In this issue

Highlights of the Quarter

Featured PPHI Specials

Disease Alert

Performance Review July-Sept 2016

Volume 5 No. 3(July-Sept 2016)

PPHI Sindh Quarterly Health Bulletin

It’s a PPHI Media Cell Presentation © 2016

Photography by

Printed at Blue Bells

3 PPHI SINDH Quarterly Health Bulletin

Overhauled integration of Preventive,Curative

& Nutrition* interventions

To reduce the maternal deaths by one fourth

To reduce preventable deaths of newborns

and children < 5 years by one third

Improved control of the disease outbreaks

To ensure the universal access to sexual and

reproductive health-care services

Revamped nutrition intervention*

Strengthened and equipped infrastructure

Value-added support to the vertical programs

State-of-the-art modern warehouses

Solarization of the 24/7 health facilities

Upgraded online resource modules

Online testing services for recruitment

Upgraded online monitoring

mechanism(MoM)

Establishment of specilized Preventive &

Curative wings

Establishment of Research & Training Wing

Public service mass campaigns

Accredited postgraduate programs for the

HCPs

*in selected districts

Mission 2016-17

4 PPHI SINDH Quarterly Health Bulletin

Health

Department

42%PPHI Sindh

58%

PHC Healthcare Distribution

(PPHI & HD)

Health Department Sindh

PPHI Sindh

Welcome

1. Highlights of the Quarter 1.1. Primary Health Care

1.2. PPHI Speacil Interventions

1.3. Quarters Key Highlights

1.4. Capacity Building -MCPC 3rd Phase

1.5. 5th Family Planning Campaingn

1.6. Health Promotion & World Health Days

2. PPHI Special 2.1. Kausar Hospital Khairpur

- A Challenge and An Opportunity

2.2 From District Manager’s Desk-Sanghar

2.3 PPHI Heroes - Featured Medics

2.2. Triumph of Unforeseen Talent

2.3. Disease Alert – Dengue Fever

2.4. From Researchers Desk – Postpartum

Haemorrhage in SAARC Countries –

Asystemic Review of Risk and Protective

Factors

3. Quarterly Performance 3.1. Health Services Performance Top 5

Districts

3.2. Maternal, Newborn & Child Health

Indicators

3.3. Quarter’s Quick Review

3.4. Top 5 Communicable Diseases

3.5. Top 5 Non Communicable Diseases

3.6. Regional Performance - Key Indicators

3.7. Monitoring of Monitors Review

3.8. In-house Medical Claims Overview

IN THIS ISSUE

On the cover…

PPHI Sindh is a Public-Private Partnership with the

Government of Sindh (GoS). The first agreement for

PPHI was signed back in February 2007 by Mr. Syed

Sardar Ahmed, former Minister for Health. PPHI’s

journey started from District Kashmore and

gradually expanded to 22 Districts of Sindh

(excluding Benazirabad and 6 districts of Karachi).

The need for partnership emerged because of a

crucial need of time; GoS had an infrastructure of

over 20 billion rupees for delivering Primary

Healthcare (PHC) in the province. Tragically, this

was either sub–optimally operational or altogether

dysfunctional. This valuable infrastructure had to be

made optimally operational therefore the

government of that time decided “contracting–out”

the management of government’s PHC

infrastructure to a Nonprofit Service Provider. This

responsibility was first handed over to Sindh Rural

Support Organization (SRSO) in 2007 and then to

PPHI Sindh in 2013. The original design included

integration of all vertical programs and transfer of

the management of integrated PHC package.

However, only the management of health facilities

was transferred to PPHI while vertical programs

were not relegated. PPHI Sindh is headed by a

Board of Directors comprising of 9 members and 3

ex-officio members from GoS and run by an

experienced management. PPHI management has

recently expanded and established MNCH wing,

Research & Training wing and a Media Cell,

ensuring sustainable growth of the organization.

A Family coming out of a PPHI Health Facility after an OPD

consultation – BHU Plus Dano Dhandhal District Tharparkar

PPHI Sindh started its journey in February, 2007 with the

objective of revitalizing health services in rural Sindh. The

immediate goal was to ensure that health facilities were fully

functional, providing health services to all persons within

their reach. A dedicated and competent management team

was hired, which embarked with full vigor to achieve this

objective. Within a short time, facilities had regular

attendance of doctors and staff as well as continuous medical

supplies.

Owing to PPHI’s efforts, health indicators, especially infant

and maternal mortality have consistently improved. PPHI has

focused on mother and child health and has continuously

improved delivery coverage all over Sindh. It has set up

round the clock delivery facilities at 24/7 MNCH Centers and

implemented Infection Prevention Protocols. Family planning

initiatives led by PPHI have successfully reduced family size

whereas health awareness sessions have pushed

communities to use the BHU as their main health provider.

Today, 1139 health facilities in 22 districts managed by PPHI

are the main healthcare providers in rural Sindh. Many have

labor rooms and ultrasound machines. Female doctors and

PPHI trained midwives are available even in remote areas.

Medicines are provided free of cost and lab tests are carried

out regularly for all patients. Uninterrupted power supply is

ensured by providing generators and moving towards solar

energy solutions.

PPHI Sindh’s achievements would not have been possible

without the support of the Government of Sindh. The

Government’s cooperation has made it possible for PPHI to

follow its mission and achieve phenomenal growth in a short

span of time. Moreover, the commitment of PPHI’s Board,

management, staff and partners deserves appreciation who

are dedicated to achieving the organization’s objectives.

I believe that a dynamic organization like PPHI will continue

to add value and become the leader in service delivery in

Sindh. PPHI’s work has made a sustainable impact in primary

health, improving and saving lives of the marginalized in rural

areas, who otherwise would have no means or access to basic

healthcare. I foresee PPHI Sindh going from strength to

strength and wish the best to the CEO, Dr. Riaz Ahmed

Memon, the management and staff as well as all those who

have extended their support and contributed to its success.

Fazal-ur-Rehman Chairman PPHI Sindh

Board of Directors

Chairman

Mr. Fazal-ur-Rehman

Members

Mr. Muhammad Nazar Memon

Mr. Tasneem Siddiqui

Dr. Suleman Sheikh

Mr Farooq Haroon

Mr. Mushtaq Shah

Mr. Khalid. M. Soomro

Dr. Saeed Qureshi

Dr. Nighat Shah

Provincial Office

Chief Executive Officer

Dr. Riaz Ahmed Memon

Chief Operating Officer

Mr. Ghulam Ali Soomro

Chief Financial Officer

Mr. Muhammad Aqib Qureshi

Director Health Services

Dr Abdul Sattar Chandio

Director Procurement

Syed Shahid Ali

Principal Officer

Mr. Abdul Ghaffar Surahio

Provincial Engineer

Mr. Ghulam Mustafa Malik

Company Secretary

Ms. Farah Yamin Khan

District Manager- Hq.

Mr. Iqbal Qureshi

Chief Auditor Executive

Mr. Hans Hussain Soomro

Legal Ad

Mr. Parvaiz Ahmed Memon

Organizational

Body A Word by the Chairman

BHU Basic Health Unit

CPR Contraceptive Prevalence Rate

CSG Community Support Group

DHIS District Health Information System

DHQ District Headquarter

EPI Expanded Program on Immunization

FMO Female Medical Officer

FP Family Planning

GD Government Dispensary

GoS Government of Sindh

HCP Healthcare Provider

HD Health Department

HF Heath Facility

HR Human Resource

HTN Hypertension

IUCD Intra Uterine Contraceptive Device

IYCF Infant & Young Child Feeding Practices

LHV Lady Health Visitor

LHW Lady Health Worker

MCHC Maternal & Child Healthcare Centre

MNCH Maternal, Neonatal & Child Health

MW Midwife

NSP Nutrition Support Program

NVD Normal Vaginal Delivery

OCP Oral Contraceptive Pill

OTP Out Therapeutic Program

PHC Primary Health Care

PNC Postnatal Care

POP Progesterone Only Pills

PPH Postpartum Hemorrhage

PWD Population Welfare Department

RHC Rural Health Centre

RUTF Ready to Use Therapeutic Food

SAM Severe Acute Malnutrition

SoP Standard Operational Procedure

SRSO Sindh Rural Support Organization

THQ Taluqa Headqaurter

ToR Terms of Reference

WHO World Health Organization

Acronyms

1.

