Project Report PR-PK-LSB2-05 Pakistan Social audit of governance and delivery of public services Lasbela District 2005: Preventive child health A Cockcroft, K Omer, N Ansari, M Baloch, S Saeed, A Dass, D Milne, N Andersson Social audit of governance and delivery of public services Lasbela District 2005 Preventive child health A Cockcroft, K Omer, N Ansari, M Baloch, S Saeed, A Dass, D Milne, N Andersson Uthal, January 2006 CIET/ Lasbela District Government: social audit 2005 ii Contents List of tables......................................................................................................................iv List of figures.....................................................................................................................v Acknowledgements...........................................................................................................vi Summary................................................................................................................................ viii Methods.......................................................................................................................... viii Findings.............................................................................................................................ix Introduction................................................................................................................................1 The social audit in focus districts ..........................................................................................1 Operationalising the social audit in focus districts ............................................................2 Focus district national core group......................................................................................4 Methods......................................................................................................................................6 The topic for the social audit cycle....................................................................................6 Data collection instruments................................................................................................7 Sample and sampling .........................................................................................................8 Field teams .........................................................................................................................9 Data collection ...................................................................................................................9 Data entry and analysis ....................................................................................................10 Findings....................................................................................................................................12 The information base ...........................................................................................................12 Childhood respiratory infections .........................................................................................14 Frequency of childhood respiratory infections ................................................................14 Household factors related to childhood respiratory infections ........................................14 Information about ARI from the lady health worker (LHW) ..........................................15 Treatment of ARI.............................................................................................................16 Experience of ARI treatment ...........................................................................................17 Satisfaction with treatment of ARI ..................................................................................17 Childhood measles...............................................................................................................19 Frequency of childhood measles......................................................................................19 Variables related to risk of measles .................................................................................19 Decision makers' knowledge about measles....................................................................21 Treatment of measles .......................................................................................................22 Childhood immunisations....................................................................................................24 Immunisation status of the children.................................................................................24 Why children are not immunised.....................................................................................25 Decision makers' knowledge and perceptions about immunisations...............................26 Decisions about immunisation for children .....................................................................28 Measles immunisation .........................................................................................................29 Frequency of immunisation .............................................................................................29 Variables related to children receiving measles vaccine .................................................29 Source and costs of measles immunisation......................................................................32 Costs of vaccination and costs of measles .......................................................................34 Understanding parents’ views about measles immunisation ...........................................34 Lady health workers.............................................................................................................37 Public satisfaction with basic services.................................................................................39 Commentary.............................................................................................................................45 Annexes....................................................................................................................................48 CIET/ Lasbela District Government: social audit 2005 iii List of tables 1. The household sample by tehsil 12 2. Household features by tehsil 12 3. Number of children in survey by tehsil 12 4. LHWs in the survey by tehsil 13 5. % households with different stove types for cooking 14 6. % households with different heating systems 15 7. Frequency of LHW visits to visited households 15 8. Variables potentially associated with the risk of getting measles 19 9. Multivariate model of variables associated with not having had measles 19 10. Model of potential population gains of vaccination against measles 20 11. Main reasons why decision makers think measles is rare in their area 21 12. Main reasons why decision makers think measles is common in their area 21 13. Known complications of measles 21 14. Time to take child for measles treatment among those who took time off 23 15. Time off work that had to be left to take child for measles treatment 23 16. % children 12-23 months immunised 24 17. Reasons why children (12-59 months) are not vaccinated 25 18. Household difficulties in getting children immunised 25 19. Improvements to ensure all children are immunised 25 20. Sources of information about immunisation (out of all decision makers) 26 21. Sources of information about bad effects of immunisation 28 22. Bad effects of immunisation reported to have been seen 28 23. Mothers’ involvement in decisions about immunisation for their child (% children) 28 24. Variables potentially related to measles vaccine 30 25. Factors from multivariate analysis associated with having measles vaccination 31 26. Model of potential population gains of different interventions to increase immunisation against measles 32 27. Time off work for measles vaccination among those families who took any time off 33 28. Type of work that had to be left to take child for measles vaccination 33 29. Cost of measles vaccination and measles treatment 34 30. Suggestions from LHWs to reach households better 37 31. Why children are not immunised: views of LHWs 38 32. Why measles is rare: views of LHW 38 33. % households reporting access to roads and public transport 39 34. % households reporting access to government garbage, sewerage, and water services 40 35. % households reporting access to government agriculture, education, and health services 42 36. % households reporting access to gas and electricity services 44 CIET/ Lasbela District Government: social audit 2005 iv List of figures 1. Sample sites for Lasbela social audit 2005 8 2. % children under 60 months with ARI during the last two weeks 14 3. Map of % mothers visited by a lady health worker 15 4. Source of health care for children with ARI 16 5. Map of % children with ARI in last 12 months taken somewhere for treatment 16 6. % of mothers/care givers of children with ARI reporting a full explanation of the child’s condition 17 7. % of children with ARI provided with all medicines prescribed 17 8. % mothers of children with ARI satisfied with doctor or health worker behaviour 17 9. % children 10-59 months who have had measles (excluding ‘measles’ at under 10 months old) 19 10. Map of % children 10-59 months who have had measles (excluding ‘measles’ at under 10 months old) 19 11. Source of treatment for children aged 10-59 months with measles in the last 24 months 22 12. Map of % children 10-59 months with measles in