Sindh Health Sector Strategy 2012-2020

PURPOSE 1.6a: Intersectoral district based pilots on nutrition and social development through collaboration w ith BISP, water & sanitation, education and other sectors Key issues:Social indicators are poor in rural areas w ith w ide disparities across and even w ithin districts.Under-nutrition risk of infections, compli cations and fatality are due to poverty, unsafe water and sanitation, female illiteracy that require be holistically integrated and up-scaled successful pilots.Strategic Actions Stakeholders Key Performance Indicators 1.6.1aInter-sectoral pilots on nutrition Pilots in catchment area of FLCF • Links for inter-sectoral action on under-nutrition with other departments such as water and sanitation, food, education, PDMA etc. Poverty reduction projects in conjunction with BNP, BISP,Bait-ul-Mal and NGOs Same + BISP+ local NGOs, line departments 1 pilot in place in each district: 2015 Health Sector Strategy Sindh 2012 -2020 37 Strategy 1.7a: Strengthen district health governance for result based implementation of services i n disadvantaged districts.Key issues: District health officers are untrained in formal district management and often appointed on political bases.District management is usually interpreted as admini stration w ith li ttle move tow ards strategic planning, evidence based monitoring and financing.Culture of use of information is low despite availability of data and outreach based aggressive monitoring is rarely practiced nor is standardized.There is absence of systems of formal district based planning w hich can be linked to budgetary cycles.Strategic Actions Stakeholders Key Perform ance Indicators 2012 -2020 40 Strategy 1.3b: Implementation of urban adjusted Essential Health Service Package at identified secondary care centers in public and private sector w ith prioritized referral links from M SDP centers, and onw ard linkage to tertiary hospi tals Key Issues: Public sector secondary care facilities are few in number compared to population density how ever there has been a parallel mushrooming of NPO hospitals.Moreover existing public sector secondary facilities despite vary w idely in terms of servi ce package ranging from maternity homes to secondary hospitals, and also suffer from infrastructure and quality issues.Strategy 1.4b: Deployment and training of LHWs and multi-purpose health workers linked to Family Practice model for community based health package targeted to entire household.Key Issues: Urban low income populations, including slums, lack outreach community based services despite having a high burden of communicable and preventive diseases, and low health aw areness.Disease profile of urban areas also suggests endemic non communicable diseases in urban poor, largely uncontrolled due to lack of screening and poor management at home.A shift if Strategic Actions Stakeholders Key Performance Indicators 1.3.1b.Standardization of public sector secondary facilities for ESDP • Standardized re-classification of urban secondary care facilities into Comprehensive Health Centers for delivery of EPHS Health Sector Strategy Sindh 2012 -2020 51 Strategy 3.4: Re-defining links w ith DOPW with shift of contraceptive services through district and urban PHC systems and aimed at birth spacing in younger couples Key issues: Contracepti ve prevalence is low and sub-optimal at 26.7%, has largely remained stagnant over the last decade and fertility reductions as seen in urban areas are mainly due to increased age of marriage rather than roll out of contraceptive services.Contrary to common perceptions, there is high unmet need for contraception in both rural and urban areas, and as much as 88% of induced abortions are due to unmet need.DOPW is responsible for population w el fare despite being a minor provider of services, and services remain targeted at w omen w ho have completed their fertility missing out on young couples.Strategic Actions Stakeholders Key Performance Indicators 3.4 Integrating contraception provision: Provision of free contraceptives and training by DOPW to all DOH facilities for birth spacing.Integration of services with pregnancy care to reach out to couples and supported by community based BCC.MNCH Program, DOPW, district managers Integrated contraceptive services with maternal care: 2016 Strategy 3.5: M ainstream ing of primary and secondary control of NCD interventions and lifestyle support in low income urban townships Key issues: With Pakistan in demographic transition, NCDs account for 56% of disease burden and are estimated to be higher in Sindh w hich has a higher urban population than other Provinces.NCDs are endemic in the urban poor and have an earlier age of onset compared to OECD countries thereby striking at the economically productive popul ation.At present there is no focal body for NCD control, lack of strategy for NCD control and efforts are concentrated at the costly tertiary level.