HIGHLIGHTS

OF THE

QUARTER

1.1. Curative & Preventive Services at PPHI Health

Facilities

Ultrasonography at BHU Makhan Samo - District Mirpurkhas

Medic Couple at PPHI Health Facility – BHU Moosa Khatyan District Hyderabad

Primary Health Care

Primary healthcare (PHC) refers to

"essential health care" that is based on

scientifically sound and socially

acceptable methods and technology,

which make universal health care

accessible to all individuals and families in

a community. It is through their full

participation and at a cost that the

community and the country can afford to

maintain at every stage of their

development in the spirit of self-reliance

and self-determination".

WORLD HEALTH ORGANIZATION. DECLARATION OF ALMA-ATA. ADOPTED AT THE INTERNATIONAL CONFERENCE ON PRIMARY HEALTH CARE, ALMA-ATA, USSR, 6–12 SEPTEMBER 1978.

Immunization

Maternity Services

Maternal & Child Health Care

Neonatal Care

Family Planning Services

Ultrasound Services

Ambulance Services

Community Support Group Network

Diagnosis of common ailments and Treatment by

Skilled Health Care Providers with Follow up and

Referral

Provision of Essential Drugs including

Micronutrient Supplements

Provision of Anti-Snake Venom, Anti-Rabies

Vaccine and Anti-Tetnaus Serum

Laboratory Services

Maternal, Neonatal & Child Health PPHI on the Directives of CM Sindh is Upgrading 150 More BHUs to

BHU Plus in FY 2016-17

PPHI made special efforts by making an extra mile by upgrading

120 6/6 BHUs to 24/7 BHU Plus with an ample workforce of female

Health Care Providers (HCPs). These round the clock maternity

centers are equipped with diagnostic labs, standby ambulances,

ultrasound services and a supply of nutrition supplements like iron,

folic acid and multivitamins. Besides that, newborn care and

Helping Baby Breath (HBB) corners are other valuable initiatives.

Family Planning Services Family Planning services are an integral component of our primary

healthcare services as it directly affects the quality of maternal and

child health. PPHI Sindh is committed to reduce maternal and

newborn mortality in Sindh and is convinced that by adopting

effective strategies, this could be reduced remarkably. Further, it

aims at the accessibility of quality family planning services in the

far-flung areas of Sindh where the unmet need for family planning

is very high. Its existence in rural areas makes clients more

comfortable for the follow up or in case of any possible

complications.

Comprehensive Emergency Obstetric Care

at RHCs & THQs Though PPHI’s prime domain is PHC but the organization has

gradually expanded its operation to secondary care at its rural

health centres. Moreover, specialist doctors at taluka and district

headquarter hospitals have also been deployed under PPHI

contract.

Services & Facilities

24/7 Labour Rooms

Postpartum Family Planning

Immunization

Laboratory Services

Free Medicines

Free Ultrasound Services

24 Hours’ Ambulance

Services

Cesarean Section Underway RHC Tandojam – PPHI Hyderabad

1.2. PPHI Special Interventions

Lady Doctors for the Rural Areas When the organization started its operations in 2007, HR gap was of a

big concern. No lady doctors were willing to serve in the rural areas

of Sindh. So PPHI remedied this with some extraordinary efforts and

successfully deployed lady doctors at most of the rural health facilities

with attractive packages. Right now the organization has some

impressive numbers with 419 lady doctors and 1049 LHVs/MWs in 22

districts of Sindh.

District Health Information System (DHIS) PPHI has successfully implemented DHIS with 100 percent compliance

that could be shared with the stakeholders with a high degree of

confidence. This comprehensive health information system ultimately

helps in evidence based decision making for improved healthcare. A

third party evaluation by Contech International (USAID) back in 2015

have reported PPHI’s DHIS data accuracy over 86 percent.

24/7 Ambulance Service All 24/7 PPHI health facilities are provided with a standby ambulance

with trained driver. In the first phase, 66 ambulances, including six

Advanced Cardiac Life Support (ACLS) ambulances and 25 Basic Life

Support (BLS) ambulances were purchased and recently 55 more

ambulances have been added to the fleet.

Vertical Program Support PPHI has been supporting the EPI program, knowing its importance.

When PPHI took over, out of 1142 health facilities, only 425 had

immunization services. The organization added 155 additional cold

chain points at its existing health facilities and appointed vaccinators.

Adding more value to it, in 2015 PPHI purchased 332 electric and Solar

Ice Lined Refrigerators (ILRs) and handed them over to the EPI

program, to further strengthen immunization coverage. Recently PPHI

Sindh has been handed over the administrative side of EPI for district

Dadu and Khairpur.

Provision of Quality Supplies & Medicine At PPHI, patient safety is our top priority, we are committed to protect

our provision of drugs and medical supplies from substandard

manufacturing practices and counterfeit products. In addition to this,

the essential drugs supply is fostered by provision of life saving highly

expensive Anti Snake Venom (ASV), Anti Rabies Vaccine (ARV) and

Anti Tetanus Serum (ATS) for the patients.

“The ultimate goal of

primary health care is

better health for all”-

WHO

WHO has identified five key

elements to achieving that

goal:

Reducing exclusion

and social

disparities in health

(universal coverage

reforms)

Organizing health

services around

people's needs and

expectations

(service delivery

reforms)

Integrating health

into all sectors

(public policy

reforms)

Pursuing

collaborative

models of policy

dialogue

(leadership

reforms)

Increasing

stakeholder

participation

Restoration & Repair of the Health Facilities At the time of takeover the situation of overall health infrastructure

was shabby and around 182 health facilities were illegally occupied.

That was one of the hefty challenges to restore or evacuate the

buildings and make them operational, all possible efforts were

made for their immediate restoration.

Approval of SNEs PPHI received 158 health facilities without approved SNEs (building

without budget). PPHI prepared documents, chased files and finally

after two years of incessant struggle, 115 SNEs were approved.

Number of approved HFs were constructed in the following years i)

1989 (15 HFs), 1992 (26 HFs), 1993 (15 HFs), 1995 (26 HFs), 2000 (8

HFs) and 2003 (26 HFs).

Value Addition to the PPHI Health Facilities PPHI has added more extra value to its health facilities by

establishing 679 laboratories, 118 with mini laboratories, radiology

services and more. Many restricted health facilities have been

provided permanent electricity, water supply, gas supply and 37

have been solarized.

State of the Art Modern Medicine Warehouses Three modern medicine warehouses in district Thatta, Badin and

Khairpur have been completed at a total cost of Rs. 62 million and

all three are operational since 2013. Fourth warehouse in

Hyderabad is under construction and would soon be operational.

Establishment of PPHI Head Office PPHI Head Office was established on ownership basis worth Rs. 60

million back in 2014. The building as been converted to a fully

equipped provincial unit to deliver the best.

Solarization of PPHI Health Facilities PPHI has planned to solarize its 500 health facilities in the first phase

with a total estimated cost of Rs. 200 million. For long term utility of

the investment, quality of the solarization has extensively been

worked on.

PPHI Laboratory Services – District Umerkot

Essentials of

Primary

Healthcare

PEOPLE’S FIRST

CONTACT

Serves as an entry point into

the health care system, and

the first source of care for

most health needs

ACCESSIBILITY

Offered within people’s

communities, at a price they

can afford

COORDINATED

Manages care across levels

of the health care system,

referring patients to

specialists as needed &

effectively following upto

ensure improvement

PEOPLE-CENTERED

Organized around the health

needs and expectations of

people rather than diseases

COMPREHENSIVE

Delivers a broad spectrum of

preventative, promotive,

curative & palliative care

CONTINUOUS

Connects people with

trusted providers who

address their ongoing health

needs throughout their lives

.

