Role of Community Based Savings Groups (CBSGs) enhancing the utilization of community midwives in Chitral district of Pakistan.

BACKGROUND: Maternal and infant mortality rates in the district of Chitral in Pakistan are alarmingly high. One of the major reasons for this is the inability of women to access skilled care due to the high costs associated with traveling and utilizing such services. The Aga Khan Health Services, Pakistan (AKHSP) in partnership with the national and provincial Maternal, Neonatal and Child Health (MNCH) program, deployed 28 community midwives (CMWs) in remote villages of Chitral district. This program has also established Community-Based Savings Groups (CBSGs) to support and facilitate access to MNCH services, in particular those delivered by the CMWs. CBSGs are a simple yet cost-effective and sustainable means of providing basic financial services to low income, marginalized, rural populations.The link between CBSGs and utilization of MNCH services is not well understood. This study will assess the relationship between women membership of CBSGs and their utilization of MNCH services, specifically those offered by CMWs, in the community. METHODS: The research question will be answered through guided interviews of women in the target population who have delivered within one month. The outcome variable will be the utilization of full continuum of skilled MNCH care (disaggregated by 1+ ANC, 1+ PNC and skilled delivery). The primary independent variable of interest will be participation in a CBSG.Focus Group Discussions (FGDs) will be conducted to generate further understanding and information about the social and financial factors that contribute to health behavior and health provider decision-making during pregnancy.Analysis will be tailored to answer how CBSGs, directly or indirectly, facilitate greater financial and/or social access to CMW services for pregnant women. Furthermore, the extent to which financial or social empowerment through a CBSG leads to greater utilization of CMW services. DISCUSSION: The role of CBSGs and their interlink with the CMWs services to be replicated in other comparable areas in Pakistan as a viable mean to increase MNCH service utilization amongst rural, low income, and marginalized communities. Findings from this research will be disseminated through community, national, and international channels consisting of policy makers and social society groups.

Use of a pneumonia management tool to manage children with pneumonia at the first level health care facilities.

OBJECTIVE: To describe the application and evaluation of Pneumonia Management Tool (PMT) to manage children with non-severe pneumonia (NSP) at the first level health care (FLHC) facilities according to the standard case management (SCM) guidelines for acute respiratory infections (ARI). METHOD: The ARI SCM guidelines were simplified to a PMT and used by health workers at 14 FLHC facilities to assess, manage and monitor children with NSP and to educate caretakers on home care and follow-up visits. The district supervisors provided on the job support to various cadres of health workers of both public and private facilities. RESULTS: Of 949 children with NSP, 940 (99%) were successfully treated at FLHC facilities. Caretakers found PMT useful and of 1888 follow-up visits: 1872 (99.2%) brought PMT copy; 1627 (86.2%) brought their children to the facility; 1799 (95.3%) were on time and; 1857 (98.4%) had maintained antibiotic compliance. Using PMT, health workers adherence to SCM guidelines improved from 14% at baseline to 29% after training and 65% with on the job support. The practices remained similar among various cadres of health workers. CONCLUSIONS: Health workers used PMT in managing children with NSP, counselling caretakers on home care, follow-up visits and monitoring the treatment outcome. District level supervision helped to maintain a uniform skill enhancement.