Health System Strengthening Project (HSSP) Zone-I of Khyber Pakhtunkhwa (Central Districts) – support and build capacities of Health Facilities in improving service delivery
In collaboration with Health Department Government of KPK, PEI carried out the Health Strengthening Program to improve the condition of health facilities through the province. The Health System Support Program is being run with the objective of ‘Betterment of health service delivery at grass root level, easy access made affordable with improved medical service standards for the poor through ensuring health facilities are functioning efficiently in collaboration with government and other partners by strengthening the capacity of these health facilities through identification and bridging the existing gaps’. Under the program needs assessment of 150 health facilities was carried out throughout the province, out of these 113 were selected for implementation of the HSSP. Details needs assessment was carried out in terms of infrastructure requirement, equipment and supplies, capacity of staff and administrative capabilities. PEI provided support to improve health service delivery in 113 of these health facilities spread in 6 districts of the Zone – I.
Pakistan ranks 4th in the world amongst 27 high burden DR-TB countries. According to WHO estimates, there were around 7100 (1700-13000) MDR-TB cases amongst new pulmonary TB cases and 2300 (800-3700) amongst retreatment cases, notified in 2010, (3.4% and 21% in New and retreatment cases, respectively). Pakistan shares 60% of the DR-TB burden in the EMRO region countries.
PEI under its National Health Program fights against Tuberculosis in area to reduce mortality, morbidity and spread of TB infection. Our Program is integrated with Primary Health Care (PHC) system implemented by the district health authorities with the support of Provincial TB Control Programs (PTPs). We strive to improve the performance and public health impact of TB programs while mitigating the risks of drug resistance.
PEI focused on four areas to uplift the overall health situation and eliminating TB.
- Strengthening Laboratories and quality assurance of smear microscopy
- Pharmacy management and provision of supplies
- Community mobilization and awareness
- Infection Control
- Capacity Building
Various government laboratories in target area has been strengthen under the project by providing disposable kits, consumables, injections, swabs and other quality medical and surgical supplies to perform better diagnostics and identification of sputum smear-positive patients in rural government health facilities. Secondly, X-Ray and Radiology units were supported for chest X-Ray and other diagnostics.
Supply Chain Management
PEI has strong computerized supply chain management system and chain of warehouses. From those warehouse through transparent mechanism, quality medical and surgical supplies were provided to hundred of hospitals of the area, along with medicines like antibiotic, analgesics and may others for the poor patients and improved health delivery system. All the target hospitals were equipped to control and eliminate the menace of TB.
District Health authorities were supported in DOTS expansion efforts, addressing the patient’s constraints; improve quality of DOTS, increase suspicion, diagnostic capacity and notifications.
Health Management Committees (HMC) were formed in target districts of KP, oriented on the objectives of the PEI health program and strengthened through appropriate institutional trainings apart from sensitization on PEI interventions viz. health and hygiene issues, TB control, availability & utility of the services in health facilities, encouraging EPI coverage, improvement of referral system, awareness raising on community diseases specially TB, malaria, vaccination along with feedback and helping in resolution of conflicts among the health services providers and the beneficiaries.
In context of TB, there is an overall higher incidence of Pulmonary TB. This could be due to the overall living conditions of our poor socio-economic class. In our awareness and mobilizing we always stress upon education and monitoring living conditions as critical for minimizing this risk.
The participatory process is designed to ensure the appropriate mobilization and involvement of local communities and their institutions to develop a common vision and undertake collective action based on that. These committees have been strengthened through institutional trainings, fully engaged in PEI programme and part of the process from planning to management, including monitoring and evaluation. PEI expert community development officers and social mobilizers have been facilitating these COs in the identification, implementation, management, operation & maintenance of health facilities so far strengthened by PEI.
Secondly PEI conducted various numbers of walks, community sessions, exhibitions, dialogues and workshops for TB control with help of various community organizations. This lead us to reduce transmission of TB in target areas and they aware that TB is not transmitted through food and water or by sexual intercourse, blood transfusion, or mosquitoes. A community-based component was an integral part of the mainstreaming stage, and sought to decentralize to public health centers, with participation from community volunteers. In the scale-up stage, the programme was expanded geographically and engaged additional community-based facilities including public- and private-initiated units, district hospitals and other public health centers.
Infection Control and Capacity Building
PEI build capacity of hundred of doctors on following which leads to TB control in the target districts.
- Health Services Providers trained on utilization of provided medical and surgical supplies
- X-Ray and Radiology units were supported for chest X-Ray and other diagnostics.
- Health hygiene improved by provision of hygiene kits and training
- Prevention of infectious diseases
- MNCH training, CDD (Control of Diarrheal Diseases)
- CDC (Communicable Disease Control)
- Chest radiographs, clinical assessment, complementary tests and referral
PEI sustained political and moral commitment to increase human and financial resources and make TB control a nationwide activity integral to the national health system. Also Human resource issues to contend with in most health centers include management, planning, quantity, quality, distribution, recruitment and retention. In addition, the need to provide and promote biosafety and infection control among health care workers was highlighted.
Still major challenge is to raise and maintain political commitment in large federal systems. Political and financial commitment are critical to sustain all of the components that have led to the successful implementation of the DOTS strategy.
Health Services Providers Capacity Building Trainings
81 different trainings have been conducted for Health Services Providers in three provinces on rational use of provided medical and surgical supplies. These trainings also include other topics like 1. Health hygiene improved by provision of hygiene kits and training Prevention of infectious diseases 2. MNCH training, CDD (Control of Diarrheal Diseases) 3. CDC (Communicable Disease Control) 4. Storing and record keeping etc. These trainings enable Doctors and paramedics to refresh their knowledge and enhance their capacities.
24/7 Help Desks at Major Hospitals
PEI established help desk in 3 major hospitals of the Peshawar city, these are leading hospitals of the province and PEI help desk work for 24/7 in these hospitals. This desk role is to facilitate the hospital staff in efficient utilization of the support provided to these hospitals and ensure the transparency and monitoring of the PEI resources.
Details of Health Facilities Supported
- DHQ Buner
- THQ Pacha Kalay
- EDO Buner
- DHQ Daggar, Buner
- DHO Buner
- CH Pacha Kalay Buner
- CH Totalai Buner
- DHQ Hosp Charsadda
- THQ Hosp Tangi
- RHC Charsadda
- Civil Hospital -Shabqadar
- EDO Charsadda
- DHQ Charsadda
- THQ Tangi, Charsadda
- DHO Charsadda
- EDO Health Mardan
- Civil Hospital -Rustum
- Civil Hospital – Lund Khwarh
- DHQ Mardan
- MMC Mardan
- DHO Mardan
- Type D Mardan
- EDO Health Nowshera
- DHQ Hosp Nowshera
- Civil Hospital Pabbi
- RHC – Manki Shareef
- Civil Hospital -Kaka Sahib
- DHQ Nowshera
- CH Akora Nowshera
- DHO Nowshera
- EDO Health Peshawar
- FATA Secretariat Peshawar
- LRH Peshawar
- HMC Peshawar
- KTH Peshawar
- Kuwait Hospital
- Paraplegic Center Peshawar
- Khyber Teaching Hospital
- Lady Reading Hospital
- Hayatabad Medical Complex
- Maternity Hospital-
- City Hospital Peshawar
- DHO Peshawar
- CH Matani Peshawar
- Molvijee hospital
- City Hospital Kohat Rd Peshawar
- EDO Health Swabi
- BMC Swabi
- DHQ Swabi
- DHO Swabi
- Bachakhan Medical Complex Swabi.