1.3. Quarter’s Key Highlights

Establishment of Training and

Development Wing at PPHI Sindh In order to make sustainable model for capacity

building of health care providers working at PPHI

health facilities, PPHI’s management decided to

establish a dedicated Training and Development wing

in the organization. The goal of this division is to

increase capacity of health care providers and

auxiliary staff working in PPHI health facilities to

improve quality of health services delivery and adopt

evidence based best practices.

Recruitment of MNCH

Coordinators for 22 Districts MNCH Coordinators will serve as focal

person for ensuring capacity building of

health care providers at PPHI facilities by

providing training through various

approaches such as classroom based

training, on the job training/coaching, role

plays, case studies etc. Additionally, their

role requires them to visit the facility to

monitor the quality of maternal and child

health services being provided at the

facilities.

Initiated 6 Weeks Training

Program for Midwives

PPHI’s innovative idea of upgrading BHUs

into BHU Plus has been very successful.

Hence, upon observing this success Chief

Minister of Sindh proposed to upgrade 100

more BHUs into BHU Plus by June 2017.

Therefore, to fulfil the gap of human

resources, PPHI Sindh devised a strategy in

which newly graduated midwives looking

for work were interviewed and shortlisted.

These shortlisted candidates will have to

undergo a 6 weeks training which includes

1 week theoretical training conducted by

MNCH Coordinators and experienced

Female Medical Officers already working at

PPHI facilities while 5 weeks practical

training at BHU Plus under supervision of

FMOs and midwives. Successful trainee

midwives after the completion of 6 weeks

training will be offered to work at selected

PPHI health facilities under CM’s initiative.

Internship Program PPHI Sindh has recently started initiative of

administering a 2 week internship program for

students studying in 12th grade from renowned

schools of Karachi like Karachi Grammar School,

Lyceum School etc. These students are given a task

related to their area of interest this includes tasks

related to administration, communications, data entry,

literature review, proof reading documents etc.

Students with parent’s consent are also taken on field

visits to the health facilities that enables them to

experience how the health system operates at the

district level.

Message from the

Chairman

Major

Achievements of the

2nd quarter

MCPC Modules Post-Partum Hemorrhage and its

management at PHC

Pre-eclampsia & Eclampsia

Abortion

Prolonged / Obstructed Labor and

Use of Pantograph

Puerperal Sepsis

Shock

Infection prevention Protocols

Clinical Approach to the Patient with

fever during pregnancy.

"Capacity building

remains one of the most

challenging functions of

development. It brings

more power to the

provider’s end

ultimately bringing

improved and

sustainable health to the

communities”.

Dr Abdul Sattar Chandio

-Director Health Services, PPHI Sindh

1.4. Capacity Building

Management of Complications in Pregnancy &

Childbirth 3rd Phase Trickle Down Trainings About 15% of pregnancies undergo some complications at one point

or the other. If complications remain unidentified, this may lead to

catastrophic consequences for maternal and newborn health. Given

that the masses are living in rural suburbs of Sindh and have no access

to PHC, we need extra effort to train the HCPs. A multiphase training

program was conceived and materialized in this quarter where more

than 345 HCPs have been trained.

The HCPs have been mastered in most common maternal and

neonatal complications that may really play well in decreasing

maternal, fetal and neonatal morbidity and mortality. First three

phases of the training have already been completed but spot revision

and follow up is need based and an on-going process being

replicated by the technical team of the district wherever needed.

Objectives

1) To build capacity of the HCPs to improve the quality of

maternal, newborn and child health.

2) Early identification, initial management and timely referral.

3) To replicate the updated guidelines and protocols for the

improved skills.

5) To reduce disease burden and mortality.

MCPC Trickle Down Trainings

Phase I. Training of Trainers at Provincial Level (May 2016)

Phase II. Training of Medics at District Level by the Master Trainers

(June 2016)

Phase III. Training of Paramedics by the Medics (July-Sept 2016)

Phase IV. Spot Revision & Follow-up (On-going)

Group Excercise during MCPC Training – PPHI Khairpur Mirs

MCPC Phase 2 Training by the Master Trainers Region III & IV – PPHI Khairpur

AUGUST CAMPAIGN

HIGHLIGHTS

Total Clients 18655

Jadalle 9155

IUCD 1310

Injectable 3488

COC 3037

POP 103

Condom 1490

Tubal Ligation 44

1.5. 5th Family Planning Special

Campaign

21, 506 Family Planning Clients in the

Campaign

Family Planning is a voluntary adoption on the basis of

knowledge, attitude and practices by the couples. This gives

them freedom to decide the size of thier family and the related

standard of living. Consequentially, it promotes the quality of

life, contributing to the social development of the nation.

PPHI Sindh started special family planning camps on quarterly

basis. The focus of these camps are on Long Acting Reversible

Contraceptives (LARC) i.e. Jadelle and IUCD. These camps are

organized at selected PPHI health facilities mostly BHU Plus.

Both female and male medical officers are available for

providing counselling and family planning services.

Additionally, free transport is also provided to the clients who

are interested to get contraceptives. Awareness regarding FP

camp are disseminated through electronic media, by

announcements in mosques and community meetings.

Furthermore, community mobilization through LHWs is also

done. This exercise has brought exceptional results and the

response has been overwhelming every time.

From August 9-11, 2016 PPHI organized fifth successful camp,

the main highlights of the campaign are 9745 Jadelle insertions

(compared to 4190 in the first camp), 1711 IUCDs including 88

tubal ligations with thousands of the short term of family

planning visits with in the three days of the campaign. These

numbers are result of great team work and commitment to

improve health indicators of Sindh.

The total Couple Year Protection (CYP) by this year is coming to

136907, till date more than 20,000 implants are inserted by

trained PPHI health care providers at PPHI health facilities.

Similar activities took place on the following dates 27-29

October, 2015, 10-12 June, 2015, 9-11 February, 2016 and 10-12

May, 2016.

Client Registration During a Family Planning Camp – PPHI Sukkur

CPR of Pakistan

35% (2012-13)

Goal 3: Ensure healthy

lives and promote well-

being for all at all ages

By 2030, ensure universal access to

sexual and reproductive health-care

services, including for family

planning, information and education,

and the integration of reproductive

health into national strategies and

programs.

"& when we both were

desperate for the child

spacing but there was no

one to help us in this as

we live near Indian

border where life is an

everyday challenge. One

day I heard about PPHI’s

family planning camp at

Hirar Deeda on a radio

show.

We just came here where

my wife has got this long

lasting capsule fixed and

even now I can feel that

freedom of mind. All I

need to say is, PPHI is like

a blessing to us”.

Mr. Rano Mal -A Peasant from Taluka

Nagarparkar

17

89

31

7 68

9

71

6

8

35

2

15

60

17

8

19

0

26

3

3

14

0

24

28

63

1

16

73

14

85

32

65

4

33

78

18

4

93

6

57

3

60

34

4

0

500

1000

1500

2000

2500

3000

3500

4000

Jaddel IUCD Injectable COC POP Condom

Contraceptives Breakup

Hyderabad Mirpurkhas Larkana Sukkur

Sukkar Larkana Hyderabad Mirpurkhas

Total Clients 5506 6909 3879 2361

Total Clients with Long Term FP

Method3562 3059 2106 1738

0

2000

4000

6000

8000 5th Family Planning Camp Performance

Focusing more on Postpartum Family Planning &

Longterm Reversible Contraception During the special campaigns PPHI focuses on PPFP and long term

methods those are more effective and reliable than the ordinary

contraceptive methods.

5th Family Planning Campaign Publicity Bannar in Shahi Bazar – PPHI Umerkot

1.6. Health Promotion &

World Health Days…

Highlights International Health Days Observed.

