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(Herams) in Health Facilities of FATA, Pakistan Health Resource Availability and Mapping System (HeRAMS) in Health Facilities of FATA, Pakistan Prof Dr. Zia Ul Haq (PhD, MPH, MBBS), Dean Faculty of Public Health & Social Sciences Khyber Medical University, Peshawar, Pakistan 1 [email protected], +92 91 9217258 Forward Federally Administered Tribal Areas (FATA) of Pakistan is one of the disadvantaged regions in Pakistan and has been through a turbulent phase since 2008, due to reprobate activities by the non-state actors, resulting in displacement of millions of people from FATA to nearby districts of Khyber Pakhtunkhwa and other provinces. The destabilization affected the delivery of social services within FATA. Over the last few years, the security situation in FATA has markedly improved due to concerted efforts of the government law enforcement agencies and civil institutes and more than 1.6 million displaced populations have voluntarily returned to their homes in FATA. The government of Pakistan has developed a 10 year Socio-economic Development plan for FATA to revive the infrastructure and social sector. To that effect, the development partners are also aligning their support through a 3 Year FATA Transition Plan in line with that of the government. Availability of comprehensive and reliable data to inform planning and measuring achievement of health program is paramount. The Health Resource Availability and Mapping (HeRAMS) is the first comprehensive health facility assessment in FATA. We envisage that findings of this assessment will provide the basis for policy development, planning and research. Program managers will also use the results of the findings for planning, implementation, monitoring and evaluation of the program. To achieve the desired effect, results of this assessment will be widely disseminated at the different planning level using different dissemination techniques to reach the different segments of the society. Lastly, we express our appreciation to the colleagues from FATA Health Directorate and Khyber Medical University for successfully conducting HeRAMS in FATA. We look forward to continue working with you towards improvement of the health indicators in FATA and an overall improvement in the health status of the people of FATA. Dr. Nima Saeed Abid Head of WHO Office in Pakistan(a.i) 2 Acknowledgement The Directorate of Health FATA in collaboration with Khyber Medical University Institute of Public Health & Social Sciences (KMU-IPH&SS), Peshawar, Pakistan and World Health Organization Pakistan has successfully completed health facilities assessment “Health Resource Availability and Mapping (HeRAMS)” in FATA. The assessment was commissioned in November 2017 to assess the health infrastructure and services in all government health facilities in all seven Agencies and six Frontier Regions (FRs), and was completed in April 2018. The FATA Health Directorate is extremely grateful for the technical cooperation from the Khyber Medical University leadership and senior management, more especially the Vice Chancellor Prof. Dr. Arshad Javed for facilitating the KMU research team. The Directorate is grateful for the excellent research work carried out by Professor Dr. Zia Ul Haq, Dean IPH&SS and his team and congratulates him on the successful execution and completion of the exercise. The FATA Health Directorate is also extremely grateful to Dr. Muhammad Assai Ardakani, ex-Head of Office, WHO Pakistan and Dr. Nima Saeed Abid current Head of WHO office in Pakistan; who led the exercise by bringing in their expertise as Health Systems Specialist and the comparative advantage of World Health Organization as the lead technical Agency for health. The Directorate equally acknowledges the technical expertise and cooperation of Dr. Michael Lukwiya, Team Lead Health Emergencies, WHO Pakistan; Dr. Muhammad Saeed Akbar Khan, Head of WHO office for KP/FATA and Dr. Sardar Hayat Khan, NPO Surveillance and Health Emergencies, WHO Pakistan who extended their technical assistance throughout the exercise. The Directorate is also grateful to the wonderful support extended by its team at the Directorate, all program managers, Agency Surgeons of all FATA agencies and assistant Agency Surgeons at the FRs for facilitating and supporting the exercise. This report provides invaluable information about health sector in FATA but the ground situation is frequently changing and hence changing context therefore, before making any important decision, the FATA health directorate must be consulted. Dr. Jawad Habib Khan Director Health Services, FATA 3 Acronyms AHQ H Agency Headquarter Hospital AIDS Acquired Immune Deficiency Syndrome BCC Behaviour Change Communication BHU Basic Health Unit CD Community Dispensary CHC Community Health Center CH Civil Hospital CMWs Community Mid Wives CPR Contraceptive Prevalence Rate DEWS Disease Early Warning System DHS Directorate of Health Services DHIS District Health Information System EHSDP Essential Health Service Delivery Package EmONC Emergency Obstetric and New-born Care EPI Expanded Programme on Immunization FATA Federally Administered Tribal Areas FMT Female Medical Technician FR Frontier Regions HeRAMS Health Resource Availability and Mapping System HFA Health Facility Assessment HIS Health Information System HIV Human Immunodeficiency Virus IDSRU Integrated Disease Surveillance and Response Unit IMNCI Integrated Management of Neonatal and Childhood Illnesses IPH&SS Institute of Public Health & Social Sciences KMU Khyber Medical University LHS Lady Health Supervisor LHV Lady Health Visitor LHW Lady Health Worker LS Labor Suite MCH Maternal and Child Health MDGS Millennium Development Goals MHSDP Minimum Health Service Delivery Package MICS Multi-Indicator Cluster Survey MISP Minimum Initial Service Package MNCH Maternal Neonatal & Child Health MO Medical Officer MT Medical Technician MUAC Mid Upper Arm Circumference OPD Out Patient Department ORS Oral Rehydration Salt/Solution PDHS Pakistan Demographic and Health Survey PHC Primary Health Care PHSA Provincial Health Services Academy PMU Project Management Unit 4 PSDP Public Sector Development Project PSWN Persons with Specific Needs RHC Rural Health Center RTIs Respiratory Tract Infections SDGs Sustainable Development Goals SRH Sexual and Reproductive Health STIs Sexually Transmitted Infections TB Tuberculosis TBA Traditional Birth Attendant TDP Temporarily Dislocated Persons THQ Tehsil Headquarter Hospital TT Tetanus Toxoid UN United Nations UNFPA United Nations Population Fund UNHCR United Nations High Commissioner for Refugees UNICEF United Nations International Children's Emergency Fund WASH Water, Sanitation and Hygiene WFP World Food Program WHO World Health Organization WMO Women Medical Officer 5 Table of Content Forward .............................................................................................................. 1 Acknowledgement ................................................................................................. 3 Executive Summary .............................................................................................. 12 BACKGROUND OF THE PROJECT: .............................................................................. 14 Health System of FATA .......................................................................................... 17 Civil Dispensary ............................................................................................. 18 CHC (Community Health Center): ....................................................................... 18 Basic Health Unit: .......................................................................................... 19 MCH Center .................................................................................................. 20 Labor Suite .................................................................................................. 20 Lady Health Workers - LHW (Health Homes) ........................................................... 20 Community Mid-Wives (CMW) ............................................................................ 20 Lady Health Supervisor (LHS) ............................................................................. 20 Vaccinator ................................................................................................... 20 SECONDARY LEVEL SERVICES: ............................................................................ 21 THQ Hospital: ............................................................................................... 21 CATEGORY “D” Hospital: .................................................................................. 21 AHQ HOSPITALS Hospital: ................................................................................. 21 Definition of terms; ........................................................................................... 23 Permanent buildings: ...................................................................................... 23 Temporary buildings: ...................................................................................... 23 Permanent buildings: ................................................... Error! Bookmark not defined. Accessibility: ................................................................................................ 23 Key tracer medicines: ..................................................................................... 23 A. Background: ................................................................................................... 25 a. Health Infrastructure .....................................................................................
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