Pakistan Child Survival Project Number 39-0496 Contract Number Project 391-04 96-C-00-0769-00
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Pakistan Child Survival Project Number 39-0496 Contract Number Project 391-04 96-C-00-0769-00 Contractor: Management Sciences for Health FINAL REPORT Sub Contractors: Harvard Institute for International Development Academy for Educational Development Jaffer Brothers (Pvt) Limited September, 1993 Funded by the United States Agency for International Development One Volume Only The Pakistan Child Survival Project Technical Assistance was funded by the United States Agencyfor International Development, contract number 391-0496-C-00-0769-00, in collaboration with the Government of Pakistan, and implemented by the prime contractor Management Sciences for Health, and three subcontractors: the Academy for Educational Development, Harvard Institute for International Development, and Jqffer Brothers (Pvt.) Limited. PAKISTAN CHILD SURVIVAL PROJECT FINAL PROJECT REPORT Project Number 39-0496 Contract Number 391-0496-C-00-0769-00 Contractor: Management Sciences for Health Sub Contractors: Harvard Institute for International Development The Academy for Educational Development Jaffer Brothers (Pvt.) Limited This report was developed under the direction of Diana R. Silimperi with significant contributions by Theo Lippeveld, Tara S. Upreti, Zahid Hussein and Youssef Tawfik. September, 1993 Table of Contents List of Abbreviations (iii) Acknowledgements . (vii) Dedication ...... (ix) I. Executive Summary 1 II. Background .... III. Planning and Management .................................. 13 Introduction Objectives Accomplishments and Objectives Challenges and Constraints Lessons Learned Actions For Sustainability IV. Health Information Systems ................................. 27 Introduction Objectives Accomplishments and Objectives Challenges and Constraints Lessons Learned Actions For Sustainability V. Training ............................................. 57 Introduction Objectives Accomplishments and Objectives Challenges and Constraints Lessons Learned Actions For Sustainability PCSP/MSH FINAL REPORT VI. Communications ........................................ 79 Introduction Objectives Accomplishments and Objectives Challenges and Constraints Lessons Learned Actions For Sustainability VII. Drugs and Logistics ...................................... 91 Introduction Objectives Accomplishments and Objectives Challenges and Constraints Lessons Learned Actions For Sustainability VIII. Research ............................................. 99 Introduction Objectives Accomplishments and Objectives Challenges and Constraints Lessons Learned Actions For Sustainability IX. Conclusion ........................................... 105 X. Appendices n List of Abbreviations ADB Asian Development Bank ADDR Applied Diarrheal Disease Research Project (HIID) ADG Assistant Director General ADHO Assistant District Health Officer AED Academy for Educational Development AHI Assistant Health Inspector AJK Azad, Jammu, Kashmir ARI Acute Respiratory Infection ATU Acute Respiratory Infection Training Unit BCG Bacillus of Calmet/Guerin BHS Basic Health Services BHSC Basic Health Services Cell BHU Basic Health Unit CDC Centers for Disease Control CDD Control of Diarrheal Diseases CEC Continuing Education Cell CHW Community Health Worker CIDA Canadian International Development Agency CMR Child Mortality Rate COP Chief of Party CS Child Survival CSD Child Survival Drugs CSTU Child Survival Training Unit CWG Communications Working Group DA Daily Allowance DCOP Deputy Chief of Party DD Deputy Director DDG Deputy Director General DG Director General DHO District Health Officer DHQ District Headquarter Hospital DHQTU District Headquarters Training Unit D&HS Demographic and Health Survey DHS Director of Health Services DPT Diphfheria, Pertussis, Tetanus DTSP Development Training Support Program DTU Diarrheal Training Unit EPI Expanded Program of Immunizations FAN A Federally Administered Northern Areas FATA Federally Administered Tribal Areas in PCSP/MSH FINAL REPORT FBHSC Federal Basic Health Services Cell FHP Family Health Project FLCF First Level Care Facilities FSMO Field Supervisory Medical Officer OOP Government of Pakistan HEC Health Education and Communication HI Health Inspector HID Health Institution Database HIID Harvard Institute for International Development HIS Health Information Systems HISC Health Information Systems Committee HMIS Health Management Information Systems HPN Health, Population and Nutrition HRD Human Resources Development (USAID) HT Health Technician ICST Integrated Child Survival Training IDD Iodine Deficiency Disease IEC Information, Education and Communications IMR Infant Mortality Rate IPC Interpersonal Communication JBL Jaffer Brothers (Pvt.) Limited KAP