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1. NATIONAL PROGRAMME FOR FAMILY PLANNING & PRIMARY HEALTH CARE:

The goals of the National Programme for Family Planning and Primary Health Care programme are as under:-

  1. To develop the necessary health manpower in support of programme by selection, training and deployment of Lady Health Workers in the country.
  2. To address the primary health care problems in the community, providing promotive, preventive, curative and appropriate rehabilitative services to which the entire population has effective access.
  3. To bring about community participation through creation of awareness, changing of attitudes, organization and mobilization of support.
  4. To expand the family planning services availability in urban slums and rural areas of Pakistan

 

The specific objectives of the programme are:

    • A reduction of IMR from 85 to 55 per 1000 live births.
    • A reduction of MMR from 400 to 180 per 100,000 live births.
    • An increase in the Contraceptive Prevalence Rate from existing 22% to 42% in rural area and from 40% to 58% in urban area.
    • An increase in Immunization coverage in children aged 12-35 months fully vaccinated from 45% to 80% in rural areas, and from 64% to above 90% in urban areas. (In liaison with EPI).
    • An increase in TT-5 immunization coverage amongst women of childbearing age from 12% to 40%.
    • An increase in the percentage of children being exclusively breastfed till age of 6 months from existing 18% to 50%.
    •  An increase in births assisted by skilled birth attendant from existing 12% to 30% in rural areas and from 43% to 80% in urban areas covered by the programme.

    LADY HEALTH WORKERS (LHWs)

    To achieve the goals of the program, Lady Health Workers (LHWs) from various communities are chosen. LHWs are educated and belong to their own communities, reducing the unfamiliarity differences. They are paid, trained, supervised by predefined criteria. A trained LHW can provide all basic health care facilities to her own community. Supervisors are appointed to supervise the work of LHW.

    LHWs can provide promotive, preventive, curative and rehabilitative services to the community. They also educate and provide Family Planning methods and MCH services.

    SELECTION CRITERIA FOR LADY HEALTH WORKERS

    Lady Health Workers are recruited with following criteria:

    • Local Resident
    • Middle School Pass
    • Preferably Married
    • Minimum Age 18 years
    • Recommended by / acceptable to the Community

     Training of LHWs & Subject Covered

    LHWs are trained before their deployment in the community. They are taught about:

    • Community Organization
    • Inter Personal Communication Skills
    • Maternal Health
    • Nutrition
    • Family Planning
    • Child Health (Acute Respiratory Illnesses, Extended Program of Immunization, CDD)
    • Care of Sick - Common diseases and their prevention
    • Hygiene - Clean drinking water and sanitation
    • Basic Data Collection and Importance of Health Management Information Systems

     

    Treatment Component

    Duration

    Modules Used

    Class Room + Practical

    (Health Education, Charts, Videos)

    03 Months

    LHW Module

    Field Practice + Class Room (one week per month)

    12 Months

    LHW Module, Practice Training & Problem Based

    Field Practice + Class Room (one day per month)

    Monthly

    LHW Module & Problem Based

                                                                    
    Scope of Work for LHWs

    LHWs are posted in their community and are involved in the following type of work:

    • Organize community by developing women groups and health committees
    • Act as liaison between formal health system and community
    • Register all eligible couples (married women age 15-49 years)
    • Disseminate health education message on hygiene and sanitation
    • Provide condoms, oral pills to eligible couples and refer clients needing IUD (intrauterine device) insertions, contraceptive surgery and injectables
    • Coordinate with TBAs (traditional birth attendants) and local health facilities
    • Undertake nutritional interventions such as anemia control, growth monitoring, and emphasize on breast feeding and weaning practices
    • Coordinate with EPI (extended program of immunization) for immunization of mothers against tetanus and children against six  immunizable diseases
    • Carry out prevention and treatment of minor ailments

    LHWs Involvement in Other Activities

    Beside provision of necessary services listed above, LHWs are also involved in other activities like:

    • Door to door Polio immunization during NIDs (National immunization days)
    • Distribution of ORS (Oral Rehydration Salt) in flood/rain affected areas in Punjab
    • Motivation of clients for surgical contraceptive camps with FPAP (Family Planning Association of Pakistan)


    Provision of Primary Health Care Services by the Lady Health Workers

    LHWs provide following primary heatlh care services to the community:

    • Treatment of minor ailments  (and referral to the First level care facility when required).
    • Registration of pregnant mothers for antenatal care.
    • Counseling of  pregnant  and  lactating  mothers in related issues.
    • Screening on neonate for referral requiring problems.
    • Weight monitoring of the children  under three years of age.
    • Counseling regarding breast  feeding  and weaning.
    • Counseling of eligible couples regarding family planning.
    • Provision of medicines and contraceptives to patients and clients.