4069 Health Education School &

Community Sessions in the Quarter

Pre-defined Health Promotion

Themes for the Quarter

- Population Explosion and Importance of FP

- Menace of Viral Hepatitis in Pakistan, its

Course & Prevention

- Role of ORS and Zinc in Treatment of

Diarrheal Disease & Metronidazole

Misconceptions

- Safe Maternity Practices

School Health SessionsCommunity Health

SessionsCSG Meetings

Community

Participation114415 6542 5245

0

20000

40000

60000

80000

100000

120000

140000

Community Participation Performance

7.2 billion* World Population - From 1950 to 2010 the

global population of the world nearly

tripled in size.

120 people per square

mile World’s Population Density

182.1 million** Pakistan is the sixth most populous country

*United Nations Department of Economic and Social Affairs.

Population Division, Population Estimates and Projections Section.

World Population Prospects: The 2012 Revision. ** World Bank, Utited States Census Bureau

11th July World Population Day World Population Day is a great event being

celebrated all through the world annually on 11th of

July and is meant to bring awareness towards the

worldwide population issues. The first World

Population Day was held in 1987, inspired by people’s

interest in world population reaching 5 billion.

World Population Day focuses attention on the urgency

and importance of population issues in the context of

overall development plans and programs.

World Population Day was celebrated at PPHI health

facilities to increase people’s awareness on various

population issues such as the importance of family

planning, including gender equality, poverty &

maternal health. Special health sessions were

conducted to celebrate world population day.

Health Education Session in Progress BHU Hatri – PPHI Hyderabad

28th July

World Hepatitis Day The theme for this year's global campaign is elimination.

Key approaches to tackle the menace of hepatitis is to

expand vaccination programs for hepatitis B; focus on

preventing mother-to-child transmission of hepatitis B;

improve injection, blood and surgical safety; “harm

reduction” services for people who inject drugs; and

increase access to diagnosis and treatment for hepatitis

B and C.

About Hepatitis Viral hepatitis – a group of infectious diseases

known as hepatitis A, B, C, D, and E – affects

hundreds of millions of people worldwide,

causing acute and chronic liver disease and

killing close to 1.4 million people every year,

mostly from hepatitis B and C. It is estimated

that only 5% of people with chronic hepatitis

know of their infection, and less that 1% have

access to treatment.

On World Hepatitis Day, 28 July 2016, WHO calls on policy-makers, health workers and the public to "Know hepatitis - Act Now?"

182.1 million (2013)*

Pakistan's estimated population in 2015 is

over 191.71 million, making it the world's

sixth-most-populous country.

1.6 percent*

Population Growth Rate

3.26 birth rate*

Of people with hepatitis are unaware of

their infection.

*World Bank

26th September

World Contraception Day WHO marks 26th September as World Contraception

Day, Promotion of family planning – and ensuring

access to preferred contraceptive methods for women

and couples – is essential to securing the well-being and

autonomy of women, while supporting the health and

development of communities.

Allowing women to choose whether, when, and how

many children to have achieves progress on global

health goals. PPHI Sindh celebrated world

contraception day by organizing special campaign at

selected PPHI health facilities for providing counselling

and family planning services.

400 million*

Viral hepatitis affects 400 million

people globally and, given the size of

the epidemic, anyone and everyone

can be at risk.

95 percent*

Of people with hepatitis are unaware of

their infection.

7 million*

Lives can be saved between 2015 and

2030, WHO advises.

*World Health Organization

2.

PPHI

SPECIAL

Performance

2016

OPD 52,732

ANC-1 11,145

ANC Revisit 3,390

PNC-1 2,867

NVD 2,173

C-Section 1,183

Indoor Admissions 4,946

Lab Investigations 38,376

Ultrasounds 13,343

2.1. KAUSAR HOSPITAL KHAIRPUR 40 bedded 24/7 MCHC gifted by Islamic Republic of Iran -A challenge and an opportunity If you saved one life, you saved entire humanity (Al-Quran). Kausar

Hospital Khairpur under the umbrella of PPHI Sindh is trying to save

hundreds of lives per month and treating thousands of patients with

the sole motto of prompt quality care. This is an invaluable gift of

Iranian Government and Honorable Chief Minister of Sindh to poor

and downtrodden people of the region.

Kausar Hospital is a comprehensive maternal, neonatal and child

healthcare Centre which is providing all components of tertiary care

health facility. It is benefitting the community by reducing prevalent

inequalities through free of cost access to quality services.

As per cited performance, the magnitude of financial benefit to poor

people is about Rs. 285 Million within a span of 15 months. The average

number of C-sections and normal vaginal deliveries at Kausar Hospital

are 7-12 and 10-15 per day respectively.

Apart from antenatal, natal, postnatal, malnutrition and pediatric

cover, Kausar Hospital is providing coverage to emergency

gynaecological and obstetrical life-threatening emergencies. Since

last month, Kausar team have operated 17 patients with severe state of

shock especially due to uterine rupture and placenta previa type-3

and type-4. Moreover, Kausar Hospital has achieved a distinction in

this state that it is even accepting the rejected cases of other public

sector hospitals. The patients’ and attendants’ level of satisfaction has

been analysed time and again and it has been found 100% satisfactory

except with a sole complaint of provision of waiting area for male

attendants in outside premises of the hospital.

Kausar Mother & Child Healthcare Centre - PPHI Khairpur

Pediatric coverage extends from comprehensive neonatal

care in NICU up to pediatric care. Many pediatric cases with

complicated diseases are effectively diagnosed and

treated.

Kausar Hospital is being planned to be extended with

Capacity Building Institute and Research Wing of PPHI

Sindh. CBI will be imparting on-job capacity building

courses to all medics, paramedics and other staff of PPHI

Sindh on routine and rotation basis. Moreover, Central

laboratory is also being planned for which sentinel sites will

be MCHC centres of the district and/or region.

The new initiative into neonatal care which is being

planned for Kausar Hospital is Kangaroo Mother Care

(KMC). KMC is a natural incubation method of care of

preterm infants. The method involves infants being carried,

usually by the mother, with skin-to-skin contact. This is

intended for health professionals responsible for

the care of low-birth-weight and preterm infants. The

initiative will be first one within the province. PPHI Sindh

through Kausar Hospital Khairpur is committed for free of

cost, prompt and quality care to the marginalized people of

the region.

Cesarean Section in Progress - PPHI Khairpur

Services at Kausar

Hospital Khairpur Cesarean Section

Safe Blood Transfusion

observing universal HIV

precautions

Treatment of Sepsis (infections)

Treatment of Hypertensive

Disorders (Pre-

eclampsia/eclampsia)

Treatment of prolonged or

obstructed labour,

Post-abortion care (PAC)

Treatment of Post-partum

Hemorrhage (PPH)

Treatment of incomplete

miscarriage

Manual removal of placenta.

Assisted Delivery using forceps

or suction

Newborn Resuscitation

Maternal and Child

Immunization

Prenatal, Obstetrical and Post-

Partum Care

Infection Prevention & Helping

Baby Breath

Modern Methods of Family

Planning (long term and short

term)

Diagnosis and Treatment of

Major Infectious Diseases

Kangroo Mother Care (KMC)

234

156

218

290

183

343

234

157

220

0

100

200

300

400

NVDS C-Sections Malnutrition cover

Performance Overview Of Kausar Hospital Khairpur July-Sept

July Aug Sep

About the District

Manager

Mr Fida Hussain Lashari

graduated in Political Science

from University of Sindh,

Jamshoro then did his Masters

in Sociology. Previously

worked as a section officer in

Chief Minister Secretariat.

Joined PPHI in September

2015. Since then he has been

posted in District Sanghar. Mr.

Fida is another good addition

to PPHI Sindh.

Sanghar’s Famous Fish Kur’ro.