Knowledge, Attitude, Practice LHV Lady Health Visitor LQAS Lot Quantity Assurance Sampling MBBS Medical Bachelor - Bachelor of Surgery MCBA Mothers of Child Bearing Age MCH Maternal and Child Health MIS Management Information Systems MO Medical Inspector MOH Ministry of Health MOIC Medical Officer in Charge MS Medical Superintendent MSD Medical Store Depot MSH Management Sciences for Health MTID Management Training Institute for Doctors NDFC National Development Finance Corporation NGO Non-Governmental Organization NHISC National Health Information Systems Committee NIH National Institute of Health NWFP Northwest Frontier Province ORS Oral Rehydfation Salts IV LIST OF ABBREVIATIONS ORT Oral Rehydration Therapy PBHS Provincial Basic Health Services PCSP Pakistan Child Survival Project PH Public Health PHC Primary Health Care PHDC Provincial Health Development Center PIMS Pakistan Institute of Medical Sciences PMDC Pakistan Medical & Dental Council PMRC Pakistan Medical Research Council PMS Project Monitoring System PPA Pakistan Pediatric Association PPHA Pakistan Public Health Association PRITECH Technologies for Primary Health Care Project (MSH) RGH Rawalpindi General Hospital RHC Rural Health Care RR Routine Reporting RTI Regional Training Institute SCKL Supervisor's Checklist SES Socio-Economic Status SMC Social Marketing of Contraceptives STTA Short-Term Technical Assistance TA Travelling Allowance TAT Technical Assistance Team TBA Traditional Birth Attendant TBC Tuberculosis Control TT Tetanus Toxoid UCI Universal Coverage Immunization USAID United States Agency for International Development UNICEF United Nations International Children's Educational Fund WHO World Health Organization WMO Woman Medical Officer ACKNOWLEDGEMENTS Members of the Pakistan Child Survival Project Technical Assistance Team and their US-based support staff wish to express deep appreciation for the dedicated effort and spirit of collaboration of our Pakistani counterparts and colleagues in the National Ministry of Health (Basic Health Services Cell, National Institute of Health, National Child Survival Program Managers and Coordinators) as well as the Provincial Ministries and Departments of Health, particularly the Secretaries, Director Generals and Child Survival Program Directors, and of course, all PCSP Project Directors. The unflagging encouragement of our USAID colleagues, particularly after the ramifications of the Pressler Amendment became clear, made it possible for the team to continue our work despite overwhelming constraints. Most importantly, we would like to thank members of the Pakistan Child Survival Project, both those in the central office as well as the provincial staff, for their years of hard work to implement an extremely challenging project. In addition, the cooperation and assistance, both technical and financial provided by UNICEF, WHO, and CIDA are sincerely appreciated. We are particularly thankful to UNICEF and the World Bank for cooperative planning to assure the continuation of training and HIS activities. A note of special appreciation to Jaffer Brothers (Pvt.) Limited for providing such effective administrative and logistical help, without which PCSP could never have successfully conducted so many of its workshops or maintained such efficient provincial offices. !n addition, recognition should be given to our communication component subcontractors, Aftab Associates and Spectrum who each provided excellent technical assistance in the mass media activities of PCSP. Without the tireless efforts of the individuals and agencies noted above, including others which space does not allow me to mention, the PCSP could never have succeeded! Your energy, work, and skills have made the PCSP a success. Thank you for helping the PCSP in its work to institutionalize child survival programs to decrease infant and child mortality in Pakistan. Last but not least, my sincere thanks and appreciation to those who assisted in the production of this report - especially Ms< Shahnaz Farooq, Mr. Gohar Khilji, Mr. Naseem Khan, Ms. Andrea Usiak, and of course the TAT! Sincerely, Diana R.. Silimperi, MD PCSP/MSH vn DEDICATED TO THE MEMORY OF DRS. DUANE SMITH AND ABDUL GHAFOOR The Pakistan Child Survival Project's Final Report is dedicated to the Memory of Dr. Duane Smith and Dr. Abdul Ghafoor. Dr. Duane Smith's tireless devotion to this project provided the foundation for its ultimate achievements. The accomplishments of the Pakistan Child Survival Project are a tribute to Dr. Smith's leadership during his tenure as the Chief of Party. Dr. Abdul Ghafoor provided constant, and unflagging support to the Pakistan Child Survival Project particularly during the difficult days following the evacuation. He was instrumental during the. development of the early collaborative bodies, such as the steering committees,