    HMIS Tools Used By LHWs

    LHWs are also trained about the basic tools for HMIS. They use:

    • Map of Community
    • Family (Khandan) register
    • Community chart
    • Treatment and Family Planning register
    • Diary
    • Mother and Child Health Card
    • Referral slips
    • Monthly report of LHW

    List of Drugs / Medicines provided by LHWs

    As a part of curative services, LHWs are responsible for the provision following medicines/items at the time of need:

    • Paracetamol Tabs 500mg
    • Chloroquine Tabs 150mg
    • Mabendazole Tabs 100mg
    • ORS
    • Cotrimoxazole Syp.
    • Ferrous Fumerate 150mg + Folic Acid 0.5mg
    • Cotton Bandages 4” x 3m
    • Benzyl Benzoate Lotion
    • Paracetamol Syp 120mg/ml
    • Chloroquine Syp 50mg/5ml
    • Piperazine Syp 500ml/5ml
    • Polymyxin “B” Sulphate Eye Ointment (4 Gram)
    • B.complex Syp Complex
    • Antiseptic Lotion

            

    List of Non-Drug Items

    • Cotton Wool (250 Gram)
    • Sticking Plaster 1” x 5m
    • Pencil Torch with Two Cells
    • Thermometer Clinical
    • Scissors
    • LHW Kit Bags
    • Salter Scale with Trouser

    LADY HEALTH SUPERVISORS

    Lady Health Supervisors are recruited to provide supervisory support and ensure quality performance by the LHWs. Supervisor collects progress reports, guides and discusses about their problems. At end of each month supervisor compiles evaluation reports and submit to the districts.

    Scope of Work

    To provide “Supportive Supervision” to LHWs which includes:

    • Identifying deficiencies
    • Providing technical / backup support
    • On the job training
                                                           

    Training of Supervisors

    After selection, supervisors undergo an extensive three phased training for a period of one year.A special Supervisors’ manual has been developed for the purpose of training.

                                                                   
    One supervisor is assigned the task of supervising 30 LHWs.
    A vehicle is provided in order to facilitate them in supervising

     2. T.B. (DOTS) PROGRAMME

    Tuberculosis is an infectious, systemic, chronic and granulomatous disease caused in the vast majority of cause by a bacterium called Mycobacterium Tuberculosis (tubercle bacilli). The organism was identified by Robert Koch on 24th March 1882. This day is now commemorated as world TB day through out world every year. Pathological signs of tubercular decay were also found in fragments of the spinal column from Egyptian mummies.

    Transmission of infection
    Tuberculosis is transmitted to other person by infected droplet generated by coughing, laughing or sneezing of someone suffering from infection pulmonary Tuberculosis. Tiny droplet thus created dry rapidly, attached themselves to fine dust particles and the smallest of them may remain suspended in the air for several hours. Only those particles that are less than 10 micron in diameter reach the pulmonary alveoli and result in the infection of individual.

    Tuberculosis (TB) is highly prevalent in Pakistan. The estimated incidence of TB is around 250,000 per year in Pakistan: in fact, Pakistan ranks 6th among the 22 high burden countries of TB in the world. The Pakistan government has therefore given high priority to TB control. It has declared TB as national emergency in 2001, and have expanded the WHO recommended TB control strategy (or DOTS) throughout the health services of the Ministry of Health by May 2005. T.B DOTS (Directly Observed Treatment Short course) has been implemented in Multan District since January 2004. T.B DOTS includes: -

    • Commitment of Government and all involved
    • Diagnosis by quality assured sputum microscopy
    • Treatment with standardized short course under Treatment supporter
    • Uninterrupted supply of quality Anti-TB Drugs
    • Standardized recording and reporting system

     

    In Multan District TB DOTS strategy was implemented in phase-wise. At present 17 diagnostic centres and 104 treatment centres are working in Multan District and these health facilities are providing free diagnostic and treatment services to all the TB patients. The list of the TB DOTS diagnostic centres in Multan District is given below:-

    Sr. No

    Name of Diagnostic Centre

    Name of Tehsil

    1

    RHC Makhdoom Rashid

    Multan Sadar

    2

    RHC Ayyazabad Maral

    Multan Sadar

    3

    RHC Qadirpur Rawan

    Multan Sadar

    4

    RHC Mardan Pur

    Multan Sadar

    5

    RHC Sher Shah

    Multan Sadar

    6

    Civil Hospital Multan

    Multan City

    7

    Nishtar Hospital Multan

    Multan City

    8

    THQ Hospital Shujabad

    Shujabad

    9

    RHC Matotli

    Shujabad

    10

    RHC Kotli Nijabat

    Shujabad

    11

    THQ Jalalpur Pirwala

    Jalalpur Pirwala

    12
    PATA TB Clinic Shujabad
    Shujabad
    13
    PATA TB Clinic Multan
    Multan City
    14
    New Central Jail Multan
    Multan City
    15
    Town Hospital Rahim Abad
    Multan City
    16
    Town Hospital Mumtazabad
    Multan City
    17
    District Jail Multan
    Multan City

     

    It is necessary to educate the people/ or patients on the importance of early presentation at a health facility for those with chest symptoms, especially cough, persisting for 3 weeks or more. Patient with these symptoms should present themselves for a sputum examination as early as possible at the nearest health facility as delay is diagnosis leads to disability and death. In addition, efforts should be made people aware of the fact that TB is curable with adequate treatment, but if not treated properly it will be converted in to resistant form of disease which is very difficult to treat. Good communication between a patient and health worker is also very important. Patients will be provided health education on continuation basis during treatment period so that he should understand the important of regularly taking al his prescribed drugs, during of treatment and importance of sputum examination.

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Province Punjab
Location 30.2°′″N, 71.45°′″E
Altitude 710 Feet
Area 3,721km²
Time Zone (GMT +5)
Towns 6 Towns
Population 5 Million
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