Family Planning Training Boost
Confidence of Healthcare Providers in North West Frontier
Province, Pakistan
By supporting provision of on-the-job quality training
to doctors, USAID is helping to ensure access to family
planning services in rural areas of Pakistan.
Farhat can remember the day she had to decline a
client services for Family Planning (FP) at her centre
because she simply did not have the technical knowledge
or skills. As a Lady Health Visitor (LHV), Farhat
Ara has been practicing primary healthcare at Zacha
Bacha Center in Rashakay (Mardan District) for the
last 12 years. With the help of a Greenstar trained
doctor, Farhat is now providing reliable and quality
family planning care to more than 250 households in
her area.
Last year, a Greenstar Assistant Manager Health Services
– a qualified MBBS lady doctor -- visited 23-year-old
Lady Health Visitor, Farhat Ara, at her clinic. After
discussing the challenges and issues, Farhat requested
the Greenstar doctor to facilitate FP training for
her. The Greenstar AMHS appreciated her interest in
refining her skills and revisited Farhat for a one-day
family planning basic training.
Very few private providers in rural areas have the
knowledge and skills to offer family planning services
in Pakistan. As a result, these women must often find
transportation and travel long distances for seeking
consultation. For most of these women, cultural sensitivity
would offer more obstacles to seeking services.
 |
“I
have learnt that continuous medical education
not only boosts confidence but also enhances
trust of my clients”. |
LHV Farhat
Ara counseling FP patients, Rashakay, Mardan,
NWFP, Pakistan
Photograph courtesy: Nasir Ahmed
|
Pakistan's health indicators are among the worst
in the world. For every 100,000 babies born, 35 mothers
die; and over 72 infants die for every 1,000 live
births. To improve these indicators, USAID is supporting
the increased availability of quality reproductive
health products, so couples can space births. To ensure
that quality family planning products and services
are available in remote and underserved areas, Greenstar
Social Marketing has expanded it’s network with
support from USAID across the country. Now, Greenstar
works in 108 Districts and Agencies, including Tribal
and Northern Areas.
Farhat shares enthusiastically that after attending
several FP trainings, she has also arranged a number
of Clinic Sahoolats (Free Clinics) for her clients.
She adds “although I have been working in this
area for the last 12 years, I am more confident now
because whenever I have any problem I receive timely
advice from a Greenstar staff doctor.” Greenstar
AMHS’ visit all active FP providers in the network
every two months, ensuring quality monitoring, technical
support and product supplies for the providers.
_________________________________
Greenstar and USAID Launch
a National Infection Prevention Campaign in Pakistan
Infection prevention and control is deservedly high
on the agenda for the Greenstar Social Marketing Program.
Last month Greenstar, with the support of USAID, dedicated
May 7th as “Infection Prevention Day”
as part of a national Infection Prevention campaign.
The campaign promotes infection prevention practices
for the safety of health workers and the individuals
and communities that they serve.
As part of the campaign roll-out, Greenstar staff
distributed educational materials and screened a docudrama,
“Tareek Kal,” at all four regional offices.
In addition, Manager Health Services planted a tree
with a team of Greenstar doctors to mark the Infection
Prevention Day.
Greenstar doctors and interpersonal communications
teams launched the campaign at the local level in
the four regional offices last month. At the national
level, Zonal and regional staff involved all partners,
including district and provincial government health
officials, in meetings and workshops.
Upon special request of the district government, Greenstar’s
dedicated and committed teams arranged special sessions
for family welfare workers in Multan. Leading gynecologists
from medical colleges and government district hospitals
gave presentations on infection prevention in all
regions. Similarly, all four regions organized workshops
and consultative meetings with relevant partners to
promote the cause.
During an infection prevention workshop
in Mardan, Dr. Farhat Rehman, mentioned that Mardan
has the fifth highest number patients testing positive
for Hepatitis C Virus (HCV) in Pakistan. While stressing
the importance of using bleach for instrument sterilization,
she shared one of her experiences:
A un-booked patient, Mrs. Ejaz, came to her with labor
pain at Mardan Medical Complex. Mrs Ejaz was a primigravida
who had received antenatal care from a local LHV.
Upon examining the patient, Dr. Farhat diagnosed Mrs.
Ejaz with Cephalo pelvic disproportion and recommended
a Caesarean section. Initial investigations were done
and the results revealed that Mrs. Ejaz was HCV-positive.