Mr Fida Hussain Lashari – DM

PPHI Sanghar BHU Plus Rukan Bur’ra – District Sanghar

2.2. From the District

Manager’s Desk… Featured District

District Sanghar – Region Mirpurkhas

One of the largest districts of Sindh province with a total area of 6650

square kilometers. It was named after a pious fisher-woman, Mai

Sanghar for more than a century according to some folk tales.The

district has remained a seat of historic significance during the British

raj where the uprising for the independence emerged under the

command of Pir Syed Sibghatullah Shah Rashidi.

Its rich in natural resources and known to be biggest cotton

producing districts of the country. According to the 1998 census of

Pakistan, the district had a population of 917, 863 of which 22.13%

were located urban areas whereas majority still lives in villages.

According to legend, the bodies of Sohni Mahiwal, the titular heroes

of one of the four popular tragic romances of Sindh, were recovered

from the Indus River near Shahdadpur city and are buried there. The

Tomb of Sohni is situated in Shahdadpur, which is 40 kilometers (25

mi) from Sanghar and 75 kilometers (47 mi) from Hyderabad.

INTERVENTION OF PPHI SINDH IN SANGHAR

PPHI Sindh took over administration of 58 BHUs, 24 GDs, 7 DCDs and

01 Unani Shifa Khana in the year 2008, PPHI has 73% share of total

primary health care in the district. However, the statistics over the

years have shown that communities of rural Sanghar have posed

their trust upon PPHI Sindh and in that way, people of faraway

catchment areas got benefit from the services.

Indicators Target JUL’16 AUG’16 SEP’16

Daily OPD Attendance 190000 160228 175645 121406

Full Immunization Coverage 2217 1873 2180 2337

Antenatal Care (ANC-I) coverage 2871 3229 3217 2446

ANC Revisit - 3218 3415 2703

Delivery Coverage at Facility 700 661 751 685

Total Visits for Family Planning 3918 1950 2312 1740

Pregnant women received TT - 2

vaccine

- 1316 1466 1275

1st Postnatal Care Visit (PNC-1) in

the facility

- 994 1183 948

PNC-Revisit - 219 325 368

CSG Meetings - 150 172 181

Women waiting for doctor’s consultation at PPHI family planning Centre

– PPHI Sanghar

By taking a step further, 6 round-the-clock fully equipped

MCHCs were established within the BHUs during the year

2014. Making it a landmark achievement given the harsh

dynamics, lowest percentage of female professional staff in

the province and the lack of basic facilities with deteriorated

infrastructure, PPHI succeeded to provide quality services in

the district.

Presently PPHI Sanghar has added 3 more round-the-clock

MCHCs and therefore now 09 HFs 24/7, with normal labor

services. Currently 45 HFs out of 81 HFs are also working as

6/6 MCHCs. Additionally, 5 local females will also join PPHI

Sanghar health facilities after completing their Midwifery

course, which will certainly put a positive impact on the

overall maternal & child health services.

It is among the top five districts in context of performance with

152426 outpatient (new cases), 2926 normal deliveries, 2001

family planning visits & 2130 fully immunized cases

Sanghar Quick Facts

Area 6650 km2

Talukas

Union Councils 70

Population (C1998) 917, 863

Population (2013) 1, 453, 028

Population Density

Literacy Ratio 30.87%

*Pakistan Bauru of Statistics

Patient at Central Registartion Point -PPHI Sanghar

Key indicators July-December 2016– PPHI Sanghar

CHALLENGES & RECOMMENDATIONS FOR THE CHANGE

Scattered population, low human development index, lack of health awareness, limited functional

health facilities with lack of professional staff are key challenges of the districts. Based on experience

and extraordinary dynamics of Sanghar, here are some recommendations for improving social and

health indicators in Sanghar;

Provision of clean drinking water to all the areas, including Khipro (Desert Area/Achhro Thar).

Provision of basic infrastructure, especially roads and electricity (Solarization of HFs) in rural

areas.

Enhancement of MCHC facilities at primary health care level along with an ensured quality of

emergency obstetric services at all THQs and RHCs.

Modern & long-term family planning interventions on war footing.

Establishment of Nutrition Stabilization Centers and nurseries with sufficient staff at all THQs.

Filling the human resource gaps by providing the professional staff with sufficient wages,

residential facilities i.e. staff colonies with all basic educational and health facilities at Taluka

level, pick drop facility, etc.

Improvement of the preventive health services on emergent basis, especially by completely

over-hauling the immunization services.

Improved secondary healthcare deliverance in the district.

2.3. PPHI Heros… Best Medical Officer BHU Jamraou 30 – PPHI Sanghar

Dr Atta-Ul-Mustafa Medical Officer, BHU 30 Jamrao is a very competent, professionally sound and

assiduous health care provider. He has been working as a medic since May 2009. Due to his extra

ordinary efforts and his generously courteous behavior he has been an inspiration to many including

the communities he has worked in. He has made his HF as a model BHU with high standards of

punctuality of staff, cleanliness and quality of services.

He is diligent in the performance of his duties. By virtue of his personal strife and coordination

through community mobilization and participation, BHU 30 Jamraoo has shown improvement in

service delivery, record keeping and store management. His supportive role for female staff

including FMO and sonologists has enhanced delivery, ANC, PNC and ultrasound service for the

underprivileged women of Sanghar.

Along with the mentioned services reworded by him during his tenure has been commendable. It

would be tantamount to injustice to endorse the services of such tremendous doctor. PPHI Sindh honors and endorse her undeniable services, as he is a real asset for the organization.

Personal Profile

Dr Syed Atta-ul-Mustafa belongs to

Village Rawtiani of district

Sanghar. He did his graduation

from LUMHS in 1999. After

graduation started working as a

medical officer in Murshid Hospital

Karachi and Ashfaque Memorial

Hospital Karachi. He Joined PPHI in

May 2009 and since then he has

been working with PPHI Sindh.

Dr Ata ul Mustafa BHU Jamarao 30 – PPHI Sanghar

About BHU Plus Jiando

Rind

Jinado Rind Mother & Child

Health Care Centre is about 45

kms away from Sanghar. Where,

before PPHI, health service

delivery was very poor. But after

taking over management of Said

BHU, PPHI turned this facility into

MCHC 24/7.

Now, MCHC Centre Jiando Rind

is working at maximum level of

service delivery in OPD, follow

ups, NVD, DNC, ANC, Family

Planning (IUCD).

A big share of highest deliveries

was from Jiando Rind MCHC

Centre. This MCHC Centre is

successful and the credit of its

success goes to Dr. Rizwana

Khokhar. She is sedulous and

diligent asset of our organization.

Dr Rizwana Khokhar BHU Plus Jiando Rind – PPHI Sanghar

Best Female Medical Officer BHU Plus Jiyando Rind Sanghar Dr. Rizwana Khokhar, Female Medical Officer is posted at BHU

Plus Jiando Rind at PPHI Sanghar since February 2010. She is

professionally sound and competent health professional, puts

all her efforts to make bring best to her catchment area

population in the best of her capacity. Her efforts reflect while

looking into the MNCH section of the health facility.

She has persuaded the population by frequent counseling

sessions for the people understanding the importance of

maternal and child health. Likewise she has done a lot for the

birth spacing eventually leading the region in FP procedures.

With her efforts & interpersonal communication skills NVDs

ratio has raised many fold. Now this BHU Plus takes lead every

time in the district.

She is also a trainer in MCPC, PCPNC and HBB. Her

contribution for establishing BHU Plus Khadro is applauded

which is now working very well and giving more than 100

NVDs.

Dr. Khokhar’s exemplary services to the community are

enough to motivate the other health care providers to serve

the poor and underprivileged rural communities. PPHI Sindh

honors and endorse her indubitable services, as she is a real

asset for the organization.

PPHI awarded me a fully funded scholarship of 2 years

Midwifery Training Program. I excelled there and after

the completion of my training got a guaranteed job at a

PPHI health facility in my village where there were no

lady healthcare providers really willing to work,

ultimately making mothers and neonates vulnerable.

