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MCHIP Pakistan End-Of-Project Report PAKISTAN ASSOCIATE AWARD/COMPONENT 2 MATERNAL NEWBORN and CHILD HEALTH SERVICES

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MCHIP Pakistan End-Of-Project Report PAKISTAN ASSOCIATE AWARD/COMPONENT 2 MATERNAL NEWBORN and CHILD HEALTH SERVICES MCHIP Pakistan End-of-Project Report PAKISTAN ASSOCIATE AWARD/COMPONENT 2 MATERNAL NEWBORN AND CHILD HEALTH SERVICES Authors: Presha Regmi Farhana Shahid Kamran Baig Emma Williams Reporting period: February 2013–March 2018 Submitted on: Submitted to: United States Agency for International Development / Pakistan under Cooperative Agreement # 656- A-00-11-00097-00 The Maternal and Child Health Integrated Program (MCHIP) is the USAID Bureau for Global Health’s flagship maternal, neonatal, and child health (MNCH) program. MCHIP supports programming in maternal, newborn, and child health, immunization, family planning, malaria, nutrition, and HIV/AIDS, and strongly encourages opportunities for integration. Cross-cutting technical areas include water, sanitation, hygiene, urban health and health systems strengthening. This report was made possible by the generous support of the American people through the United States Agency for International Development (USAID), under the terms of the Leader with Associates Cooperative Agreement GHS-A-00-08-00002-00. The contents are the responsibility of the Maternal and Child Health Integrated Program (MCHIP) and do not necessarily reflect the views of USAID or the United States Government. October 2018 Table of Contents List of Figures and Tables ........................................................................................................... iv Abbreviations ............................................................................................................................... v Executive Summary .................................................................................................................... vii Key Achievements .......................................................................................................................................... ix 1 High-Level Results .................................................................................................................... 1 1.1 Survey Results ........................................................................................................................................... 2 2 Background ............................................................................................................................... 4 2.1 Situational Analysis ................................................................................................................................... 4 2.2 Landscape Analysis ................................................................................................................................... 5 2.3 Rationale ................................................................................................................................................... 5 3 MCHIP Interventions ................................................................................................................. 7 3.1 Geographical Scope .................................................................................................................................. 7 3.2 Project Strategic Framework .................................................................................................................... 9 4 MCHIP Associate Award Activities and Results by Objective ............................................... 12 4.1 Mapping Health Services in the Districts .............................................................................................. 12 4.2 Strategic Objective 1: Increase Access to MNCH Services Through Community Mobilization .......... 13 4.3 Strategic Objective 2: Improve the Quality of MNCH Scope and Services at Public and Private Health Facilities ............................................................................................................. 17 4.4 Strategic Objective 3: Facilitate Referral and Transportation to Health Facilities ............................. 23 4.5 Strategic Objective 4: Improve Quality and Scope of Comprehensive Emergency Obstetric and Newborn Care at Public and Private Hospitals ................................................ 25 5 MCHIP Associate Award Activities and Results by Technical Area ...................................... 29 5.1 Maternal Health ..................................................................................................................................... 29 5.2 Newborn Health ..................................................................................................................................... 32 5.3 Child Health ............................................................................................................................................ 36 5.4 Family Planning ...................................................................................................................................... 41 5.5 Nutrition .................................................................................................................................................. 43 6 MCHIP Associate Award Activities and Results by Cross-Cutting Area ................................ 46 6.1 Quality Improvement .............................................................................................................................. 46 6.2 Midwifery ................................................................................................................................................ 49 6.3 Training Institutes .................................................................................................................................. 53 7 MCHIP Associate Award Program Learning .......................................................................... 55 7.1 By Objective ............................................................................................................................................ 55 7.2 By Technical Area ................................................................................................................................... 57 7.3 By Cross Cutting ..................................................................................................................................... 59 8 Program Legacy ..................................................................................................................... 61 8.1 By Objective ............................................................................................................................................ 61 8.2 By Technical Area ................................................................................................................................... 62 8.3 By Cross Cutting ..................................................................................................................................... 64 Annex A: Performance Indicators ............................................................................................. 66 Annex B: List of Materials or Tools Developed or Adapted by the Program ........................... 67 MCHIP Pakistan End of Project Report iii List of Figures and Tables Table 1. Six components of the Maternal and Child Health Program in Sindh (2013–2018) ....................... 1 Table 2. Intervention districts by project year .................................................................................................... 8 Figure 1. Map of project districts by project year .............................................................................................. 8 Figure 2. The project strategic framework, based on providing a continuum of care to women throughout their reproductive lives ........................................................................................... 9 Table 3. MCHIP interventions by space along the continuum of care model ............................................... 10 Figure 3. Geographic information system mapping of Tando Allahyar district showing facilities that offer five services: antenatal care, family planning, newborn care, normal vaginal deliveries, and postnatal care (BHU: basic health unit; DHQ: district headquarters hospital; GD: government dispensary; RHC: rural health center; THQ: tehsil [subdistrict] headquarter hospital) .................................................................................................................. 13 Figure 4. Distribution of 1,108 facilities by type across the 16 target districts ........................................... 18 Table 4. Criteria facilities must meet to be designated an MNCH center ..................................................... 18 Table 5. MCHIP training packages by technical area ..................................................................................... 21 Figure 5. Increase in average number of antenatal care (ANC) visits, total deliveries, and postnatal care (PNC) visits from 2014–2017, including number of facilities reporting ....................................................... 22 Figure 6. Introduction and percentage completion rates of cesarean section surgical safety checklists (CS-SSCs) at CEmONC facilities, July 2016–September 2017 ......................................... 26 Figure 7. Number of cesarean sections and coverage of antibiotic prophylaxis, by quarter and project year .............................................................................................................................. 26 Figure 8. Increased compliance to quality standards across 29 CEmONC centers ..................................... 28 Figure 9. Increased compliance to the QIPS respectful
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