The MS of the hospital refused to operate her in regular
OT since she was HCV positive and sent her to the
separate OT for HCV Positive patients. She returned
to Dr. Farhat for stitches removal after 7 days when
her husband asked Dr. Farhat if she needs any further
tests. Dr. Farhat asked her to get her blood test
(ALISA) done, the tests were all in normal limits
which cepititus reated confusions Mr. Ejaz got her
HCV tests done from three different laboratories and
this time to their amazement it was confirmed she
is HCV negative the initial reports from the laboratory
were wrong.
The client and her husband were very concerned that
she might become positive after two or three months
since she was operated in OT specifically for HCV
positive patients. Dr. Farhat told her that decontamination
and Autoclaving of the instruments was done and there
is no chance that she has contracted the virus but
for their satisfaction Mrs Ejaz was asked to get the
tests repeated after three months which were again
found negative.
“I highly appreciate the efforts of Greenstar
for conducting seminars on IP for private sector providers
and educating them specifically on decontamination
and High Level Disinfection (HLD) for instrument processing
which are very easy steps yet so helpful in preventing
one of deadly diseases” Dr. Farhat Rahim, Mardan.
_________________________________
Opting for the suitable
choice:
With access to affordable family
planning (FP) services and products, couples are enjoying
marriage in North West Frontier Province of Pakistan
Tubal ligation for sterilization is a common method
of contraception used by women in developing countries,
including Pakistan. The current contraceptive prevalence
rate of 30% in Pakistan is much lower than that of
neighboring countries, and an unmet need still persists
due to the inaccessibility and inconsistent quality
of FP services available. In Pakistan, female sterilization
is a common method used (8%), followed by condoms
(7 %), among women in their late 30s and early 40s,
according to the Pakistan Demographic and Health Survey
2006/2007. Greenstar Social Marketing’s voluntary
surgical contraception (VSC) service provides yet
another choice, offering a permanent method of contraception
to couples who have finished building their families.
35 year old Fatima sells vegetables in Timergraan,
a remote village in the Mansehra district of the North
West Frontier Province in Pakistan. She first learned
about FP methods at Shaukat Private Hospital in her
village in February 2007. Before that time, Fatima
and her husband lacked access to FP information and
quality reproductive health services.
“After my fourth child, my husband went to another
city. We thought staying away for long could address
the problem, but it did not. Now he is always with
me and works in the same village, we’re a happy
family,” Fatima said. She said her husband made
the decision to stop conceiving after having their
sixth child.
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VSC
surgery being performed at Greenstar providers’
facility, Gojar Khan, Punjab, 2006 |
“I wish I had known about birth spacing and
FP methods earlier, when I had my first four children,
we are poor and do not have enough money to send all
six children to school and support their other basic
needs.”
Hundreds of other people like Fatima, who have learned
about various forms of contraception from Greenstar
gynecologist Dr. Mussarat Shaukat, say that the FP
and reproductive health services give them peace of
mind and they can now “enjoy” their marriages.
While breastfeeding her sixth child at the hospital,
Fatima shared her experience with Greenstar Dr. Samina
Afzal, “I decided to speak with Dr. Musarrat
about stopping getting pregnant. The doctor explained
all the options to me, and asked questions. Since
I knew that my husband thought negative of the methods,
I could not readily decide. Dr. Mussarat asked me
to bring my husband along the following week. During
our next consultation, the doctor explained the methods
of contraception and, since my husband too did not
want more children, he was convinced and opted for
a permanent solution”.
Prior to January 2007, there were no specialized centers
in Timergraan for FP services. Many couples, who felt
they had completed their families, expressed interest
in learning more about family planning and obtaining
family planning services.
“In this small village with around 75,000 inhabitants,
I have performed fifty seven VSC procedures over the
past five months,” says Dr. Mussarat Shaukat,
who runs the hospital.
 |
“The
response is so overwhelming that there is still
the need to expand the facilities to accommodate
more clients and services”
Dr. Mussarat Shaukat, May, 2007, Timergraan,
NWFP. |
With support from USAID, Greenstar has provided reproductive
health information and services to couples in more
than 108 cities and villages across Pakistan. Greenstar
provides VSC services in all four provinces and maintains
special focus on remote areas, like Timergraan. A
total of 5064 VSC procedures have been performed nationally
by Greenstar during the past three months with 835
procedures in the North region alone.
For Fatima and the thousands of clients like her,
the USAID-funded VSC services offered by Greenstar
clinics not only help to limit family sizes, but also
improve the health of mothers, making it possible
for them to better provide for their children, while
enjoying their marriages with peace of mind.