Today I am serving my people with pride, where I have

helped many to the best of my capacity.

Moreover, PPHI has given me power to be a helping

hand of my family financially with dignity.

Ms. Bhaou Mehboob

PPHI Sanghar

2.3 The Triumph of the

Unforeseen Talent of Sindh... Ms. Bhaou and her husband Mehboob a jobless graduate had some

amazing things to share while they were asked for this featured

story. This is truly inspirational and portrays symbolic chemistry of

a Sindhi couple. Both took the toughest decision against the social

duress and just broken the shackles and the rest is known to us that

how an Unforeseen talent triumphed.

When both were jobless and were looking for some decent

livelihood. Bhaou’s husband found a scholarship training cum job

advertisement in a sindhi daily. He discussed it with his spouse and

instantly applied for the scholarship. When she appered before the

selection panel nobody ever wandered that she would be the best

graduate of the batch. Simultaneously both had to face extreme

defiance and the couple have had gone through the tormenting

outrage everyday as if they had brought disgrace to the family and

the village.

Bhaou came along with her husband to Karachi, completed 2 years

midwifery training by hooks or crooks, not only this but she

excelled by securing the highest marks in the batch & not only this

she was pledged as the best graduate.

But since she has joined back as a midwife near to her place of

residence, she has served many. Now contrary to the said the

situation is entirely different as Bhaou has helped many in saving

lives and people have started pursuing them actually.

The story does not end here there are still many who are source of

naussance to them and the couple keeps on listening the jabbing

taunts of the people around but now Ms.Bhaou and Mehboob have

more ardor and are more intend towards their kids as they want to

see them the future doctors.

Under this Midwifery Training

Program 75 matriculate girls

have graduated on a fully

funded scholarship by PPHI

Sindh and 50 are in the process.

Ms. Bhaou and Family – Village Kamal Khan Leghari District Sanghar

Measures for Vector

Control Protect your houses from

mosquitoes and remove

breeding places by removing

water accumulates and

garbage.

Regularly check for the

stagnant water in pot plants,

wheelbarrows, roof guttering

and birdbaths.

Cover fresh water tanks and

cisterns

Spray under beds and behind

curtains with residual surface

spray.

Keep you houses well lit and

ventilated.

Use screening for the doors

and windows

Use mosquito nets preferably

impregnated nets

Wear light colored full

clothing especially during the

dark hours.

Use mosquito repellents in

outdoors.

*Source Pakistan Today

2.4. Disease Alert… Dengue Fever

Dengue is a mosquito-borne viral infection causing a severe

flu-like illness and, sometimes causing a potentially lethal

complication called severe dengue. The incidence of dengue

has increased 30-fold over the last 50 years. Up to 50-100

million infections are now estimated to occur annually in over

100 endemic countries, putting almost half of the world’s population at risk.

Transmission

The full life cycle of dengue fever virus involves the role of

mosquito as a transmitter (or vector) and humans as the main

victim and source of infection.

Signs & Symptoms Sudden, high fever

Severe headaches

Pain behind the eyes

Severe joint and muscle pain

Fatigue

Nausea and Vomiting

Skin rash, which appears two to five days after the onset of

fever

Mild bleeding (such a nose bleed, bleeding gums, or easy

bruising)

Treatment There is no specific medicine to treat dengue infection. If one is

suspected to have dengue fever, one should use pain relievers

with acetaminophen and avoid medicines with aspirin, which

could worsen bleeding. The patient should also rest, drink

plenty of fluids, and invetigate the case thouroughly . If the

condition worsens in the first 24 hours should be hospitalized immediately to be checked for any possible complications.

Herbal remedies that are proven to cure Dengue Fever – LiveLonger.com Aedes Aegypti (Tiger Mosquito) is the Primary Vector of Dengue

2.5. From the Researcher’s

Desk… POSTPARTUM HAEMORRHAGE IN SAARC

COUNTRIES-A SYSTEMATIC REVIEW OF

RISK AND PROTECTIVE FACTORS - DR. MUHAMMAD BAKHSH RAJA DHAREJO

DM KHAIRPUR A

Background and Rationale PPH is the leading cause of maternal deaths worldwide with

escalating global incidence from 1.5% to 4.1% during first

decade of twenty first century, despite the number of

interventions by international organisations and

governments. Sustainable Development Goals (SDGs) have

replaced Millennium Development Goals (MDGs) in 2015 by

reconsidering the priority of the maternal health. PPH is a

preventable public health emergency in developing

countries due to soaring incidence rates. The majority of

maternal and child health policies and programmes primarily

focus on clinical aspects of PPH by adopting small individual

studies while failing to recognise and address social and

public health factors due to lack of composite research

evidence of the region. A substantial number of maternal

deaths are as a result of limited access to maternal healthcare

services, their poor quality and lack of awareness. Moreover,

there are number of primary studies conducted in South Asian

countries regarding risk and protective factors of PPH but

there is a substantial gap in literature for a holistic

comparative account of factors associated with PPH, which

could be generalizable and reproducible into local, national

and regional policies.

Aim To identify various risk and protective factors of PPH in South

Asian countries.

Methods A systematic review which explored databases of MEDLINE,

Science Direct, CINAHL in addition to Discover and Google

Scholar for relevant primary research studies through

inclusion and exclusion criteria. The studies were

systematically searched and screened in accordance with

standard methodology of Centre for Reviews and

Dissemination University of York. The data was extracted into

MS-Excel spread sheet. Additionally, quality appraisal of each

research study was conducted. The results were thematically

analysed by narrative synthesis in postpartum period and

psychosocial status of partners are associated socio-

behavioural protective factors associated with PPH.

Recommendations*

Preventive

Scheduled Antenatal Care

Adequate Birth Spacing

Controlled Chronic Diseases

Balanced Diet and Prompt

Application of good methods

of obstetrical care in a

hospital setting reduces the

risk for presentation with PPH

Curative

The use of uterotonics for the

prevention of PPH during the

third stage of labour

In settings where skilled birth

attendants are not present

and oxytocin is unavailable

Administration of misoprostol

(600 µg PO) by community

health care workers In settings where skilled birth

attendants are available, CCT

is recommended for vaginal

Births

Late cord clamping

(performed after 1 to 3

minutes after birth) is

recommended for all births

while initiating simultaneous

essential newborn care

*These rocommondations are not

part of the research abstract.

Results The review identified five categories of risk and protective factors

associated with PPH. Increasing maternal age, nulliparity,

primigravidity and grand-multiparity are associated biological

risk factors. Besides, Uterine atony, placental tissue retention,

abnormal placentation including gestational trophoblastic

neoplasia, trauma or tears of genital tract, assisted abortion,

antepartum haemorrhage, multiple pregnancies, any history of

previous PPH and obstetric complication, polyhydramnios, and

uterine rupture are investigated as obstetric risk factors while

level of antenatal care and visits during the gestation is the

obstetric protective factor against PPH. Moreover, anemia, sepsis,

infections, coagulopathy, gestational diabetes mellitus,

macrosomia, maternal obesity, hepatitis C infection, dengue

fever, pre-eclampsia and eclampsia are identified as medical risk

factors. Furthermore, prolonged labour duration, obstructed

labour and home based deliveries are recognised as clinical

settings related risk factors. While, active management of third

stage of labour, instrumental mode of delivery, hospital based

booked deliveries, and trained birth attendant are the clinical

settings related protective factors for PPH. Lastly, literacy and

awareness of mothers, adequate hydration level, and intake of

milk by mother during gestation, rest in postpartum period and

psychosocial status of partners are associated socio-behavioural

protective factors associated with PPH.

