
He said husbands were educated about the delays which fuel the MMR and transporters were coached about the need to take pregnant women swiftly to the nearest healthcare centre.
Dr Midhet said due to the efforts launched by his team, positive outcomes were witnessed in the selected areas of Khuzdar as opposed to control areas in which no intervention took place.
Saulat Yar Khan of the Women’s Reproductive Health-care Project, Khanpur, described the efforts which were launched in parts of Punjab to help decrease the MMR. This programme involved the creation of Community-Based Organizations (CBOs) which disseminated information about the delays that caused maternal deaths.
In addition to creating awareness about the delays, the initiative helped upgrade various health facilities, which in turn helped reduce the MMR in the area considerably. Gijs Walraven of the Aga Khan Health Services made a presentation on issues in assessing the MMR. Mehtab S. Karim of the AKU also spoke on the occasion.
Meanwhile, at the inaugural session of the two-day event experts from home and abroad emphasized the role of research in guiding improvements in health systems and for developing new initiatives in the area of reproductive health.
Prof S. Arulkumaran of the International Federation of Gynaecologists and Obstetricians said the life-cycle approach was needed to improve reproductive health in developing countries.
He said new health policies, action plans and interventions were the need of the hour and operational research should be undertaken to identify the most effective strategies.
“Reproductive health should be built into the national health service framework and should constitute part of the millennium development goal. The NGOs can help in the service and research strategy,” he added.
Prof Javed Rizvi of the AKU said data on reproductive health were inadequate in many developing countries. Therefore, it was important that developing countries regard research as an area of priority.
He said there was a need to identify the type of health delivery systems which were possible, sustainable and affordable in local environments. “Funding of research is an issue.
The key is to develop proposals, which are simple and workable and have realistic outcomes that can be implemented,” he said. Partnerships with government, NGOs, research institutions and pharmaceutical industry would pave the way to translate research into practice, he added.
Prof Mehtab S. Karim of the AKU said reproductive health issues were not restricted to reproductive ages, but covered the whole life-cycle. “Proper research studies need to be carried out on each of the components of National Reproductive Health Services Package, including family planning, maternal healthcare, infant healthcare and STDs,” he added.
Dr Karim also discussed in detail the research carried out on related issues at the AKU. David Taylor of the AKU presented the welcome address. Dr Shahida Zaidi of the Asia-Oceania Federation of Gynaecologists and Obstetrics, Olle Soder of the Karolinska Institute, Stockholm, John Cleland of the London School of Hygiene and Tropical Medicine, Prof Laetitia J. King of the Aga Khan University East Africa and Gijs Walraven of the Aga Khan Health Services spoke at the plenary session.