Conclusion and Implications The research has a potential to benefit in devising holistic

reproductive and maternal health policies and practices which

may plug the existing gaps in postpartum care at local, national

and regional levels. Moreover, due to deficiency of substantial

literature evidence, it has been recommended to conduct

randomised controlled trials in Afghanistan, Bhutan and Maldives,

to explore the temporal association of identified risk and

protective factors with PPH.

Keywords PPH, Risk Factors, Protective Factors, South Asia

Conditions that

may increase the

risk for Postpartum

Hemorrhage

Placental abruption

Placenta previa

Overdistended uterus

Multiple pregnancy

More than one placenta

and overdistention of the

uterus

Gestational hypertension

or preeclampsia. (High

blood pressure of

pregnancy)

Having many previous

birth

Prolonged labor

Infection

Obesity

Medications to induce

labor

Medications to stop

contractions (for preterm

labor)

Use of forceps or

vacuum-assisted

delivery

3.

QUARTERLY

PERFORMANCE REVIEW

Badin Sanghar Khairpur-A Ghotki Mirpurkhas

Outpatient Visits

(New Cases)170155 152426 144314 139558 136435

170155152426 144314 139558 136435

020000400006000080000

100000120000140000160000180000

Outpatient (New Cases)

Sanghar Jacobabad Mirpurkhas Ghotki Khairpur-B

Normal Deliveries 699 675 647 622 617

699

675

647

622 617

560

580

600

620

640

660

680

700

720

Normal Deliveries

Sanghar Ghotki Mirpurkhas Khairpur-A Khairpur-B

Normal Deliveries 2964 2524 2436 2381 2358

2964

2524 2436 2381 2358

0

500

1000

1500

2000

2500

3000

3500

Antenatal 1

3.1. Health Services Performance

PPHI Top 5 Districts

Khairpur-A Mirpurkhas Badin Sanghar Dadu

Family Planning 2447 2171 2100 2001 1908

24472171 2100 2001 1908

0

500

1000

1500

2000

2500

3000

Family Planning Visits

Ghotki Khairpur-A Sanghar Khairpur-BNaushero

Feroze

Fully Immunized 2306 2138 2130 1962 1889

23062138 2130

1962 1889

0

500

1000

1500

2000

2500

Fully Immunized

ANC PNC TT2 Deliveries

Performance 123123 32684 56924 20666

Revisits 122373 16047

123123

32684

56924

20666

122373

16047

Maternal Care

Performance Revisits

Number of

Live Births

Number of Still

Births

New Born

ComplicationsPremaurity

Newborn

Resucitations

New Born Care 12312 327 577 165 377

0

2000

4000

6000

8000

10000

12000

14000

New Born Care

New Born Care

3.2. Maternal, Newborn & Child Health

3.3. This Quarter Performance

- A Quick Review…

Services at PPHI

Health Facilities

Treatment of Common

Diseases

Maternal & Newborn Care

Services including

Antenatal Care, Nutritional

Supplementation, Basic

Emergency Obstetric Care,

Postnatal Care, Emergency

Referral Mechanism for

Obstetric Emergencies,

Ultrasonology

Provision of Essential Drugs

Immunization

Family Planning including

Counselling on Cafetaria

Choice

Control of the Endemic

Diseases

Health Education via

Community and School

Health Sessions

Basic Laboratory Services

Radiography at Selected

Centres

Promotion of Food Supply,

Water Supply & Sanitation

6,346,714 Outpatient Visits 5,465,162 Last Quarter Over 5.4 million OPD visits in the quarter with ensured

quality diagnosis, treatment and management as per

guidelines.

972,43 Family Planning 100,885 Last Quarter

Good family planning strategies have

remarkable impact over the quality of life,

reducing maternal and neonatal morbidity

and mortality, ultimately contributing to

positive health outcomes.

115,202 Antenatal Visits 123,123 Last Quarter

Antenatal care is an essential part of pregnancy and

should start as soon as one finds out they are

expecting. Having a healthy pregnancy is one of the

best ways to promote a healthy birth.

20,666 Normal Deliveries

20,666 Last Quarter

Most of the ladies were pre-booked during all ANC

checkups including all services such as

deworming, iron and folic acid supplementation.

989 High risk pregnancies were closely followed

and were referred for comprehensive emergency

obstetric care.

42,067 Postnatal Visits 32,684 Last Quarter

Postnatal care is of great importance as it helps the

mother and the baby to achieve optimal health.

78,794 Fully Immunized 74,529 Last Quarter

The main objective of quality immunization is to assure the

provision of the quality immunization services that promote,

protect and preserve the children against the vaccine

preventable diseases.

726,212 Laboratory Tests 607,531 Last Quarter

Accurate and reliable diagnosis is the cornerstone of

disease management and control. Integration of

laboratory and other diagnostics at PHC is of great

importance, making comprehensive healthcare a complete healthcare

1,125,505 Follow Ups 921,563 Last Quarter

Good follow up amounts to quality healthcare

deliverance. Ideally all the new cases must be

followed excluding few exceptions to this rule.

3.4. Top 5 Communicable

Diseases…

Case Definitions

Acute Respiratory Infection

Any acute onset of cough with

mild fever, runny nose,

pharyngitis, laryngitis, otitis,

tonsillitis,

with normal breathing

and without any general

danger sign.

Acute Watery Diarrhoea

Acute diarrhea (passage of

three or more loose stools in

past 24 hours) with or without

dehydration. In case of

dysentery a person having 3 or

more loose stools over last 24

hours with visible blood in the

stool, abdominal cramps,

tenesmus, fever and anorexia.

Dermatitis & Scabies

Dermatitis, also known as

eczema, is a group of diseases

that result in inflammation of

the skin. They are

characterized by itchiness and

red skin.

Scabies is characterized by

rash or lesion and intense

itching especially at night.

Lesions prominent around

finger webs, wrists, elbows,

axilla, beltlines, thighs,

external genitalia, nipples,

abdomen, buttock folds, head,

neck, palms and soles of infants

may be involved.

Suspected Malaria

History of recent fever within

last 48 hours (may be

continuous or irregular in the

beginning), chills, headache,

body ache, weakness, anemia,

hepatosplenomegaly.

Worm Infestation

Worm infestation occurs when

worms live as parasite in the

human gastrointestinal tract.

1,118,517 Acute Respiratory Tract

Infections The disease is more prevalent in the

children under 5 years of age most of

the viral infections are self-limiting,

seldom requiring antibiotics but need

careful follow-up.

525,413 Diarrhoea/Dysentery The disease is prevalent in South Asia,

mostly involving children under five.

The treatment of most diarrheas

involves staying hydrated with clean

and safe drinking water, zinc sulphate

and no antibiotic usually.

797,773 Dermatitis & Scabies

Dermatitis and related syndromes are very

prevalent. Heat rashes, fungal disease,

photosensitive dermatitis, acnes and other

skin allergies are common diseases of

summer season.

317,207 Suspected Malaria

The disease is endemic in our part of the

world although many have developed

resistive immunity against it. It is prevalent

especially in children. There are major

issues with the management of malaria as

per guidelines.

37,725 Worm Infestation The helminthic worm infestation is very

widespread in rural Sindh, affecting a

majority of children under 5. PPHI

Sindh has all standard treatments

regimes available at all the HFs.

3.5. Top 5 Non-Communicable

Diseases…

Case Definitions Peptic Ulcer Disease

Gnawing pain, burning

discomfort, and tenderness in

the epigastric area are the

symptoms and signs most

commonly associated with PUD.

However findings are not

specific or sensitive enough to

diagnose this condition so

confirmed diagnosis is made on

laboratory basis.

Asthma

The chronic inflammation is

associated with airway

responsiveness that leads to

recurrent episodes of wheezing,

breathlessness, chest tightness,

and coughing, particularly at

night or in the early morning.

Dental Caries

Dental caries, also known as

tooth decay or cavities, is a

breakdown of teeth due to

activities of bacteria

Hypertension

Blood pressure measurements

are classified in stages,

according to severity:

Normal blood pressure:

<120/80 mmHg

Pre-hypertension:

120-139/80-89 mm Hg

Stage 1 hypertension:

140-159/90-99 mm Hg

Stage 2 hypertension:

>160-179/100-109mmHg.

Based on average 2 or more

readings on 2 or more different

occasions after initial screening.

Diabetes

Symptoms of hyperglycemia

(polyuria, polydipsia,

unexplained weight loss, visual

blurring, genital thrush,

lethargy)

&

Raised venous glucose detected

once.

Fasting > 125 mg/dl

Random > 200 mg/dl

14,535 Diabetes Mellitus Diabetes mellitus, commonly referred to as

diabetes, is a group of metabolic diseases

in which there are high blood sugar levels

over a prolonged period. Even disease is

diagnosed and managed without following

the standard diagnostic guidelines at large.

158,058

Peptic Ulcer Disease It is a lesion in the lining of the digestive

tract, typically in the stomach or duodenum,

caused by the digestive action of stomach

acids. This is one of the most misreported

diseases on the clinical grounds.

35,580

Asthma A respiratory condition marked by attacks of

spasm in the bronchi of the lungs, causing

difficulty in breathing. It is usually connected

to allergic reaction or other forms of

hypersensitivity. Widely prevalent in both

urban and rural population.

59,512

Dental Caries Tooth decay is a common disorder, second

only to the common cold. It usually occurs in

children and young adults, but can affect any

person. Tooth decay is a common cause of

tooth loss in younger people. This is an

underreported disease.

21,714 Hypertension

HTN is an iceberg diseases with many of the

people living with it asymptomatically and

most of the patients are missed by the

physicians usually. Generally HCPs do not

follow the diagnostic criteria of 3

consecutive blood pressure readings failing

to manage it properly.

Last Quarter This Quarter

Hyderabad 25715 24284

Mirpurkhas 33458 31567

Larkana 26875 28537

Sukkur 36074 30814

Antenatal Care - 1

Last Quarter This Quarter

Hyderabad 23559 23984

Mirpurkhas 24129 25165

Larkana 24458 25584

Sukkur 25102 26152

Family Planning

3.6. Regional Performance This quarterly performance is actually based on the four key

indicators including outpatient visits, total number of antenatal

visits, normal delivery coverage and family planning visits.

The graphical analysis of the all four key indicators is shown

herein;

Last Quarter This Quarter

Hyderabad 1236596 1383284

Mirpurkhas 1603822 1803419

Larkana 1117986 1417082

Sukkur 1506758 1742933

Outpatient Visits

Last Quarter This Quarter

Hyderabad 4225 4825

Mirpurkhas 5632 6917

Larkana 4938 8193

Sukkur 5871 8311

Delivery Coverage

Focused ANC-1 1. Check for the Weight &

Nutritional Status

2. Check for the Anemia -

Hemoglobin

3. Check for the Blood Pressure

for early detection of

complications

4. Check for the Urine Albumin

5. Blood Grouping

6. Tetanus Toxoid Immunization

7. General Danger Signs

While birth is a natural

process, that does not

generally require

medical intervention, it

is still one that is fraught

with danger for women

and infants around the

world so it requires safe

preparation as well as

clean and safe

institutional delivery.

Key

Indicators

July-September

2016

Good quality of care in family

planning (services help

individuals and couples to meet

their reproductive health needs

safely and effectively.

Therefore, assessment and

improvement of the quality of

family planning services could

enhance family planning

services utilization.

An OPD visit is a medical

service provided that does

not require a prolonged stay

at a facility. This can include

routine services such as

checkups or visits to clinics.

0 50000 100000 150000 200000

Last Quarter

This Quarter

Last Quarter This Quarter

OCPs 36232 34619

Injections 33779 33789

Condoms 10287 88082

IUCD 2820 2896

Implants 12004 11853

Surgical 362 271

Family Planning Breakup

This Quarter Last Quarter

Hyderabad 15552 17486

Mirpurkhas 18744 21718

Larkana 15257 15086

Sukkur 24976 27869

Fully Immunized

Good quality of care in family

planning focuses on who can use

contraceptive methods safely,

providing guidance on the safety

of various contraceptive methods

in the context of specific health

conditions and characteristics.

Immunization is a proven tool

for controlling and eliminating

life-threatening infectious

diseases and is estimated to

avert between two and three

million deaths each year. It is

one of the most cost-effective

health investments.

3

3.7. Monitoring of Monitors…

PPHI has a very comprehensive monitoring,

data collection and analysis system that play

a vital role in quality assurance and in

forecasting improved real time health

planning according to desired needs. Since

PPHI operates in rural areas, MoM is a

revolutionary intervention where a monitor

is used for gathering first hand statistics

directly from the field. It improves analysis

and improvement of planning.

On the other hand, MoM has an advance

online dashboard with a real time

synchronization that gets the farthest

updates within the matter of seconds. The

dashboard could be accessed by the

authorized from anywhere around the

world, whenever one wants a have peep into

the things.

Quarterly Review of Mobile

Monitoring

The overall coverage of all four region for the quarter was

satisfactory whereas Mirpurkhas and Larkana regions

covered the set targets very well.

The main observations that were made during the data

analysis are as follow;

Many required sections of the reporting format

are often missed in reporting.

GPS positions are mismatched.

The HR codes of absentees are often mismatched.

Some of the indicators are filled without ensuring

the LQAS.

The formats need to be filled the way they are

designed. Even a single variable is of great

importance so the reporting must be meticulous.

Monitoring of Monitors Real Time Dashboard Mobile Interface

Salient Features

Tracking reporting individual

coverage and performance

District wise data analysis

Summary and frequency of

monitoring

Validation of the data source

by GPS and live shots

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40

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Monitoring of Monitors Coverage Districtwise

Last Quarter This Quarter

PPHI Big Achievements

First and only Province to upgrade 122 BHUs to 24/7 BHU Plus (Maternal

Services)

Appointment of the Lady Doctors for the first time in Rural Areas of Sindh

with a total strength of 485 FMOs in 21 Districts of Sindh

Restoration of 182 Illegally occupied Health Facilities

Managed Approval of 158 SNEs out of 158 HFs

Repair and Renovation of over 982 HFs

Dedicated PPHI Research & Training Wing

Use of Technology with fully equipped ERP Modules like Human

Resource Maagement System, Job Portal, Financial Information System,

Medicine Invntory, cLMIS and more

Flood & Rain Emergency - Disaster Relief Services (2010-2012)

Smart Phone Monitoring

District Health Information System with 100% Compliance and 86 percent

Data Accuracy*

DIVIDEND OF PARTNERSHIP (Value for Money)**

Head Office worth Rs. 60M

Establishment of 03 Medicine Warehouses with District Offices worth Rs.

62M (Badin, Khairpur & Thatta)

3 Warehouese under Progress worth Rs. 75M (Hyderabad, Sukkur,

Larkana)

Ambulances worth Rs. 86M

Distribution of 332 ILRs worth Rs. 36M for EPI

141 Ultrasound Machines worth Rs. 63M

Establishment of 2 Eye Hospitals at Khairpur and Matiari worth Rs. 40M

ARV 275,000 Doses worth Rs. 115M In last 5 Years

MSPH Postgraduate Program for 25 PPHI Doctors worth Rs. 14.39M

Midwifery Training Program for 150 Girls worth Rs. 135M

PPHI Sindh – A Non Profit Organization Committed to Serve the People of Sindh

www.pphisindh.org | www.facebook.com/pphisindh | help@pphisindh.org | 0800-77755

Electricity won’t be a problem anymore!

PPHI Sindh

to Solarize all 24/7 BHU Plus

in 22 districts to ensure

round the clock quality

maternity services.

PPHI Sindh Just Introduced KMC*…

Kangaroo

Mother

Care*

could save

thousands of

babies each year. KMC* launched at

PPHI Kausar Hospital Khairpur & soon to be implemented throughout 22 districts of Sindh.